Many people do not seek psychiatric and sometimes psychological help for fear of being stigmatized for life or because they simply do not know who to go to and what to expect from a consultation with a psychiatrist. The authors of the book “Going Crazy” not only popularly explain various psychological conditions and psychiatric diagnoses, but also have compiled a short reference guide in case you need a psychiatrist or psychotherapist.
Psychiatrist or psychotherapist
Psychotherapy is a way of self-knowledge, support in resolving internal and interpersonal conflicts, assistance in changing those personality traits and behavior patterns that prevent you from realizing your inner potential in life, work and relationships.
The main “tool” of psychotherapy is the special relationship between the client and the therapist, within which the disclosure and resolution of psychological problems occurs (or does not occur). Psychotherapy is not a medicine and does not diagnose or treat mental illness. It is suitable for correcting psychological problems that anyone, healthy or sick, can have. In the second case, it is used in combination with psychiatric treatment.
Psychiatry is a branch of medicine. It studies human mental states through medical means and treats mental illness as a disease of the body that can be studied to find its “root” in the brain—and treated with medication like any other disease. Psychiatry believes that by influencing the brain, one can change the psyche.
The same disorder can be caused by psychological reasons or biochemical disorders in the brain. For example, depression can develop against the background of unresolved emotional problems - or due to an organic disorder in the production of dopamine in the brain. Often psychological problems and brain disorders manifest themselves simultaneously - and even doctors cannot always say which comes first. And it’s almost impossible to independently understand the reasons for your subjective state of being “bad,” especially if you feel bad right now. Therefore, in good clinics, a psychiatrist and a clinical psychologist work with the patient in tandem.
If you want the "talking cure" and you go to a therapist, he may refer you to a psychiatrist if he sees that your emotional state is too unstable and needs to be corrected. At the same time, if you feel that you are always in an abnormal state for yourself without any external reason, and you go to a psychiatrist, then after stabilizing your condition, he can refer you to a psychotherapist. After all, you will have to deal with those features of behavior and thinking that destabilize you in addition to physiological disorders.
If you suspect you have a mental disorder, choose a psychotherapist with medical education and clinical experience. Psychologists' diplomas are most often issued by humanitarian universities, and their graduates have a rather weak understanding of psychiatry.
However, in the acute stages of a mental disorder, communication with a psychotherapist can be not only useless, but even harmful. For example, if depression is at its height, a qualified psychotherapist will not suggest you delve into your relationship with your parents, but will send you to a psychiatrist to stabilize the emotional background (without which a constructive conversation and insights will not happen). If you yourself feel that psychotherapy does not help get rid of an abnormal condition for you or even worsens it, go to a psychiatrist yourself.
If you have 100 people working in your office, up to 30 of them will sooner or later experience mental illness. Most likely, it will be depression, phobia, obsessive disorder, eating disorder or mental changes caused by dependence on alcohol or other harmful substances.
Most of the psychiatrist’s patients are ordinary people whom others consider somewhat “nervous,” “lazy,” “weak-willed,” “strange,” or do not notice their problems at all. If you seek help in time, in most cases you can improve your condition and return to normal life. But if the disease is ignored for years (which is what thousands of Russians do), then even banal depression or anxiety disorder can result in the loss of work, family and place in society.
How not to go crazy
Where to go? Why are we so afraid to turn to psychiatrists? And why is a state mental health program necessary? The RG columnist talks about this with the chief psychiatrist of Moscow, professor, doctor of medical sciences Georgy Kostyuk.
Georgy Petrovich! The movie It's a Mad, Mad, Mad World was once very popular. Do you think the name is outdated? Agree, probably, each of us wants peace and quiet. Is this possible nowadays?
Georgy Kostyuk: The title of the film is more than relevant. The world has become neither kinder nor smarter. Can a world be called healthy where means of self-destruction have been created and are being built up, capable of destroying all of humanity in a matter of minutes?..
Have you made it clear that psychiatrists will not be left without work?
Georgy Kostyuk: They will never stay. If only because if the same surgeons can be replaced by robots, then no Da Vinci, even with artificial intelligence, will replace us, psychiatrists. Because the main thing for us is the ability to communicate with the patient, understand him, and sympathize with him.
How do medical school graduates get into psychiatry? In particular, how did you, a former naval colonel, become the chief psychiatrist of such a powerful metropolis as Moscow?
Georgy Kostyuk: I am a colonel in reserve. And being a naval doctor, he was engaged in the same psychiatry. Service is not easy. And even this seemingly trifle: a sailor does not receive news from his girlfriend or parents for a long time. Gets depressed. And he must be taken out of this state. After completing my service in the navy, I switched to civilian life. And since I had extensive administrative experience, I was offered to head one of the Moscow psychiatric hospitals. I did not become the chief psychiatrist in Moscow right away, but five years later.
