Clinicians who have lived with mental illness share how it impaired them - and strengthened them - on the job.

Publication Date: 05/27/2024

Duration: 21 minutes, 50 seconds

Transcript:

KELLIE NEWSOME: What’s it like to practice psychiatry when you yourself have bipolar disorder, PTSD, or addiction? Clinicians who’ve walked that fine line share how it impaired them, and how it strengthened them in this work.

CHRIS AIKEN: Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003. I’m Chris Aiken, the editor in chief of the Carlat Report.

KELLIE NEWSOME: And I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue.                                                

CHRIS AIKEN: In 1913, at the age of 38, Carl Jung began to hear voices. They were paired with hallucinogenic like visions, and they worried the young psychiatrist, who wrote that he was "menaced by a psychosis” or "doing a schizophrenia," a diagnosis he would have been familiar with, having worked as an assistant to physician who coined the term “schizophrenia,” Eugene Bleuler. About 1 in 50 people have normal hallucinations that are not connected to any psychiatric disorder. That’s a controversial fact, and if you want to delve into the evidence it’s based on check out our July 2019 article on normal hallucinations by Joseph Pierre, MD. Suffice it to say that – unlike psychiatric patients - these healthy voice hearers have no major functional impairments and tend to have hallucinations that are helpful, like a guiding angel. Some have other clairvoyant powers, and function in society as ministers, soothe-sayers, or psychics. Several of Jung’s relatives – including his mother – had such clairvoyant powers. Jung’s experience was frightening at first, but he came to see it as a valuable encounter with his subconscious mind. He leaned into it, actively inducing more visions in private by exercising his imagination. Jung recorded these visions in a red leather book that his family kept hidden after his death. It was finally published in 2009 as the “Red Book” complete with an imitation leather cover. It reads like one of the prophetic books of the Bible:

KELLIE NEWSOME: “I saw a terrible flood that covered all the northern and low lying lands… from England up to Russia… I saw yellow waves, swimming rubble, and the deaths of countless thousands. …the spirit of the depths gave me this word…I am the serf who brings it and does not know what he carries in his hand. It would burn his hands if he did not place it where his master orders him to lay it.”

CHRIS AIKEN: We brought Jung into this podcast because he introduced psychiatry to the archetype of the wounded healer. We don’t know what the wounds were that drove Jung toward the deep, empathic stance he developed as a therapist, but I doubt it was these psychotic like symptoms, which he seemed to view as a portal of healing rather than a wound. Jung was isolated as a child, bullied in school, and at home lived with a distant father and a mother who suffered frequent bouts of depression. When Jung was just 3 years old, his mother had a nervous breakdown and spent several months in hospital.

KELLIE NEWSOME: Today we’ll hear from clinicians who work at a very high level as psychiatrists, psychiatric NPs and PAs, or psychotherapists, despite significant psychiatric symptoms. Among them are people who have had hospitalizations, suicide attempts, and times of work related disability. Many had bipolar disorder, and described how the two poles of mania and depression affected them at work. I’ll read from a nurse practitioner who asked that we disguise her voice

“We have three moods in bipolar disorder – up, down and mixed – and all of these affect work in different ways. Maybe your memory is impaired in a depressive state, and in a manic state your mind is going so fast that you can’t hear what your patient needs. I think you’re more at risk if you choose to work in an active manic episode – maybe you’re going so fast and distracted that you give the wrong medication. That’s why it’s our duty to take a step back and check ourselves – take some PTO or medical leave – whatever you need to do to protect your patient and yourself and your license.”

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KELLIE NEWSOME: For a therapist with schizoaffective disorder, understanding what normal is was part of his recovery, and a critical part of his clinical work. He asked we read his words:

CHRIS AIKEN: “You don’t know what normal is if you’re sick – I’m using that term in air quotes – but you don’t know what healthy is if you have a psychotic disorder, or at least I didn’t. Let’s just say that. But learning the precepts of psychological health – I was like ‘Oh, I only have that sometimes.’ It was a long path to figure out what was normal – a lot of education, a lot of therapy, a lot of talking to other people and a lot of books.”

CHRIS AIKEN: Many cited external motivators to stay well – they were keenly aware of how dangerous their symptoms could be to their patients, their practice, and their families. Others added that the memory of how miserable they felt during depression or how chaotic they became under the influence of alcohol was motivation enough.

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A psychiatrist advised that one of the most important things family can do is to come to the doctor’s office, to share what they are seeing in their relative, and to bring some hope back with them:

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KELLIE NEWSOME: These healers understand that deep suffering sometimes requires serious or risky interventions. Many shared that their experience had taught them not to minimize dangerous symptoms like suicide, addiction, mania, and depression. They didn’t shy away from using intensive treatments like day programs, ECT, or lithium when needed, even though they knew first hand what kind of side effects those treatments bring:

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CHRIS AIKEN: The clinicians we spoke with tried ECT, vagal nerve stimulation, lithium and antipsychotics, and though these pulled them out of deep episodes, none of them achieved full recovery through medication alone. Some drove to other cities to take part in support groups. Exercise, sleep, and social supports were key to their recovery, as was getting rid of caffeine for this psychiatrist with panic disorder. 

CHRIS AIKEN: As helpful as treatment is, these healers also understood how difficult treatment is to stick with it:

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KELLIE NEWSOME: Let’s pause for a preview of the CME quiz for this episode. Earn CME for this podcast through the link in the show notes, or click on Podcast under the multimedia link on the Carlat Report website.

1. Which medication can cause patients to struggle with high appetite even if they do not gain weight, according to a psychiatrist who tried it himself?

A. Lithium

B. Haloperidol

C. Valproic acid

D. Quetiapine

CHRIS AIKEN: One thing that struck me in was the lack of burnout in these clinicians. We can debate whether burnout and depression are the same thing – but for these 14, the personal experience of mental illness inspired their work. Many felt a sense of awe at the privilege of giving back to others who had some of the same struggles they went through.

KELLIE NEWSOME: From an NP who asked that we read her words:

“Hope is very powerful, but it’s also very fragile. We don’t have to cheerlead, but if we can keep hope alive than we are doing something for our patients. I feel so blessed that I get to do this, and that prevents burn-out. It’s inspiring, I mean where else do you get to pretend to be sane all day long.” 

CHRIS AIKEN: That concludes our Wounded Healers series. Thank you for coming with us on the journey, and thank you to each clinician who led the way.

KELLIE NEWSOME: Everyday Dr. Aiken posts a practice-changing research update, and you join the conversation on LinkedIn, Twitter, Facebook or Threads, just search for Chris Aiken MD. Thank you for helping us operate free of commercial support since 2003.

The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one quarter (.25) AMA PRA Category 1 Credits^TM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity.