Psychiatry is commonly known as the branch of medicine which deals with the disorders of the mind. This is a popular branch abroad, but in India there is yet a social stigma looming over it. As of now it is unexplored- a branch where there is a lot of need and tremendous potential for expansion. A lot of mentally ill patients are referred to the general physicians instead of the specialised psychiatrist. Roughly there is just one psychiatrist per three lakh patients.Need is present but the demand is not that obvious, since nobody willingly goes to the psychiatrist. Popular belief says only mad people visit this doctor, which is so not true.
As a psychiatrist you will come across loads of disorders like depressions, addictions, schizophrenia, dementia, shock, etc. your patients will range from children to adults to senior citizens. Both genders are equally vulnerable to psychological disorders or diseases so you will have a blend of males and females. It is seen that the higher socio economic class visit the psychiatrist, but that doesn't mean the lower socio economic class is free from mental disorders. The only fact it states is that the lower socio class need the treatment but can rarely afford it.
A psychiatrist has more often than not been confused with a psychologist. There has also been a confusion in the functions and duties performed by each of them. A psychologist is someone who has completed a bachelors or a masters in psychology. A psychiatrist is someone who has undergone the rigorous process of becoming a doctor [acquiring the MBBS degree] and then specialising in psychiatry. A psychiatrist gives a diagnosis, prescribes medicines, and can administer the psycho therapy and counsel the patient, while the psychologist can only perform the latter two functions. Sometimes the psychologists and the psychiatrists work as team, or a psychiatrist may refer a patient to a psychologist.
A psychiatrist takes the patients history, observes the behaviour, interviews him or relevant persons, and gives the diagnosis. Since the psychological disorders are caused due to a chemical change in the brain, there is no MRI or other scan to prove the disease. You may have to use the EEG machine to find out about few neurological changes. You may also have to administer ECT [electric shocks in local terms] to a patient in which case you will have to work with a anaesthetist.
To become a psychiatrist, you have to pursue a specialisation after completion of MBBS. The specialisation can be MD psychiatry, which is three year long, or a diploma which is for two years, or a DNB [Diplomate of National board] which is a three year long course. For either of these, you will have to qualify through an entrance exam like the all India post graduate entrance test, or the individual state entrance tests for domicile holders, or entrance exams held by central government institutes, private colleges and deemed universities. Entrance for DNB is separate. The DNB is considered equivalent to the MD.
The three years of MD will take the students through psychology, anatomy, physiology, and biochemistry of the brain, neurology and neurosurgery. Special aspects of psychology such as child psychiatry, community psychiatry, social psychiatry, forensic psychiatry and preventive psychiatry are also taught in the programme. The course also includes practical training at mental hospitals.
The ranks you acquire determines which colleges you can apply to. For pursuing this branch your rank can be a bit relaxed ad a bit less competitive. But this fact is subject to change every year.
The preferred colleges for psychiatry across India are:
1. National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangaluru
2. Central Institute of Psychiatry, Ranchi, Jharkhand
3. Christian Medical College Vellore
4. Post Graduate Institute Chandigarh
5. King George Medical University, Lucknow
Please note that after acquiring a diploma, if you still desire to pursue MD or DNB, you can take the entrance tests and pursue the respective course which will be reduced to two years for you. Scope of further studies after specialisation in this field is largely absent in India [hardly one or two odd courses are visible like the DM in geriatric mental health offered by King George Medical University, Lucknow]. Abroad some psychiatrists receive additional training in a specific area of interest such as geriatric psychiatry, child and adolescent psychiatry, addictions and so on.
There are certain skills which are required if you want to be a successful psychiatrist. Observation and active listening are at the top of the list. You have to empathise with the patient keeping in mind that every patient has the ability to solve his own problem, you have to help him not by showing him the path, but by removing the hurdles from his path.
After acquiring this specialisation, one can join a teaching institute, join a government or private hospital, or set up his own practice. For gathering experience and honing their diagnostic skills most prefer joining a government hospital rather than plunging in one’s own practice.
If and when you wish to set up your own clinic, the cost of investment will include the real estate, the EEG machine and the ECT machine [which costs anywhere between a lakh to fifteen lakhs – a decently average one for around three lakhs]. If you are a good doctor and stimulate trust then your practice can shoot off .
Earnings are decent. Now everyone is aware that decent is subject to individual perception, but to get a clearer picture we can state that the earnings are almost equivalent to that of a MD medicine. Also it should be noted that private practice will fetch you a better return than working in a hospital government or otherwise.
Albeit there are no emergencies and one may believe that this branch will enhance your quality of life, there are obvious and subtle drawbacks of this branch. The obvious was that it is considered as a social stigma, but the subtle ones are more impactful. Since the psychiatrist is asked to empathise with the patients, he has to experience the shoe on his foot, that is to understand the distress of the patient by actually putting himself in the situation. Well this unfortunately sometimes leads to involvement of the psychiatrist to such an extent, that the mental garbage being thrown by the patient starts settling in the minds of the psychiatrists. This in turn leads to depressions and addictions in case of the doctor himself. Psychiatry makes it to the top three specialisations, as far as the number of suicides by doctors is concerned. These facts are not to scare off or discourage prospective students from taking up this branch, but to lay bare the facts. You will need immense mental strength to tred on this fine line of empathising and not getting involved.
If you are someone who is truly interested in this branch, and find it intriguing and challenging enough then the possibilities are excellent. Considering the current scenario, the stress and pace of life, the scope of this specialisation will only widen.
Image Source - http://www.flickr.com/photos/shattered_art/3369289879
Garima is a free lancer with Gyan Central. she is someone who dares to dream, and performs to progress.
