David Baxter PhD
Late Founder
Where Can the Doctor Who?s Guided All the Others Go for Help?
By ELISSA ELY, M.D., New York Times Mind
June 23, 2009
Psychiatry is a relatively safe profession, but it has a hazard that is not apparent at first glance: if you are in it long enough, there may be no one to talk to about your own problems.
It is not that way when you start out. Most psychiatric residents spend a good deal of time in therapy with a senior psychiatrist, for a number of reasons ? not least, that it is the most intimate way to learn technical magic. Books teach the same thing to everyone who reads them. But no one forgets the crystalline remark their therapist made just to them, and how they viewed themselves differently ever after.
At a certain point, though, you stop being the student and become the teacher. You settle into the details of a career ? hospital, research, private practice. Roots go down, time passes. Eventually, younger psychiatrists begin to approach you. Now you are the generation above, saving early-morning slots for residents before they head off to clinic and class. You lower fees and accommodate their hurtling, insane schedules. You remember how it was.
But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?
Sometimes the situation is clear. During my training there was a formidable psychiatrist who disappeared periodically. Everyone knew she was being hospitalized for a recurrent manic psychosis, and that she would be back to intimidate the trainees as soon as medications had stabilized her.
There was an oddness about it, but no dishonor. Actually, her illness made her more impressive. We are taught to explain that mental illness has a biological component responsive to medical treatment, just like diabetes or heart disease. Her example brought conviction to our tone.
In my residency, I moonlighted in a medication clinic where an elderly psychiatrist was being treated for a dementia he did not recognize. He could not remember simple requests, raised his cane to strangers, screamed at family members; his wife met with me separately and told me she was ready to leave him.
Carefully writing ?Dr.? on the top line of each of his prescriptions, I felt undersized and overregarded. Yet he took the pills without question and showed a fatherly interest in my career. Years later, I thought maybe his wife had chosen a student deliberately. My junior status allowed him to maintain his senior status.
Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation ? the nakedness necessary in therapy ? is hard when you have been a model to others.
?In my situation, it would be difficult to find someone,? Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren?t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.
Surrendering that professional identity to become a patient reverses a kind of natural order. ?You can?t be a simple patient,? Dr. Buie said. ?Anyone I?d go to, I?ve known.? To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).
There is also the factor of experience. It is one thing if my internist is younger than I; she is closer to the bones of medicine, and with any luck we can get to know each other for years before serious illness requires more intimate contact. It is another thing if my therapist is younger than I.
?It would be a big mistake not to turn to someone,? Dr. Buie went on, ?but I might have some trouble going to younger colleagues. It?s hard to understand the issues that come up in the course of a life cycle unless you?ve lived it yourself.?
Dr. Rachel Seidel, a psychoanalyst and psychiatrist in Cambridge, said that when people feel vulnerable, ?we want someone with more insight than we have.?
?It?s a paradox,? she added. ?Do I have to have gone through what you?ve gone through in order to be empathic to you? And yet, I?d have a preference for someone who?s been around longer.?
Some look laterally for help. Peer supervision is a well-known form of risk management; presenting troubling professional cases to colleagues prevents folly and mistakes at any age.
?I use a couple of peers,? said Dr. Thomas Gutheil, professor of psychiatry at Harvard Medical School. ?Then they use me. It?s the reciprocity that?s key ? you feel the comfort of telling everything about yourself when you know the reverse is also true.?
Other solutions are even closer. The playwright Edward Albee once wrote that it can be necessary to travel a long distance out of the way in order to come back a short distance correctly. The best source of help can be the nearest source of all. An elderly luminary at the Boston Psychoanalytic Society and Institute listened without comment when asked: Whom does he ? the doctor others seek out for help ? seek out for help himself? He wasted no words.
?My wife,? he said crisply.
Elissa Ely is a psychiatrist in Boston.
By ELISSA ELY, M.D., New York Times Mind
June 23, 2009
Psychiatry is a relatively safe profession, but it has a hazard that is not apparent at first glance: if you are in it long enough, there may be no one to talk to about your own problems.
