The Instigator
Capitalistslave
Pro (for)
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The Contender
imheretodebate321
Con (against)
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Psychiatry(pro) versus clinical psychology

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Voting Style: Open Point System: 7 Point
Started: 3/4/2017 Category: Society
Updated: 1 year ago Status: Post Voting Period
Viewed: 439 times Debate No: 100555
Debate Rounds (3)
Comments (1)
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Capitalistslave

Pro

This is a continuation of a previous debate which is here: http://www.debate.org...
Same rules apply, but instead we will just be skipping round 1 since round 1 is in the above debate. Basically this round is round 2 of the previous debate so I will be re-posting my arguments from that one.

My opponent chose an interesting choice for a career, one that is closely related to psychiatry. I will, however, still argue that psychiatry is better than clinical psychology.

Now, it should be noted that psychiatrists and psychiatric nurses are the ones who prescribe medication to people as treatment for mental health, psychologists are the ones who usually offer therapy for people as treatment of mental health. In other words, those going into psychiatry are the prescribers and those in clinical psychology are the nonprescribers.

There is a greater need for prescribers than non-prescribers
Now, while there is a shortage of both psychologists and those in the psychiatric field, there is a greater shortage of those in the psychiatric field. In a study conducted by Kathleen C Thomas M.P.H. Ph.D et al, it was found that only 8% of US counties had a severe shortage of nonprescriber mental health professionals, and 18% had at least some unmet needs[1, pg 1325]. On the flip side, 77% of US counties have a severe shortage of prescribers and 96% had at least some sort of shortage[1, pg 1325] In other words, 72% of all counties in the US have their psychological needs met, while only 4% have their psychiatric needs met. There is a much greater need for psychiatrists and psychiatric nurses than psychologists, therapists, etc.

I contend, then, that because there is a greater need for psychiatry currently than clinical psychology a career in psychiatry would be superior than for clinical psychology. Not only does this mean you are helping the severe shortage of psychiatric-related fields when you go into psychiatry, and thus helping society more than if you went into clinical psychology, but you will have better job stability because there is a higher demand for psychiatric careers. It not only helps the community, but yourself as well.

Psychiatrists and psychiatric nurses earn more income than Psychologists
The average psychiatrist yearly income in the United States ranges from $171,660 to $195,510, depending on who you work for[2] in comparison, the average salary a psychologist makes is $72,580[3]. That's a difference of about $100,000 or more, and both fields require traditionally 8 years of education beyond high school. The average yearly earnings of a person who takes on an advanced degree beyond a master's degree, is $124,584. [4] This means that a psychologist is very underpaid in comparison to other advanced degrees, while a psychiatrist is paid much more than other advanced degrees. Overall, it is more profitable to become a psychiatrist in the long-run than a psychologist.

What is insane, a psychiatric nurse, which only needs a master's degree, even earns more than a psychologist, which requires a Ph.D. The average psychiatric nurse yearly income is $91,963[5]

Clearly, in terms of what you can earn in these jobs, psychiatry is superior.

Psychiatrists can do what psychologists do, but rarely the other way around.
In every state, a psychiatrist is authorized to perform psychotherapy if they so choose, but only in 3 states, Illinois, Louisiana, and New Mexico, can psychologists prescribe medication[6]. So basically, if you decide to become a psychologist, you're pretty much limited to performing therapy unless you decide to live in one of those three states. However, psychiatry offers more flexibility. Although it's not too common, as a psychiatrist, you can give a patient psychotherapy if you so chose. So, as a psychiatrist, you can both prescribe medication and provide psychotherapy to a patient, whereas for a psychologist, you're more than likely going to only be able to provide therapy.

Patients seeking mental treatment, when seeking for therapy most want medication as well.
In a study discussed in this article, patients with PTSD who sought therapy treatment, only 30% of them chose to also not get medication[6], based on what I've learned in my psychology classes(I am on the track to becoming a psychiatrist myself, hence this debate) it tends to be the case that majority of people with any mental health problem also want medication if they are seeking therapy. If my opponent challenges that statement, I can later add some sources, I just chose not to in order to save time and I just stated what I learned in my psychology courses, since anyone who has taken psychology courses may have also been told this.

Thus, what this means is that society needs psychiatrists and/or psychiatric nurses in addition to psychologists. However, psychologists may not even be necessary since, if they wanted to, psychiatrists could also do what psychologists do.

