Concern with affects of Psychiatry on own mental health

[HeyJey]

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Hello. I am a first year medical student and came in with the notion that I would most likely do something in mental health but have always had the concern in the back of my mind of the affects of listening to people's stories of depression, anxiety, trauma, poor life choices would have on my own affect, my own mind.

Is this a risk of the job?

Thank you for any input.

 

[Ceke2002]

I'm not a Psychiatrist, nor do I play one on TV (full disclosure, I'm a patient who sometimes lurks on here, because I find the discussions interesting), but my understanding is countertransference is an isssue in many fields, but you learn/are taught how to deal with it. I think the fact that you're already aware that you might be affected by the life stories/experiences of patients already puts you ahead in terms of being able to recognise and deal with any countertransference issues once you have the proper tools and training. I'm sure someone with way more knowledge will be along shortly to give you more specific advice.

Good luck with your studies. 🙂

 

[gibits]

Yes, there is that risk. It's called counter-transference and it will happen of you are someone with a strong sense of empathy. I find myself talking and thinkIng a bit silly when I'm interacting with manic patients (my personal favorites). I feel like giving my crying patients a hug. I find my tone to more childish when speaking to pts with MR. And yes, I sometimes have a hard time thinking clearly with an attractive patient. I know all this because I monitor myself when I'm done.

But as you get more experience you will get a better sense of your boundaries and how to enforce them. If I find myself being drawn in, I fall back on the idea that I am a consummate professional and I will make the diagnosis followed by the the treatment plan. It will get to you, but you will deal with it because you know your pt needs you to hold it together.

 

[MDchouette]

It can be tiring, yes. But there are so many different settings/roles available in psychiatry that you can match the intensity of the patient population to what you are able to tolerate. For me, inpatient is too much emotional distress that I can't/don't like to screen out. So I'm happier in consult and outpatient settings. And in outpatient settings, psychopharm (most of the time) has a lot less intensity than psychotherapy. That's another way to find balance.

But, I am early in my career; so perhaps other more senior folks have more wisdom on this.

 

[BobA]

Hello. I am a first year medical student and came in with the notion that I would most likely do something in mental health but have always had the concern in the back of my mind of the affects of listening to people's stories of depression, anxiety, trauma, poor life choices would have on my own affect, my own mind.

Is this a risk of the job?

Thank you for any input.

Psychiatry is actually a fairly broad field - general outpatient psychopharm, inpatient acute vs. voluntary inpatient, geriatric psychiatry (where pts are all so sweet!), inpatient consults, etc. So you can find a place in psychiatry that fits your personality. In many areas of psychiatry you're not talking with people about their deep trauma (esp, Geriatrics and consults).

Any field of medicine that involves direct patient care will involved listening to people's stories of poor choices and bad outcomes - that's why people come to the doctor! Most of us just deal with people's problems all day.

 

[Shikima]

Have a cookie at the end of the day. You'll feel better.

 

[whopper]

I've hardly had a problem, nor seen many providers have a problem with the patient's depressing stories. IMHO because we're working to get these people better, and that emotion overrides the feeling of sorrow for them.

I got home an hour late today because a patient of mine got tremendously better, to the point where I was able to cut down his tx costs to the point where he has an extra $500 a month, and he's in a position where he can now find work (before he was pretty much unable to work). That $500 for this guy goes a long way. He can now actually buy decent food for his family, and he's got two beautiful kids. The guy called me up, telling me I really helped him out, he's doing to drop his quest to get SSDI and it was a good feeling for me. The entire time I had this guy up until this point, he did have a pretty sad story, but never did it make me feel terrible to the point where it took me over because I knew I was helping him and that he realistically could get out of his bad situation.

(>3.8 GPA, developed severe back problems, then later opioid dependence because of a quack doctor that kept giving him ever higher amounts of opioids, he later developed panic disorder and atrial fibrillation, had to drop out of school, and couldn't work due to the back pain. Got him on Suboxone, he's been weaned off of it, back pain is for the most part under control due to a good pain management doctor, a real one, not a pill-pusher, panic attacks are now down to about once a month).

The only times I see providers consistently really feel bad because of the woes of their patients is when a suicide happens because then the provider cannot get the patient better, and they go into a state of pseudo-PTSD, becoming too safe and over-questioning everything they do for a few weeks.

A colleague of mine that has several more years of experience and IMHO is superior to myself as a psychiatrist had a suicide a few months ago, and I saw him too go through the same thing mentioned above. Felt odd to see someone better than me and with more experience default to feeling insecure for a few weeks.

