Your patients are behind a locked door
There are some people who are just downright incapable of functioning
within society. They drive with their eyes closed, they hear voices
telling them that their neighbor is going to get them, they're bizarely dressed/unkempt/disorganized in their behavior, they're incapable of fitting into the "norm". I'm not talking about the Emo crowd that is sad because life
sucks (though their overly tight jeans do make me nervous at times). Pretty often, they're the kind of people that you'd see and cross the street to avoid because you don't feel safe. Basically your spidey-senses are telling you to stay away from them...but you still have to sit down across a table from them and try to understand where they are coming from.
Now it's not It's pretty hard to convince a patient to talk to you when you're behind locked doors. The therapeutic relationship is almost prisoner-jail keeper and I spent about 75% of my time in an adversarial role with my patients. Atleast medical patients know that they're sick, they know that they need your help and willingly accept it. Inpatient psych is kind of like trying to sell the iPhone to an isolated tribe in the amazon that has never had contact with modern man...some of them are in awe and accept willingly, while others would rather spear you and go back to their little world.
The need to fit everyone into a diagnostic box
There were some brilliant folks who sat around and thought about the way that people think. Freud had his Id, Ego and Super-Ego to explain every conscious act as the interaction between the competing forces of the unconscious world. While brilliant, it's not much more than a load of crap that he made up and wrote down while toking the ol' opium pipe. Nowadays we rely on those so-called "neurotransmitters" that become "imbalanced" and cause a person to act "crazy"...OK, that I can buy because it's scientifically based, peer reviewed research and corresponds to treatments that work.
But then we have the DSM-IV QS. It is the biggest piece of crap in the world created by psychiatrists for the express purpose of diagnosis and billing. While it is quite comprehensive, the Diagnostic and Statistical Manual makes diagnosis of patients a simple checkbox process. While it works for some people, it gives the absolute wrong impression of how we view individual psych patients and the agony that is individualizing their treatments.
The patients don't always get better
Granted, I was just doing in-patient psych, but these people have some scary things going on in their heads and we give them a couple pills and boot them out the door as soon as they're no longer a threat to themselves and others. It wasn't really satisfying to wonder "what did we actually do for this person" at the end of a 6 week stay or "what if I run into this guy on the street" or "what if her voices tell her to close her eyes while driving again and I happen to be in the other lane". Most people will stop their meds at some point and bounce back. Others just get stuck in a state institution somewhere. It's not like a STEMI or an appy or pneumonia where you can manage the acute problem and send the people on their way...they need extensive rehab to fit back into society, which they usually cant afford. It's sad.
The understanding of the diseases sucks
Sure you have Freud's theories and the neurotransmitter models, but be don't really understand the entirety of what's going on. That makes it tough to effectively design therapies and meds to fix the problem. And the side effect profiles are nasty too...
But on the bright side, I got pretty good at talking to crazy people, their families and other health care providers...