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Madison Marcus
Advanced Placement Language and Composition
Mr. Rhodes
February 27, 2014
Psychiatry: an Exploration of the Mind
A young man sits hunched over in the corner of a cold, dark, barred cell. He tries to
picture the faces of his wife and children but he no longer recollects them. He trembles with fear
as men in uniforms walk past him. These men say they will help him but he knows they will
only hurt him more. They throw leeches at him, beat him with clubs, and try to chip a hole in his
skull. Now, striped of his dignity, he cowers in his cell as crowds walk by, pointing and staring
at him like an animal in the zoo, calling him names like lunatic, crazy, or demented. Had this
same man lived in the 21
st
century, he would have received drastically different care. Educated
professionals with medical degrees would come to his aid. He would sleep in a room with a
warm bed and many amenities, and make friends with other patients going through similar
challenges. While the professionals taking care of this man in both situations call themselves
psychiatrists, their approaches to patient care contradict each other and therefore, these
professionals have vastly different careers. A career in the field of psychiatry has developed into
a more legitimate science thanks to the contributions of influential individuals, and todays
specialists practice a more refined science of diagnosis.
Psychiatry dates all the way back to the Stone Age. During this era, people believed
individuals behaved abnormally because evil spirits had entered their minds. In order to cure
these afflicted individuals and release the evil spirits, educated members of the community
treated the insane with a process known as trephining (Institute for Career Research 5). This
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brutal treatment entailed chipping a hole in the individuals skull in order to allow the evil spirits
to escape. Unfortunately, this treatment method often resulted in the death of the patient. As
time progressed, people in the Middle Ages thought God sentenced individuals with insanity as a
punishment for sinning. Since people considered insanity a curse from God, the majority of the
mentally insane resulted to prayer. If prayer proved unsuccessful, they turned to other primitive
procedures such as bloodletting. Bloodletting involved removing bad blood from the patient (5).
Due to the low success rates of procedures such as trephining and bloodletting, people
brainstormed new ways to treat the mentally unstable.
King Henry VIII had the revolutionary idea of creating insane asylums, or treatment
facilities that specialized in caring for patients suffering from mental illnesses. In 1574, King
Henry VIII created the worlds first insane asylum in London, England, named St. Marys
Hospital of Bethlehem, commonly referred to as Bedlam (Institute for Career Research 5).
Unfortunately, this did not become a groundbreaking treatment center, but instead transformed
into a tourist attraction where people flooded the hospital to view the mentally unstable in their
cells (5). Also, patients received harsh and inhumane treatment such as bloodletting, beating,
and confinement with chains, because modern science and medication did not exist (6). In fact,
Bedlam failed at treating patients so tremendously, that today the word bedlam means chaos,
confusion, or madness (Shorter 5). This brutal and ineffective treatment of the insane lasted for
centuries until a few enlightened thinkers rethought treatment methods for the mentally ill.
When the French physician, Philippe Pinel, created a new treatment method called moral
therapy, the insane finally began to receive humane treatment (Institute for Career Research 6).
In 1801, Pinel published a textbook expressing his desire to reorganize asylums to make them
humane and beneficial (Shorter 12). Under Pinels treatment, patients received clean living
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quarters and simple work to keep their minds busy. Pinels radical ideas spread across the
nation. Benjamin Rush and Dorothea Dix followed Pinels example to reform mental institutions
in North America (Institute for Career Research 6). Reformers such as King Henry VIII, Philippe
Pinel, Benjamin Rush, and Dorothea Dix all had a tremendous impact in psychiatry.
While individuals transformed the field of psychiatry, World War II (WWII) sparked
change and advancement in the field more than any individual. During WWII, many men could
not serve in the military because of mental health problems. The military turned away men eager
to serve and referred them to mental hospitals. This drastically increased the number of people
confined to mental institutions. Since more people had exposure to mental institutions, the
public finally began to uncover the truth about the horrible conditions in these establishments
(Institute for Career Research 7). With modern technology, doctors no longer used barbaric and
primitive procedures such as bloodletting and trephining, but they still implemented terrifying
treatment methods with technology and medicine.
