December 3, 2014

Is It My Childhood, Adulthood, or Am I Just Crazy Enough to Be a Psychiatrist?

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Joseph W. Iskandar, DO, and John Eric Vance, MD

Virginia Tech Carilion School of Medicine, Roanoke, Virginia


Dr Iskandar: “You must’ve had a bad childhood” is what my internal medicine attending physician said when I told him during medical school that I was going into psychiatry. Years later, when I decided to survey primary care residents in two teaching hospitals about their perspectives on mental health, I couldn’t resist asking a question about what they think of us. The question was, what percentage of mental health care professionals (MHPs) do you think has mental health problems? The answer choices were 25%, 50%, 75%, and over 75%.

Of course, my selfish reason was to know what they really think of me when I work or sit at lunch with them daily. Unfortunately, the survey revealed a positive correlation between primary care residents’ advancing training level and their growing belief that MHPs have mental health problems. While 60% of first-year and 70% of second-year residents reported a belief that 25% and 50% of MHPs, respectively, have mental health problems, 80% of third-year residents reported a belief that more than 75% of MHPs have mental health problems.

In denial, I told myself that these results are not statistically significant, and maybe they do not represent our colleagues’ true perceptions of us. But, if true, how do the perceptions of primary care residents form and grow with time?

I decided to ask Dr Eric Vance, my mentor and a coauthor of the study, about his experiences dealing with the perceptions of others about his career choice.

Dr Vance: In my experience, the survey confirms the perceptions of many people outside of our profession—that those who become MHPs end up there due to having their own mental health problems. As for me, I recall choosing the field due to thinking that the brain was the most interesting organ in the body (and meeting a couple of cool psychiatrists in med school). Of course that didn’t keep my father from asking why I didn’t choose to be a “real doctor.” My father passed away before he repaired all the damage caused by his own narcissism, but, by entering psychiatry, I’ve been able to gain enough insight to control my own. Perhaps if I hadn’t become an MHP, my unexamined narcissism would’ve served me in the role of a ruthless businessman, or a tyrannical surgeon terrorizing residents and medical students. I’ve also heard the common perception that psychiatrists as a group are “a bunch of oddballs.” I acknowledge that I’ve met many colorful MHPs over the years, but do we really have more mental disorders than the pathologist with Asperger’s, the depressed internist with no bedside manners, or the addicted anesthesiologist? I’m not sure I went into the field to “figure out my own problems,” but I think maybe it has helped a bit. In any case, most people eventually realize that very few of us can solve our own problems, and the help of another person is often needed to guide us. That person is often an MHP.

Dr Iskandar: Then, should we accept the perception or fight it?

Financial disclosure:Drs Iskandar and Vance had no relevant personal financial relationships to report.

See also “Why Become a Psychiatrist? The Id Speaks” by Aditya Joshi, MD.

Category: Mental Illness
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11 thoughts on “Is It My Childhood, Adulthood, or Am I Just Crazy Enough to Be a Psychiatrist?

  1. Great article!
    The question is valid and the more we continue to have confidence in who we are as psychiatrists, I believe the image will correct itself with little to no effort. Psychiatry is still in its infancy, continuously undergoing development. If we keep expanding on the solid base we have now, before we know it we will be answering these questions with the necessary statistics to back us up.
  2. The real question might better be why our colleagues in other fields of medicine perceive us in this way. And even more vexing is the question of how this perception is perpetuated in trainees as this survey found. I think we have all experienced similar interactions to ones described by Drs. Vance and Iskandar. In my own experience I often hear funny stories or jokes about psychiatrists followed by “but you don’t act like a psychiatrist”. I find myself puzzled by exactly what a psychiatrist is supposed to act like…..then I think about the state of psychiatry and psychiatrists in years past. It always seemed to me that psychiatry went out of its way to separate itself from the rest of medicine. In years past, we heralded ourselves as “different”, refused to wear white coats, and even refused to touch patients for fear of some sort of psychosexual intrusion. So, I think, if this is what psychiatrists “act” like then maybe they are right…..I don’t act like a psychiatrist.

    We are beginning to teach an integrated model of psychiatric care where we are the experts in behavioral expression of the brain. We are a critically valuable part of medicine that every student needs to learn. Students need to know the mental status exam as surely as they know how to auscultate the heart or examine an abdomen. We are physicians and we need to promote the value of our profession to students fighting the vestiges of separation and perhaps even aloofness at every opportunity. When students are taught to value our expertise as a part of being a physician, we will begin to see changes in long perpetuated stigmas. Now that’s acting like a psychiatrist!