It is not that way when you start out. Most psychiatric residents spend a good deal of time in therapy with a senior psychiatrist, for a number of reasons ? not least, that it is the most intimate way to learn technical magic. Books teach the same thing to everyone who reads them. But no one forgets the crystalline remark their therapist made just to them, and how they viewed themselves differently ever after.
At a certain point, though, you stop being the student and become the teacher. You settle into the details of a career ? hospital, research, private practice. Roots go down, time passes. Eventually, younger psychiatrists begin to approach you. Now you are the generation above, saving early-morning slots for residents before they head off to clinic and class. You lower fees and accommodate their hurtling, insane schedules. You remember how it was.
But no amount of wisdom prevents personal frailty. You are never too old for your own problems. Yet when you are the professional others go to, where do you bring your sorrows and secret pain?
Sometimes the situation is clear. During my training there was a formidable psychiatrist who disappeared periodically. Everyone knew she was being hospitalized for a recurrent manic psychosis, and that she would be back to intimidate the trainees as soon as medications had stabilized her.
There was an oddness about it, but no dishonor. Actually, her illness made her more impressive. We are taught to explain that mental illness has a biological component responsive to medical treatment, just like diabetes or heart disease. Her example brought conviction to our tone.
In my residency, I moonlighted in a medication clinic where an elderly psychiatrist was being treated for a dementia he did not recognize. He could not remember simple requests, raised his cane to strangers, screamed at family members; his wife met with me separately and told me she was ready to leave him.
Carefully writing ?Dr.? on the top line of each of his prescriptions, I felt undersized and overregarded. Yet he took the pills without question and showed a fatherly interest in my career. Years later, I thought maybe his wife had chosen a student deliberately. My junior status allowed him to maintain his senior status.
Often, though, the situation is not straightforward, and medication is not the problem. Life is. Maybe we are overcome, maybe ashamed, maybe despairing. Self-revelation ? the nakedness necessary in therapy ? is hard when you have been a model to others.
?In my situation, it would be difficult to find someone,? Dr. Dan Buie, a beloved senior analyst in Boston, told me. It is not that psychiatrists aren?t waiting in wing chairs all over the city. It is that so many of them are former students and former patients. One generation of psychiatrists grows the next through teaching and treatment.
Surrendering that professional identity to become a patient reverses a kind of natural order. ?You can?t be a simple patient,? Dr. Buie said. ?Anyone I?d go to, I?ve known.? To avoid it, some travel to other cities for therapy (probably passing colleagues in trains heading in the other direction).
There is also the factor of experience. It is one thing if my internist is younger than I; she is closer to the bones of medicine, and with any luck we can get to know each other for years before serious illness requires more intimate contact. It is another thing if my therapist is younger than I.
?It would be a big mistake not to turn to someone,? Dr. Buie went on, ?but I might have some trouble going to younger colleagues. It?s hard to understand the issues that come up in the course of a life cycle unless you?ve lived it yourself.?
Dr. Rachel Seidel, a psychoanalyst and psychiatrist in Cambridge, said that when people feel vulnerable, ?we want someone with more insight than we have.?
?It?s a paradox,? she added. ?Do I have to have gone through what you?ve gone through in order to be empathic to you? And yet, I?d have a preference for someone who?s been around longer.?
Some look laterally for help. Peer supervision is a well-known form of risk management; presenting troubling professional cases to colleagues prevents folly and mistakes at any age.
?I use a couple of peers,? said Dr. Thomas Gutheil, professor of psychiatry at Harvard Medical School. ?Then they use me. It?s the reciprocity that?s key ? you feel the comfort of telling everything about yourself when you know the reverse is also true.?
Other solutions are even closer. The playwright Edward Albee once wrote that it can be necessary to travel a long distance out of the way in order to come back a short distance correctly. The best source of help can be the nearest source of all. An elderly luminary at the Boston Psychoanalytic Society and Institute listened without comment when asked: Whom does he ? the doctor others seek out for help ? seek out for help himself? He wasted no words.
?My wife,? he said crisply.
Elissa Ely is a psychiatrist in Boston.
), either through therapy myself or through clinical supervision, two are masters level therapists and one was a psychiatrist with MFT training.
