What's the difference: psychiatrist, psychologist & shrink?

This is a question that comes up pretty frequently, and someone just asked it again here on the blog a few days ago. Psychologist, psychiatrist, psychotherapist, shrink. To-may-to, to-mah-to? Or completely different concepts?

My suspicion is most people have an idea that they're all different, they just can't put their finger on it. Well, here's the finger right here.

I'll give you the short version and the long one. The short version is simply this:

  • Psychiatrists treat mental disorders. They have to be medical doctors.
  • Psychologists study human behaviour and the human mind, and those who go on to work with people with disorders in hospital settings are clinical psychologists.
  • Psychotherapists help people deal with psychological problems using talk therapy. They can be psychiatrists or psychologists or just trained in those specific type of talk therapy.
  • "Shrink" is a name for any of the above. Yeah, that means it's a pretty loose term.

So that's the short version. If you want the long version though (plus a bit of my story), read on.

How I got interested in psychiatry…

I first got interested in psychology, to be honest. I can't say exactly when it was it did get interested in it, but the earliest I recall was when I was about eight or nine. I ran across a book titled, Child Jealousy (if I recall the name correctly), in my grandpa's library. (Used to rummage through the place every chance I got back then). I was absolutely fascinated by the idea that children could be jealous (never mind that I was still one myself).

And that was how I began. I continued to be interested in the psychological aspects of the movies I saw and the books I read. I didn't call it that, then, but I realised later, when I was older that my best ones were always the ones that somehow left me with a deeper understanding of how people' minds worked.

I didn't go on to study psychology in school, though. Because, you know, back then we were brought up to believe that if you were really smart, you should do medicine or engineering. And what kind of job would a psychologist be doing anyway? (Yeah, we asked such questions back then. Or rather, people asked and you realised you didn't have an answer. Keep in mind, the internet wasn't yet a thing.)

Anyway, I did go on to study medicine, and much as I enjoyed that, I found out along the line that I was more interested in the mind than in the body. Kinda weird, given everyone else's interest in surgery and internal medicine and obs and gynae, but there it was. Except I wasn't sure I wanted to focus on mental disorders. This despite thoroughly enjoying my psychiatry posting as a medical student. It just felt restrictive: my interest was, I thought, more in psychology than psychiatry; more in the mind as a whole, than in treating mental disorders.

It took finishing school and internship, to realise, one day, like a bolt out of the blue, that psychiatry was it, was what I really wanted to do.

As it turned out, the application deadline for the residency entrance exams (aka "Primaries") was about two weeks from the day I had my epiphany. I had to have the forms couriered to where I was doing my mandatory year of youth service and then couriered back to Lagos after I'd filled them, to beat the deadline.

And thus began my journey in mental health.

What's all this have to do with the original question of the difference between psychology and psychiatry?

Quite a bit, really. Here, let me explain…

Psychologist

Let me start with psychology. Like I said earlier, psychology, simply put, is the study of the mind and behaviour of people. It's very broad, though, and those who study it in university can go on to many other fields, from occupational psychology (who could work with, say, human resources departments), and sports psychology (who may work with individual sports people or whole teams). If a psychologist is interested in working with people in a hospital setting, though, they have to specialise in clinical psychology.

(The requirements of that vary from place to place. In Nigeria, you'll have to do a Masters in Clinical Psychology plus an internship period in a hospital to get to be called one. Some go on to do a PhD.)

So if you meet a hospital-based psychologist, that's a clinical psychologist right there.

Psychiatrist

A psychiatrist has to first be a medical doctor. That's the easiest way to put it: a medical doctor who has gone on to specialise in psychiatry, like other doctors go on to specialise in everything from paediatrics to radiology or anaesthesia. In some countries, psychiatrists can go on to subspecialise, but that's still pretty limited here. (Less than one psychiatrist to one million Nigerians, and it's only slightly more psychologists.)

Another key difference is, psychiatrists, being doctors, are authorised to diagnose mental disorders and to prescribe medications for them. (Psychologists can make some diagnoses using things like questionnaires, but typically can't prescribe meds—they are allowed limited prescribing rights in some places, though.)

Psychiatrists are generally trained to have an idea of the basics of psychology, but some go on to actually get a masters in clinical psychology, and even other aspects of psychotherapy.

Which brings me to…

Psychotherapy

Psychotherapy is also known as talk therapy, and any of the two above can engage in it, as well as any mental health professional who's interested enough to learn a specific type of psychotherapy—and there's a ton of them. They all have some things in common, though: a relationship with the client known as a “therapeutic alliance,” some form of dialogue, and empowering clients to overcome problematic thoughts or behaviors.

Anyone engaging in this is a psychotherapist. Oh, and by the way, that image of a couch you're seeing in your head right now? Totally outdated. Lose it. Psychotherapists already did ages ago. Not all, but largely. (The couch is a hangover from the type of psychotherapy Freud pioneered: psychoanalysis. Which is only one of many different types of psychotherapy.)

By now, you probably see why I love what I chose: I get the best of both worlds: I get to be a doctor, but in the field I've always loved. Plus I get to help people almost everyone else gives up on.

And finally, shrink…

That's just a random name, in the sense that it can be applied to anyone of the above three: psychiatrists, psychologists, psychotherapists—they're all “shrinks.” It's not clear where exactly the term comes from, but it's believed to be rooted in "headshrinker," which in turn is supposed to come from the idea that mental health professionals shrink your problems (hopefully not a reference to head-eating cannibalistic behaviour!).

It's also the easiest recognisable name for most people, which is partly why I use it on this site. (That, and the fact that it's rather a fun name.) :-)

Did you learn a thing or two? Great! Please share! And let me know what you think in the comments.