Conclusion of this round:
Due to that there is a growing need for psychiatrists, moreso than psychologists, psychiatrists earn more income, psychiatrists can do what psychologists do, and most people don't seek to have therapy alone, these are reasons which mean that psychiatry is either very much more needed than therapists/psychologists, but also that it is better for a person themselves to seek to become a psychiatrist. Additionally, the amount of education between the two fields is the same, and actually, if you wanted to become just a psychiatric nurse, the amount of education is 2 years less than that of a psychologist. Psychiatry is thus better for these reasons and now I turn this over to my opponent

Sources:
[1] www.oregonhwi.org/resources/documents/countylevelMHshortage.pdf
[2] http://learn.org...
[3] https://www.bls.gov...
[4] www.pewresearch.org/fact-tank/2014/02/28/for-millennials-a-bachelors-degree-continues-to-pay-off-but-a-masters-earns-even-more/
[5] https://www.indeed.com...
[6] https://www.psychologytoday.com...
imheretodebate321

Con

clinical psychology is a better career in the sense it works to understand the cause, the true pathology of why a mental illness has arose. of the many types of clinical applications of therapies CBT is more of the renowned way of treating clients. a study done by Simon, Cord"s, and Bottino found that CBT is more effective at treating adults with depression (2015). its not necessarily that this study compares anything major but just from a clinical standpoint, the training a psychologist would obtain in their graduate program allows for treatment without the invasive additive of an external substance and potentially disrupting the system further in the client and creating some comorbidity.

looking at an article done by psychology today, contrasted the difference between a psychiatrist and neurologists. both of which are medical doctors, while a psychologist is just specialized in the skill and education of the mind and working through mental pathologies. the type of schooling that a psychiatrists endures is that closer to a medical physician at which lacks the necessary experience and understanding a psychologist would get working through a PhD program. potentially creating the overuse of medical prescriptions to treat mental health as oppose to getting to the root cause.

an article written by the American psychological Association looked at the prevalence of inappropriate prescribing. the article looked at how many patients who have been prescribed a medication may be given an inappropriate medication or one that does not even work properly for their specific illness. "I would say at least half the folks who are being treated with antidepressants aren't benefiting from the active pharmacological effects of the drugs themselves but from a placebo effect," says Steven Hollon, PhD, a psychology professor at Vanderbilt University who has conducted extensive research on the effectiveness of antidepressants. "If people knew more, I think they would be a little less likely to go down the medication path than the psychosocial treatment path" (smith 2012).

now even looking at a sample schedule of what a clinical psychology student would go through in a graduate program provided by UC San Diego, the classes are focused around clinical application, philosophy, internship (on the job experience), and learning to apply statistical date, since psychology is still a science where measuring objective date is valid and most certainly possible. leaving the psychologist as a much more proficient professional for navigating and working to heal the root cause of and mental pathology. not to say medication is not useful, just with the training a psychiatrist gets, they are more attuned to diagnosing and treating biologically rather than testing, assessing, diagnosing, and altering the clients mental capacity or state, whether it be cognitively, behaviorally, spiritually, morally, or any other form at which the psychologist can take to help reshape the clients pathology.

http://clinpsyc.sdsu.edu...

Smith, L. B. (2012). Inappropriate prescribing. American Psychological Association. 46 (No. 3). Retrieved from http://www.apa.org...

Simon, S. S., Cord"s, T. A., & Bottino, C. C. (2015). Cognitive Behavioral Therapies in older adults with depression and cognitive deficits: a systematic review. International Journal Of Geriatric Psychiatry, 30(3), 223-233.
Debate Round No. 1
Capitalistslave

Pro

General rebuttal to opponent's argument:
I would argue that psychology and psychiatry are about equal in terms of finding out the cause of and treating mental illness. Psychiatrists, when they think there is not a biological cause of a patient's mental illness, will recommend psychologists to go to, or else offer to attempt therapy themselves. Both a psychologist and a psychiatrist do attempt to find out the causes of mental illness, it's just that a psychiatrist may first attempt medication in order to rule out the possible biological causes of the mental illness. Once the biological causes are ruled out, then they think it must be psychological causes. Likewise, a psychologist will attempt psycho-therapy first, and if that is not helping the patient, they may begin to conclude that there is a biological, not a psychological problem that the patient has and will then recommend psychiatrists in the area, or else if they live in one of those three aforementione states, they will prescribe medication themselves.

