The Health Care Services Act restricts psychologists from using the term “treatment” and those with doctoral degrees from using the title “doctor” in case they are misconstrued as offering medical services (Psychologists call for better regulation of profession amid mental health push, Feb 13).
The implicit message is that mental disorder is a (medical) condition “treatable” only with medical procedures, reflecting a reductionist approach to mental health care. Mental disorder, as characterised by a complex network of biological and psychosocial factors interacting with each other in feedback loops, requires a multidimensional paradigm. The meaning of “treatment” must be expanded.
The American Psychological Association differentiates between medical and psychological treatments. The former includes psychotropic drugs, whereas the latter includes psychotherapy.
In the case of depression, using both psychotherapy and antidepressants is more helpful than medication alone. In some circumstances, psychotherapy may be more effective than medication as psychotherapy teaches life skills to prevent relapse.
Psychotherapy enhances mental well-being by improving functioning in some brain regions, suggesting that therapeutic experiences gained from psychotherapy can modulate the neurobiological architecture.
When the Act recommends psychologists use the word “support” instead of “treatment”, members of the public may misinterpret psychotherapy as an adjunct to medication.
A reductionist approach also over-medicalises everyday life suffering. Medicalisation and increased use of psychotropic medication may not reduce the stigma of psychiatric diagnoses, but induce fear and a sense of losing personal control in some cases.
I do not see how the “doctor” title will cause serious ethical problems. Although a doctoral-level psychologist may be mistaken for a physician, malpractice is unlikely to happen because medical treatments are regulated in Singapore.
Psychologists adhere to professional codes of conduct by not performing therapies they are not trained in. They will recommend pharmacotherapy when necessary. The issue is not whether the “doctor” title would confuse members of the public, but whether they know the different complementary roles played by psychologists and psychiatrists.
The multidimensional character of mental disorder requires a multidisciplinary approach without prioritising a particular treatment over another. This holistic strategy is necessary for progress in mental health care when mental well-being is now a national priority.
Lee Boon Ooi
