Are
shrinks nuts?
September
28, 2012
Dear
Cecil:
Is it
true that, as a class, psychotherapists and other mental health professionals
are crazier than average? And that despite their training and experience, they
can recognize their own issues less readily than the average nutcase?
— Paul
Cecil
replies:
I defer
judgment on whether shrinks don’t recognize their problems. On the contrary,
there are indications some mental health professionals enter the field because
they do recognize their problems and think their work will help them get a
grip.
I can
hear you saying: that’s like becoming a cop so you can work on your anger
management. Please, a little sympathy. The best way to understand shrinks is to
put yourself in their shoes.
Let’s
suppose you dedicate yourself to healing the psychic wounds of others. Are you
probably nuttier than average? Depends how we define nutty. I haven’t seen good
evidence you’re statistically likely to hear voices, think you’re the angel
Gabriel, or otherwise show signs of clinical insanity. On the other hand, are
the odds decent that you'll show signs of what we might call maladjustment? No
question, they are.
It’s easy
to see why. Psychiatry and psychology, like police work, have long been
recognized as high-stress fields of practice due to constant exposure to
humanity’s dark side. In interviews with medical students about their
perceptions of psychiatry, researchers found a common concern was that (as one
subject put it) “working with crazies will make you crazy.”
For all
that, the prevalence of mental disorders among mental health workers didn’t
receive much attention until the 1980s. A widely noted study from 1980 found 73
percent of psychiatrists had experienced moderate to incapacitating anxiety
early in their careers, and 58 percent had suffered from moderate to
incapacitating depression.
To some
extent this is simply a result of working in medicine — physicians in general
suffer from higher stress levels and depression than the general population and
have a higher suicide rate. But research suggests mental health specialists are
particularly at risk. One British study found psychiatrists had nearly five
times the suicide rate of general practitioners, and U.S. research indicates
psychiatrists commit suicide at two to three times the rate of the general
population.
Similarly,
depression, stress, and burnout are high among physicians but higher among
psychiatrists; the same is true of alcohol and drug abuse. Psychiatrists have a
divorce rate 2.7 times that of other physicians and as much as five times that
of the general public. From a quarter to a half of psychiatrists say they’re
suffering from burnout at any given time.
A study
of more than 8,000 Finnish hospital employees found the psychiatric staff was
81 percent more likely to suffer from a current or past mental illness and 61
percent more likely to miss work due to depression. Psychiatric staff were
twice as likely to smoke as other hospital staff and had much higher rates of
alcohol use. A 30-year study of 20,000 UK medical workers found psychiatrists
were 46 percent more likely than their peers to die from injuries and
poisoning, and at 12 percent greater risk of dying overall.
If you
were a woman in the mental health field, Paul, you’d have an especially tough
time of it. Compared to other female physicians, female psychiatrists have a 67
percent greater likelihood of suffering from psychological problems, primarily
depression, and have a 26 percent greater likelihood of having a family history
of psychological problems. They’re twice as likely to smoke, drink 50 percent
more alcohol, and rate their personal health much lower than their peers do.
As a
male, you may find other ways to alleviate your stress. The California Medical
Board found male psychiatrists were almost twice as likely to be disciplined
for unethical sexual relationships with patients as their peers.
Many of
the problems you’ll encounter as a mental health professional have a lot to do
with the nature of the work — hey, skimming through my inbox
any given week is enough to make me reach for the Thorazine. Jung called the
transference of psychological problems from patient to doctor an “unconscious
infection.”
Patients
can get violent, either with you or themselves. Dealing with certain types of
patients can be emotionally draining, such as those with borderline personality
disorder or victims of sexual abuse. You’ve also got stressors such as
overwork, job instability, liability fears, paperwork overload, and
disciplinary actions and monitoring.
But let’s
get back to the point I made at the outset. Does the mental health field
attract people with mental problems? Research is thin, but some studies have
found mental health workers are more likely than average to have experienced
early abuse and trauma. A much-cited 1963 study reported that 24 out of 25
psychiatrists had entered the field because of a wish to explore some personal
conflict.
That
gives one pause. Sure, there’s value in consulting a health professional who’s
been down the same road as us. But who wants their therapist thinking, “Maybe
after I get this head case straightened out, I’ll figure out what’s wrong with
me”?
— Cecil
Adams
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