During the 1940s and 1950s, doctors treated patients with a variety of diverse and
dangerous therapies, including insulin-coma therapy, shock therapy, and electroconvulsive
therapy (Shorter 212). Insulin-coma therapy, invented by American psychiatrist Manfred Sakel,
entails injecting schizophrenic patients with large amounts of insulin in order to put them into
medically-induced comas on a daily basis (212). In shock therapy, doctors inject patients with
the drug Metrazol to induce severe epileptic attacks and comas (214-215). Similarly, in
electroconvulsive therapy, doctors tie patients down and electrically shock their brains in order to
prompt convulsion (218). When the public heard about the frightening medical experiments
happening in mental institutions, it started a movement of deinstitutionalization. The publics
discontent with mental institutions, advances in medication, and reductions in funding all
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attributed to this social revolution (Institute for Career Research 7). Americans aimed to close
down these institutions and reintegrate patients into the broader community. (Elshtain 601).
Today, Americans still oppose institutionalization and work to treat patients without confining
them to a hospital.
While many mental institutions utilized dangerous treatment methods, Sigmund Freud,
the most world-famous psychiatrist, explored humane and non-intrusive methods of therapy.
Sigmund Freud remains a world-renowned name in the field of psychiatry because of his theory
of psychoanalysis. Through psychoanalysis, Freud discovered the unconscious mind, the part of
the mind individuals have no conscious control over and determines how individuals think and
behave. He thought humans pushed anxiety and stress-arousing thoughts deep into their
unconscious. Freud studied human thought and behavior through examining the unconscious
mind with psychoanalytic techniques such as dream analysis and free association (McEntarffer &
Wesely 46). Freud closely analyzed dreams because he thought individuals acted out their
unconscious desires in dreams. In his dream analyses, Freud did not concern himself with the
manifest content of the dream, meaning the events actually happening in the dream. Instead, he
focused on the latent content of the dream, or Freuds interpretations of what the patient desired
based on the events in the dream (124). Freud also practiced free association, a technique in
which he asked the patient to say whatever came to mind without thinking (259). Freud believed
the patients response during free association came from his unconscious mind. Freuds theory
of psychoanalysis prevails as one of the most famous theories in all of psychology.
Although Freud remains one of the most highly regarded psychiatrists of all time, he
receives criticism from his peers for his highly controversial work. Freud verbalized his
opinions about the taboo subject of sex and sexuality long before any other psychiatrist dared to
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discuss it. Freud published research about the Oedipus complex, a stage that young boys pass
through in which they sexually desire their mothers and view their fathers as rivals for their
mothers love (McEntarffer & Wesley 208). This emphasis on the Oedipus complex in Freuds
research caused his partners, CG Jung and Eugen Bleuler, to leave him. Medical professionals
disapproved of Freuds ideas because they believed his theories had no basis in science or reality.
Since Freuds findings proved untestable, many doctors dismissed them as untrue or irrelevant.
In addition to criticism from psychiatrists and doctors, Freud also endured criticism from
feminists because much of Freuds research seemed biased towards males (Sigmund Freud).
For example, he believed in a theory he called penis envy, a theory in which young girls develop
an envy for the male extra genitalia. Today, very few psychiatrists agree with Freuds theory of
penis envy (Bothamley 403). In fact, only a small number of modern psychiatrists actually
practice psychoanalysis or any part of the Freudian theory. However, Freud and his theories still
receive world-wide recognition for their influence in fields such as anthropology, education, art,
and literary criticism (Sigmund Freud).
Freuds peer, Jean Piaget, also theorized about psychological phenomena, such as the
cognitive development of children. Swiss psychologist, Jean Piaget, theorized that cognitive
development occurs in four genetically determined stages that each have a unique set of
behaviors and always follow the same sequential order. These stages include the sensorimotor
stage, preoperational stage, concrete operational stage, and formal operational stage
(McEntarffer & Wesley 196). The sensorimotor stage lasts from birth to two years of age.
