A new patient recently told me, “I’ve already seen two doctors about this.” She meant a life coach with an online certificate and a therapist with a doctorate in education. Neither was a physician. Neither had examined her, ordered labs, or considered medical causes for her rapid cognitive decline.
When I evaluated her, it was immediately clear she needed urgent neurological workup. She wasn’t suffering from “stress.” She had an early neurodegenerative process. This is not an isolated story. It is the result of a cultural confusion we have allowed to grow unchecked, a confusion that would never be tolerated in any other branch of medicine.
Psychiatrists are physicians. But culture keeps forgetting this.
To become a psychiatrist, one must first become a doctor. Four years of medical school. Four years of residency. Often one to two additional years of fellowship in addiction, geriatric psychiatry, neuropsychiatry, consultation-liaison, or neurophysiology. Our training is long because the brain is complex, and its diseases are deadly.
Psychiatrists diagnose catatonia, encephalopathy, autoimmune psychosis, thyroid disease presenting as depression, brain tumors presenting as anxiety, and delirium masquerading as agitation. We perform physical exams. We interpret labs, imaging, EKGs, medication interactions, and neurological red flags. We manage suicidality, emergencies, and the interface between medicine and mind.
Yet despite this, psychiatry is the only medical field where non-medical professionals routinely call the people they serve “patients,” carry the title “doctor” by virtue of an academic degree, and market themselves as treating mental “disorders.” A family therapist calling their clients “patients” is treated as normal. A psychologist diagnosing complex psychosis without medical training is tolerated. A life coach offering “trauma treatment” is shrugged off as harmless.
Imagine, for a moment, if this occurred in cardiology. Would we accept a personal trainer calling someone a “heart patient”? Would we tolerate a nutritionist diagnosing heart failure? Would we allow a wellness coach to manage chest pain? The answer is obvious, yet mental health remains an exception.
This blurring of roles is not benign. It is dangerous.
Psychiatric symptoms often arise from medical illnesses. When non-medical clinicians take on roles that appear medical, patients with brain disease fall through the cracks. A person with autoimmune encephalitis may spend months in “trauma counseling.” A teenager with new-onset psychosis may be told they have “stress.” A perimenopausal woman with severe depression may never receive the hormonal and metabolic evaluation she desperately needs. These cases are not theoretical. They walk into psychiatric clinics every day.
This is not about disrespecting psychologists or therapists. They are essential, skilled, and irreplaceable partners in care. But they are not medical doctors, and they do not claim to be. The problem is the cultural erosion of boundaries, a gradual merging of language and roles that leaves the public unsure who does what.
In mental health, everyone seems to be a “doctor,” everyone treats “patients,” and everyone is assumed to offer equivalent expertise. But when the mind is affected, the brain is often involved, and only physicians are trained to evaluate the medical dimension of psychiatric symptoms.
Confusion in this space does not merely inconvenience clinicians. It endangers patients.
The deeper root: a culture that still believes mind and body are separate
Our society continues to cling to an outdated mind-body dualism. Emotional suffering is viewed as “psychological,” separate from biology. The brain, despite being an organ, is treated differently from the heart or liver.
This outdated view allows the public (and policymakers) to ignore the medical nature of psychiatric disease. It enables non-medical fields to encroach into territory that requires medical training. And it leaves patients with serious illnesses wandering between “healers,” hoping someone will recognize that their mind is not simply distressed but medically unwell.
Clarity protects patients, not turf
This is not about professional hierarchy. It is about accurate diagnosis and medical safety. We need psychologists, therapists, and social workers. But we also need clear language, clear boundaries, and public understanding of what psychiatrists actually do.
Patients deserve to know who is medically trained to evaluate brain disease and who provides essential but non-medical therapies. They deserve a system that recognizes mental illness as medical illness.
Psychiatry is medicine. Its patients are medical patients. And serious brain disorders deserve real medical care, not semantic confusion. Until our culture accepts this, more patients will fall through the cracks.
Farid Sabet-Sharghi is a psychiatrist.