If you ask me, it is potentially harmful to attempt giving medication to someone, when their mental health problem is something psychological, not biological, as well as when their mental health problem is something biological but you attempt therapy. There are potential side effects of medication which would be the downside of giving that to a person who actually has a psychological problem rather than a biological one, and therapy could be absolutely useless to a person if their problem is biological and within that time could have dangerous problems from having to go through their mental illness for an extended period of time. While someone could argue experimenting with medication is worse because not only is there potential side effects, but also you're not treating the problem if the problem is something psychological, it can still treat the problem through placebo, as my opponent pointed out. Even if they are being treated through placebo, at least it still gets rid of the mental health problems, and thus the problem I pointed out with therapy allowing the problem to continue to exist because it's something biological, would still be there.

The fact both are problems is a problem with both fields. If there was some better way to gauge whether someone has a biological versus a psychological problem causing their mental illness, that would be much better to use. However, I don't know of a means of gauging the problem like that. The only way, I suppose, would be to take a MRI scan of the patient's brain in order to see if something biological is causing the mental illness. If it's not, then you can conclude that it is likely something psychological. The problem is, MRI scans are expensive usually, as much as $2,200, and somehow this place can get it as low as $575[7], but that's still a good amount of money. I also don't think insurance companies would cover the cost of an MRI scan just for this reason, otherwise I'm sure people would be getting MRI scans when they have a mental illness. So, really, there is no way to know from the beginning whether the patient has a psychological problem or a biological problem that is causing their mental illness. This is sort of a guess that both psychologists and psychiatrists have to make, and it's an unfortunate fact about both fields.

Oh, and a side note, it would also be more difficult to tell what mental illness someone has, even with an MRI scan, if they have multiple mental illnesses. While an MRI scan could tell you that someone has some problem with the brain, it can't tell you what specific mental illness the person has. I suppose that's where the psychiatrist and psychologist would come in, they would of course give a person some sort of mental health examination, and their responses to that exam can be used to help determine what mental illness(es) they have. Still, the MRI scan would be able to determine if the mental illness is due to biological/neurological reasons or psychological reasons, even if the patient has multiple mental illnesses.

Specific rebuttals to opponent's arguments:
I'll quote from my opponent in italics
of the many types of clinical applications of therapies CBT is more of the renowned way of treating clients. a study done by Simon, Cord"s, and Bottino found that CBT is more effective at treating adults with depression
I just wanted to point out that the study my opponent refers to, which an abstract of it can be found here[8] is specifically comparing CBT to other types of therapy. It is not a comparison of CBT with medication. In other words, this point of argument doesn't seem to indicate that psychologists are better at treating mental health problems than psychiatrists, since psychiatrists use medication to treat mental health problems. As I pointed out above, to be honest, there is guesswork going on for both psychologists and psychiatrists. The bottom line is, this doesn't establish that psychology would be better than psychiatry.

It should be noted that for depression and panic disorders(and likely each mental illness) medication and psychotherapy are approximately as effective as one another, which these two studies show[9][10]. Now, there is one potential point that could help my opponent, which in many studies comparing anti-depressants and CBT, CBT usually results in better after-treatment effects.[11] In other words, when someone used medication and someone used CBT, someone who used CBT is less likely to experience a return of the mental disorder. However, there is one problem with these studies, which is that the medicaons used in the trials were older medications which are more likely to have averse side effects than modern medications.[11] This can result in people quitting early from the medication because they don't want to deal with the side effects of older medications.

the article looked at how many patients who have been prescribed a medication may be given an inappropriate medication or one that does not even work properly for their specific illness. "I would say at least half the folks who are being treated with antidepressants aren't benefiting from the active pharmacological effects of the drugs themselves but from a placebo effect," says Steven Hollon, PhD, a psychology professor at Vanderbilt University who has conducted extensive research on the effectiveness of antidepressants.
First, I would like to point out that my opponent quoted a psychology professor. Given that they are a psychology professor, they may have a bias in favor of psychological treatment of individuals instead of psychiatric treatment of individuals. Additionally, they would not be the most qualified to answer the question, as would say a doctor or psychiatrist. Granted, a psychiatrist could have bias in the opposite way, where they favor medications over psychotherapy, but they would be more knowledgeable on the subject of medication since they deal with medication and went to medical school. Another group of people who would be knowledgeable on this topic, maybe moreso, would be pharmacists. In a study conducted by pharmacists, medical school students, and the center for pharmacoepidemiology and drug safety, where they conducted a study of several mental health hospitals and their prescriptions, there was only a 6.3% prescribing error rate among the medications[12] Additionally, this other study also found that between 2% and 12% of hospital admissions in the UK received an error in their medication[13]. While this is a problem, I don't believe it's as large as my opponent has stated where half of the time they receive a medication that is not doing anything for them and is a placebo. Again, the psychology professor they quoted wasn't offering a specific study on the matter and could have bias.


