On the Emotional Well-Being of Psychiatrists: Overview and Rationale

There are two characteristics of our time contributing to the increased openness of concern about the impaired physician. Although the focus of this paper is upon the emotional well-being of the psychiatrist, the broader issue of the impaired physician cannot be separated from it and is therefore pertinent. The two characteristics are the legitimization of concern with the quality of life and the emphasis on the accountability, and therefore on the competence, of the physician. The latter applies to all physicians but has a particular thrust for psychiatrists because of both the hitherto general privateness of the work of so many of us and the close relationship, particularly in psychotherapeutic endeavors, between our emotional state and our efficacy. In a somewhat different way the legitimization of personal concern about the quality of one's life has a particular pertinence for the psychiatrist in that it raises the question of whether he can allow for himself that which he encourages in his patients.

Those of us who are particularly concerned with the issue of the emotional well-being of psychiatrists are repeatedly impressed with its complexity and far-reaching ramifications. One way to conceptualize and therefore to bring order to considerations of the issue is to think in terms of two dimensions, a longitudinal one and a cross-sectional one. The longitudinal axis is the range of emotional ill-being/well-being. The cross-sectional axis calls attention to categories to be considered at various points along the longitudinal axis.

At the most lethal end of this longitudinal scale is suicide, either intentional or subintentional. Examples of the latter are the psychiatrist who repeatedly injects large doses of analgesics at the same time that he is drinking heavily, until one night the lethal combination occurs, and the psychiatrist who misses a curve while driving on a lonely road at a high speed in a small sports car shortly after rhetorically querying his answeri