"Why Shrinks Have Problems" - What's your opinion?

[DocBlackOut]

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Hi folks!

I'm a general practioner since January 2012, and I'll have to choose a medical speciality until the end of this year. I'm Portuguese, in Portugal and that is how the system works in here.

I've always been interested in mental health (both child psychiatry and psichyatry). The problem is that when I started sharing the intention to be a Psychiatrist, all my mentors (specially anesthesiologists) claimed that I would turn crazy... Typical idea: Shrinks are crazy...

I resisted to that idea but also started to gather some kind of evidence against the concept that "shrinks are crazy"... Until I found this:

http://www.psychologytoday.com/articles/200909/why-shrinks-have-problems

That article really frightned me up! What do you think about those numbers? Do you think it is really that "risky" to be a "Shrink"?

I'm really confused right now!

 

[peppy]

That article is quite sensationalist. I wouldn't take it very seriously.
Freud was actually a neurologist, by the way, so maybe he's just proof that neurologists are very disturbed people. 🙂

Seriously, though...for one thing, that article may be misleading because it focuses mostly on therapists (who may not be a physician at all - in the USA, many therapists are social workers or psychologists). That could give a skewed idea of what psychiatrists are like and how they work.

It's true that doing therapy can be emotionally draining. I personally don't enjoy doing full-time therapy and plan to focus my practice on medication management (though I do hope to employ techniques I learned from therapy in my patient interactions). However even I, someone who is very biologically oriented, would admit that therapy can also be fun and interesting at times. You get to have a very unique relationship with patients and many of them are grateful for the help.

Sure, having a patient commit suicide is a major event for any psychiatrist. I know psychiatrists who have unfortunately experienced that. Still, I wouldn't say that it's *more* stressful than the deaths that other physicians who work with patients encounter. I think any doctor who finds out a patient died will ask him/herself "Was there something I did or didn't do that caused this?" but in many cases in psychiatry these suicides, when they do happen, aren't about the doctor at all.

I do think that there is some truth to the saying that "Physicians are the worst patients". Many doctors are not great at taking care of their own health. I know when I go to a doctor for my own need, I have very specific ideas about what I want from them. That could be an issue if someone does have a problem with mental illness, because it's hard to have great insight into your own mental illness.

In some cases I do think that people are attracted to a career in mental health because they have a personal history of mental illness. I don't think this should really be surprising, anymore than it would be surprising if a pediatrician was inspired to go into the field by a personal experience with childhood illness or a sports medicine physician became interested in the field because of personal experience with sports injury. I have met some mental health workers that I felt were letting their own psychopathology influence their work in a negative way. However, I also think that if you try to screen out everyone who has been personally touched by mental illness you would lose many people who only use that experience in a healthy way such as having more empathy for those who deal with mental illness. Look at the work of Marsha Linehan for example - she used her own experiences to come up with the current gold standard treatment for Borderline personality disorder.
However, I don't think that going into psychiatry "Makes you go crazy" or any such nonsense.
I think those kinds of ideas are rooted in the public's fear and prejudices about mental illness. If you're a stable, well-adjusted person, I think you can cope with working in mental health just fine.

 

[OldPsychDoc]

Two (oops, 3) points to add to Peppy's excellent reply:

1) You could write virtually the same article and substitute ANY physician specialty (or profession, for that matter) for 'therapist'. Surgeons, internists, lawyers...they all have burnout, depression, substance abuse, and other impairments too. Staying alert for impaired colleagues is an important professional responsibility. Knowing what resources are available locally to assist these individuals is important, too.

2) Several of their references were from the 70s and 80s. Seriously??? In addition, the authors seemed to have a great deal of difficulty deciding whether they were discussing physicians or psychologists, or both, or what. (If this paper had been submitted by one of my med students, I would not have been grading it very highly!)

3) Anesthesiologists are worried you'll go crazy??? The people who have to listen to ranting surgeons all day and night, work 24 hour shifts, have the highest level of access to narcs, and the highest suicide rate by specialty??