How did you become a psychiatrist? In my diploma, like all graduates, in the “specialty” section it says “general medicine.” Everyone chooses their own path. After the Kirov Military Medical Academy in St. Petersburg, I was assigned to a psychophysiological laboratory. There I quickly realized that this was very interesting, but it gave an incomplete picture of a person. And then I formed a clear desire to become a practicing psychiatrist. Would you say it was an accident? I will answer as a psychiatrist: accidents are of enormous importance in our lives. And this applies not only to people with mental disabilities, but to everyone.
Recently, a colleague, relatively young and successful, approached me. He had a request: help find a specialist who would relieve terrible depression. He said that he had been to many specialists and was taking a lot of prescribed medications. But depression doesn't go away. I had to honestly tell him that I don’t know who to refer him to, I don’t know how to help him. Unfortunately, this was before I met you.
Georgy Kostyuk: I hope it’s not too late to send him to us. And we will try to help him. But in general, the problem of seeking and receiving psychiatric help is huge. And not only in our country. Moreover, the main thing in such situations is to overcome the psychological barrier. After all, just the thought that one of your loved ones or colleagues finds out that a person has sought psychiatric help... This is a stigma for almost a lifetime. Many people fear such a stigma more than anything else in the world - both in the sense of a career, and in the sense of a profession, and, if you like, in the sense of having children.
By the way, about the birth of children. Are mental disorders inherited?
Georgy Kostyuk: Yes. There is a genetic predisposition. And I want to tell you about one big problem. In almost all countries of the world, various depressions, phobias, and stress disorders are treated by general practitioners. And turning to such a specialist does not cause any fear in anyone, there is no fear of the same psychiatric stigma. And I cannot explain why our legislation believes that if a person becomes depressed, he needs to go to a psychiatrist. Why do we have such distrust of general practitioners?
Maybe I'm wrong, but it seems to me that these are some echoes of our past, when, to put it mildly, unwanted famous figures were isolated in psychiatric hospitals. And there could be no talk about general practitioners. If only because the control over the maintenance of such patients was special.
Georgy Kostyuk: The first thing I would like to say. The flair of punitive psychiatry is greatly exaggerated. And I say this not as a former colonel, but as a modern psychiatrist. There were abuses of psychiatry, but no more than in any other country, including the most democratic. And they talked about them so much and so loudly because it is a taboo topic. And the forbidden fruit is always sweet. But you are right about the main thing: the current problems are largely determined by these echoes.
None of the eight federal target programs of the national project "Healthcare" affects psychiatry
Let's go down to earth. Is it possible to forcibly send a person to a psychiatric hospital?
Georgy Kostyuk: Yes. Both involuntary and forced. The legislation provides for this form of medical care for mental disorders. This is due to dire necessity. Because such a person can be dangerous both for others and for himself. The same suicides, as a rule, occur in such people.
Open the procedure for referral to a psychiatrist, to a psychiatric hospital. How does this happen in practice now? It cannot be that someone in a state of passion insulted or hit someone. You can understand: is he just a hooligan or is he mentally ill?
Georgy Kostyuk: You will be surprised, but this can always be understood. Even the police who are the first to arrive at the scene of an incident are quite good at this. If we are really talking about a mental disorder and the patient poses a danger to himself and others, then an ambulance, even without the patient’s consent, must take him to a psychiatric hospital. At the hospital, a committee of psychiatrists has 48 hours to determine the need for inpatient treatment. And again: even if the commission considers inpatient treatment of such a patient necessary, that’s not all. There must be a court decision.
Who is suing?
Georgy Kostyuk: Not relatives, not the patient himself, but the hospital administration is going to court. And the court makes one decision or another.
Once a diagnosis of schizophrenia has been made, can it be subsequently removed? Or is he forever?
Georgy Kostyuk: Schizophrenia is a primary chronic disease. In practice, such a diagnosis can only be canceled if it was made incorrectly.
Does a person with schizophrenia have prohibitions on certain activities?
Georgy Kostyuk: There is a special government decree that defines a list of restrictions. Let's say he cannot be a teacher working with children. And, of course, owning a weapon, flying an airplane, etc. should not be allowed.
Is schizophrenia curable or lifelong?
