February 2, 2007

What Goes Wrong In A Psychiatrist's Family?

So maybe I am generalizing a bit, but I'm trying to get at something that isn't easily explained by science: why do so many psychiatrist families go bad in the same way?

In my experience (see, there's my disclaimer) psychiatrist-parents go wrong in a very specific way. They judge behavior, not the person.  It sounds like a good thing, I know.  For kids, it's a disaster.

Psychiatrists identify the behavior, but then focus on changing not the behavior directly, but the underlying cause of the behavior-- which is still not something intrinsic to the person.  If a guy with bipolar spends $10,000 in a week, psychiatrists link the behavior to the bipolar, and then try to medicate the bipolar.  (NB: "the patient has bipolar," not "the patient is bipolar.")

The obvious problem here is that maybe the guy spent $10,000 in a week because he doesn't give a damn? Or he wanted to impress some girl? i.e. just because someone has bipolar, doesn't mean every breath he takes is related to bipolar.  Psychiatrists are going to deny that they make it so simple, but in actuality they do: the moment you raise the dose of Depakote, you are sending the message that the behavior was related to bipolar. 

The psychiatrists with children-patients handle their kids in the same way.  They teach them what they are allowed to do and what they are not, what is acceptable and what is not-- but make no judgment on the kids themselves. Doing this denies the kid's identity, which is the whole purpose of childhood to begin with.  Rules then exist in an invented framework, or worse, in a vacuum.  There's no internalization of the rules; there's no superego.  Just some arbitrary limits on id.

If you tell a kid that a behavior is unacceptable, the kid has learned nothing about himself; he's only learned that this one thing is something he can't do. But if you make the kid own it-- make the behavior part of his identity, then he has a chance to change his identity.  Instead of learning it is unacceptable to take his brother's potato chips away, he can learn that he has a choice: to be the kind of person who takes chips, or the kind of person who doesn't. 

I understand the trickiness of this; you don't want to make the kid feel like he is a bad person.  But you do have to find a way to teach him that if he does that thing again and again, then he is a bad person.  Is that what he wants?  Who are you, kid?  Who do you want to be?  This also allows his to take personal credit for doing something good:

And you can see the creation of a future borderline here.  For God's sake, will someone please tell me who I am?  Give this storm of emotions some context?  Right now, I get angry/sad/thrilled/terrified over nothing, it just comes over me-- I wish I could be angry/sad/thrilled/terrified over something.  But all people ever do is tell me what I can and can't do.  If I do something bad, people freak. If I do something good, no one even notices.  No one likes me for me, they just over/underreact to what I do.

There's a second lurking trouble: parents' control of their affect. 

The psychiatrist isn't supposed to get mad at his patient; but then he comes home, and tries very hard not to get mad at his kid-- just tells him the behavior is unacceptable, gives him a time out, whatever.  But guess what?  The psychiatrist is exhausted, eventually his patience runs out, and BAM! a tsunami of anger.


The explosion part can come at any time, depending on how much patience the parent has that day.  And that's exactly the problem.  What does the kid learn? That this ethereal rulebook for what is acceptable and unacceptable only has two, binary results: no affect, or all affect-- and you never know what you're going to get.

In the biz, this is called inconsistent parenting.

What the kid needs to know are the rules of the game; they need the parent to be consistent, predictable, so that they can be safely chaotic, experimental, exploratory off of your foundation.   You want her to know exactly how you'll react if she tries pot, you want a superego so well constructed you're superfluous.   And you want levels of emotion, different things get you more or less angry.  We know you went berserk because your boss is a big jerk whose been riding you all day, but your two year old thinks you went berserk because she spilled the milk.  Geez, sorry.  May as well try heroin, what's the difference?

It doesn't necessarily mean you have to be an angry parent-- your predicted reaction could be anxious acceptance or loving disappointment-- but it has to be predictable.  And it has to be about the kid, not the behavior.  The kid needs to know you're connecting with them, not what they do, or else they'll think that the only way to connect is by behaviors.

You can see the further development of a borderline here: what the hell do I have to do to get some emotional response from you?  Kill myself?  Keep pushing until you finally blow up?  I don't even feel like I'm alive, but I'm not sure that you are either-- or is it just me, that I matter so little that I can't even get a little affect? You're insanely jealous if I talk to another guy, but you totally ignore me when I'm with you. At least with jealousy you're being real with me. Etc.

