A Straight Dope Classic from Cecil's Storehouse of Human Knowledge

Are shrinks nuts?

September 28, 2012

Dear Cecil:

Is it true that, as a class, psychotherapists and other mental health professionals are crazier than average? And that despite their training and experience, they can recognize their own issues less readily than the average nutcase?

Cecil replies:

I defer judgment on whether shrinks don’t recognize their problems. On the contrary, there are indications some mental health professionals enter the field because they do recognize their problems and think their work will help them get a grip.

I can hear you saying: that’s like becoming a cop so you can work on your anger management. Please, a little sympathy. The best way to understand shrinks is to put yourself in their shoes.

Let’s suppose you dedicate yourself to healing the psychic wounds of others. Are you probably nuttier than average? Depends how we define nutty. I haven’t seen good evidence you’re statistically likely to hear voices, think you’re the angel Gabriel, or otherwise show signs of clinical insanity. On the other hand, are the odds decent that you'll show signs of what we might call maladjustment? No question, they are.

It’s easy to see why. Psychiatry and psychology, like police work, have long been recognized as high-stress fields of practice due to constant exposure to humanity’s dark side. In interviews with medical students about their perceptions of psychiatry, researchers found a common concern was that (as one subject put it) “working with crazies will make you crazy.”

For all that, the prevalence of mental disorders among mental health workers didn’t receive much attention until the 1980s. A widely noted study from 1980 found 73 percent of psychiatrists had experienced moderate to incapacitating anxiety early in their careers, and 58 percent had suffered from moderate to incapacitating depression.

To some extent this is simply a result of working in medicine — physicians in general suffer from higher stress levels and depression than the general population and have a higher suicide rate. But research suggests mental health specialists are particularly at risk. One British study found psychiatrists had nearly five times the suicide rate of general practitioners, and U.S. research indicates psychiatrists commit suicide at two to three times the rate of the general population.

Similarly, depression, stress, and burnout are high among physicians but higher among psychiatrists; the same is true of alcohol and drug abuse. Psychiatrists have a divorce rate 2.7 times that of other physicians and as much as five times that of the general public. From a quarter to a half of psychiatrists say they’re suffering from burnout at any given time.

A study of more than 8,000 Finnish hospital employees found the psychiatric staff was 81 percent more likely to suffer from a current or past mental illness and 61 percent more likely to miss work due to depression. Psychiatric staff were twice as likely to smoke as other hospital staff and had much higher rates of alcohol use. A 30-year study of 20,000 UK medical workers found psychiatrists were 46 percent more likely than their peers to die from injuries and poisoning, and at 12 percent greater risk of dying overall.

If you were a woman in the mental health field, Paul, you’d have an especially tough time of it. Compared to other female physicians, female psychiatrists have a 67 percent greater likelihood of suffering from psychological problems, primarily depression, and have a 26 percent greater likelihood of having a family history of psychological problems. They’re twice as likely to smoke, drink 50 percent more alcohol, and rate their personal health much lower than their peers do.

As a male, you may find other ways to alleviate your stress. The California Medical Board found male psychiatrists were almost twice as likely to be disciplined for unethical sexual relationships with patients as their peers.

Many of the problems you’ll encounter as a mental health professional have a lot to do with the nature of the work — hey, skimming through my inbox any given week is enough to make me reach for the Thorazine. Jung called the transference of psychological problems from patient to doctor an “unconscious infection.”

Patients can get violent, either with you or themselves. Dealing with certain types of patients can be emotionally draining, such as those with borderline personality disorder or victims of sexual abuse. You’ve also got stressors such as overwork, job instability, liability fears, paperwork overload, and disciplinary actions and monitoring.

But let’s get back to the point I made at the outset. Does the mental health field attract people with mental problems? Research is thin, but some studies have found mental health workers are more likely than average to have experienced early abuse and trauma. A much-cited 1963 study reported that 24 out of 25 psychiatrists had entered the field because of a wish to explore some personal conflict.

That gives one pause. Sure, there’s value in consulting a health professional who’s been down the same road as us. But who wants their therapist thinking, “Maybe after I get this head case straightened out, I’ll figure out what’s wrong with me”?

Related Posts with Thumbnails


Bohnert, Phil and O’Connell, Anne. “How to avoid burnout and keep your spark” The Journal of Family Practice 5.1 (January, 2006).

Carpenter, Lucy M. et al. “Mortality of doctors in different specialties: findings from a cohort of 20 000 NHS hospital consultants” Occupational and Environmental Medicine 54 (1997): 388-395.

Cohen, Dora and Arnold, Elaine. “The female psychiatrist: professional, personal and social issues” Advances in Psychiatric Treatment 8 (2002): 81–88.

Cutler, Janis L. et al. “Discrediting the notion ‘‘working with ‘crazies’ will make you ‘crazy’’’: addressing stigma and enhancing empathy in medical student education” Adv in Health Sci Educ 14 (2009): 487–502.

Firth-Cozens, Jenny. “Improving the health of psychiatrists” Advances in Psychiatric Treatment 13 (2007): 161-168.

Frank, Erica et al. “Characteristics of Female Psychiatrists” Am. J. Psychiatry 158.2 (February, 2001): 205-212.

Hawton, K. et al. “Suicide in doctors: a study of risk according to gender, seniority and specialty in medical practitioners in England and Wales, 1979–1995” J. Epidemiol Community Health 55 (2001): 296–300.

Sherman, Michelle D. “Distress and Professional Impairment Due to Mental Health Problems Among Psychotherapists” Clinical Psychology Review 16.4 (1996): 299-315.

Thoreson, Richard M. et al. “The Distressed Psychologist: Prevalence and Treatment Considerations” Professional Psychology: Research and Practice 20.3 (1989): 153-158.

Virtanen, M. et al. “Health risk behaviors and morbidity among hospital staff − comparison across hospital ward medical specialties in a study of 21 Finnish hospitals” Scand J. Work Environ Health 38.3 (2012): 228-237.

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