Georgy Kostyuk: If a person seeks help in a timely manner and complies with all the instructions of specialists, then those around him will never know about his illness. Unfortunately, primary care does not provide positions for psychiatrists or even psychotherapists. Therefore, a person even with ordinary depression has nowhere to go. He is forced to take, at his own discretion or even as prescribed by his local therapist, various so-called sedatives. Some relief occurs, but only some. I am convinced that now that such attention is paid to primary care, it is necessary for mental health specialists to appear in this link; it is an integral part of a healthy lifestyle.
Do you have the patience to talk to those who are depressed? Can you tell me what to do, say, for my favorite heroine “Aunt Masha from the entrance” so that she doesn’t go crazy or at least get depressed?
Georgy Kostyuk: Right now, DNA determination has become a craze, and you can probably go crazy waiting for the results. Do you think this is not serious? You are wrong! This is some manifestation of the madness of the world, when no one believes anyone, when they begin to rely only on DNA. Now, when many people experience the autumn blues, in order not to fall into depression, you need to be especially attentive to your lifestyle. The best means of prevention are healthy, full sleep, less cigarettes and alcohol, and more walks in the fresh air. And drive away black thoughts from yourself, do not let them take over you.
But these are general recommendations.
Georgy Kostyuk: Personal recommendations can only be formulated based on the results of an individual conversation and analysis of specific circumstances. In each case they may be different.
78 years life expectancy of Russians until 2024 (by 2030 - up to 80 years)
There are state programs on oncology, cardiology, and children's healthcare. But for some reason there is no program on mental health, on the development of psychiatric services.
Georgy Kostyuk: You raised a very sore point. None of the eight federal target programs of the national project “Healthcare” affects psychiatry. I would especially like to emphasize that by presidential decree, the average age of the population should reach 78+ years by 2024, and 80+ by 2030. In Moscow, such indicators have already been achieved. Increasing life expectancy is a great benefit. But the added years of life should in no case become a heavy burden. Should not lead to an increase in the number of the same dementias in people of advanced age. And we need to think about this now. There is clearly a need for a state mental health program.
Business card
Photo: Alexander Korolkov
Georgy Petrovich Kostyuk was born on February 2, 1970 in Zhitomir. Graduated from the Military Medical Academy in St. Petersburg in 1994. Served as chief psychiatrist of the Baltic Fleet. Colonel of the reserve medical service. Since 2020, the chief physician of the State Budgetary Healthcare Institution “Psychiatric Clinical Hospital named after N.A. Alekseev of the Moscow Health Department.” Doctor of Medical Sciences, Professor. Author of more than 200 scientific papers devoted to organizational and clinical problems of psychiatry.
Before you suspect you have a mental disorder
1. Get enough sleep and rest. In modern city dwellers, disruptions in brain function can be triggered by banal overload and constant stress.
2. Rule out other reasons for feeling “strange.” Go to a neurologist (you may have physical damage to your nervous system) and an endocrinologist (hormone imbalance can also cause behavior changes). Not often, but there are cases when a person begins to be treated for schizophrenia, and then it turns out that the psychosis is caused by a brain tumor.
3. Remember that medicine has not yet been able to establish the exact causes of mental disorders. But scientists agree that there are always several factors: biological (that is, innate characteristics of brain biochemistry), psychological (stress, the habit of thinking and behaving in a certain way) and social (upbringing, relationships with others). Tablets will only help with the first group of problems. The rest will have to be dealt with on your own or with the help of a psychotherapist.
Why you shouldn't be afraid of psychiatrists
Not all horrors about psychiatry are fictitious: in the 20th century in the USSR they could actually send a person who tore up his party card “to the madhouse”, in the USA thousands of patients were lobotomized, and in Canada experiments were carried out on helpless patients. Modern psychiatry has become completely democratic and does not aim to “cause health” by force: until you commit a crime, your mental health is only your problem (and your loved ones).
Domestic hospitals still lag behind European ones in terms of humanism, but in general they are moving in the same direction as the entire civilized world. For example, in Moscow they are opening psychiatric departments at regular clinics in order to overcome the outdated habit of isolating the mentally ill; in clinics you can make an appointment with a psychotherapist, and the city’s chief psychiatrist speaks at conferences along with patients.
Mikhail Balkarey , psychiatrist, psychotherapist
“You shouldn't be afraid of psychiatrists. The average level of psychiatric care in Russia is decent. In St. Petersburg, where I work, it matches and sometimes exceeds the quality of many Western countries. The dispensary observation system, for all its shortcomings, also has a lot of advantages. For example, free provision of medicines, including the most modern ones.”
PSYCHOLOGIST
First of all, a psychologist is not a doctor. This is a specialist with a higher education in the humanities, trained in the field of scientific and applied psychology. Psychologists have a significant amount of knowledge about the development and functioning of the psyche, the psychology of personality and the psychology of individual differences.
