Hey, Mental-Health Experts- How About Healing Thyselves?

By, Robert Epstein

Suicide, stress, divorce- psychologists and other mental-health professionals may actually be more screwed up than the rest of us.
In 1899 Sigmund Freud got a new telephone number 14362. He was 43 at the time and he was profoundly disturbed by the digits in the new number. He believed they signified that he would die at age 61 (note the one and six surrounding the 43) or at best at age 62 (the last two digits in the number).

He clung, painfully to this bizarre belief for many years. Presumably he was forced to revise his estimate on his 63rd birthday, but he was haunted by other superstitions until the day he died- by assisted suicide, no less- at the ripe old age of 83.
That’s just for starters. Freud also had frequent blackouts. He refused to quit smoking even after 30 operations to correct the extensive damage he suffered from cancer of the jaw. He was a self-proclaimed neurotic. He suffered from a mild form of agoraphobia. And, for the time, he had a serious cocaine problem.

Neuroses? Superstitions? Substance abuse? Blackouts? And Suicide? Theses problems typical for psychologists? How are Freud’s successors doing? Or, to put the question angother way: Are shrinks really “crazy”?

Mental-health professionals are, in general, a fairly disturbed lot- at least as troubled as the general populations. This may sound depressing, but having sick shrinks around is not in itself a serious problem. In fact, some experts believe that therapists who have suffered in certain ways may be the best therapists we have.

The problem is that mental-health professionals- particularly psychologists- do a poor job of monitoring their own mental-health problems and those of their colleagues. In fact, the main responsibility for spotting an impaired therapist seems to fall on the patient, who presumably has his or her own problems to deal with.

Therapists struggling with marital problems, alcoholism, substance abuse, depression and so on don’t function well as therapists, so we can’t just ignore their distress. And ironically, with just a few exceptions, mental-health professionals have access to relatively few resources when they most need assistance. The questions, then, are these: How can clients be protected and how can troubled therapists be helped?

Here’s a theory that’s not so crazy: Maybe people enter the mental-health field because they have a history of psychological difficulties. Perhaps they’re trying to understand or overcome their own problems, which would give up a pool of therapists who are a bit unusual to begin with. That alone could account for the image of the Crazy Shrink.

Freud’s daughter, Anna, herself a prominent psychoanalyst, once said, “The most sophisticated defense mechanism I ever encountered was becoming a psychotherapist.”

So it’s only appropriate that John Fromson, director of a Massachusetts program for impaired physicians, describes the mental-health field as one in which “the odd care for the id.”

These impressions are confirmed by published research. An American Psychiatric Association study concluded that “physicians with affective disorders tent to select psychiatry as a specialty.” In a 1993 study, James Guy, dean of the School of Psychology at Fuller Theological Seminary, compared the early childhood experiences of female psychotherapists to those of other professional women. The therapists reported higher rates of family dysfunction, parental alcoholism, sexual and physical abuse and parental death or psychiatric hospitalization than did their professional counterparts.

And a 1992 survey of male and female therapists found that more than two-thirds of the women and one-third of the men reported having experienced some form of sexual or physical abuse in early life.

Check out the numbers: According to studies published in 1990 and 1991, half of all therapists are at some point threatened with physical violence by their clients, and about 40 percent are actually attacked.

Try to put this in context. A special, intimate relationship exists between therapist and client. So being attacked by a client is a serious emotional blow, perhaps comparable, in some cases, to being a parent attacked by one’s child.

Let’s take this a step further. Imagine working with a depressed patient every week, without fail, for several years and then getting a call saying that your patient had killed herself. How would you feel? Patient suicide is another hazard of the profession. Between 20 percent and 30 percent of all psychotherapists experience the suicide of at least one patient, again with often devastating psychological fallout.
Virtually all mental-heath professionals agree that the profession is inherently hazardous. It takes superhuman strength for most people just to listen to a neighbor moan about his lousy marriage for 15 minutes. Psychologists, or course, enter the profession by choice, but you can imagine the effects of listening to clients talk about a never-ending litany of serious problems- eight hours a day, 48 weeks a year.

