How do healthcare professionals balance empathy with detachment?

January 15, 2007 10:19 PM

Doctors, nurses, therapists, social workers, health professionals of any and all flavors: how do you dissociate yourselves from the misery, suffering, and death of your patients or clients?

I'm seriously contemplating going to medical school to become a psychiatrist. Without going into too much autobiographical detail, the prospect fits in a way no other prospects ever have - the best way I can describe it is that it seems a natural outcome of the way I'd like to live my life anyway, in an ideal world, if that makes any sense at all. I've thought carefully about it, and having the M.D. is very important to me - medical training combined with training in psychotherapy is exactly what I want in graduate study and in a profession.

My biggest concern, though, is that I'm overwhelmingly, almost pathologically, empathetic. Like the most overly sensitive emo bitch you ever saw. Like sobbing uncontrollably when my sister and I stopped the car one time to remove a dead cat from the middle of the road (we hadn't hit it - i can only imagine the hysterics if we had). Like not being able to watch game shows because I feel too bad for the losers. Like still getting spine-chills while remembering mean things I said to people in grade school. Even if I learn to tone this down through therapy or whatever, I'm always going to be a very sensitive person, prone to taking on others' problems as my own.

Obviously, I think empathy is essential in any healthcare profession, but it seems like there needs to be a delicate balance between this and detachment, so that the suffering you face daily does not overwhelm you. And I'm sure the thrill of helping people heal does counterbalance this, but still: how do you deal with this? Does it require extensive psychological acrobatics, or does detachment come naturally over time? How do you avoid ending up a sour, burnt-out alcoholic?

(My own squeamishness is another possibly related concern, but I suspect I'll get over that a couple weeks into my first-year residency, if not sooner, yes?)

posted by granted to human relations (16 comments total)

I worked for 5 years as an optometrist's assistant (in a medical office, not a "let's sell as many glasses as we can" office)... I don't know if you'll consider my experience to be worthwhile in terms of your question or not, but I found that my empathetic tendencies were an asset rather than a hindrance... I was able to commiserate with people who had very difficult situations (medical, emotional, financial) and I was able to make them feel comfortable and understood...

I think dissociation happens automatically... When you're on the job you assume one "role" and when you are off the job you assume another "role"... It's something that happens automatically for each individual person...

You state that you are contemplating a career in psychiatry, and I know anecdotally that a lot of people who are extremely empathetic are drawn to that field... I, personally, would rather have an empathetic psychiatrist than one who is cold and detached... I congratulate you for wanting to pursue such a noble field, and I wish you the best of luck.
posted by amyms at 11:16 PM on January 15, 2007

Dissociation is not how you deal with this. You integrate it into your worldview. If you take care to keep your early experiences positive you can integrate these things in healthy ways.

For this you need unflinching honesty, which is to say, you need to have a desire not to be deceived. If you would prefer not to think about, or think falsely about, the reality of what is going on around you, it's hard to help others.
posted by ikkyu2 at 11:20 PM on January 15, 2007

I've worked as a front line staff and supervisor working with people with developmental disabilities and mental illness for about 12 years now. The way I stay sane and not burnt out is to 1) separate your work life from your other life as vigourously as you possibly can. 2) Be professional, realize your job is to make things better for those you serve and work towards that no matter how you actually feel about the person. Work towards that equally for all those you serve (this is the professional part), realize just because someone is sick, or has a disability does not make them any better or worse then members of ANY population. You will run into saints and bastards and most often people in-between. Your job is not to refuse to work with some over the other.


Try and cultivate that what you do for a job need not be the sole defining (or even the major defining) characteristic of who you are.
posted by edgeways at 11:37 PM on January 15, 2007

I am not a medical professional but I strongly considered going to medical school for psychiatry last year, and I would strongly suggest that you personally talk to several psychiatrists about your concerns and (importantly) volunteer in a medical setting with psychiatrists before you devote 8 years of your life to becoming a psychiatrist. Psychiatry is a very rough profession, and even people with tough skin have a hard time dealing with some of the issues you raise. I don't think a bunch of anonymous people on the internet, or even people who know you, can answer the question "is this right for me" - I'd encourage you to put yourself in the situations you will be facing so that you can come to an answer for yourself.
posted by btkuhn at 1:00 AM on January 16, 2007

i doubt btkun's suggestion to work voluntarily with psychiatrists is possible.

but having worked in a caring profession i can tell you that the only way to survive is recognise your own worth in the equation....as edgeways said. and make sure you're always trained to do the job you're doing.

and have constant professional supervision and debriefing.
posted by taff at 2:30 AM on January 16, 2007

Empathy helps. It will guide you where the DSM fails.
posted by Goofyy at 3:50 AM on January 16, 2007

I too am overly sensitive for my own good; I sob over news stories, feel bad for the losing team, etc. But, I kick into professional mode when I am at work as a nurse. I am there to do a job. There is really no time to think about 'me' and how I am feeling. There's too much work to be done. My only concern is that my particular patients are receiving the best care, and that I am a competent caregiver.