Typically, a psychologist specializes in one or more areas of practical psychology: child psychology, social psychology, or organizational psychology. Psychologists are more focused on the problems of generally mentally healthy people.
Under the name “psychologist”, up to a dozen professions are encrypted in the mass consciousness, which often have little in common with each other. This includes psychological counseling, psychodiagnostics, psychological testing (for example, for career guidance), business consulting with coaching, and training with psychological groups. There are also specialists in theoretical psychology: academic research psychologists and educational psychologists and teachers. The listed representatives of different psychological specialties cannot replace each other, just as a gynecologist without proper retraining cannot treat clients’ teeth.
But when we go to a psychologist about our own or our children’s mental illness, about family troubles or problems at work, then most often we mean a practical consulting psychologist. Ideally, a specialist consultant has not only theoretical knowledge, but also confident skills in working with clients. It would be good if the psychologist himself underwent psychotherapy: firstly, in order to better understand the mechanisms of the psyche in crisis situations, and secondly, in order not to try to solve his own problems at the expense of clients. Consulting psychologists help you find a way out of a crisis situation, believe in yourself, find internal reserves, and get out of depression. Depending on the complexity of the problem, on the client’s condition, on the technology in which the psychologist works, we can talk about either short-term counseling, designed for one or two meetings, or long-term therapy lasting from several weeks to several months, or even years .
In what cases should you contact a psychologist:
· dissatisfaction with yourself and your life;
· depression;
· lack of understanding with loved ones;
· separation, divorce or other crisis situations in personal life and at work;
· in children - including for diagnosis and correction of the cognitive sphere (attention, thinking, memory, imagination) - with delayed speech and mental development, learning difficulties, to diagnose the child’s readiness for school;
· fears, anxiety;
· enuresis, tics, stuttering;
· psychosomatic diseases (if you notice that a child’s chronic diseases worsen under stress - asthma, ulcers, neurodermatitis);
· problems in communicating with adults and peers;
· aggression, hyperactivity;
· if the child has experienced sexual, physical or psychological violence;
· after a trauma (death of a loved one, parental divorce, surgery, road accident, etc.)
When is it time to see a doctor
Everyone will name symptoms that are generally considered psychiatric: hallucinations, delusions, sudden outbursts of aggression, inappropriate behavior. But less obvious problems can also be signs of a mental disorder. Science has long recognized that the world is not divided into “crazy people” who need to be isolated and “normal ones”. There are many intermediate options between health and psychosis, and even experienced doctors cannot always say where character traits end and illness begins. Western psychiatry is guided by the following principle: the patient will be treated if the symptoms bother him, and medications will help him get rid of them.
What signs may indicate mental disorders
- Depressed or apathetic mood without external reasons for more than two weeks in a row; an outwardly prosperous life seems gray and meaningless.
- A complete lack of willpower, even simple things like washing your hair have to be done “under pressure.”
- A sharp decrease in thinking abilities, absent-mindedness, habitual work is difficult.
- Insomnia for weeks on end, lack of appetite or, conversely, indiscriminate eating of everything.
- Constant internal tension, irritation or anxiety (“something terrible is about to happen”) without external causes.
- Habitual situations have become unbearable, and you want to avoid them at all costs (strangers, loud music, trips on the subway).
- It seems as if the world around you (or you yourself) has suddenly changed a lot, become different, alien.
- Constant pain in the body, the cause of which doctors cannot find. This may be a feeling of heaviness, suffocation, a wound in the chest, or a foreign object inside.
- And many others.
Mikhail Balkarey, psychiatrist, psychotherapist
“If you suspect you have a mental disorder, the first step is to talk to a trusted person, friend or relative about your concerns. You will definitely need support; it is better not to solve many practical issues alone.
Choose a specific doctor, not a clinic. Find an experienced doctor with expertise in the area you think your disorder relates to.
If the condition is serious and hospitalization is necessary, immediately contact the dispensary at the place of registration.
If your health and means allow, consult a private doctor to get all the attention and information you need.
You can seek advice from a large scientific center and, if necessary, stay there for treatment.”
What are the treatment regimens?
Hospital
If you are in serious condition, you will be sent to hospital. You can ask to go to the hospital yourself if you don’t have the strength to go to work, or you come from another city to get examined.
Sometimes this is really necessary: even if you do not have an acute attack, choosing medications and their dosages takes time, and it is best that it takes place under the constant supervision of doctors. This is due to the fact that while the body gets used to the drugs, quite strong side effects may appear: weakness, nausea, dizziness. Carrying out daily duties in this state is quite difficult.