 

[nitemagi]

Two (oops, 3) points to add to Peppy's excellent reply:

1) You could write virtually the same article and substitute ANY physician specialty (or profession, for that matter) for 'therapist'. Surgeons, internists, lawyers...they all have burnout, depression, substance abuse, and other impairments too. Staying alert for impaired colleagues is an important professional responsibility. Knowing what resources are available locally to assist these individuals is important, too.

2) Several of their references were from the 70s and 80s. Seriously??? In addition, the authors seemed to have a great deal of difficulty deciding whether they were discussing physicians or psychologists, or both, or what. (If this paper had been submitted by one of my med students, I would not have been grading it very highly!)

3) Anesthesiologists are worried you'll go crazy??? The people who have to listen to ranting surgeons all day and night, work 24 hour shifts, have the highest level of access to narcs, and the highest suicide rate by specialty??

👍

 

[F0nzie]

Reality check: You are looking for control over how others perceive you as a person and how others appraise the choices you make in your life. When you decide to give up that control, you are infinitely free to choose how to live your life.

 

[Mattchiavelli]

my 2 cents (from a neurologist, who is probably crazy as he still lurks on psych boards for fun)

Granted I did not slog through the whole article, but I think psychiatrists would be more willing to be open about their mental health issues because they and the people that work with them know that mental illness is a very large gradient of functionality based on treatment, which would make it seem like psychiatrists have higher rates of mental illness when it really is other physicians in other specialties hide it more. I don't trust self-report surveys to give accurate data because they are notoriously poor methods at first and second I think other specialties might be paranoid about revealing this info.

 

[whopper]

There's a theory that anesthesiologists have higher rates of drug abuse because a human's sense of smell is actually as sensitive as a dog--when it comes to subconscious data processing. Of course humans cannot smell as well as dogs when it comes to conscious processing, I'm talking subconscious. The theory is that like any specific stimuli, smells can act as a trigger to cause an urge to use drugs, but subconscious smells can act as a trigger. Anesthesiologists are exposed to opioids more giving them more access, but even if the just tried it a few times, they are always surrounded by a subconscious smell of it when they break the glass vials with the opioids in them. Other chemicals in the surgery room could also act as triggers as well.

There is data backing this theory up, and because of my limited time right now I only found this article as of right now, but there is more out there.
http://findarticles.com/p/articles/mi_hb4345/is_12_32/ai_n29146836/

 

[DocBlackOut]

Thank you very much for your answers. I feel safer about my convictions on this subject.

Although I've been some 3 months of clinical practice in Psychiatry, I couldnt deal that well with the harsh comments from older colleagues, relative to psychiatry.

I guess it is a mix of fear and respect for the unknown. It is quite different to dedicate a life to Psychiatry, rather then just a few months.

I feel very confortable and confident dealing with psychiatric patients. My ideas and convictions stay just the same and I feel more and more interested about human behavior. I just wanted to know the possible impact of long-term practice.

I really feel that I have right profile for the job.

Once again, thanks for your help. For me, It is of paramount importance to get over those "rooted ideas and fears", based on the knowledge of proper "connaisseurs".

Thanks

 

[splik]

Lots of good points already raised. I would add that there is a difference between psychiatrists and other mental health professionals in that the competition and demands of getting into and through medical school tend to weed out a lot of people with more serious mental health problems and impaired function whereas most of the mental counselors and psychotherapists I have met who weren't psychiatrists or clinical psychologists (getting a PhD in clinical psychology is even more competitive, im not sure about the PsyD though) have been deeply troubled individuals who I would not trust with my mental health or those of my patients. By and large, the more highly functioning people will be found in medicine so the mental health problems will be more minor or the functional impairment is less pervasive.

Then there is the element of reverse causation - the evidence favors people who have mental health problems going into mental health professions. Many people who have their own psychotherapy or psychoanalysis are encouraged by their therapists to become therapists in their own right. There are others who seek a career in the mental health professions because of identification - they identify with their abusers (the mental health professionals). Others still use a profession as a ticket of entry into psychotherapy in a more legitimate way (as personal psychotherapy is often part of the training). Then there are those are wounded healers, unable to help themselves or their families, they attempt to help others. This may be a form of undoing (i.e. 'if i can help other suicidal people then it means my brother won't have killed himself').