Trust me on this: at age 2, a kid feels your rage and your love the same.  It's exciting, and they haven't yet learned to fully differentiate the two feelings.  What counts is the amount of emotion, not which emotion.  (Horror movies and porn are the same to a 14 yo for this reason.)  Fast forward 20 years-- that all-out screaming match with your boyfriend felt weirdly relaxing.

And so you have a scenario: busy psychiatrist, often tired, can't generate much emotion past anger-- and it can come at any time.  No deep connection with the child as a person-- as their kid, yes; as the sum total of their behaviors, yes-- but not as a developing individual.  The kid learns that as long as some things are done correctly-- e.g. school-- they can get away with other things that the parent won't notice, e.g. pot.

Oh, and this is the best part: if the kid (adult or child) becomes a psychiatric patient, they now have a bond with their parent-- and the parent's over-involvement in their kid's psychiatric care is the framework for a relationship.  It's analogous to helping them build a go cart. 

And that's all the kid ever wanted anyway.


Oh, glad to hear to hear th... (Below threshold)

February 3, 2007 8:49 AM | Posted by Whatever: | Reply

Oh, glad to hear to hear that psychiatrists can be inconsistent too. I thought it was only the rest of us.

So when does it all stop being the parent's fault?

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Whatever commented: "So whe... (Below threshold)

February 3, 2007 2:29 PM | Posted by annekat: | Reply

Whatever commented: "So when does it all stop being the parent's fault?"

So, Whatever, your view seems to be that the parent is always held responsible.

Did you stop to consider that parenting style actually can impact the way a child grows up? Huh. Isn't that revolutionary.

The author is saying that there are very specific ways that psychiatrists are taught to deal with people that may cause their parenting to create certain problems. Their children may grow up messed up, because they were raised weird.

I'm sure your own children are being raised badly as well, but this is a blog post specifically about how PSCHIATRISTS can make parenting mistakes.

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To: WhateverI'm no... (Below threshold)

February 3, 2007 4:25 PM | Posted by Admin: | Reply

To: Whatever

I'm not sure...

Though my point about the parents wasn't that all patients' parents are to blame , but rather that patients' parents who are psychiatrists are usually to blame.

And also, not all psychiatrist's kids go on to be patients, but that if they do, it is usually with the same cluster of problems.

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And now I see that Annekat ... (Below threshold)

February 3, 2007 4:27 PM | Posted by Admin: | Reply

And now I see that Annekat already pointed this out. Thanks, annekat.

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Just wanted to say that my ... (Below threshold)

February 4, 2007 7:01 AM | Posted by Whatever: | Reply

Just wanted to say that my antagonistic comment was not directed to the good doctor himself. It was out of place. Thanks for your answers anyway.

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Uhm.. in "Wovon man nicht s... (Below threshold)

February 4, 2007 3:09 PM | Posted by Sven: | Reply

Uhm.. in "Wovon man nicht sprechen kann, daruber muss man schweigen", darube should be darüber and you should at least give credit to Ludwig Wittgenstein, who said it!

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Uhm.. in "Wovon man nicht s... (Below threshold)

February 4, 2007 3:11 PM | Posted by Sven: | Reply

Uhm.. in "Wovon man nicht sprechen kann, daruber muss man schweigen", daruber should be darüber and you should at least give credit to Ludwig Wittgenstein, who said it!

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I don't know about all the ... (Below threshold)

February 4, 2007 4:10 PM | Posted by Me: | Reply

I don't know about all the other children of psychiatrists out there but I am the product of two and I have an alternate theory based on my experience. What is one reason why people become psychiatrists as opposed to cardiac surgeons, OB/GYNs, or Dermatologists? It's not the money. It's not the prestige. It's because mental discomfort resonates with them. They are invested in alleviating it. And why is that? Because they or someone close to them (like a family member) has experienced it. And this stuff is fabulously hereditary. And growing up in a home with a depressed or withdrawn or obsessional parent/psychiatrist gives a template for future behavior. In my family, the genes are stacked against us in terms of mood. And lo and behold: bright, happy, well-socialized children become depressed, obsessional, and anxious as they grow older. It's nature and nurture. Fortunately, my parents were consistent, loving, and involved. I received no therapy or medication until I was ready for it, in college. And I'm not the happiest or most stable person in the world, but I'm a functioning, intelligent, and empathetic person... who's thinking about becoming a psychiatrist. And adopting.

