It’s not that unusual for people to say to me:
‘On psychiatric wards you can’t tell the staff from the patients’
‘Aren’t psychiatrists all mad?’
Depending on how narky I am, I sometime say to people:
‘Is what you’re saying that people with mental health are in some way unworthy of our attentions, to such an extent that the only people who might wish to treat them would need to be mentally unwell themselves?’
Which normally stops them in their tracks. I do believe there may be a degree of unspoken prejudice within the question, and my distaste for this is contained within my answer. It may also be that people don’t talk to psychiatrists very often and this is the first thing they can think to say in their quest to make small talk; in this case they should think more carefully before saying something stupid.
As for the ‘madness’, there are a few possibilities:
- Psychiatrists are mentally unwell before they enter the profession
- Psychiatrists become mad by virtue of engaging in psychiatric practice. Is it possible that by spending so much time with disinhibited people that we become disinhibited ourselves? Are mental health problems contagious?
- This is all bollocks and psychiatrists are not any more likely to suffer mental health problems than anyone else.
I can only find one paper on this subject. This was published in 1989 and is not available on the internet so I have not read it in full, but intend to track it down. Its abstract suggests that there is no evidence that psychiatrists suffer more from mental health disorders than other medical practitioners.
But do medical practitioners suffer more from mental health problems than the working population at large?
It’s not a great leap of logic to think that the caring professions might attract people who are more sensitive than might the more robust jobs in the City of London. Some people with mental health problems feel contained by a job in the caring professions and may feel that they are more understood and that their problems will get more sympathy. In psychodynamic terms people who wish to be cared for may express this wish by caring for others. This is the defence mechanism of projection.
It is also the case that if you work in the public sector than you are less likely to get sacked should you have a problem with your mental health. A source close to me who works in the city tells me that people with mental health problems there tend to be quietly paid off. Furthermore medical jobs are stressful and often support and understanding are lacking.
Here are the main points
- It is reported that personality traits of perfectionism, self-criticism and dependency are common in medical students
- Doctors have higher rates of mental disorder than the general population
- Problems with alcohol, drugs and depression are particularly common. Up to 7% doctors will have a substance misuse problem in their lifetime
- Suicide rates are increased especially in female doctors, anaesthetists, GPs and psychiatrists
- Medicine is a stressful profession. Sources of stress include:
- Work pressure – workload, inadequacy of resources and poor support
- Nature of work – high demand and low control, in conjunction with the inherent trauma of dealing with suffering
- Poor relationships with colleagues – particularly poor team working
- Service pressures – investigations, complaints and court cases
- A charicature persists that good doctors do not make mistakes and that illness, especially mental is regarded as a weakness.
- Taking time off is letting colleagues and patients down
- Disclosure of mental illness or substance misuse is to invite disciplinary involvement.
- The average doctor takes three days sick leave each year. The general population on average take 8 and nurses 15.
- 40% of early retirement is due to psychiatric problems.
- Even those with serious mental illness if they are provided with appropriate help and are given support at work can continue to practise successfully.
So, pick any given doctor and there’s at a greater than one in ten chance that they will have had, at some time, a serious problem with their mental health.
For an excellent blog written by a psychiatrist with bipolar disorder can I direct you to Trick Cycling for Beginners.