What I see much more often that's the problem with counter-transference are when we get mad at patients, and these usually happened with malingering, cluster B or C personality disorders, or factitious disorder.

When I did private practice, I had some counter-transference issues I noticed didn't happen until then. It was a time where the majority of my patients were people I identified with because they were almost all middle class or higher. When you work in the inner-city, you often get homeless patient with a wrap sheet of several misdemeanors and/or felonies. In private practice, you get people that could've been your neighbor.

So on occasion, I had very attractive women come to me for help, several of them for sexual issues and immediately I noticed myself thinking "don't even go there," and I kept that thought up the entire time like a force-field. I never had that problem ever with any patients I previously had.

 

[HeyJey]

Thank you all so much for your pertinent experiences with this issue. I'm going to print this out and keep it with me whenever I fear counter-transference issues. I won't let them stop me from going into psychiatry if that is the path I'm supposed to take. Again, thank you all.

 

[shan564]

I've hardly had a problem, nor seen many providers have a problem with the patient's depressing stories. IMHO because we're working to get these people better, and that emotion overrides the feeling of sorrow for them.

I got home an hour late today because a patient of mine got tremendously better, to the point where I was able to cut down his tx costs to the point where he has an extra $500 a month, and he's in a position where he can now find work (before he was pretty much unable to work). That $500 for this guy goes a long way. He can now actually buy decent food for his family, and he's got two beautiful kids. The guy called me up, telling me I really helped him out, he's doing to drop his quest to get SSDI and it was a good feeling for me. The entire time I had this guy up until this point, he did have a pretty sad story, but never did it make me feel terrible to the point where it took me over because I knew I was helping him and that he realistically could get out of his bad situation.

(>3.8 GPA, developed severe back problems, then later opioid dependence because of a quack doctor that kept giving him ever higher amounts of opioids, he later developed panic disorder and atrial fibrillation, had to drop out of school, and couldn't work due to the back pain. Got him on Suboxone, he's been weaned off of it, back pain is for the most part under control due to a good pain management doctor, a real one, not a pill-pusher, panic attacks are now down to about once a month).

The only times I see providers consistently really feel bad because of the woes of their patients is when a suicide happens because then the provider cannot get the patient better, and they go into a state of pseudo-PTSD, becoming too safe and over-questioning everything they do for a few weeks.

A colleague of mine that has several more years of experience and IMHO is superior to myself as a psychiatrist had a suicide a few months ago, and I saw him too go through the same thing mentioned above. Felt odd to see someone better than me and with more experience default to feeling insecure for a few weeks.

What I see much more often that's the problem with counter-transference are when we get mad at patients, and these usually happened with malingering, cluster B or C personality disorders, or factitious disorder.

When I did private practice, I had some counter-transference issues I noticed didn't happen until then. It was a time where the majority of my patients were people I identified with because they were almost all middle class or higher. When you work in the inner-city, you often get homeless patient with a wrap sheet of several misdemeanors and/or felonies. In private practice, you get people that could've been your neighbor.

So on occasion, I had very attractive women come to me for help, several of them for sexual issues and immediately I noticed myself thinking "don't even go there," and I kept that thought up the entire time like a force-field. I never had that problem ever with any patients I previously had.

This.

Also, hearing a lot of my patients' stories gives me the opposite experience sometimes. It makes me thankful for how lucky I am to be where I am. Maybe it helps to have spent a good chunk of my life in a third world country, so I grew up with a strongly integrated idea of just how bad somebody's life can be... and as a result, it takes a LOT to faze me. No matter how hard somebody's life has been, I can think "well, at least this person lives in a country where we can provide them with a disability check and a case worker and give them free healthcare in the residents' clinic and treat their illness to the point where they can live a functional life instead of dying of starvation on the street." I still feel terrible for the strife faced by a lot of my patients - sometimes I even dream about it - but at the end of the day, I'm just glad that I can do something to help them.

 

[F0nzie]

I think Psychiatry has greatly improved my own mental health. I am definitely more open minded and health conscious. I feel like psychotherapy has greatly improved my way of interacting with others on a professional and personal level. The mental drain thing is pretty real which is part of the reason I elect to work 3 days out of the week.

 

[Shikima]

I think Psychiatry has greatly improved my own mental health. I am definitely more open minded and health conscious. I feel like psychotherapy has greatly improved my way of interacting with others on a professional and personal level. The mental drain thing is pretty real which is part of the reason I elect to work 3 days out of the week.

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