Hospitalization usually takes from two weeks to two months. Upon discharge, you will be given a legal sick leave, and at your request, the psychiatric profile of the hospital may not be indicated on it.
Day hospital
In hospitals and mental health centers there is such a convenient option as a day hospital. If your condition is not critical, you can visit the doctor once a day and undergo examinations, and then calmly go about your business.
Periodic observation by a doctor
If you are able to lead a normal lifestyle, it is quite possible to limit yourself to periodic observation. In this mode, you need to visit a public or private psychiatrist once a month (if necessary, more often) to report on your condition and adjust the dosage of the drug.
In Russia, you can get psychiatric help free of charge, not only in mental health centers, but also in leading scientific centers. To do this, you must have a compulsory medical insurance policy and a referral to a psychiatrist from the district clinic. The psychiatrist may then refer you for hospitalization. Obviously, you won't be able to meet these conditions if you're already sick. So if you suspect you have a mental disorder or have already been diagnosed, it's worth making a plan of action before you have an attack. Choose a doctor and clinic in advance and pass this information on to your loved one, so that in an emergency, your family will know what to do.
How does the diagnosis affect the recognition of sanity and legal capacity?
Sanity and legal capacity are different concepts: the first is used only in criminal law in relation to people who have already committed serious crimes, and the second - when concluding any transactions, both before concluding a contract (if there are doubts) and after the fact, if one of the parties wants terminate it. But both terms define a person’s ability to act of his own free will, control his actions and be aware of their consequences.
To assess both capacity and sanity, a psychiatric examination is carried out. Medical documents documenting the person’s condition and evidence from his relatives, neighbors and employers are collected; letters and diaries may also be involved. All this means that experts will look not just at the severity of the diagnosis, but also at the course of the disease, prospects, tendency to exacerbations and the person’s adaptability to social life.
Not all mental disorders lead to insanity and/or incapacity—agoraphobia is unlikely to prevent you from selling your house or help you avoid jail if you killed someone. Even in severe illnesses such as schizophrenia and bipolar disorder type 1, there can be long “bright periods” when a person is fully capable of taking responsibility for his actions.
Free psychoneurological clinic
A psychoneurological clinic at your place of residence is the most obvious option. Treatment there is completely free (including pills). There is a chance to find not only a good psychiatrist, but also a psychologist.
However, in free PND one can often find a formal, superficial attitude of doctors towards patients who do not try to delve into each case and prescribe a standard set of drugs. The drugs are often inexpensive and outdated, with unpleasant side effects. Living conditions are more than modest.
Most likely, the PND will help you relieve your acute condition with the help of potent medications. But to maintain balance for a long time, an individual approach is needed, that is, periodic monitoring after discharge from the hospital. And in the PND you may be lucky with an attentive doctor - or maybe not. Then you will have to look for another doctor for money.
It must be borne in mind that the PND stores patient records for decades. And if for some purpose in the future (for example, to obtain a driving license) you need a psychiatrist’s opinion, this information may be raised. Then you will have to prove to a special medical commission that your condition has improved since then.
In order not to depend on the bias of the IPA, you can get a certificate from a private clinic, provided that the clinic has a license for such activities. A private clinic will issue a negative opinion only if your inadequacy is really “obvious”.
Ilya Bakhtin, clinical psychologist
“If you go to the dispensary at the place of registration, then, like in a regular clinic, there is a system of sites. You have a local therapist, and you also have a local psychiatrist. You should be prepared for a queue and dissatisfied people in it - just like in any clinic.
If you already have an established diagnosis and some kind of extract in hand, take it with you. If you came with a referral from another institution, then it can send an extract to the PND for you.
If you come to your appointment for the first time, the doctor may refer you to a psychologist and an electroencephalogram to obtain information important for making the correct diagnosis.
If contact with the doctor does not work out, you can ask the head of the outpatient service in writing to transfer you to another doctor.”
A man raised in love
Photo from arcor.de
It’s like a hard drive can have a lot of information that is not organized into folders. Only the human brain has more than a terabyte of memory. And therefore, even in the case of the debut of the disease with productive symptoms, that is, with delusions, with hallucinations, the nature of the delirium will always depend on what the person has in his memory.
A person brought up in love, in affection, in mutual understanding, even if he develops delusional syndrome, will produce, for example, some works of art. And such a person, even if he is immersed in himself, still looks outside, because the outside world is interesting and desirable for him.
I have to observe such patients, but, unfortunately, there are very few of them among my patients. We have very few prosperous families. And most of my patients of this type of delusion prompt either to show aggression or to withdraw.