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Its worth looking at... (Below threshold)

February 5, 2007 11:16 AM | Posted by AK: | Reply

Its worth looking at the process of socialization/self selection that causes persons to embark on the pre-medical track in high school/undergraduate years, then medical school, and then what type of person within this special human cluster chooses psychiatry.

((I tried to succeed on the pre-med track and eventually faced that I hated it and my grades kept slipping. So I know the pressures))

1) Kids who do pre-medical academic study may be pushed into this by anxious parents, or may themselves embark on pre-med because they feel anxious to prove themselves worthy by opting for lives of high achievement.

2)All the time spent getting A's in difficult mathematics and hard science courses is time subtracted from the process of adolescent self discovery and time subtracted from learning friendship and intimate relationships. Unless a child is exceptional, it is very hard to find ways to achieve a level of social and emotional development commensurate with high academic achievement.

3) The competitiveness and pressure only get worse if one arrives at medical school. One risks losing sight of the warmth and idealism that led one to wish to become a doctor in the first place.

4) The medical machismo toughening process in medical school and residency can also cause numbing on top of whatever troubles a young person already has.

5) Its very difficult in such circumstances to figure out who you are, what kind of person you want to spend your life with--and you risk partnering with someone who has a similar pattern of emotional scarring. Meanwhile persons who want someone who is fully available for adult intimacy and play may not want to get involved with a time pressured medical student or resident.

Persons who do try to marry doctors may do so for reasons of greed or social ambition. In college I met a sorority girl who told me she intentionally studied at the medical library. She was determined to capture and marry a doctor. Yuck.

Finally when someone like this marries and has children, they are rarely home or if they are home, may have difficulty being emotionally available.

And if on top of all this a psychiatrist parent takes the easy way out of 'psychologizing' relationships with the children, that's going to be crazy making for the kids. How can a child dare to imagine that Mommy or Daddy could be mistaken--especially if Mommy or Daddy is a psychiatrist?

The power imbalance that the professional title brings to the parent child relationship brings additional complexities.

Suppose the child acts out his or her distress at school or in playgroup. How can the teachers or the nanny dare to challenge the kid's parent when that parent is a psychiatrist?

Its tough.

Again, for additional edification, get and read 'Children of Psychiatrists and Other Psychotherapists' by Thomas Maeder.

It can be found on alibris book search

'Me' says something very interesting--that persons already sensitized to human suffering may be likely to self select and become psychiatrists.

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This may be an example of ... (Below threshold)

February 8, 2007 9:18 AM | Posted by AK: | Reply

This may be an example of what the author is describing. On a parenting forum, a mother wrote in concerning herself and her 14 year old son ('DS' is short for 'dear son'--a peculiar affectation of this particular forum)

When is this going to end? 02/07 17:37:54

My DS acts like I owe him something.I have been sick all day with what I think is the start of the flu.

I had to run errands that had to be done but he still wanted to go to the mall to buy new clothes which I told him we would do the other day. I am just not feeling up to walking the mall.

I told him that we would go this weekend but he is now being an ass to me.

When will this stop? I am so mad. I can not even be sick for one day without the natives going wild."

Later she wrote

He is sitting on the back patio right now. 02/07 17:57:27

I went out and asked if he wanted to come in and eat since I made dinner.

Thanks for the advice people.

Maybe you liek being told to Fuck off but I know I don't. I want to leave him outside for the night now.


I wanted to whack him one but I new I 02/07 18:02:09

would just feel terriable for it later.

I don't like punishing him when I am mad. I owuld rather just wait until I am calm and then strike.

DH is out to dinner with a new client. I was suppoosed to go but I feel like shit. (unquote)

Now...given how this 14 year old child behaved, how on earth could an ailing mother give a timely effective response that would not be an angry response?

If she waited until she could respond without anger, so much time would elapse that the kid would not get a sense of cause and effect lesson that lack of empathy will entail loss of priviliges--and loss of respect from the person the kid is browbeating.

The worse someone behaves, the harder it is to respond calmly to them, anyway. Seems to me if we stay polite even when children and others are being nasty, they wont discover that being treated politely is a privilige,not something they are entitled to.

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Me's post is quite insightf... (Below threshold)

February 8, 2007 10:33 AM | Posted by Dr DJ: | Reply

Me's post is quite insightful and it highlights something that therapists have known about for years, i.e. very healthily, well adjusted people have poor abilities in helping those with difficulties. I mean, how many bad psychiatrist in therapy jokes and sketches can you remember?