A number of surveys, conducted by Guy and others, reveal some worrisome statistics about therapists’ lives and well being. At lest three out of four therapists have experienced major distress within the past three years, the principal cause being relationship problems. More than 60 percent may have suffered a clinically significant depression at some point in their lives, and nearly half admitted that in the weeks following a personal crisis they are unable to deliver quality care.

As for psychiatrists, a 1997 study by Michael Klag, found that the divorce rate for psychiatrists who graduated from Johns Hopkins University School of Medicine between 1948 and 1864 was 51 percent- higher than that of the general population of that era, and substantially higher than the rate in any other branch of medicine.

All too often the stresses of work and everyday life lead mental-health professionals down the suicide path. According to psychologist David Lester, director of the Center for the Study of Suicide, mental-health professionals kill themselves at an abnormally high rate.
Indeed, highly publicized reports about the suicide rate of psychiatrist led the American Psychiatric Association to create a Task Force on Suicide Prevention in the late 1970s. A study initiated by that task force, published in 1980, concluded that “psychiatrists commit suicide at rates about twice those expected (of physicians)” and that “the occurrence of suicides by psychiatrists is quite constant year-to-year, indicating a relatively stable oversupply of depressed psychiatrists.”

Mental-health professionals are probably at heightened risk for not just alcoholism but (all types of) substance abuse, further reports Peter Nathan of the University of Iowa. It’s not surprising: Substance abuse is one of the most common- albeit destructive- ways people deal with anxiety and depression.

Richard Thoreson’s decades of research on alcoholism, in fact, stemmed from his own problems with the bottle. “I began drinking at a fairly early age,” he says, “and I continued during my early academic career. My life was organized around drinking. It had a very negative impact on my family. At one point I resigned as president of an organization because I was too shaky to speak before a group. I stopped drinking in 1969, at which point I was drinking the equivalent of 16 ounces of whiskey a day.”

In the 1970s, with the help of several colleagues, Thoreson founded an informal group called Psychologists, which has held open Alcoholics Anonymous meetings at the annual APA convention ever since. This unofficial, all-volunteer group has helped hundreds of psychologists over the years with no financial support from the APA.

If therapists really have special tools for helping people, shouldn’t they be able to use their techniques on themselves? University of Scranton psychologist John Norcross and his colleagues have studied this issue extensively with two major findings.

First: “Therapists admits to as much distress and as many life problems as laypersons, but they also claim to cope better. They rely less on psychotropic medications and employ a wider range of self-change processes than laypersons.”

This sounds encouraging until it comes up to Norcross’s second finding: “When therapists treat patients, they follow the prescriptions of their theoretical orientation. But the amazing thing is that when therapists treat themselves, they become very pragmatic.”
In other words, when battling their own problems, therapists dispense with the psychobabble and fall back on everyday, common-sense techniques- chats with friends, meditation, hot baths, and so on.

But aren’t psychotherapists required to be in therapy at various points in their careers, so that they get specialized help from their colleagues? No so, “People are shocked when they learn this isn’t true,” says Gary Schoener, who directs the Walk-In Counseling Center in Minneapolis, perhaps the country’s first and last free psychology clinic. “Lawyers are subjected to more psychological screens than psychologists are.”

Surveys do indicate that most therapists- between 65 percent and 80 percent have had therapy at some point, but they are not required to do so.

So you have gotten into therapy because your life is falling apart and now you have to keep one eye on your therapist just in case his or her life is falling apart, too?

Basically, yes. Like it or not, the client probably is carrying the major responsibility for spotting the signs of distress or impairment in your therapist, especially if you are seeing an independent practitioner.

The current president of the California Psychological Association, Steven Bucky, puts it this way: “The truth of the matter is that unless someone complains about an impaired therapist, there is no protection for the client.”