Psychiatrist vs Educationist-Selecting whom to consult: Psychiatrist, Neurologist, Psychologist, Educationist, "Aamil" (Exorcist), "Pir" or "Shaikh"

Selecting whom to consult: Psychiatrist, Neurologist, Psychologist, Educationist, "Aamil" (Exorcist), "Pir" or "Shaikh"

This post describes the roles various professionals such as psychiatrists, neurologists, psychologists, educationists and "aamils" (exorcist), "pirs" or "shaikhs" play during periods of tremendous stress. It also defines a process that needs to be followed when you are referred to anyone of them. Serious harm to your loved ones leading to drug dependency, permanent loss of mental physical health, and even death may occur if the distinction between the roles played by these professionals is not understood and the process described below is not followed.


Over the last few years I have come across material related to learning and education and the underlying psychological processes. I have had the opportunity to meet and discuss with prominent educationists, neurologists, philosophers and psychologists who have reported that they are now coming across scores of cases of children and teenagers every month who have been classified and labeled variously as slow learners, learning disability, ADHD, dyslexic, autistic, and even bordering on mentally retarded. There seems to be an increase in the reports of symptoms and behaviors related to various manifestations of psychosis such as schizophrenia, bipolar disorder, hallucinations, etc. Many of these symptoms and behaviors often overlap with medical conditions related to neurological deficiencies and diseases. Severe or even mild forms of such symptoms are also getting referred to "aamils" or "pirs" or "shaikhs" or exorcists specializing in dispelling the evil spirits, avoiding the spell of black magic, getting rid of the jinn, and taking off the "nazar" for which they take liberal support from religious sources. Later part of this post would also give pointers to why there is an increase of such incidences. But, first we look at the process of selecting an appropriate professional.

First note that there is a difference between professionals who look at problems of diseased minds and those who look at the problems of healthy minds. Professionals whose training extensively covers the problems of diseased minds and mentally ill patients are psychologists, psychiatrists and neurologists. Professionals whose training extensively covers the problems of the healthy minds such as learning issues are knows as educationists or educational psychologists. Note that the symptoms related to problems of healthy minds and diseased minds often overlap and often start with some common ailments: Parents start worrying when they begin to notice increased frequency of common ailments such as anger, headaches, hyperactivity, aloofness, indigestion, boredom, lack of interest, poor grades, and missed milestones. At times there are sudden episodes of severe degradation of behavioral norms in terms of interpersonal interactions, speech, eye contact etc, or personal idiosyncrasies. This post describes the process through which these professionals should be selected.

• Step 1: Ruling out the Emergency and Infectious Causes
• Step 2: Building the Understanding of Stress Issues
• Step 3: Understanding Educational and Learning Problems
• Step 4: Ruling out the Physiological and Neural Causes
• Step 5: Psychologist before a Psychiatrist
• Step 6: Psychiatrists as a Last Resort
• Step 0: Aamils, Pirs and Shaikhs vs Your Faith

Step 1: Ruling out the Emergency and Infectious Causes

If the problem has suddenly increased in intensity and is of so much severity that it is noticed by everyone around, and causes a significant loss of activity, and a severe degradation of normal behavior, then it must be treated as an emergency irrespective of the symptoms and the patient must be taken to a well equipped hospital that has the entire range of experts from medical doctors of various specialities including neuro physicians and surgeons. Going to a psychiatrist or a small hospital is not recommended till the condition of the patient stabilizes.

The first step must be to rule out any physical, viral, bacterial or infectious source of the behavioral issue. Physiological basis of the emergency must be ruled out before any psychological expert is consulted. Today there are several viral, bacterial infections that produce symptoms similar to the ones encountered in psychosis. Many doctors and physicians often bypass this step of ruling out of the physiological causes and directly recommend psychiatric treatment. This often becomes a fatal mistake, literally, because precious time may be lost because many trigger-happy psychiatrists do not feel their foremost medical duty to rule out the physiological and neural causes before administering mind-changing psychiatric drugs. It is therefore of vital importance that the viral, bacterial or infectious source of the disease is ruled out by the hospital as the patient is being taken out of the emergency life threatening situation and the vital signs of the patient are stablized.

