THE HUMAN CONDITION: Cheer up: your shrink's probably more depressed th an you are

Your therapist will have sorted himself out before he starts on you. Won't he? Not necessarily, says Hettie Judah
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Humour is often a mask for disturbing truths, claimed Freud. Now, after the years of side-splitting mirth provided by that favourite workplace slogan, "You don't have to be mad to work here - but it helps!", we discover that it might just be right. Practitioners in certain areas of mental health, it has been claimed, enjoy a distinct professional advantage if they are armed with a spot of experience from the other side of the couch. Which is fortunate, since a recent article by American psychologist Robert Epstein published in the magazine Psychology Today suggests that all is not well in shrink city. Mental health is fast becoming the field where "the odd care for the id".

The thrust of Epstein's argument is that mental health professionals do a poor job of monitoring their own mental health. In theory, many people enter the field because they have a history of psychological difficulties (Freud, a superstitious, neurotic agoraphobic with an occasional cocaine habit, being no exception). This tallies with an American Psychiatric Association study which concludes: "Physicians with affective disorders tend to select psychiatry as a speciality". Dysfunctional, abusive and alcoholic family backgrounds were also more prevalent among mental health professionals than other health workers.

The profession itself is inherently hazardous to both physical and mental health. An estimated 40 per cent of therapists are actually attacked by their clients. Between 20 and 30 per cent experience the suicide of at least one patient. At its most basic level, the job involves listening to an almost never- ending succession of serious problems and grim world views. According to Epstein, mental health professionals kill themselves at an unusually high rate: almost twice that expected of physicians. It is a high-stress job, in which the professionals turn to drink and drugs for solace. Some even become addicted to the work itself and find retirement particularly difficult to face.

Despite all this, psychotherapists are unlikely to seek therapy, often because of feelings of embarrassment or professional superiority; even therapists mistakenly see therapy as a form of failure. Far from being a sign of professional impairment, it is often the therapists who don't seek help who are in the most trouble.

Epstein concludes that since the therapists seem incapable of looking after themselves, the onus is on you, the little guy, to spot the therapist in trouble. As he puts it, "If, during your session, a little voice begins screaming `This guy's eyes remind me of my college roommate's when he was tripping on acid', don't be afraid to ask questions."

A number of former clients were only too happy to tell me about the incipient craziness they had witnessed in their shrinks. Yet often it was the method of practice itself which seemed bizarre.

Sarah described a shrink she visited while living in Geneva. "His room was full of big soft cushions and you were given a huge stick: you had to pretend the cushion was your brother or boss and belabour the cushion, while he stood there saying `Harder, harder'. We had to do a lot of talking to chairs. The worst thing he did was, every session he would ask me: `Can I hold you like a baby?' I would never let him, so of course we would have sessions about why not. Finally I did agree, and it was the single most embarrassing experience of my life. I never went back after that. I had been seeing him for a year and a half, and he definitely made me worse, not better. But the problem is, you can't shop around for a therapist like you can for a dentist." Another friend told me that his psychiatrist had suffered a nervous breakdown, but, he quickly added, "I'm sure that it wasn't my fault."

Since little similar research seems to have been carried out in Britain, it is hard to determine whether mental health work here also attracts individuals from affected backgrounds. Dr Stephanie Ansel did six months in psychiatry as an senior house officer and is now considering specialising. She is circumspect about her own motives : "My mum has had mental health problems, but if anything that would put me off going into psychiatry; it brings it too close to home, somehow". What she did witness with surprise was the relaxed attitude towards alcoholism amongst her colleagues. "There was another SHO in my department who was a really heavy drinker - he would come in in the morning smelling of it. It was discussed once or twice, but mainly it was brushed under the carpet - they just said `He can cope with it'. Doctors drink pretty heavily in general. He was very good at the job, but he did definitely indulge."

Doctors in general do indeed drink pretty heavily. "The rates of alcoholism and drug abuse, mental illness and suicide among health care workers, especially physicians, are elevated significantly beyond that of the general population," states a 1987 report. Indeed most of the problems identified by Epstein are common to all health care workers. As an area of employment it is right up there with air traffic control in terms of stress.

What does set psychiatrists apart is that a little first-hand experience does not seem necessarily to be a bad thing. As Epstein puts it, "Having crazy 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 very best therapists we have."

One area where this certainly seems to be true is in alcohol and drug addiction treatment. "It is incredibly beneficial if you have a trained professional with long-term stability who is in recovery," says Steve Stephens, Hospital Manager of the Nottingham Clinic, an alcohol and drug addiction treatment facility. "People who have suffered with an addictive illness are often drawn to helping other people with addictive illness, partly to offer the means by which they found sobriety to others".

So is Britain awash with nutty shrinks? Oliver James, clinical psychologist and author of Britain on the Couch, a study of depression published last week, is not persuaded. "It is something that the great British public would love to believe ,that shrinks are all like Peter Sellers in What's New, Pussycat? Anybody who suggests it is in a way pushing an open door. In theory there is a kind of logic to it - people who can't solve their own problems and who have a number of them are more likely to be using their mechanisms to cure other people's, but I'm not really convinced of it.

"To be perfectly honest, I'm not sure that they are any more screwed up than the rest of us."

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