The reality is there has got to be something wrong with you if you wanted to be a doctor in the first place. Why would anyone put themselves through the grueling training and constant exposure to death, dying, aging, morbidity, suffering, pain, and misery? This is especially true outside the US in countries like Portugal, Spain, Germany, and Italy where most physicians do not make the high salaries made by US physicians (thus money cannot be the motivating factor) or outside many South Asian countries where being a doctor is associated with high respectability and increasing marriage capital. Looking at my own medical school class we had a ton of people with depression, bipolar disorder, psychosis, anorexia, bulimia, alcohol dependence, drug addiction (coke, GHB, speed), borderline personality disorder... most of them did not go into psychiatry.

 

[splik]

my 2 cents (from a neurologist, who is probably crazy as he still lurks on psych boards for fun)

Granted I did not slog through the whole article, but I think psychiatrists would be more willing to be open about their mental health issues because they and the people that work with them know that mental illness is a very large gradient of functionality based on treatment, which would make it seem like psychiatrists have higher rates of mental illness when it really is other physicians in other specialties hide it more. I don't trust self-report surveys to give accurate data because they are notoriously poor methods at first and second I think other specialties might be paranoid about revealing this info.

I think you're way off on this one, psychiatrists are the most stigmatizing of the mentally ill (at least the mentally ill tend to report the most felt stigma from psychiatrists), and possibly the least tolerant of mental illness within their own ranks. Concealment and silence are not only encouraged but mandated.

 

[peppy]

my 2 cents (from a neurologist, who is probably crazy as he still lurks on psych boards for fun)

Granted I did not slog through the whole article, but I think psychiatrists would be more willing to be open about their mental health issues because they and the people that work with them know that mental illness is a very large gradient of functionality based on treatment, which would make it seem like psychiatrists have higher rates of mental illness when it really is other physicians in other specialties hide it more. I don't trust self-report surveys to give accurate data because they are notoriously poor methods at first and second I think other specialties might be paranoid about revealing this info.

I like seeing people from other specialties on here. Always good to see different perspectives on here.
Your comment reminds me of the articles that came out a while back about surgeons having an abnormally high rate of suicidal ideation, but also being reluctant to seek help: http://archsurg.ama-assn.org/cgi/content/short/146/1/54

I definitely think that it's possible that we're more aware of the mental health issues in psych because we're looking for them, and other specialties may not be as comfortable discussing them openly.

 

[notdeadyet]

I think you're way off on this one, psychiatrists are the most stigmatizing of the mentally ill (at least the mentally ill tend to report the most felt stigma from psychiatrists)...

This makes sense, no? Tell a psychiatrist you suffer from anxiety and you've opened yourself up to a slew of questions as they attempt to diagnose. Tell the same to your OB-Gyn, and you're much more likely to hear "oh, that's too bad..." the latter sounds more comforting and sympathetic...

 

[kugel]

I think you're way off on this one, psychiatrists are the most stigmatizing of the mentally ill (at least the mentally ill tend to report the most felt stigma from psychiatrists), and possibly the least tolerant of mental illness within their own ranks. Concealment and silence are not only encouraged but mandated.

Please explain.

 

[splik]

I was being deliberately provocative. The evidence is not clear-cut (and indeed contradictory) on whether exposure to psychiatry, or being a psychiatrist vs being a non-psychiatric physician has an effect on stigmatizing attitudes, and there are huge variations as psychiatrists are not a uniform group. However, it is certainly the case that there is a group of patients who feel they have experienced to most stigma from psychiatrists themselves, which I imagine represents a specific type of psychiatrist (i.e. did not choose psychiatry as primary specialty, more likely to have a biological model of mental disorder etc). Then is the type of mental illness - psychiatrists tend to be more stigmatizing of patients with personality disorders, chronic help-rejectors and substance abuse patients compared with those who have mood disorders or psychosis.