I quote Dr. Robin Skynner as I can't find a better way of expressing it, "If you're trying to climb a mountain, the guide who's most helpful is the one who's just above you and can guide your next step. The chap who's 10,000 feet further up isn't much use"

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Dr. DJ, I strongly d... (Below threshold)

February 10, 2007 4:49 PM | Posted by Anonymous: | Reply

Dr. DJ,
I strongly disagree. I would much prefer someone who is well balanced, well adjusted treating me than one who isn't. In fact, I think that's part of the problem in the mental health field - there are many who go into it to work out their own problems. The last thing a patient needs is treatment by somebody who doesn't have their own crap together.

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To Anonymous, I agree with ... (Below threshold)

February 11, 2007 9:15 AM | Posted by Dr DJ: | Reply

To Anonymous, I agree with you whole heartedly and I think you have misunderstood the point of my post. What I'm trying to say is that there is likely a normal distribution of balanced and adjusted people, i.e. a small minority of very poorly adjusted and balanced people, a very small minority of very well adjusted and healthy people and the vast majority somewhere inbetween. The very small number of people who have been very well nurtured all their lives, adjust to change well and are healthy 'balanced' individuals are most unlikely to have suffered the emotional trauma and difficulties that most people have experienced. How can these rare people 'work through' the problems of those with psychological distress if they've never had to do it themselves? If you ever meet anyone like this, the common reaction is one of, "bloody do-gooders, what do they know of my troubles?"

Here in the UK, it is mandatory that all psychotherapy trainees undergo therapy themselves, and psychiatrists in other fields are also encouraged to explore personal issues be it in dynamic therapy, CBT or commonly in Balint groups. The question I ask you is this; would you feel more comfortable if your psychiatrist has their own 'baggage' (vast majority of the general population) and has overcome it and knows how to do it and can guide you to do the same, or would you prefer a psychiatrist who has never had any baggage to start off with (the vast minority)?

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Dr. DJ,You asked: ... (Below threshold)

February 11, 2007 4:38 PM | Posted by Anonymous: | Reply

Dr. DJ,

You asked: "Would you feel more comfortable if your psychiatrist has their own 'baggage' (vast majority of the general population) and has overcome it and knows how to do it and can guide you to do the same, or would you prefer a psychiatrist who has never had any baggage to start off with (the vast minority)?"

I think the answer to that is, it depends. Certainly anyone that lives long enough is going to have some baggage, but I don't think that a psychiatrist or therapist has to necessarily have experienced the same thing I have been through in order to be helpful. In fact, I would rather they hadn't. I'll give you an example. I had a psychiatrist who was (probably still is) in a bad marriage. To make himself feel better he used his therapy sessions to hit on his female patients. That experience left me feeling pretty jaded about the therapy field in general, it betrayed my trust, and it also cost me financially. The therapist that helped me out of that mess has, as far as I know, never been hit on by a psychiatrist. Yet, she had empathy and helped me to find direction after that difficult time. I think there's a danger of the psychiatrist/therapist identifying too closely with the patient's problems, and when that happens it's detrimental to the patient. I like the idea of therapists going through therapy before being licensed - maybe it would weed out some of the psychos.

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Well anonymous, I can't rea... (Below threshold)

February 12, 2007 9:12 AM | Posted by Dr DJ: | Reply

Well anonymous, I can't really comment on your experiences as I don't know you, but I do apologise for not making myself clear again. I just wanted to point out that inherently very well adjusted human beings are few and far between and likely to have little inclination to work in this profession. That is all. I hope that I haven't misled you into taking my oversimplified arguement too literally. This is a fundamentally complex area and I mean to cause no offence.

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The analytic ideal of the n... (Below threshold)

February 12, 2007 10:41 AM | Posted by Admin: | Reply

The analytic ideal of the neutral therapist certainly reduces these complications, and so whether or not a therapist is well adjusted may be unimportant so long as they maintain neutrality in the session. (e.g. Hannibal Lecter was, possibly, a great analyst, provided he never let on he was eating people.)

On the other hand, if therapy is a relationship like any other, even a maladjusted therapist might be able to do a good job as long as he's able to deal with the transference that develops. "I know I hit on you (and I probably know that it was wrong and I should work on not being an idiot) but let's work on why you reacted that way (scared/angry/thrilled, etc?)"

My point is not that this could ever happen (if you can't keep it in your pants, your not going to be empathic and savvy enough to be able to work on transference), but to suggest that progress in life comes from learning why you act the way you do, why you are the way you are, and then making the appropriate changes.

