The Psychiatrist as Wounded Physician

In the past whenever occupations such as fire fighting, steeple chasing, or chimney sweeping were advertised, their dangers were made clear to the neophyte apprentice. In our experience, no such warning has ever been given concerning the practice of psychiatry. Yet now, with reports coming in of occupational disabilities among psychiatrists, it could be said of the practice of our art, “Warning: this may be hazardous to your health.” More accurately, to enter the vocation of psychiatrist-healer in our culture has great dangers for the physical and psychological health of both doctor and patient.

The direction of inquiry of this paper will be to explore some of the causes and possible solutions to the problem of emotional and physical ill-being as they may relate particularly in the practice of the specialty. In consideration of these issues, an attempt will be made to look beyond purely personal, idiosyncratic factors to the unique aspects of the practice of psychiatry itself that may be sources and/or aggravations of ill-being.

The following thesis will be elaborated. Only in an approach to the practice of psychiatry that includes the personal equation of potential and actual illness, wounds, or vulnerabilities of the healer himself can one hope to adequately deal with the dangers of this vocation—dangers that accrue to both patients and psychiatric physician. That is, if this personal equation is not accounted for, the chances that the patient may not be healed or that the psychiatrist will “catch the illness,” or at least have his own wounds aggravated, is greatly increased. Let us see how this theme can be amplified. First, as to origins: What is it that causes a person to choose the profession of psychiatry, particularly those who do psychotherapy? Many common responses have been: great love of mankind; power over people's lives; financial and other social rewards such as prestige; a peculiar fascination with the psyche; to understand why people behave as they do