Who Should We See First?

Anita, twenty-six, had been having panic attacks on her commute to Bengaluru for three months. Her heart pounded, her hands tingled and she was sure she would faint. Her family argued about what to do. Her uncle said she needed a psychiatrist, which frightened her. Her aunt said a counsellor would be enough. A cousin said only a clinical psychologist was proper. Anita felt more anxious about choosing than about the attacks.

Her friend Zoya suggested starting with the family doctor. Dr Rao checked her heart, blood pressure and thyroid, and found nothing physical. He explained the different helpers in plain words. A psychiatrist is a medical doctor who can diagnose and, if needed, prescribe medicines. A clinical psychologist is trained in assessment and talking therapies. A counsellor helps people work through stress, relationships and life changes. 'These are not rivals,' he said. 'Often they work as a team.'

He referred Anita to a clinical psychologist who asked about her qualifications openly, explained how sessions worked and how fees and cancellations were handled. Anita liked that she was asked questions as well as given answers. After the first few sessions, the psychologist said that if the symptoms did not ease, a visit to a psychiatrist would be considered, and that she would send a note to Dr Rao with Anita's permission.

Anita learned to recognise the first signs of a panic wave and slow her breathing. The family stopped arguing and began asking how the sessions were going instead.

How to recognise it

Repeated episodes of intense fear with racing heart, breathlessness or dizziness.
Avoiding places or situations out of fear of another attack.
Confusion in the family about which professional is the right one.
Symptoms lasting weeks or months and interfering with work or travel.
Physical causes not yet checked.

What this story explains

This story shows the differences between psychiatrists, clinical psychologists and counsellors and how the family doctor can act as a gateway. It also shows that a team approach is common.

Probable root causes

Ongoing stress and fear of fainting in public that feeds the cycle of panic.
Body's alarm system reacting strongly to normal sensations.
Possible physical contributors such as thyroid problems, caffeine or poor sleep.
Biological sensitivity to anxiety, sometimes running in families.
Family confusion and stigma that delays the start of care.

What to do

Start with a family doctor to rule out physical causes.
Ask the doctor to explain which type of professional fits your problem.
Ask about training, registration, experience, fees and cancellations before starting.
Book a first session and treat it as a trial; you may change helpers if the fit is poor.
Share relevant information between professionals, with your permission.
Practise what you learn between sessions.

Whom to consult

Family doctor first for a physical check and a referral.
Clinical psychologist for assessment and talking therapy for anxiety and panic.
Psychiatrist if symptoms are severe, long-lasting, or medical treatment may be needed.
Counsellor if the main issue is stress, relationships or life transitions.

Do and don’t

Do	Don’t
Do ask what training the helper has.	Don't choose a helper only because someone shouted loudest.
Do ask how confidentiality works.	Don't assume a psychiatrist means 'madness'.
Do give a method a fair trial.	Don't skip the physical check.
Do tell each professional what the others advise.	Don't stop treatment suddenly without discussing it.
Do bring a trusted person if it helps.	Don't be shy about asking questions.

How to behave and communicate

Ask openly and politely: 'Could you explain how you work and what we can expect?'
Describe symptoms in plain words: when they start, how long, what helps.
Listen to the person's choice; this is their care.
Avoid pressure with phrases such as 'you must see this person'.
Show support: 'Would you like me to come with you to the first visit?'