Step 2: Building the Understanding of Stress Issues

This step must proceed immediately if you are reading this post because you have the capacity to understand and counsel. Many issues related to learning and behavior are caused by stress related issues including job-related problems, family conflicts, trauma, life style emergencies, emotional shocks, and nerve wreaking experiences. Many a times severe behavioral idiosyncratic manifestations may only require life style changes, change in environment, closeness to nature, help from loved ones, family counsellors, educational counsellors and conducive family support systems. Taking charge of the situation by the parents and the family support is a major boost and potent supplement. Understanding of issues and susceptibilities of human thought processes is must by those managing the treatment of the person and the correctness of this understanding plays a vital role in the resolution of problems.

Anyone who has been close to a patient recovering from stroke, must have seen and experienced that the recovery of human mind is slow, gradual, and may take a lot of time even several years. It is all about love, care, support, physiotherapy, life style changes. You need to know that patients do come out of severe brain damage and are able to live productive life with reasonable quality. However, this recovery process often takes a long time as the brain gradually activates its backup capacity by enabling others cells to take over the responsibility of the damaged cells. The patient requires comfort of love, support and sustained care through this long recovery period.

For many psychological ailments and setbacks, human mind has an immense capacity to work out the recovery process on its own given the right support system. Internet is replete with the documentation on several self help websites (such as getselfhelp). There are ted talks (such as Elyn Saks'), YouTube videos and books of people having gone through the recovery and living productive and healthy lives.

Please note that developing of this understanding of psychological issues is an on-going process. Once started, it must continue. However, some start up understanding can be obtained in about 5-10 hours on the various psychology related self-help websites and about 5 hours spent watching various videos and ted talks related to people who recover from such issues. After gaining the start up understanding, one can move to the next step.

Step 3: Understanding Educational and Learning Problems

As mentioned earlier symptoms of problems of the healthy mind often resemble problems of the diseased mind. Therefore, it is necessary to first treat the issue optimistically. We should  first assume that the patient has a healthy mind and that the patient may be showing some disturbing symptoms because of artificial stresses and pseudo psychological labeling as further explained at the end of this post.

It is a famous saying that if the only thing you have is a hammer than every thing appears to be nail. When the the psychologists and psychiatrists analyze the learning issues, they assume that source of these behavioral issues is a diseased mind because that has been their major focus during their long professional training and education where most of the cases they came across were related to diseased minds. They forget that by training and education they are not experts of healthy minds. They have no experience of schools and dealing with the learning issues of healthy children in schools. In such cases psychologists and psychiatrists who have disturbed family lives, or who have no children, or who have no professional experience of working with healthy minds further complicate and exacerbate the issue. In the hands of these kinds of psychologists and psychiatrists, very ordinary behavior like hyperactivity has been turned into a disease as described in my post on Truth about ADD/ADHD (Attention Deficit Hyperactivity Disorder). Further reasearch may reveal that even so called learning disabilities like autism and dyslexia, may belong to the ADHD category. If the only thing you have is a hammer, then every problem looks like a nail indeed!

This leaves us with educationists and educational psychologists whose life has been spent dealing with the healthy children and their problems, and whose training and education related to the learning issues. These are the people who should be first consulted for these issues. Even in educationists people with a positive view of life and human nature should be consulted. Fundamental assumptions about the human nature can severely cloud the judgement of even the educationists as seen in my posts on Problems with Bloom Taxonomy: Impact on motivation, Education as Tazkia: Is Child Like a Clean Slate, Bell Curve Evaluation and Islamic Conception. Revolution in learning took place with John Holt's seminal books: "How Children Learn" and "How Children Fail". I personally regard this to be a criminal act if a person makes any judgement about the learning disability of a child, who has not read these two books and pondered on them. 

Only if several such knowledgeable educational psychologists agree, only then the person with the behavioral issue may be referred to a neurlogist. 