– You say that you cannot act too straightforwardly with such people. What possible approaches to them can there be?
– It's very individual. For example, I had a case: a guy refused to come to me for 5 years, his relatives worried about him for 5 years, but continued to support him. For all 5 years I recommended to them: “Reduce its content to a minimum.” But in general, this is a relatively risky gesture, because sometimes our patients follow the principle - again, for delusional reasons.
But you can try. Moreover, if a person follows the principle and, in the absence of money, simply stops eating, one can already try to resort to involuntary measures of influence.
But this patient of mine (he is now 23 years old) fell for this. But they didn’t just cut down his content, they patiently explained to him: “You’re sending us, you don’t want to communicate. Why then do we have to feed and water you? Go to work".
He sat and sat and one fine day came to see me on his own. Gradually we started talking, and little by little he began to tell me what was bothering him, and what, on the contrary, pleased him. As a result, it turned out that yes, he is comfortable being alone when no one touches him, but he experiences anxiety in the evenings and has sleep disturbances.
I suggested the easiest drug therapy - my principle is this: first offer something that is least traumatic, and only if this does not help, see what happens next.
And on minimal doses, the guy began to come to me, noted that his mood had improved, and there was a desire to communicate. Now he has a simple job, but as a courier - that is, he is constantly in public, travels by public transport. But at first it was impossible to persuade him to go into the subway.
This is the case when the restrictions had an effect on the patient. And even when introducing restrictions, you need to speak to the person calmly and kindly. But there is only one universal advice for all cases - do not put pressure on a person under any circumstances, suggest that he see a doctor in an unobtrusive manner.
This is perhaps the only thing you need to do before consulting a doctor. And then, if the patient does not agree, the relatives come to me without him, and I ask them for a long time about how the person communicated, what his inclinations were, how he reacted to what. And based on such a heap of information, I can give one or two pieces of advice, and only approximate ones.
Image from princessmaggiemor.blogspot.ru
– What if the patient is economically independent?
– In principle, you need to act the same way. But if a person has some kind of job that suits him, if he is not a danger to himself and others, but simply does not want to communicate with relatives, then it is less likely that he, for example, will sell his apartment - he needs it. The question is: do we have the moral right to do something with it?
If there are concerns, then we are there to answer this - me and my colleagues. True, not every psychiatrist will agree to such a conversation. By law, any conversation between a patient’s relatives and a psychiatrist is possible only with the patient’s written consent.
But if relatives come to a psychiatrist without such a document and talk about their problem without giving their names, the name of the patient, or his address, that is, they simply ask: “What to do if this is how it is?”, then there is no crime in this. The only thing is that in this case I do not have the right to ask for passport information. And I don’t refuse advice to people.
– For the relatives of a person who has become withdrawn into himself like this, is it more correct to immediately contact a psychiatrist? Or first see a psychologist?
– This is not important. Indeed, in such situations, at first people turn to me practically as a psychologist. I become a doctor for their relative only when I begin to prescribe some treatment methods. After all, who is a psychologist? This is, first of all, a diagnostician.
State psychiatric hospitals
A psychiatric hospital is a multidisciplinary institution. Scientific research and examinations are carried out on its basis, so the equipment and level of training of hospital specialists is usually higher. Unlike PND, it is not necessary to go to the hospital at your place of residence.
The absolute advantage of the hospital is its relatively reasonable price (or even free if you have a referral). In hospitals at large research centers (for example, the Moscow Research Institute of Psychiatry) you can find the best specialists in your field. If you come to the capital without a referral, the costs for 1–2 months of treatment can be quite large.
In terms of the level of medicine and living conditions, mental hospitals vary greatly depending on the “wealth” of the city budget. In Moscow and St. Petersburg it is easier to find excellent specialists and everything you need. For example, in the hospital. Alekseev in Moscow there are art therapy classes, support groups and even a radio broadcast by patients. But already in the Moscow region (not to mention areas farther from the capital) there is a risk of ending up in the forgotten 80s with harsh Soviet-trained doctors who sometimes behave stranger than their patients, and in depressing living conditions.
How can a psychiatric diagnosis affect your career?
In a counseling and treatment group, restrictions are minimal. Most likely, the fact that you attended such a group will affect your chances of entering contract service in the army, law enforcement agencies, or civil service. Also, law enforcement agencies may turn to this part of your past if you find yourself somehow involved in the investigation. This information is not disclosed to anyone else - and it certainly does not concern your potential employer.
