Psychiatrist, psychoanalyst: the physician and the analyst

You may have heard this sentence before: “You should perhaps see a psychiatrist.” The implication: it is more serious, it is medical, it is for severe cases. And psychoanalysis, in the collective imagination, is the couch, Freud, and years spent talking about one’s mother. Neither of these images is quite right. Let us take them up again.

The psychiatrist: a physician first of all

The psychiatrist is a physician. He studied medicine — six years minimum — then specialised in psychiatry for four further years. A decade of training, at the very least.

What that gives him: the capacity to make psychiatric diagnoses, to prescribe medication — antidepressants, anxiolytics, mood stabilisers, antipsychotics — and to take charge of mental pathologies in their biological and neurological dimension.

The psychiatrist treats. He evaluates, prescribes, follows up. Some also practise psychotherapy, depending on their additional training. Others concentrate on the medical side and refer their patients to other practitioners for psychic accompaniment.

The psychoanalyst: on the side of speech

The psychoanalyst is not a physician — unless he is one besides. He prescribes nothing. He does not evaluate in the medical sense. No white coat, no prescription pad, no DSM open on the desk.

What he has: a frame, a listening, and a long and demanding training — personal analysis, theory, supervision. His tool is speech. Not to give advice or correct behaviours, but to create a space where the subject can loosen the grip of what holds him — his repetitions, his symptoms, his impasses.

Psychoanalysis does not treat a disease. It addresses a subject.

Two approaches to psychic suffering

This is where the distinction becomes really interesting.

Psychiatry starts from a medical model: there are symptoms, they correspond to nosographic entities, they are treated. It is rigorous, it is useful, it is sometimes vital — nobody would dispute the usefulness of a mood stabiliser in a severe manic episode.

Psychoanalysis starts from another axiom: the symptom is not a dysfunction to be eliminated. It is a message, a compromise formation, something that has its own logic in the subject’s history. To treat it without hearing it is to risk missing what it says.

These two readings are not necessarily enemies. They speak of different levels of psychic reality.

In practice: they complement each other

Many patients I receive are also followed by a psychiatrist. It is often a configuration I encourage — and that I actively articulate with my colleagues, notably in the context of psycho-evaluative assessments carried out in liaison with referring psychiatrists.

The psychiatrist holds the medical side. I hold the analytic side. It is not a rivalry — it is a complementarity, when it is thought through and coordinated.

Some sufferings need both. A medication that stabilises enough for speech to be able to work. An analysis that digs where medication cannot go.

My approach: psychoanalysis and complementary tools

My training is psychoanalytic, Lacanian and Freudian in orientation. It is the bedrock — the way I think suffering, the subject, the symptom. But I practise integratively: I integrate tools from DBT — Dialectical Behaviour Therapy — and CBT, for the clinical situations that require them.

Concretely, this means I do not work in a vacuum. I carry out psycho-evaluative assessments — ADHD, burnout, personality disorders — in close liaison with referring psychiatrists, who handle the medical side and prescription when indicated. This collaboration is not incidental: it is thought through, structured, and part of my practice.

The analytic frame holds the depth of the work. Behavioural tools intervene when the situation demands it. And the relationship with the referring psychiatrist ensures that nothing essential is left aside — neither the body, nor the brain, nor the subject.

In summary

The psychiatrist treats the brain and prescribes. The psychoanalyst listens to the subject and creates the conditions for working on oneself. One is not the subcontractor of the other — but together, they can do a great deal.