During this stage, babies begin to explore the world through their senses. They also develop
object permanence, or the idea that objects continue to exist when they cannot see them. The
preoperational stage follows the sensorimotor stage. In this stage, children between the ages of
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two and seven learn to use symbols to represent real-world objects. For example, a child may
use a broom as a horse because he learned to represent the animal of a horse with the common
household object of a broom. After the preoperational stage, children enter the concrete
operational stage. This phase lasts until the child reaches approximately 12 years of age (196).
During this stage, children develop logic skills and learn to apply these reasoning abilities
towards solving complex problems. Children in this stage also learn the concept of conservation,
or the realization that properties of objects remain the same when their shapes change. For
example, after pouring a cup of water into a different shaped cup, a child not yet in the concrete
operational stage would believe the volume of water changed. However, a child in the concrete
operational stage would recognize that the amount of water remained constant, and only the
shape of the glass changed (196-197). Finally, during the formal operational stage, children gain
adult reasoning skills, such as the ability to reason abstractly and make hypotheses.
Additionally, they gain metacognition, or the ability to think about the way humans think. While
most people above the age of 12 think in the formal operational stage, Piaget did not believe
everyone reaches this higher area of thought (198). Piaget gained a tremendous amount of
notoriety and remains a well-known name in the field of psychiatry for his theory of cognitive
development.
Today, in order to theorize about psychiatric phenomena, prospective psychiatrists must
earn certification. To accomplish this, students need to go through an extensive amount of
education and training. This training begins in college, where undergraduate students enroll in
pre-medical classes, including biology, organic or inorganic chemistry with a lab, English,
calculus, and biochemistry. Students must work hard in these undergraduate classes because
most medical schools only accept students with a grade-point average of a 3.5 - 4.0 (Institute for
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Career Research 23). Most medical schools also require prospective students to take the Medical
College Admission Test (MCAT) which assesses students understanding of physical and
biological science, and ability to reason verbally and write essays (23). After passing the
MCAT, students attend one of the 125 medical schools in the United States (Institute for Career
Research 23). These medical schools offer general courses in biochemistry, embryology,
pathology, pharmacology, microbiology, and immunology to all aspiring doctors (23). During
students final year of medical school, they select a specialty, such as psychiatry. To specialize
in psychiatry, students take one year of general medical practice in a residency program and two
to three years of supervised residency training in general psychiatry. During residency training,
students begin working with patients for the first time. These psychiatrists-in-training check on
patients with a supervising doctor and attend lectures. Also, students receive payment for their
work for the first time (24). After college, medical school, and residency training, students take
the licensing exam to earn certification from the American Board of Psychiatry and Neurology
(Roukema 292). In order to keep this certification, students must pass a standardized test and
have their colleagues formally review their work every 10 years (Chien). Students go through an
extensive amount of hard training to become a certified psychiatrist, but the work pays off when
they make a difference in a patients life.
Before psychiatrists can begin to help patients, they must first diagnose and classify the
patients illness. To do this, psychiatrists gather an extensive amount of information from the
patient and his family, school, co-workers, primary physician, social worker, and other important
individuals in his life. For further evaluation, psychiatrists order laboratory tests or refer
patients to specialists. Once psychiatrists gather information about the patient, they make their
diagnosis based on the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Institute
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for Career Research 9). The DSM defines what variety of symptoms health care professionals
recognize as mental disorders, as well as which patients require treatment. The most recent
edition of the DSM, the DSM V published in 2000, changed the description of many mental
disorders (Tanner). For example, the DSM V adopts the term autism spectrum disorder to
encompass individuals with all severities of autism. It also labeled children with frequent temper
tantrums as suffering from disruptive dysregulation disorder, preventing many children from
receiving the incorrect diagnosis of bipolar disorder. Additionally, the DSM V eliminated the
term dyslexia, instead encompassing the term into the broader category of learning disorders.
