Why Are People Often Reluctant to See a Psychiatrist?

People living with mental illness may be eager to seek relief for their condition yet decide to avoid visiting a psychiatrist. Of course, psychiatry is not the only field that deals with the treatment of mental health conditions but it is the institution that specifically exists to diagnose, prescribe treatment for, and treat conditions that psychiatry itself delineates.

The general public, however, does not tend to view psychiatrists in the same way as physicians who deal primarily with physical issues and illnesses, even though all psychiatrists are themselves medically qualified doctors (this separates them from psychologists and psychotherapists). Indeed, there appears to be a widespread aversion toward seeing a psychiatrist.

In this piece, I would like to outline some of the main reasons why people avoid psychiatrists. This piece is not intended to remark on these reasons in a highly critical way — I bring them up only to highlight that there are various barriers to mental health treatment; the outcomes of avoiding psychiatry may be beneficial or misguided, depending on the context and the individual’s circumstances. I hope that the following is a balanced and measured discussion on public attitudes toward psychiatry.

Stigma Toward Psychiatrists and Psychiatric Medication

To begin with, many people feel an aversion towards psychiatrists because of the stigma attached to the profession. Many believe psychiatrists are evil, manipulative, and coercive, impressions that — I argue — are influenced by portrayals of psychiatrists in mass media. This isn’t to say that some psychiatrists or the profession of psychiatry aren’t flawed, only that a strong fear towards psychiatrists may come down to certain misconceptions and prejudices. The cruel and inhumane mental health treatments of the past may also feed into people’s fear of psychiatrists.

Negative attitudes toward psychiatric medication are also pervasive. Many people, including those with severe mental illness, might be reluctant to see a psychiatrist because they don’t want to be prescribed psychotropic medication. People may believe that taking such medication is a ‘quick fix’ (implying that non-medicated recovery is more admirable), even though the process of finding the right medication and dosage — as well as recovery through the use of medication — can be a long process. It is also common to view taking medication as a sign of laziness or weakness, or to view medication (antidepressants in particular) as ‘happy pills’, which provide a fake or forced kind of happiness.

Concerns About Psychiatric Medication

Here I should reiterate the point made about stigma towards psychiatrists: there may be valid criticisms of psychiatric medication and concerns related to it (such as efficacy, unpleasant side effects, emotional blunting, dependence, withdrawal symptoms, and overprescription), but feelings of aversion toward psychiatric medication can at the same time be influenced by stigma. Thus, in some instances, avoidance of psychiatric treatment can be more based on fear than a careful appraisal of the treatment and its efficacy.

The Way People View Psychiatry Compared to Psychotherapy

In many people’s minds, the cultural implications of visiting a psychiatrist and seeing a therapist are vastly different. There is, undeniably, a stigma attached to help-seeking in general, which includes seeking out a therapist, as this can be seen as a failure of self-reliance, an impression that disproportionately puts men off seeking mental health treatment.

Yet such stigma may be especially pronounced in the case of seeking help from a psychiatrist. This could partly come down to the negative attitudes toward psychiatric medication already touched upon — engaging in talk therapy might be viewed in a more favourable light if the person in therapy is seen as putting more effort into their recovery and confronting their issues, rather than supposedly avoiding those issues through medication. This is in spite of the fact that many patients who take psychiatric medication also attend therapy sessions, and they might find that the relief and stability from medication benefit their therapy sessions (indeed, some research underscores that therapy plus medication is better for the treatment of certain conditions than just medication alone).

Another potential reason for this difference in judgement toward psychiatry and therapy is that the former could be perceived as reserved for the most severely ill and dysfunctional, whereas the latter is seen as being acceptable, not just for those with more mild mental health issues but also for healthy, typical people who might want to work on their personal problems and relationships. So, out of fear of being perceived by others as ‘crazy’ or ‘mad’, people may avoid psychiatry.

Also, those who do have symptoms of severe mental illness could worry that visiting a psychiatrist will result in a loss of autonomy via involuntary admission (this is when you are admitted to a psychiatric hospital against your will, based on the belief that you are at serious risk of causing harm to yourself or others). This worry could be unfounded or founded. In the latter case, many people intent on taking their life will be reluctant to get help from a psychiatrist because they don’t want to be involuntarily admitted and therefore be unable to go through with the act. Moreover, they could perceive a psychiatrist as the type of person most likely to — or most able to — involuntarily admit them to a psychiatric facility.

Other people have reservations about whether they want to potentially receive a psychiatric diagnosis (as these labels carry potential benefits and downsides). For some people experiencing mental distress, a diagnostic label can be illuminating and beneficial, whereas for others it can magnify feelings of shame, isolation, and hopelessness.

Critical and Anti-Psychiatry Perspectives

Critical psychiatry refers to constructive criticism of diagnostic classification and the use of psychiatric medication. It is distinct from anti-psychiatry, a movement that calls for the abolition of psychiatry and advocates for more talking-based therapies, although some psychiatrists, such as Jonathan N. Stea, believe the distinction between the two is nebulous, similar to the distinction between being vaccine-hesitant and anti-vaccine.

It’s hard to say how much of people’s aversion toward psychiatrists boils down to critical or anti-psychiatry perspectives, but many patients who have received psychiatric treatment and had negative experiences will adopt such perspectives and hence avoid seeking help from a psychiatrist in the future. Additionally, people who have never sought treatment from a psychiatrist may hold critical and anti-psychiatry beliefs and so naturally avoid that option should mental illness ever strike.

This is not to say that critical psychiatry or anti-psychiatry is counterproductive in terms of mental health recovery, only to highlight that scepticism and ideology can be a further reason why people are often reluctant to see a psychiatrist.

The Cost of Seeing a Psychiatrist

On the practical side of things, the cost of visiting a psychiatrist can be off-putting to many people. Someone may have no personal or ideological aversion toward psychiatry — they want the perspective, diagnosis, and prescription from a psychiatrist — but they are unable to — or don’t want to — pay the cost. The average psychiatrist’s fee is between $100 and $300 per appointment, and around $500 for an initial consultation. After several or continual appointments with a psychiatrist, treatment for mental health can turn out to be quite expensive. And based on the uncertainty of whether people will initially get the right diagnosis (misdiagnosis is common) or find the correct medication and dosage, people may decide that, financially, seeing a psychiatrist isn’t worth it.

Financial concerns, however, really only apply to visiting a psychiatrist with a private practice. If you live in a country with universal healthcare, or if your health insurance plan covers psychiatric treatment, then there may be fewer financial disincentives. Practically speaking, though, seeking help from a psychiatrist through universal healthcare can be more challenging than if seeking assistance from a private psychiatrist, due to issues like waiting lists and overstretched services, leading to limited appointments.

The reasons for avoiding psychiatrists are manifold. If you are someone who is in psychological distress — or someone close to you is — and psychiatry is an option being considered, it’s important to carefully think about what might be behind hesitancy about going down that route. Being as informed as possible about psychiatry will ensure that any decision made is based on evidence and what your needs are in that moment.

Originally published at https://www.samwoolfe.com on December 22, 2020.