Because psychiatrists are worried about the perception of people thinking psychiatrists are all mentally ill themselves, I do think they are less tolerant of those with mental illness within our ranks - one only has to look at the advice those with mental illness have been given to conceal their diagnosis on this board. This goes so far as some people denying the motivations of why some people choose psychiatry when it clear that experience of mental illness (one's own or that of others) is a powerful motivating factor for many people choosing a career in psychiatry.

 

[whopper]

One thing I've noticed is people with mental illness tend to go into the field, just like someone who may have survived childhood cancer may want to become a pediatric oncologist.

Maybe this has something to do with the relatively high rate of psychiaric suicides? Personally I don't see much reason why it's relatively higher among psychiatrists. I find my job less stressful than other jobs in the medical field such as surgery. The only other thing I can think of is as a profession, we deal with suicide much more than other fields. I figure if a psychiatrist decides to kill himself, that person's decision will be with very strong finality because we deal with the issue so much, where as many other people who attempt suicide may have done so merely out of a cry for help.

 

[nitemagi]

Maybe this has something to do with the relatively high rate of psychiaric suicides?

Reference for this?

I personally fall more into the camp of "Oh that's too bad" because I don't need to hear everyone's story every minute of the day.

I do not believe that psychiatrists have a higher suicide rate, and if that's true I'd think a self-selection bias is in place. Keep in mind that with the decline of autopsies, many many deaths that are suicide are not ruled as such.

 

[kugel]

with the decline of autopsies, many many deaths that are suicide are not ruled as such.

If "autoimmune" means "developing an immune reaction to my own tissues..."
Shouldn't "autopsy" mean "cutting myself open to see why I died?"



Perhaps zombie pathologists will discover the cure to the zombie apocalypse.

 

[thoffen]

I think the more relevant question is: of psychiatrists who are mentally ill (lets face it they're out there), was the illness a result of or exacerbated by their career in psychiatry?

If not, then they would be sick regardless of choice of career. Perhaps there are more ill psychiatrists but perhaps they would be more ill in other careers.

Of course the next step is... What impact does their illness have on their patients?

 

[whopper]

Maybe this has something to do with the relatively high rate of psychiaric suicides?




Reference for this

The data as mentioned above, is already highly questionable. I personally don't buy it at face value, just thinking out-loud on a devil's advocate stance.

 

[ShrunkenHeads]

Well, it seems like almost anything these days can be labelled as some sort of disorder, so part of it is being more "self aware" - especially now that you're more educated on psychiatric disorders and can label anyone as having something/being something (whatever), and ...well that's pretty much it really. In my worthless opinion anyways. One could easily say that it's everyone else that's underdiagnosed. Or something.

Maybe disorders are contagious (transference)? 😕



The more you talk to people, the more you find out a persons unique oddities and such. You're more likely to hear a shrink talk more than, say, a cardiologist. Everyone is weird in their own way and the peculiarities only surface with more words spoken. That could be another reason. Unless you're just in your face eccentric.

 

[Jorje286]

more likely to have a biological model of mental disorder etc)

And why is that? IMO, a lot of the stigma that goes along mental illness is caused by an assumption that the functions of the "mind" are NOT grounded in biology and organic reasons - that somehow they are tributary of one's "soul". Usually providing a causative biological mechanism of a mental illness tends to decrease the stigma imo.

 

[nitemagi]

And why is that? IMO, a lot of the stigma that goes along mental illness is caused by an assumption that the functions of the "mind" are NOT grounded in biology and organic reasons - that somehow they are tributary of one's "soul". Usually providing a causative biological mechanism of a mental illness tends to decrease the stigma imo.

True, though with the flipside of then externalization of blame for bad habits or behavior. "Oh that's just my ADHD, that's why I'm 3 hours late." Rather than recognizing a problem and then making compensatory actions to help it.

 

[Jorje286]

True, though with the flipside of then externalization of blame for bad habits or behavior. "Oh that's just my ADHD, that's why I'm 3 hours late." Rather than recognizing a problem and then making compensatory actions to help it.