Along with dyslexia, the phrase gender identity disorder no longer exists because psychiatrists do
not want to label it as a disorder. Therefore, they renamed it gender dysphoria, which means to
have emotional distress over ones gender (Tanner). Psychiatrists stay up-to-date about the
changing definitions of mental disorders so they can treat patients to the best of their ability.
Based upon a patients diagnosis, psychiatrists create an individualized treatment plan to
relive the patients symptoms. These treatment plans consist of goals for the patient, methods to
obtain these goals, and an estimation of the length of therapy (Institute for career Research 10).
Usually, a patients treatment plan begins with prescribing medication. The idea of medicating
patients has increased in popularity because it allows patients to receive treatment on an
outpatient basis (9). Psychiatrists prescribe medication based on the severity of the patients
symptoms and the side effects of the drug (Roukema 306). Ideally, they aim to prescribe
medications with beneficial side effects for the patient. For example, if a patient has trouble
sleeping at night, a psychiatrist would prescribe a medication that causes drowsiness for the
patient to take at night. Along with the specific type of medication, psychiatrists must also select
the correct dosage. The prescriptions dosage differs with the severity of the symptoms. At the
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beginning of a patients treatment, the psychiatrist may prescribe a high dosage, and reduce the
dosage as the patient recovers (307). Psychiatrists meet periodically with patients to assess
whether the dosage of medication needs adjustment (Institute for Career Research 9). Due to
advances in medicine, prescribing medication has become a very popular method of treatment,
however, other techniques for helping patients do exist.
Many psychiatrists create treatment plans for patients involving individual or group
therapy. During individual therapy sessions, psychiatrists meet with a patient to discuss stressful
events in the patients past, offer an interpretation, and give suggestions of how the patient
should proceed in the future. In group therapy, a psychiatrist meets with a group of patients
dealing with the same challenges. The psychiatrist encourages members to share their feelings
with the group, allowing group members to work together and help each other (Institute for
Career Research 11). Since psychiatrists treat such a wide variety of patients, group and
individual therapy sessions can occur in an assortment of different locations such as treatment
centers, prisons, or mental hospitals (10). This means that psychiatrists do not work in one
specific location, but instead have an unlimited number of options for work environments.
A psychiatrists work environment relies heavily on his specialization area as they can
specialize in a large variety of areas such as forensic psychiatry, children and adolescent
psychiatry, geriatric psychiatry, and addiction psychiatry. These specialized areas dictate where
psychiatrists work. For example, psychiatrists specialized in forensics commonly work with
attorneys and court systems to treat the criminally insane, help victims of crimes, and assist
attorneys in understanding psychological aspects of cases (Institute for Career Research 8).
Child and adolescent psychiatrists advise schoolteachers, parents, pediatricians, and staff of
childrens homes about caring for children with emotional problems (Lock et al.). Child and
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adolescent psychiatrists work in places such as isolated treatment centers for children and
adolescents, foster care agencies, and schools (Institute for Career Research 8). Addiction
psychiatrists commonly work in rehabilitation treatment centers, and geriatric psychiatrists work
in rehabilitation centers for older patients, convalescent homes, or hospice sites. Since
psychiatrists have a great variety in specialization area, they also have a wide array of work
environments to choose from.
Regardless of a psychiatrists specialization, most tend to work in heavily populated,
urban areas (Institute for Career Research 7). Psychiatrists flock to large cities in order to attract
more clients. In North Carolina, psychiatrists working in populous cities such as Raleigh and
Winston-Salem receive salaries above the $156,250 annual average for the state, and more than
the $167,610 national average (Psychiatrists Wages). Wages vary by state from $229,210
per year in Oregon, to $121,340 annually in Illinois (Psychiatrists Wages). While psychiatry
does not pay as much as other medical fields, they will still earn enough money to live
comfortably.