Step 4: Ruling out the Physiological and Neural Causes

If there is no emergency situation or once the patient is out of the life threatening emergency, and the condition is such as to be recommended to a psychologist/psychiatrist, then the first specialist to be consulted is a neurologist. Neuro must be consulted before a psychiatrist or psychologist in every case. To understand this I would give an analogy from the computer field. The domain of enquiry of the neuro specialist can be thought of as the hardware, wiring and the signals flowing in neurons of the brain, whereas the domain of the psychiatrist and the psychologist may be thought of as the software and operating system. In case of computer malfunction, hardware issues must be ruled out before the attention should be focused on software especially operating system related issues. Many a times, the problem may simply be because of faulty power supply, lack of RAM, lack of hard disk space, or a weak processor, or low bandwidth connection. Once such hardware issues are ruled out, then one can focus on software or operating system and anti virus softwares. Similarly, neurologist investigates the hardware of the brain and the neural signals moving through the network of brain cells. Issues related to these must be resolved before the psychological makeup and thoughts are analyzed by the psychiatrists or psychologists.

"A neurologist is a medical doctor who diagnoses and treats diseases of the brain and nervous system such as epilepsy, cerebral palsy, etc. They specialize in PHYSICAL ailments of the brain and nervous system - i.e. disorders with the nerves themselves and the way they interact with each other. A neurologist is a medical doctor, and looks at the brain for disease and illness."

During the early stage, we want a pure neuro-specialist to investigate all the physiological and chemical causes of the problematic behavior. Neuro specialist is trained to consider the behavioral problems as originating from the physical processes in the brain that trigger neurons and causes the electrical pulses to be carried to the various parts of the body through nerves and elicit the observable behavior. In case of any abnormality of the behavior, the neurologist tweaks those causes using medicines that control the chemical imbalance.Neuro specialist may take from a few weeks to few months to investigate the problem, and achieve the desired balance. Please beware at this stage of neurologists who often put on the hats of trigger happy psychiatrists and they must be avoided at all costs as explained below.

Unless the neuro specialist gives up, option of a psychologist or a psychiatrist should not be considered.  Supposing the primary neuro specialist concludes that the case does not pertain to the neuro area and belongs to the psychology area and needs to be referred to a psychologist/psychiatrist,  then, my strong recommendation is to get a second opinion from another neuro specialist. Unless two out of three neuro specialists agree that the problem being analyzed is not the domain of a neuro physicians, a psychiatrist/psychologist should not be consulted. However, if at least two out of three neurologist agree only then should the psychologists domain be explored.


Step 5: Psychologist before a Psychiatrist

A psychologist is an expert who is not a medical specialist and can not prescribe drugs. A psychologist tries to understand the psychological needs and requirements of the person and through therapy sessions enables the patient to identify the knots and twists in his thought processes and identify ways of coming out from those dead end alleys. He is a specialists who enables the patient to understand various setup options and see if different choices can overcome the issues.

"A psychologist is not a medical doctor. They may give evaluations to test someones intelligence or if they have some sort of mental illness, brain damage, or have been abused. Sometimes the role crosses over with a psychiatrist, but a psychologist does NOT have the authority to prescribe medication or admit someone to a hospital. A psychologist is either a scientist who studies the human mind or a PhD doctor who specializes in therapy and in treating mental illnesses such as chronic anger and use psychoanalysis to find a root to their problems.
He looks at the brain for thought processes and mental illness that shows up as personality manifestations, etc. A psychotherapist is someone who counsels people to help them with emotional problems. They are not medical doctors either. There are different kinds of therapists such as occupational therapists, physical therapists and speech therapists. They are not medical doctors, they are trained to give therapy for specific problems. Therapy usually has to be ordered by a doctor. [From various websites]"

Please note that there are issues with psychological therapies and several points of views consider this to be a form of abuse, manipulation and problematic.

Step 6: Psychiatrists as a Last Resort

There are several reasons why psychologist should be preferred over a psychiatrist and the psychiatrists and their psychiatrist drugs should be avoided. 

