top of page

Psychiatrist as a professional: interview with Professor Eugenijus Laurinaitis

 

How would you define the core features of psychiatric professionalism?


Let’s start with the three main components of each profession: knowledge, skills and attitudes. It is quite well-defined what knowledge any psychiatrist should have: the main task of psychiatrist is to have knowledge in psychopathology and to relate it to the condition and diagnosis of every particular patient. When it comes to skills, it is more about the ability to see, hear and understand what one sees and hears. We have just a few instrumental tests in psychiatry field. Some video imaging techniques emerged in last decades, but still, they cannot be directly related to particular psychiatric pathology as it is the case of PTSD when brains’ alarm system is more irritable than in healthy persons brain, but in the cases of very common and difficult psychopathology as depression or schizophrenia we do not have instrumental tests we can rely on in diagnostic process. So, the skills of psychiatrists are mainly communication skills and the ability to see and hear. I remember when I was a trainee in psychiatry, I found it strange when I was told that a good psychiatrist should discover the symptoms instead of just seeing or noticing them. Discovering the symptoms is actually my personal fantasy about what is going on in the head of the patient and I don’t think it’s professional. As this is a projection of one’s fantasy, it bases on the factors irrelevant to that particular encounter of patient and psychiatrist, and so we are missing something that this patient is actually saying and showing, which is much more important.


The main task of every code of ethics is to define the attitudes. They are defined quite well in the new standards, but the main thing which is the most important is the alliance of this particular patient and this particular psychiatrist, their equality in discussing issues that are vitally important to patient. Surely, the welfare of the patient is the main interest of a psychiatrist, but what we understand under that welfare, what components we put in it sometimes differ a lot between the two parties of that contact. That is why it is crucial to find this equality, because if, in the field of knowledge, we really differ from the patient, we are equal in the field of attitudes and values that we find in basis of every person’s existence, and it is every person’s fundamental right to live according to one’s own attitudes and values. I think, that in the level of attitudes this equality must be not only acknowledged but also implemented in every particular conversation.

How in your opinion professionalism of psychiatrist relates to professionalism of psychotherapist in the same person? Is there any conflict?


Yes, it is, for a very simple reason. Doctors, including psychiatrists, are taught to know better than patient, what is going on with the patient’s inner or outer world, how it is called, and this is actually the basis of our psychiatry training. Meanwhile professionalism of psychotherapist is expressed through realising, that psychotherapy is a process of patient changing himself.


And how profoundly patient will change depends mostly on him. It depends on my professionalism, too; of course, I must have knowledge of diagnostic and to be skilled in intervening, but when it comes to degree of the change in psychiatry we talk about reduction of symptoms, social rehabilitation of the patient, his return to normal life. Meanwhile in psychotherapy this is not enough, because a significant part of the suffering that patient brought to the therapist is caused by existential motives, and his problems often are unconsciously caused by himself. Patient is often unaware of that, and the process of becoming more aware of the reasons and consequences is containing that changing potential. Therapist cannot change for the patient, as no-one can change for the other person. That is why therapist’s work is much more complex than psychiatrists in the sense that therapist never knows whether or not his patient is intended to change and how far he’s intended to go that way. Undoubtedly it is discussed and questioned to comprise the two perspectives, as the therapist also has his own perspective, how and when we will assume that therapeutic process is complete and that we have already reached our goal. But the patient here is always half a step ahead of the therapist. Furthermore, the way of solving this conflict is the choice and responsibility of each professional. I think that since the moment I prescribed a medication to my patient, that part of doctor identity, knowing better, comes into action. And since then, patient is often prone to pass the responsibility for the final result to the psychiatrist. And when I try to act as therapist, it contradicts that initial position. So that is really hard to combine. Some professionals do it better, and others refuse to combine those two roles. I think this is a choice of professional and his ability to contain this contradiction in sufficient professional coherence. It is complicated.


E. Laurinaitis: "The main task of psychiatrist is to have knowledge in psychopathology and to relate it to the condition and diagnosis of every particular patient." Image by Wix Media.
E. Laurinaitis: "The main task of psychiatrist is to have knowledge in psychopathology and to relate it to the condition and diagnosis of every particular patient." Image by Wix Media.

Professionalism is defined as fulfilment of certain legal expectations of society, external standards with honesty and compassion, which are internal human dimensions. How do those two poles interact in your view?