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Dr. Dj,You caused no... (Below threshold)

February 12, 2007 1:14 PM | Posted by Anonymous: | Reply

Dr. Dj,
You caused no offense at all. I suppose I was thinking more about people who are in the field who go into it because of their own pathology, and I think that's unfortunate. I was not, however, intending to mean that people should be, or even can be, baggage free. I can't help but cringe when I hear other people who are in the midst of a lot of emotional probelms say I'm thinking about being a therapist. My gut reaction is, PLEASE don't.


I hear what you're saying but really, I don't want to have to pay (financially and emotionally) for a therapist to figure out his own problematic behaviors and then have to analyze why I then reacted the way I did. If it was the UK and I wasn't paying out of pocket, maybe then. But the bottom line is if the psychiatrist/therapist IS maladjusted then they need to get some help or get out of the field. Because the patient doesn't need the mental health professional's baggage too.

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Really serious trouble happ... (Below threshold)

February 13, 2007 11:36 AM | Posted by AK: | Reply

Really serious trouble happens if someone gets through a training program, passes the tests, is licensed to practice and then, with mastery of various and sundry techniques, goes on to function as a lone wolf therapist.

These are the ones who have genuine credentials but who do not socialize as true professionals. They are often charming, dislike accountability, and do not enjoy relationships with thier peers.

They're the ones who want to recieve positive transference and dodge negative transference.

Some of these types create what have been termed 'psychotherapy cults' and there's some literature on this.


Others who obtain training and credientials may turn maveric and cook up various quack therapies that never pass peer review but are marketed in charisma driven group settings--or they pervert psychotherapy into TV entertainment.

For a survey, Science and Pseudoscience in Clinical Psychology, by Lilienfeld, Lynn and Lohr, Guilford Press 2003 is excellent.

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AK, thanks for the link. I... (Below threshold)

February 14, 2007 1:15 AM | Posted by Anonymous: | Reply

AK, thanks for the link. It was a very interesting read (and quite accurate, I think).

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I'm going to tell this stor... (Below threshold)

February 15, 2007 12:28 PM | Posted by Texas Sue: | Reply

I'm going to tell this story even though it's not about raising kids. But I think it applies in a way. I met a psychiciatrist on an online dating site. I had my reservations about proceeding but I thought I could hang. I felt I was emotionaly healthy and had a lot to offer. We decide to talk on the phone. He calls and he's real high energy and laughing but it's like I'm not even involved in the conversation. He's very unatatched and it's not a two way conversation. He asks me a hundred questions about my family, childhood, and parents. It was rapid fire and he seemed almost like a plastic doll that could ask questions. It was horrible. I should have stopped it sooner. It comes out that my parents are divorced. He didn't view me as an individual from the beginning and now he had all the stats of kids from divorced families in his head. It's no wonder he was single even though he was cute and succesful. We didn't talk again thankfully.

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Wow! Were you watching my c... (Below threshold)

February 24, 2007 5:02 PM | Posted by Karen: | Reply

Wow! Were you watching my childhood? My step-father was a good ol Freudian psychiatrist. It used to drive me nuts when I needed help and asked, "What do you think I should do." His answer was ALWAYS, "tell me what you think you ought to do."
To make matters worse I grew up living on the grounds of a NP VA hospital. All of my friends were the children of psychiatrists. I could write a book!
One time I questioned my dad, saying something to the effect of why are you acting like this--you're a psychiatrist! His answer, "That s**t doesn't work on your own family."
Needless to say I see a psychiatrist, psychologist and a therapist. I have dealt with depression since age six (according to dad). I have Bipolar II with major depression and TRD. I'll be getting VNS on 3/1.
Personally, I think that the children of psychiatrists should receive free care from psychiatrists for life! It seems only fair that they clean up each others parenting disasters.
Thanks for this great posting.

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My X-inlaws decided to tell... (Below threshold)

March 13, 2007 1:10 AM | Posted by Anonymous: | Reply

My X-inlaws decided to tell my doctors that I lied about being sick; I was diagnoised with major depression-suicidal-hospitalized and took over a year off from work. (my X-inlaws where never in my life at the time)-funny the doctors believed them and I could not get proper care for 2 1/2 years. I finally got better-told my x-inlaws off. I lost everything. No apology-just insults.

I hope this doesn't happen to anyone else- I tried to take my life because I needed the pain to stop-but it never did and I wonder what my life will be like because of what they did-I can't wake up and feel happy-I am scared for life. I can't believe how many doctors and people just don't care

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