1. Psychiatrist drugs available today are highly potent. They are often by-products of intensive research taking place in the design of nerve wreaking weapons, brain washing, psychological torture and mind reading medicines. Many of their side effects are highly dangerous, produce dependency, and can alter and damage the psychological makeup of a person permanently. This is akin to putting patches in the kernel of the operating system that can permanently destabilize the system often necessitating a complete factory-data-reset. That is, why smart phones often require factory-data-reset facility because a number of patches and updates destabilizes the system. Unfortunately, there is no facility currently available that can do a factory-data reset for human minds, once the damage is done by such mind changing drugs; changes in the mind's kernel introduced by these drugs are often permanent and can cause irreversible harm. 
2. Psychiatrists often become trigger happy because power like the one available with these highly potent psychiatric drugs gives rise to a tendency for producing instant results through over medication and aggressive treatment. 
3. Generally in Pakistan, patients expect instant relief and think that a doctor, even a general physician is not a good one unless he can make the fever go away instantly, or one who does not administer drip or an injection, or one who does not prescribe a long list of medicines. People who are status conscious determine the worth of a doctor from the amount of fee that he charges and the range of expensive drugs that he prescribes. For many physical ailments, a patient can often recover from the side-effects of high potency drugs. However, this practice carried over to the psychiatric domain can cause permanent brain damage, with no hope of recovery. Therefore, psychiatric drugs need to be crossed checked and independently verified as to their side effects before their extended use or even short term use. 
4. The problem is especially acute in countries like Pakistan where there is minimal regulatory oversight on the practice of doctors and the legal protection regime is not available and powerful can bribe themselves out of tight legal situations. Hence, doctors in Pakistan are prone to prescribe medicines under pressure from the bribes received from the pharmaceutical companies. They often prescribe medicines that are not needed and ofter over prescribe to take advantage of the unethical incentives offered by the pharma companies such as overseas excursion trips, funding of appliances installed in the homes of the doctors, and fun and frolic outings. 

Unlike a psychologist that tweaks the setup options available to a user, the psychiatrist is a specialist who has the capacity to open up the operating system, go inside the deep recesses of the internals (known as kernel) and install changes, install patches and change wirings of the psychological thought processes. This is a highly invasive process and can often produce irreversible changes as explained above.

"A psychiatrist is a medical doctor who diagnoses and treats mental disorders such as depression psychosis, etc. A psychiatrist is a doctor in MEDICINE who specializes in understanding and treating CHEMICAL ailments in the brain. A psychiatrist might treat a patient for ailments like schizophrenia, bipolar disorder and prescribe them medicine."

Psychiatrists should only be used with deep insight and care. The treatment must be cleared through second opinions and the treatment should be used for the shortest time possible. If possible, psychiatrists trained in USA should be used in close coordination with a trusted family physician also trained in USA. There are horror stories related to psychiatrists and psychiatric clinics. There is immense literature on the philosophical issues related to such clinics and their deleterious effects. There is widespread criticism about the nature of psychiatric illnesses whether they exist or not. There are questions about whether psychiatry is a pseudo-science and whether their exist any medical and scientific basis for the so called psychiatric diseases. This treatment must be carried out with deeper understanding and self research in the medications and processes. 

Step 0: Aamils, Pirs and Shaikhs vs Your Faith

Typically in countries like Pakistan and elsewhere, there are well wishers with their home grown recipes and their own particular experiences who are bent upon helping you with incomplete knowledge and information. They start advising you about super-natural phenomena; about jinns, about evil spirits, about black magic, about "asar", about "nazar", about what not. They will advise you to go to Aaamils (exorcists), pirs and shaikhs of various hues, specifically referring you to the one belonging to your religious school of thought. They will tell you about traditions related to the validity of such super natural occurrences. However, they would often forget to advise you and remind you about the repeated verses and repeated exhortations in Quran and Hadiths and books of believers; about the power of prayer, about God's beneficence, about power of faith, and about power of gratitude (shukr), and about power of trust, and about power of belief. In fact, these exhortations far outnumber in frequency and intensity to the very few isolated incidences often quoted by them.

In the sea of despair, when we find ourselves alone, weak, and the challenge in front of us insurmountable, then this is the time for "yaqeen", for "sabr" and for "salah": 

WastAeinoo bis-sabr e wasSalah (Ask for help with sabr and salah).

