Answered Quora Questions

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Question: What is the average time frame for seeing a GP, getting referred to a psychiatrist, and having an initial consultation?

Dr. Sugarman's Answer: The time varies from 1 day to I suspect as much as 1 year, with the average being weeks to months.

It depends on where you are in the country and when. It simply comes down to supply/demand at the time you reach out to the GP [for both the GP and the psychiatrist]. Also, although some insurance plans insist you go thru the GP, many are in the situation where they could reach out directly to a psychiatrist, lessening the wait time.

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Question: Is psychiatry evil? Dr. Sugarman's Answer: I have been a psychiatrist for almost 60 years. My view is that psychiatry is not evil. Psychiatry is a specialty of medicine. Thus, generally, the morality underscoring it reflects the morality underscoring medicine. So, I [and I doubt almost every psychiatrist and other non-psychiatric physicians} would say that they are practicing something evil. However, they are examples of well-intended treatments [certain brain surgeries and other treatments for schizophrenia], that looking back, were misguided. However, we do the best with what we have at the moment. We know that double mastectomies [to prevent certain malignant breast cancers in very genetically vulnerable women] are something that in the future, with better oncology, we won’t have to do. Is that evil to do now? Well, we are trying to prevent death. Also, homosexuality was a disorder, when I started practice in the 60s. That changed as the general cultural morality changed over the subsequent decades.

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Question: When is it appropriate to end a relationship with a psychologist or psychiatrist? How should one go about ending the relationship with the patient? Dr. Sugarman's Answer: These are complicated questions, and there are many permutations/nuances. However, either the clincian or the patient should end the relationship if it isn’t productive. Ideally, this should be discussed openly to make whatever efforts are possible to get a constructive relationship back on track if that is possible.

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Question: What topics do psychiatrists typically discuss with their clients during therapy sessions?

Dr. Sugarman's Answer: Most sessions focus on what the patient’s symptoms and/or what they want from therapy as the starting point. Different schools of therapy [of which there are hundreds] approach the solutions in different ways.

As an example, I am of the psychodynamic/insight-oriented school. This school/approach-to psychotherapy uses free-association as the guiding protocol. So, I say to patients: “say whatever comes to mind; nothing is irrelevant, and all roads lead to Rome.” Meaning that even if the patient starts with something that might seem tangential or unrelated, by the time they are on to the third or fourth association, it is starting to form a pattern and allow me then [or eventually] to make some comment regarding underlying [unconscious] themes, that hopefully will move the therapy along.

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