RE: psychologists are more fit for performing therapy than a psychiatrist
I agree with this, so I suppose it would still be necessary for psychologists to exist still. Nonetheless, it is still possible for a psychiatrist to perform therapy if they so chose to do so, so there is a little more flexibility in becoming a psychiatrist than a psychologist. A psychiatrist, usually, would have a bachelor's in psychology just like a psychologist, and I believe that is what makes them at qualified minimally to offer some level of therapy.
Sources:
[7] https://www.saveonmedical.com...
[8] https://www.ncbi.nlm.nih.gov...
[9] https://www.ncbi.nlm.nih.gov...
[10] http://jamanetwork.com...
[11] https://pro.psychcentral.com...
[12] http://bmjopen.bmj.com...
[13] https://www.ncbi.nlm.nih.gov...
imheretodebate321

Con

there are now two different arguments happening,
1. looking at whether one is more effective at treating illness.
2. which career is superior to the other

both of these are adequate for debates on their own. if we were to look at which is superior in terms of providing a better quality of life that is left up to the individual. there is an inability to objectify a subjective reason.

psychiatry being more likely to take a biological route to treat mental illness will have created more work for the individual receiving said treatment.

it is a fallacy to assume that a psychologist "will" take a psychoanalytic approach to treating a mental disturbance. with the amount of psychological models to follow, there is an integration among all of them. each model will present a necessary component to help solve an attribute to the disturbance within the client.

also to confirm, the CBT study I provided, was not supposed to infer that CBT is better at treating a mental disorder over medication, I was simply providing examples of the most testable and objective psychological approach. so no I did not use that study to prove that CBT is better than medication.

the thing about arguing whether the career is superior, looking at income, and other instances that come with the career, is subject to poor numbers, hence the hundreds of private practices that are throughout the country.

keeping an eye on the actual debate, looking at psychiatry as a superior career in terms of numbers, with the information you provided and what I found. psychiatrists make more. in terms of the second debate that is also going on here, the treatment outcomes for either a psychiatrist or psychologist, as you stated, are relatively equal. so what is really being debated here is the ability to provide as much information possible to prove that our opinion is valid.
Debate Round No. 2
Capitalistslave

Pro

It looks like as though what my opponent has offered this round is more of a summary of what we've debated thus far, or they clarified something such as the CBT study. I would like to just state that I knew you weren't using it to show it's better than medication, I just wanted to make sure it was clear to anyone who read this.

Now, I do slighly disagree with my opponent's assessment of the debate. They claim we are having two different arguments now.

I would argue that the first argument they mentioned: which is looking at whether one is more effective at treating illness, would have to do with which one is superior. It is one of the many things one can use to argue that one is superior to the other. If, say, psychiatr was more effective at treating mental illness, then it could logically be argued that it would make more sense to go into psychiatry because you are more likely to do more good for people. So, really, argument 1 can be used to argue for argument 2 in my opinion. Do you see how that could work? Really, we're just arguing the pros of each career essentially. Every pro would be a good thing about that career and a reason why that career is superior.

Since my opponent opted not to use this last round for promoting clinical psychology, I am going to modify the round structure a little bit to help them out. I'll be perfectly alright with them presenting new arguments in this last round if they have more arguments as for why clinical psychology is superior to psychiatry. I would recommend you do this. Because, as it stands right now, it seems like you've not met your burden of proof yet, and I want to give you a chance to do this.

So, to voters: you don't need to penalize my opponent in terms of conduct if they bring up new arguments in the last round. It's ultimately still up to you if you feel you should, but I am getting rid of that original rule from the original debate. I suspect my opponent would agree to it since it helps them out. My oppoent is relatively new to the site, and I would guess new to debating in general, no? That is another reason why I will allow that.


Thanks for the debate, and I look forward to seeing what you have to bring up in the last round!
imheretodebate321

Con

no need to change the rules for me, I am not here to win the debate I am here to hone my skills and learn to develop clearer and more precise points. That is why I was bringing things to light throughout the debate to make sure the scope of the argument was understood from both sides. I will accept the fact that I utilized my rounds poorly and will now allow for the voting to commence. thank you for your sportsmanship and your patience with me throughout this learning experience.
Debate Round No. 3
1 comment has been posted on this debate.
Posted by Smithereens 1 year ago
Smithereens
psychiatry and clinical psychology perform unique functions which are not mutually exclusive. A clinical psychologist might refer you to a psychiatrist, and vice versa. Think of it like a GP and a specialist. They are different things and they don't compete with each other.
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