Yes, with biological explanations comes a more deterministic approach to mental illness and I want to also add that removing the weight of etiology from psychosocial dynamics to biological ones has the effect of diminishing a level of social embarrassment that comes along with mental illness, partly because of a decrease in the level of responsibility felt by the affected individual and the people around him. Of course I don't believe that the two perspectives aren't ultimately connected (though I'm much more biased to a biology first approach because I think it's better suited for solid scientific investigation).

 

[snarfer]

IThen is the type of mental illness - psychiatrists tend to be more stigmatizing of patients with personality disorders, chronic help-rejectors and substance abuse patients.
.

All physicians/clinicians tend to dislike these patients. These people are often insulting, belligerent and entitled.

I have met numerous physicians in other medical specialties whom I am very glad are not in psychiatrists. Otherwise, it means very little to me what others think about us.

 

[heyjack70]

I think this is a pretty hard job. At the end of the day, you are dealing with the complexities of another human mind. IMHO this is tougher than following lab values, blood pressures, and prescribing pills, or learning how to cut out an appendix.

 

[snarfer]

I think this is a pretty hard job. At the end of the day, you are dealing with the complexities of another human mind. IMHO this is tougher than following lab values, blood pressures, and prescribing pills, or learning how to cut out an appendix.

I agree. Psychiatry is much more complicated than managing fluids, cycling cardiac enzymes, ck labs, etc...Looks easy from the outside though. Hence the social workers and psycholosigsts and case workers make up terms like "med check, med eval' for psychiatry assessments and follow up visits. Somehow we go along with it calling ourselves psychiatrists and other MDs 'medical doctors.'

 

[billypilgrim37]

I agree. Psychiatry is much more complicated than managing fluids, cycling cardiac enzymes, ck labs, etc...Looks easy from the outside though. Hence the social workers and psycholosigsts and case workers make up terms like "med check, med eval' for psychiatry assessments and follow up visits. Somehow we go along with it calling ourselves psychiatrists and other MDs 'medical doctors.'

about 3 times in the last few months i have joked w/ confused patients that i was in fact an md, as I "had the loans to prove it." they don't get it, but it makes me feel better.

it doesn't help that our pediatric psychiatry consult service is called a "behavior health" service, and thus we're all just social workers until we have to explain otherwise.

 

[snarfer]

about 3 times in the last few months i have joked w/ confused patients that i was in fact an md, as I "had the loans to prove it." they don't get it, but it makes me feel better.

it doesn't help that our pediatric psychiatry consult service is called a "behavior health" service, and thus we're all just social workers until we have to explain otherwise.

Yeah. "behavioral/mental health, psychopharmacologists,etc.." What ever happened to good ol Department of psychiatry or just plain old psychiatrist?

Unfortunately, a big part of psychiatry involves social services so we hire these mid levels with big egos to help out. There aren't enough of us and we don't want to deal with these issues either. Thereby, we change to accomodate the social workers, psychologists and case managers. In return, they marginalize us. However, when the roof is falling, they do look to us for guidance and blame.

 

[kugel]

Yeah. "behavioral/mental health, psychopharmacologists,etc.." What ever happened to good ol Department of psychiatry or just plain old psychiatrist?

Unfortunately, a big part of psychiatry involves social services so we hire these mid levels with big egos to help out. There aren't enough of us and we don't want to deal with these issues either. Thereby, we change to accomodate the social workers, psychologists and case managers. In return, they marginalize us. However, when the roof is falling, they do look to us for guidance and blame.

We aren't social workers, and the social workers aren't residential drug rehab, and the drug rehab staff aren't able to make free housing appear.

Each dept, including social work, has the problem of others expecting them to magically solve all the patients' problems. Just like when someone consults IM for obesity (that is not likely to change in the hospital and better addressed by the PCP - so don't forget it on your D/C plans) and psych is consulted for "he seems anxious about his Whipple tomorrow morning." and PT gets consulted for "patient wants to start exercising at home."

When I write on the d/c order, "RN: please give pt list of shelters, drug rehab facilities, and AA/NA meetings" for a pt who has refused all such resources on several occasions, often the nurse will call social work and initiate a consult for "the doctor said he needs placement" instead of picking up a copy of the lists that are stacked in the nurses' station. And we waste another 4 hours in the emergency dept.