But there are nuances: if you are going to get a job in a large corporation, there is a possibility that the local security service can “break through” you into closed medical bases. Of course, such actions are illegal, but, unfortunately, this does not stop everyone. It is important to weigh the pros and cons here - if you clearly cannot cope with the disorder on your own, you are still unlikely to stay in a corporation where strict requirements are imposed on employees.
If you end up in a dispensary observation group, the restrictions will be more serious: in particular, you will have problems obtaining a driver's license (but, again, everything is decided individually, depending on the severity of the disorder). However, this can hardly be called unfair discrimination - it is really undesirable for a person in a state of severe depression or with the possibility of psychosis to get behind the wheel.
Also, according to the law, it will be impossible to own weapons, work with children, be allowed to perform particularly dangerous jobs and hold positions requiring high financial responsibility. Well, you can also forget about the civil service. But if you get a job permitted by law, having a psychiatric history is no one’s business. In addition, this is not a sentence for life: the decision on labor restrictions in relation to a specific person is made for five years, and it can be reviewed. The government also promises to review the criteria for labor restrictions every five years in accordance with scientific advances.
Private psychiatric clinics
In a private clinic, you are not a patient, you are a client, so you will be surrounded with comfort and attention, and your opinion will be taken into account. You will have the opportunity to choose a doctor and be treated in a manner convenient for you.
Treatment in such a clinic is expensive or very expensive: from 2,000 to 20,000 rubles per day - and the price does not always guarantee quality. As in any private clinic, additional services may be intrusively offered here (only in the acute phase of a mental disorder you will not be able to assess their need). So you need to approach the choice of a private institution as responsibly as possible, study patient reviews and get to know the doctor before you feel ill. Provide your loved ones with the necessary information so that at a critical moment they know what to do and understand what of the clinic’s services you really need and what you don’t.
Private doctor
If you do not need to go to the hospital, it is most convenient to choose a specific doctor and see him periodically. This could be a doctor from a public or private clinic who conducts a private consultation: he will not create a card for you and, moreover, will not impose treatment. The price varies from 1,500 rubles per appointment in small cities to 5,000–7,000 in Moscow.
The main advantage of a private doctor is an individual approach: he will listen to all your complaints, not limited to the 20 minutes allotted by the state. If things get worse, you can call him and get urgent recommendations without waiting for an appointment.
The main disadvantage is the difficulty of choice: there are basically not enough qualified and progressive-minded psychiatrists, and it is not so easy to objectively evaluate these qualities. A caring and charming doctor (or a fashionable and expensive one) does not always mean the best. Many patients have to change 2-3 doctors before finding “the one.”
In addition, this option is suitable for responsible patients in a relatively stable condition. The success of such treatment strongly depends on your personal responsibility: outside the hospital, the doctor cannot assess your condition - so taking additional tests and timely reporting of deterioration will be solely on your conscience.
A community survey of people with bipolar disorder and depression found that most patients preferred to see a private doctor.
Of the 370 people, more than a third made this choice. Another third are treated in IPAs and public hospitals. 15% are not treated anywhere because they cannot find a good doctor in their city. Private doctors also lead in the effectiveness of treatment, ahead of both public and private clinics. But there is also an alarming fact: about a third of those surveyed say that none of the treatment options helped them.
When choosing a psychiatrist, keep qualifications, ethics, and trust in mind.
Only a qualified psychiatrist - a specialist with a medical diploma - has the right to make diagnoses and prescribe pills. Psychologists and psychotherapists cannot do this. In addition, no one specialist understands the whole variety of mental disorders equally well. Find out what specialization the doctor has. A good option is to find a physician with research interests in “your” field, such as someone who has completed a PhD on anxiety disorders.
An absolutely mandatory requirement for a psychiatrist is to follow ethical rules. Confidentiality, separation of personal and professional relationships and willingness to answer your questions are mandatory requirements for the behavior of a doctor. He is also obliged to explain the essence of the diagnosis, explain how long the treatment will require and that it depends not only on the pills, but also on the lifestyle of the patient himself.
For effective treatment, it is very important to find a doctor whom you can truly trust. There cannot be a single recipe here: some people are reassured by a patronizing attitude, while others need a conversation on equal terms.
Maybe we can show ourselves?
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– In what situations should relatives be wary? What preventive measures can they take?
– There are people who are prone to reflection and philosophy. But, as a rule, if these are my potential patients, then they are also poorly socialized, most of them have not been employed for a long time, that is, they earn odd jobs or are generally subsidized by relatives.
Even if one of them has a permanent job, it is either some kind of easy freelancing (for example, writing simple computer programs, editing texts on the Internet). Many of them shy away from contacting me (“I don’t need anything like that, I feel good”).
