Phil Hammond MD

'Psychoanalysts and psychotherapists are unstable.' 'And psychiatrists aren't...?'
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"Depression is contagious", a depressed psychiatrist told me on his retirement. It's a nice theory, but not one I found much support for from Matthew, his replacement. "Surrounding yourself with mental illness is very stressful and can precipitate depression in those who are disposed to it, but it doesn't cause it." He then regaled me with his theory of depression ("it's a result of altered receptor sensitivity to mono-amine transmitters in certain areas of the brain") with all the enthusiasm of someone who's become a consultant at the tender age of 32.

Explanation of mental illnesses in biochemical terms has at least given psychiatry some scientific credibility, as well as improving the drug treatment for patients, but psychiatrists still have to fight to gain acceptance from other doctors. Many regard mental illness as incurable and psychiatrists as misfits who choose the speciality to work out their angst. The "all psychiatrists are mad, depressed and bearded" stereotype still flourishes among doctors who've opted for a more macho career pathway and long ago consigned any psychiatric knowledge to the "cupboard under the sink" area of their brains. Hence although half of hospital inpatients experience depressive symptoms, these usually go unrecognised.

But are psychiatrists more prone to depression than other doctors? The often quoted statistic that a larger percentage of American psychiatrists commit suicide than their patients cuts little ice with Matthew. "There are two problems. First, suicide is not synonymous with depression. Some people make a rational decision to kill themselves because they have truly dreadful lives. Second, the US figures include psychoanalysts and psychotherapists - very unstable people" "And psychiatrists aren't?" "No. All of us feel fed up on occasion. But being stressed and fed up is not the same as depression. Depression is the closest you can come to brain death without losing consciousness - and all branches of the profession are vulnerable to it."

Interdisciplinary rankings of depressed British doctors show anaesthetists ahead of psychiatrists. This may be because of the type of person anaesthetics attracts - oddballs who can't relate to conscious patients or talk about their problems - or it may be that it's a tough job. Not only the life and death stuff, but having to listen to the ramblings of surgeons as they relive their medical school days over the incision.

Surgeons suffer as much depression as psychiatrists - but refuse to talk about it. This macho stereotype is very powerful and, says Matthew, extremely damaging: "If they can't acknowledge their own feelings, what hope have the patients got?"

Perhaps the self-destruction of the emotional side of the brain is the only way surgeons can cope with the saturation of human suffering and a lifetime's overwork in an underfunded health service. Those who don't invest too much effort in empathy tend to get higher up in the career ladder and shape the attitudes of their juniors. Such defensiveness is common in many branches of medicine, despite the support groups and counselling services available for doctors. I worked on a baby unit where the staff would gather once a month under a clinical psychologist to talk about our feelings of loss when babies died. The nurses sat up one end, crying loudly, the paediatricians sat up the other, twitching and coveting the M&S sandwiches.

Matthew believes the blame for the high levels of depression and emotional detachment among doctors are not only down to the work, but the type of student we accept into medical school. "The academic hurdle of medical school entry is so great that students have ludicrously high expectations and an obsessional need to overachieve. This creates a paranoid, competitive working environment controlled by dogma, obsequiousness and fear of failure. Many develop tunnel vision towards an unachievable goal and are unable to accept anything else. When the harsh realities of the outside world confront them, they lose control and depression can be triggered."

For doctors who have insight into their depression, help is available, though many don't seek it because of the stigma and career consequences of diagnosis. I only know two hospital doctors, both psychiatrists, who've spoken openly about their depression and both waited until they were consultants to do so. One visited a consultant outside his area, had a course of electroconvulsive therapy and is now much better. The other maintains that depression is contagious and is looking forward to a mood enhancing retirement. He deserves it.

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