Not only do psychiatrists benefit from substantial wages, they also benefit from the
comfort of having a secure job. In the popular and growing field, experts anticipate employment
to grow faster than the average for all occupations through the year 2020, meaning with
projected increases anywhere from 20% to 28% (Employment and Outlook). In North
Carolina, experts project employment to increase by 31% (North Carolina Employment). In
recent years, women have attributed to the success of this up-and-coming field. In just the past
decade, the field has seen an increase in women training to work as psychiatrists (Chien).
Researchers predict the most growth in employment for child and adolescent psychiatrists
through the year 2020, expecting 12,000 more child and adolescent psychiatrists will start
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working in order to meet the publics demand (Institute for Career Research 26). This career
continues to develop as the population increases and people have a greater acceptance of
individuals taking medication or receiving counseling (Institute for Career Research 27). As
long as people continue to experience mental illnesses, there will always be a need for
psychiatrists.
In one of the fastest growing fields of psychiatry, child and adolescent psychiatry,
psychiatrists study, diagnose, treat, and prevent psychological disorders in children and
adolescents. These specialists focus on studying disorders impacting the younger generation,
such as attention deficit hyperactivity disorder (ADHD), which ranks as the most prevalent
childhood disorder, affecting 9% of children age 13 - 18 (Who is at Risk?). Children who
receive this diagnosis often exhibit difficulty paying attention and staying focused, an inability to
control their actions, and hyperactive, impulsive behavior (Signs & Symptoms). In an effort to
explain these symptoms, experts attempt to discover possible causes of the disorder.
While researchers do not know exactly what causes children to exhibit ADHD symptoms,
they do have a number of theories. Experts find ADHD highly hereditary, often running in
families, therefore, some believe babies are predisposed to suffer from the disorder. In addition
to genetic influences, ADHD also has biological ties, as children with ADHD have thinner brain
tissue in areas of the brain associated with attention, however, when the children grow older, the
tissue thickens and the childrens symptoms improve (Causes). Research also shows a definite
link between children with ADHD and exposure to cigarette smoking and alcohol consumption
before birth. Despite popular belief, research discounts the idea that the presence of sugar in an
individuals system worsens ADHD symptoms. In professional studies, two groups of children,
one given sugar and the other given sugar substitute, behaved identically (Causes). From these
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studies, psychiatrists and other medical doctors have begun to uncover why children suffer from
ADHD.
Based on these studies, psychiatrists consider medication and psychotherapy the most
effective treatment methods for ADHD. Psychiatrists prescribe stimulants such as Adderall,
Concerta, or Focalin to reduce hyperactivity and impulsivity in patients (Treatments). These
stimulants actually have a calming effect and improve most patients symptoms. For less serious
cases, professionals recommend behavioral therapy, where children work with specialists to
organize their schoolwork and monitor their behaviors (Treatments). Many families prefer
behavioral therapy and find it an effective and non-invasive treatment method. An increasing
number of children undergo treatment for ADHD as the number of diagnoses skyrockets.
With the increasing prevalence of ADHD, many doctors question whether psychiatrists
over-diagnose the disorder. The number of children receiving an ADHD diagnosis has seen an
increased 16% since 2007, and 53% in the past decade (Schwarz & Cohen). These numbers will
continue to grow since the American Psychological Association plans to broaden the definition
of ADHD to encompass a wider variety of symptoms (Schwartz & Cohen). Currently, two-
thirds of the 6.4 million children with a diagnosis of ADHD take prescription medication
(Schwartz & Cohen). With the new, more expansive definition of ADHD, even more children
will take prescription medication. This concerns many psychiatrists who worry that children
may develop a reliance on prescription drugs (Schwartz & Cohen). While medication helps
many people, in order to reduce the risk of over-medicating, doctors must make sure their
patients need a prescription. One of the hardest parts of a psychiatrists job is finding the perfect
balance of medication and therapy, but once he does so, the patient will benefit tremendously.
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Psychiatry has developed from its early stages of bloodletting and trephining into a
gratifying study of modern science. Psychiatrists work in a variety of different areas to diagnose
and treat mental disorders afflicting people of all ages. Today, instrumental individuals continue
to shape psychiatry into a well-respected, and thriving career.

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