And for the vast majority of these people, the situation is such that their relatives come to me with the question: “What should I do? He locked himself away, doesn’t communicate with us and doesn’t communicate with anyone at all, doesn’t leave the house.” But what can I recommend?
As I already said, under no circumstances should you get too close to a person. All schizophrenia spectrum disorders have three characteristics: negativism, autistic behavior, and a thinking disorder characterized by reasoning and paralogicality.
If a person has previously been seen by a psychiatrist, you need to inform the specialist about what is happening. Because the attending physician already knows the person and can better navigate the situation. Everyone has their own “zest”; it is possible to hook a patient with something, although not always.
If a person has never consulted a psychiatrist before, you should try to carefully suggest that he go to a specialist. It’s better to use questions: “Maybe we can try? Maybe we should show ourselves?” That is, do not put pressure under any circumstances. If this does not help, the slippery option turns out to be when you have to contact law enforcement or judicial authorities.
After all, some patients not only withdraw into themselves, but also stop taking care of themselves and refuse to eat. We do not predict anyone who has not just schizophrenic, but schizoaffective disorder (that is, in addition to the listed triad of symptoms, they are also characterized by mood swings).
He may become disinhibited and go into mania (when, in a fit of fun, he can hit someone or break furniture), or he may fall into a depressive disorder, which, in the schizoaffective version, often leads to suicide.
– But in this case, this is already a legal problem, and with unclear algorithms.
– Not just unclear... These algorithms do not exist. We have to wait for some dangerous actions by a person to resolve the issue of involuntary treatment. That is, these are proven actions that are dangerous for others and for himself.
For example, a person refuses food for the fifth day, turns on the gas so that neighbors complain about the smell, and gets into conflicts using threats. It would be desirable then for at least an administrative, or better yet, a criminal case to be opened - then the psychiatrist will have more opportunities.
But it can be very difficult to prove some actions of a person, for example, the fact of refusing to eat or the fact that a person keeps a rope at home with which he thinks to hang himself. Only if a person himself demonstrates this to others. But demonstrative actions are characteristic not of a schizophrenic, but of a psychopath, who in such ways attracts the attention of others.
Patient's rights
Russian psychiatry is based on fairly progressive laws, but it is worth keeping in mind that practice often lags behind theory. Therefore, it is important to know what rights you have.
Voluntariness
To be treated or not to be treated is voluntary. A patient can be hospitalized only with his written consent. Involuntary hospitalization can be in three cases: if a person poses an immediate danger to himself (attempting to commit suicide) or to others, and if he is helpless (not able to take care of himself). In such cases, the decision is made not by one doctor, but by a special medical commission.
There is compulsory treatment by court order, but that is a completely different story. So if you were taken to the hospital due to someone’s mistake or malicious intent, there is every chance of returning home.
Confidentiality
Transferring data from your medical record to third parties, be it an employer or your own mother, without your written consent is prohibited. Both the diagnosis and the very fact of contacting a psychiatrist constitute a medical confidentiality. Such information can only be requested by law enforcement or a court if there is reason to believe that you are involved in a crime.
Psychiatric registration, which still scares people, was officially abolished 25 years ago. So the requirement to “bring a certificate” about registration in the IDP is illegal. The accounting system was replaced by dispensary observation. It does not cover all people with diagnoses, as was the case in the USSR, but only those whose illness is severe, with frequent exacerbations. Monitoring does not take away your rights, and it can be removed over time if you achieve remission.
Despite the illegality, in Russia they can still require a certificate from the IPA. In this case, the PND should assess the patient’s current condition and write about it, and not about what happened to him several years ago.
Restrictions
There are indeed restrictions on the choice of work for people with chronic disorders: these are professions associated with weapons, high risk, or responsibility for other people. Your suitability for work is determined not by “registration in the IPA”, but by a medical board that assesses your condition at that particular moment.
Patient Responsibility
Recovery (long-term remission, to be precise) is impossible without your own active participation. If you want to feel better, you need to change your lifestyle and give up habits that undermine your peace of mind. Each disease has its own characteristics, but the rules of a healthy lifestyle have remained unchanged since the time of Hippocrates: adequate sleep and rest, moderate exercise, no overload and healthy food rich in nutrients for the brain. Drugs and strong alcohol (or weak alcohol in large quantities) are harmful to everyone, but for a psychiatry client they are a taboo: they not only give unpredictable side effects in combination with medications, but can also provoke attacks of the disease.
Take care of your mental health, do not be afraid of doctors, and remember that mental disorders rarely “go away on their own”: if they are not treated, the consequences for your family and your future can be much worse than from admitting the fact of the disease and the need for help.
