Occupational Hazards of Psychiatry

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COMMENTARY

Many professions are associated with occupational hazards. Dancers and athletes risk injury. Coalminers risk lung-disease. Psychiatry is no exception. Over the course of my career, I have noticed quite a few psychiatry-specific occupational hazards. I am sure that many psychiatrists will have met with some of these dangers themselves—and could probably add a few of their own.

Dangerous Patients

Working with mentally ill individuals is risky. Whether one’s clients are severely and chronically mentally ill or the worried well, psychiatrists always face the risk of losing a patient to suicide. This can occur despite one’s best efforts. One feels great guilt and despair, even if on review the act was not preventable.

There is also the risk of violence. Psychiatrists could be assaulted or even killed by a patient with a grudge, or one responding to voices telling them to do harm.

There is the risk of being stalked by a patient. With the internet, psychiatrists’ home addresses can be found. Even if they are not literally stalked, some doctors face patients who hold grudges for committing them involuntarily or, in the patients’ words, “forcing them to take meds” that they perceived as poison. It can be hard to live a normal life when you know that someone out there wishes you ill.

Here is an extreme example of this hostility. There is a museum in Los Angeles called “Psychiatry: Industry of Death.” It accuses the field of psychiatry of inflicting torture on its patients, be it through medications, confining them to locked wards, prescribing electroshock therapy or other treatments. It is operated by the Citizens Commission on Human Rights (CCHR), an antipsychiatry organization founded by the Church of Scientology and psychiatrist Thomas Szasz, MD.

Noncompliant Patients

There is the frustration that comes with trying hard to help patients but encountering resistance. This can be resistance to keeping appointments or taking medications, or even filling prescriptions. It can make one feel helpless and ineffective. We see patients get hospitalized over and over again. Some clients relapse frequently due to noncompliance with medication and appointments. Naturally, substance abuse disorders make these patients even more difficult to stabilize.

Those of us who work in emergency rooms know all too well the “frequent flyer” that returns week after week with the same complaints or self-inflicted wounds. One can easily become exhausted, cynical, and burnt-out. Human effort and thousands of dollars are spent on the same work-ups, with no real progress over time.

I think the general public does not realize how hard it is to do what we do. It takes a strong stomach to handle others’ crises. It can be heart-breaking and depressing to hear patients’ stories of abuse, sexual assault, and tragedy. On several occasions, I have had the experience of having a patient confide in me that I was the very first person on earth to whom she or he has ever disclosed being raped. It takes effort and dedication to remain present and supportive no matter what.

Absorbing All That Suffering

We want to help our patients. However, it is not natural or particularly healthy to spend one’s work week listening to folks who are anxious, depressed, disturbed, or psychotic. It can leave one reeling with mental exhaustion and world-weariness. One comes to expect suffering as the norm.

During my residency, one of the senior attendings said that psychiatrists are “grandiose masochists.” I assume he meant grandiose in the sense that we like to feel empowered to heal patients with our extensive knowledge and training, and masochists because along the way we ourselves suffer as we sit with those who are suffering.

After a busy work week, have you ever walked down the street and seen a happy individual and wondered, “What are they so happy about?” When happiness starts to look odd, it is time for a break.

It is crucial for self-preservation that we not bring our work home. But how do we leave it all behind? We counsel our patients about good self-care: relaxation, meditation, the importance of exploring hobbies, and, of course, taking vacation. We need to do the same for ourselves.

Popular Misconceptions

I have observed other occupational hazards. Socially, when you tell someone you are a psychiatrist, they often express fear: “Are you gonna analyze me? I’d better watch what I say!” Or outright hostility: “You’re a shrink? Every shrink I’ve ever met is nuts!” Or how about: “Didn’t you ever want to be a real doctor?”

Then there is the opposite reaction: the casual acquaintance who wants free advice or an instant consultation. Some folks have no qualms about disclosing their mental health histories on the spot and asking your opinion of their meds or other treatments. How about those who even think it is appropriate to ask for a prescription or refill? I have learned to set boundaries and refer them to their own practitioners. Also, I would like them to respect my free time outside of the office.

This goes for co-workers, friends, and family members as well I refer them to their own therapists and prescribers. Keeping the boundaries helps preserve all your relationships.

Taking the Work Home

There are also hazards that can occur in one’s personal relationships. I have observed that some psychiatrists are drawn to partners who have untreated mental health issues or are quite troubled. In my opinion, this is a pitfall to be aware of and guard against. The psychiatrist in us is tempted to treat and win the love of the partner. Who doesn’t want to be a hero? It would feel great.

In the long run, I have found, this mostly does not work. It is better to be drawn to another’s mental health and strength, rather than to their symptomatology (no matter how fascinating). Ultimately, that partner may resent and reject the help, whether consciously or unconsciously. She or he may become hostile and turn it against you, saying, “Stop trying to change me or fix me. You knew who I was when we met.” Try to be mindful of this dynamic and avoid it.

Instead, try to find a romantic partner who is already reasonably psychologically healthy. Two healthy individuals have a better chance. If emotional issues arise, make sure your significant other gets her or his own therapist or psychiatrist. Do not take it all upon your shoulders. Refer them for help. Do not prescribe for loved ones, even if tempted. That is not your role. Just be the loving partner. Keeping such boundaries is very important; you will protect and preserve your relationship.

Also try to avoid someone who is not at all psychologically minded or even ridicules our field or the use of medications. They say opposites attract, but do not mistake the repression of feelings or closed-mindedness for serenity. If you enjoy discussing human behavior but your partner thinks you’re just over-analyzing everything, you may end up frustrated and lonely.

Minor Hazards

There are a few other occupational hazards that are minor but still a bit galling. Many individuals do not realize that a psychiatrist is a physician. Many do not know the difference between a psychiatrist, a psychologist, and a therapist. We who have toiled for one of the longest training periods known to mankind (college/med school/4 years of residency), we do enjoy getting that MD recognition.

Sitting all day is another occupational hazard, one that we share with all sedentary office workers and airline pilots. Weight gain and hemorrhoids are no fun. As standing desks grow in popularity, perhaps one day we will find a way to stand during sessions.

Concluding Thoughts

I hope this list will make you smile and, more importantly, appreciate how hard this work can be. Just as we need to have compassion for our patients, we need to have compassion for ourselves. Let’s treat ourselves very well in our time off.

Dr Mausner is a board-certified psychiatrist. She is on the staff of Manhattan Psychiatric Center and works in their mental health outpatient clinic. Her new book Jacob Weinberg, Musical Pioneer is available on Amazon.com.