  3. Perhaps we should survey psychiatrists about the mental health status of their colleagues; primary-care physicians, internists, surgeons, anesthesiologists, pathologist.

    75% would be a good estimate for any of these specialties?
    This would make out ratings normative!

  4. I think the real discussion should be centered on:

    How many of these primary care or surgical providers have mental health problems they don’t recognize in order to maintain the illusion of being “normal”.

  5. It seems to me that this is a case of the “pot calling the kettle black.” Don’t we all have “mental health problems?”
    Look at all the unhappy MDs’, divorces, suicides, drug addictions,
    terrible financial losses for bad business decisions, lawsuits,
    malpractice cases, etc.; not even counting the myriad of bitter partnership disputes. I’d say we are all in need of a “good psychiatrist/
    or a life coach of some sort.”
    Ethics, morality, and spirituality is the fundamental bottom-line for a successful life. even if one did not have the benefit of getting off to a good start, it is never too late to turn one’s life around. Try it!
  6. ALL have psychopathology! More apparent in some than others.

    As one becomes more aware, it is easier to see in others.

    In becoming aware of my own, not trying to hide from self or others, there may be hope of reducing distress and dysfunction.

    I intend to continue enjoying the psychiatric mystique.

  7. I think this is a really interesting survey and I enjoyed Dr Vance’s reply. I have also just been reading about physician suicide in the USA and the case histories of those who committed suicide. Amongst the case histories I read there were no psychiatrists or even residents intending to study psychiatry.
    If anything going into psychiatrist increases our insight into our own problems as well as those of others. So, perhaps we are more aware of our own mental health issues than other specialties in the medical field and more willing to admit being vulnerable and human which can only make us better doctors for our patients and better people for our families and friends.
    I went into pscyhiatry because of an interest in the workings of the brain and as a discipline it has brought me a lot, intellectually, personally and also convinced me of the need to bring a more humane approach back into all areas of medicine. If that makes me a psychiatrist with a mental health problem then so be it!
  8. The perception of psychiatrists is a matter of expectations. People would like psychiatrists, of all medical specialists, to appear “normal” (i.e.: someone you don’t know very well). The interpersonal relationship may be more important in psychiatry than in any other medical specialty. It matters less whether the arrogant surgeon, the harried internist, or the odd Neurologist can relate well because the relationship is less important than the exam findings or procedure outcomes. In psychiatry, the relationship is, perhaps, the most important factor in recovery. We want our psychiatrists to appear “normal” so we can feel safe.
  9. I am writing from australia. As migrant from south east asia, I went into psychiatry by default as few doctors choose it at that time as the specialty of choice. things are chnaging and trainess can’t get into training posiitons now. I was emergency medicine trained and also worked as a general practitioner before. Psychiatrist are an unusual bunch and I still get along better with no psychiatrists even now.
  10. It is most interesting as a MH Social Worker in Australia to read what I feel is an excellent article.
    The very fact that such an article is written separates MH from ‘Ordinary’ medicine as we have the honesty and courage to take a critical look at ourdelves, scary if you have much to hide!
    Psychiatrist I’ve worked with over 30 years fit ALL categories from sublime to absolutely ridiculous and yes that includes Social Workers also.

    One strategy of our sense of self preservation includes ‘Dark or Black Humour’ being capable of seeing the ridiculous in even the most serious of situations, this can prevent burnout [or going crazy!] from the constant stressors.

    Keep it up and by the way, don’t forget your Allied MH Professionals that support you, go and thank them.


  11. Other responders seem defensive in their responses. I believe that I am definitely a product of my upbringing, although at first I do not think that I was consciously aware of how much that affected my choice of career. I have no need to reassure patients or colleagues that I am “normal,” because I am not interested in being normal, I am interested in being real. That seems to me to put patients far more at ease, in my experience.

    I think that the one word that describes my experience of being ‘real’ is broken-hearted. I grew up with a mother with severe schizophrenia, with no father and no siblings and a woefully inadequate and neglectful community that eventually allowed her to die this past February. Every day I wonder why I continue this work, but I honestly believe that I need to do my small part, because there are fewer of us every day who are willing to show others grace and compassion that we may not have received ourselves.

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