I think we ALL have a tendency to "consult" someone else hoping they will somehow sprinkle fairy dust and make the problems go away. We have to fight that tendency, and try to utilize our team mates responsibly. When I look at the face sheet and can tell the Social Worker that "he lives in an apt with his sister in Fairfield and has XYZ insurance," it puts them that much further ahead. It all probably starts with having a friendly discussion about "So how do you want us to handle it when a patient has...?" and "What are the things we should and shouldn't be asking of you?" That way we can have an understanding of what they can and can't accomplish, and a collaborative approach to the whole person.

 

[OldPsychDoc]

Yeah. "behavioral/mental health, psychopharmacologists,etc.." What ever happened to good ol Department of psychiatry or just plain old psychiatrist?

Unfortunately, a big part of psychiatry involves social services so we hire these mid levels with big egos to help out. There aren't enough of us and we don't want to deal with these issues either. Thereby, we change to accomodate the social workers, psychologists and case managers. In return, they marginalize us. However, when the roof is falling, they do look to us for guidance and blame.

I am a psychiatrist, who works for a department of behavioral health, which draws from multiple disciplines to work as a team to address the mental health issues of our patients (and no, I don't care if you want to call them a client...they're my patient--they can be your client...)

 

[snarfer]

I am a psychiatrist, who works for a department of behavioral health, which draws from multiple disciplines to work as a team to address the mental health issues of our patients (and no, I don't care if you want to call them a client...they're my patient--they can be your client...)

Referring to patient as 'client' is another silly and incorrect phenomenon. Client seeks help from lawyers and financial advisors for advice. A patient comes to us for treatment.

 

[aphenomenon]

Referring to patient as 'client' is another silly and incorrect phenomenon. Client seeks help from lawyers and financial advisors for advice. A patient comes to us for treatment.

As I understand it, the term is supposed to imply choice and empowerment, selection of services, etc.

Interesting, though:
http://www.ncbi.nlm.nih.gov/pubmed/21614831
[Patient, client or...--the terms preferred in mental health services].

[Article in Polish]
Anczewska M, Switaj P, Waszkiewicz J, Indulska A, Prot K, Raduj J, Pałyska M.
Source

I Klinika Psychiatryczna IPiN w Warszawie.

Abstract

AIM:

To analyse the patients' and staff opinions on preferred terms in regards recipients of mental health services.
METHOD:

In 2008, 489 patients and 318 providers from one of Warsaw mental health services answered the survey on preferred terms in regards recipients of mental health services anonymously.
RESULTS:

The term "patient" was the most preferred, as well as by the recipients (77.5%), as the providers (87.7%) of the services. The second choice in both groups, however much less preferred was the term "person with mental disorders" (respectively 18.2% and 22.3%) and indicated by the patients "person using mental health services" (18.2%). The less preferred were the terms: "user" (2.0% by the patients, 1.6% the providers), "beneficiary" (respectively 3.3%, 2.5%), "client" (5.5%, 5%). The patients from day hospitals and community based facilities also favoured the term "patient" (85.0% responders). In spite of staff occupation and number of years spent working in mental health services, the term "patient" was the most preferred one.
CONCLUSIONS:

The term "patient" was the most preferred one in the group of patients and service providers. The form of services provided did not differentiate the patients' opinion in regards to the preferred terms. Occupation and number of years spent working in mental health services did not differentiate the providers' opinion in regards to the preferred terms. Further dialogue on the preferred terms is needed, since they might empower or stigmatise.

 

[nancysinatra]

about 3 times in the last few months i have joked w/ confused patients that i was in fact an md, as I "had the loans to prove it." they don't get it, but it makes me feel better.

it doesn't help that our pediatric psychiatry consult service is called a "behavior health" service, and thus we're all just social workers until we have to explain otherwise.

This bothers me to no end. Like in CPRS at the VA, everything from psychiatry to rehab to the jobs program to temporary housing gets lumped under "mental health care line." We're essentially part of the "miscellaneous care line."