Firstly, I think that in every profession we serve society and meeting its legal expectations is a must. And this is my attitude, my choice. I decide whether this profession, its requirements, its opportunities are acceptable to me, will I be able to work in it. Understanding that certain specific requirements in the sphere of values are applicable in each profession, and aspirations for psychiatrists’ integrity, coherence, ability for compassion for suffering are crucial. I still remember the short quote from a book “Schizophrenia” by famous Polish psychiatrist A. Kempinski: “ones who suffer the most and whose adaptation to the challenges of our life is the poorest are those whom we call schizophrenic.” We call. I really loved this phrase.


The character of interaction of the two poles in my opinion is as follows: the existence of those external standards is a condition, and I have to act responding to it. And the existence of my inner standards is the process of my development, my growth, - dynamic process. In the beginning of psychiatric or psychotherapeutic carrier the illusion of omnipotence is quite common: it seems that I learned a lot and now I am going to make a huge difference, but later with experience the modesty comes. And I think that this professional modesty is one of the most important and valuable features: thanks to it we acknowledge, that we actually can only help patient in the process of changing himself. And when we talk about treatment of mental conditions, in the end of the day everything depends on the potential this particular patient carries. The resilience theory is based on the idea that the recovery depends on inner resources and energy of every particular patient. And we need to know how to wake up this potential in the patient.


How do you see professional growth of the community of psychiatrists as a vector? Where do we come from and what direction we are moving in this process?


I think that the further the more psychiatry turns itself towards the rebuilding that potential of the patient rather than symptoms’ removing approach. It is very important; it is how we become real servants of society. In that case the patient receives the help that empowers him to live on together with other people. In some cases, it is very hard, in other cases it may be even impossible. Then we have a treatment result which we call poor outcomes. It really exists. But still, we accept that assumption, that each person has something healthy in him, and in the process of our work we need to refer to this healthy part, and not to pathology that we diagnose. We need to discover this healthy part or personality and use it collaborating for patient’s sake. In that case I think that our growth lies firstly in our capability to help the patient in the search of his own potential that could drive him forward. I think this is the main thing, and of course there are some challenges here because our patients are discriminated and eliminated from society, because society is afraid of them. And this is a very well-known process of stigmatisation, and our role would be to help the patient to ignore that process, rely on that healthy part of himself, so that he could live his life at his own pace and in his own direction. This may sometimes contradict to norms of society, but I think that we as professionals must pay attention to individual patients needs rather than society’s norms and expectations.


What resources do you see for professional growth of psychiatrists?


The most important resource is learning and high-quality professional teaching. And I think, that the objections against psychiatrists becoming analysts half century ago especially in the USA were overreactive, and nowadays more and more young psychiatry trainees understand that their professional functioning will be very hard without this second group of skills and they begin to study psychotherapy


This is an international tendency. The life itself shows to psychiatrists the necessity of psychotherapy; it is necessary to psychiatrist as his second hand. I think that as psychotherapy is the process of the patient changing himself, use of psychotherapy is limited and psychiatric approach is dominant when patient is not motivated enough for the therapy.


But when we talk about the sense of psychiatrist himself, we come to that search for the potential resources in patient and for the ways to actualise them. And here the border lies between what is possible to me and what is possible to the patient. And the finding of this boarder can give a great meeting point, where I can acknowledge, that I am not omnipotent and communicate the idea that I can only help but not change for you. This is the feature of our professionalism. This understanding hopefully comes with the age, but ongoing growth with the help of colleagues is crucial, too. It may be lectures of some professional authority, demonstrations of sessions, and these are really available nowadays. Also, supervisions are a great opportunity to analyse your own work. And, undoubtedly, intervisions that are really encouraged in psychotherapeutic field when professionals of equal level gather and discuss what are their challenges working with their patients. There is such a byblical saying about seeing the speck in your neighbour’s eye but not noticing the log in your own eye. This, I would say, innate feature of ours becomes very valuable in the process of intervisions: you can observe and notice much more from outside. The main obstacle in this process is that it often seems to professional that if he shows that something is difficult for him, he will seem a poor professional. And this is untrue: only those who dare to see their weak points, have a chance to grow. That is why I want to encourage all my colleagues to have a look at themselves to realise what actions led to certain consequences and to discuss that with their colleagues.


Thank you for sharing your thoughts with us.



Comments


bottom of page