This is the time for tahajjud prayers. Forget everyone. Just focus on the Omniscient and Omnipotent. Seek help from Him. "When you start walking towards Him, He would come running towards you". "He is nearer than your jugular vein". "If you take one step towards Him, He would take ten steps towards you". 

When we start looking up to Aamils, Pirs and Shaikhs, we show weakness in our belief, and weakness in our yaqeen (faith) that He is listening to us. We forget the number of times that we repeat that He is Rahmaan and Raheem. Challenging situations like these prompt us to show our gratitude (shukr) to his beneficence and to demonstrate that we are steadfast in our beliefs and so that we can revert to Him and pray for His help and support. 

Soon, such difficult times would be over. We would then forget that we ever prostrated in front of Him with such fervor. When the difficulty goes away we become as if it went away because of our effort and we forget about His beneficence, and completely forget that we were ever in so much trouble and used to prostrate in front of Him for His beneficence. 

In the end, it is all about our faith, our belief, our yaqeen and our eemaan!

Guman Abad-E-Hasti Mein Yaqeen Mard-E-Musalman Ka

Byaban Ki Shab-E-Tareek Mein Qindeel-E-Rahbani

While lost in the doubts of our existence, the certainty (yaqeen) of the Muslim hero;

is like the light of the monk in the pitch darkness of the desert night (light at the end of tunnel).

How Educational System is Inducing Increase in Pseudo-Psychological Labeling

There is a wide variety of labels that are now being bandied about carelessly and freely by the so called school teachers and administrators with no qualification or research in educational psychology or the psychological processes underlying various learning and behaviorist theories. There seems to be a sudden increase in such labeling over the last decade as number of A's secured at the O'level and intermediate have now become a major basis of competitive advantage in the high stake commercial competition in the huge private school industry. The mad rush of schools for showcasing the 10 or more A's has led to the show-casing and media hype surrounding super-kids who make world records of 20+ A's. This has forced the school administration to exert "super-grading" pressure downstream to lower classes to an extent that people are now worrying about the admission of their kids before they are born and are clamoring to admit them to pre-schools at a young age of even 1.7 to 2.5 years. Mind you, these are not just playgroups, they are actual schools with curricula related to reading and even writing and maths, instructions being given at such an early age is a phenomenon not recommended anywhere in the world by educationists.

The school administration responding to such pressures instead of improving the quality of their teacher or instead of improving the quality of their instruction or improving the quality of their resources are further shifting and transmitting the pressure to the students in the form of increased homework so that parents are forced to hire tutors. To further transmit such pressure they make the parents responsible for the students' performance by freely bandying about such "medical sounding" labels. Eventually, this also becomes an easy pretext for getting rid of the students who are not responding with improvement of their grades. The super-hit success in Pakistan of Indian Movies such as "Tarey Zameen Par" has unfortunately facilitated the increase in this labeling as teachers and administrators can act like pseudo experts bandying about such labels, and interestingly enough has made parents also more compliant, gullible and more easily convinced. There is also literature that suggests how commercial pressures by pharmaceutical companies promoting their medicines are trying to ensure that such learning disabilities are accepted as medical conditions requiring prescriptions.

See Also: 

1. Do you think your child has some learning deficiency? Top 9 Questions to Answer Before You Start Worrying
2. Truth about Attention Deficit Disorders (ADD/ADHD): Reasons and Revelations
3. My child does not sit still and concentrate!
4. How Parental Judgements can Shatter a Child - Self Fulfilled Prophecies 
5. Are you really concerned about your child's education
6. Bell Curve Evaluation of Students and Islamic Conception
7. How to define success of a school or a student
8. Problems with Bloom's Taxonomy: Impact on Curriculum and Motivation of Students
9. Education as Tazkia: Is a child like a clean slate?
10. Are you really concerned about your child's education
11. School Discipline vs Prison Discipline
12. Does Mental Illness [of the Psychiatry Kind] Exist? 
13. Horror Stories of Crimes Committed
14. Questions about the philosophical and scientific basis of psychiatry. 
15. Anti-psychiatry groups. See comment below for more resources and links