I've only cried once, on the way home, after a particularly emotional code. That was more than ten years ago, and I was very green. When you are directly involved in patient care you may be surprised how well you are able to conduct yourself and have control over your emotions.
posted by LoriFLA at 7:59 AM on January 16, 2007 [2 favorites has favorites]

Also not a healthcare professional, but I seriously considered it. I recently held my severely handicapped 5-year-old cousin in my arms and realized that she needed something that I could not (or was not willing to) give her.

There is nothing wrong with having something affect you. Doctors deal with some heavy shit. It should affect you. I think once you have the tools that a medical education will give you, you can focus on using those to do the best you can for someone, while accepting that you can't help everyone, instead of crumpling up into a ball every time you see something sad.

There's a difference between "tough" (or detached) and "strong", in my opinion. Tough people try to keep the emotions out, through blaming others and denying the realities of what's going on. I think toughness is overrated. Strength, on the other hand, involves letting things affect you, but addressing them honestly, putting them in perspective, and getting on with your life and work. I think this is an essential quality for a good doctor.

If you feel you have almost no control over your emotions a short course of therapy may be helpful, but that control can also come with time and experience.

And remember that seeing things more wholly and honestly can help control your emotions. Maybe that cat lived a full life and it was nice for him to go quickly. Maybe losing on game shows teaches people an important lesson about greed and materialism. You said mean things in grade school, but maybe that rotten feeling it gave you helped to make you into the empathetic person you are. To each ying there is a yang.

Good luck with your decision.
posted by Idiot Mittens at 8:53 AM on January 16, 2007 [1 favorite has favorites]

Going to medical school will do things to your empathic skills, because it's filled with continual exposure to horrifying situations, some of which you will be helpless to do anything about. I'm not saying that docs don't have empathy, just that continued exposure to people in lots of physical, spiritual, and psychic distress, combined with the urgent demand to keep on working will put you in a place where you will learn to contain your empathic responses.

Remember also that these days, much of what psychiatrists do involves giving meds rather than doing talk therapy. The talk therapy work is more and more being done by people with MAs and PhDs. There is currently a movement to get prescribing privileges for PhDs, and I believe that psychologists in New Mexico and Lousiana have such privileges. But this is a long and contentious fight, and no one knows where it will end.

As far as the psychotherapy part of your question goes, your own personal therapy and good supervision are the most vital elements of being able to learn how to value and use your empathic responses without being overwhelmed by them.
posted by jasper411 at 10:02 AM on January 16, 2007

I've done child protection work for 15 years as a caseworker and a supervisor, and this issue comes up a lot. It's very difficult for people to know when they are hired if they can separate enough to be successful without getting too detached; we have a lot of folks think they can do this, and have to quit later. So I'd third the above suggestions to do whatever you can to immerse yourself in the work before you invest a lot of time and money. I'd consider myself empathetic-but I have to say that things like sad movies and dead animals are harder for me to deal with than truly tragic things at work. I think because of the fact that it IS work; that I am my professional self there and it doesn't even cross my mind to walk around weeping and breaking down. Feeling like you are making things better, if you're good at what you do, is tremendously helpful. After all, these horrible things happen whether or not you are there to witness them, so I see working in the field as a posiitve for me-it would be harder for me to stand aside and just let it happen.

And it should go without saying that you need to have a strong and healthy life outside work. I also always tell new hires that this is not the job to do to work through any issues you might have in your personal life. Those need to be well and truly resolved before you wade in.
posted by purenitrous at 10:03 AM on January 16, 2007

I think all this advice is pretty good, and that you are on the right track.

IANAD, but I would simply suggest that you should be equally concerned with the positive emotional effects of your empathetic nature in the field you're pursuing - that you should examine and control whether your feelings of accomplishment are overly contingent on happy outcomes instead of a professional and competent performance. Don't look forward to work that will provide you with a big emotional high.
posted by Ambrosia Voyeur at 10:51 AM on January 16, 2007

i doubt btkun's suggestion to work voluntarily with psychiatrists is possible.

It is, however, very possible to volunteer in heavy-hitting helping positions. Rape crisis hotlines, suicide hotlines, AIDS/HIV hotlines, hospice work, women's shelters, etc. almost always (at least in San Francisco) advertise for volunteers, and those volunteers, after training, are often put on the front lines of helping people in emotional crisis.

I do agree that pursuing such volunteer work may be a good way to get a sense of whether the plus of doing good for others outweighs the minus of having to sort through so much distress.
posted by occhiblu at 11:19 AM on January 16, 2007

(I should add: After volunteering for a few such organizations myself, I became much more dedicated to the idea of pursuing a degree in counseling. It was so wonderful to open myself up to people in need and help them that I wanted to learn more so that I could help more; my compassion, it seemed, kept butting up against my ignorance and inexperience, and I ended up going back to school to remedy that. I only just finished my first semester, though, so I can't speak knowledgeably about how it will work out professionally.)
posted by occhiblu at 11:23 AM on January 16, 2007

Hotlines are a good way to go to acclimate yourself to some of what you might be exposed to if you pursue psychiatry. Not only will you hear from people who really need your help, but, just as importantly, you'll hear from people who are trying to game you for something. Dealing with your first con can be as eye-opening and disturbing as dealing with your first suicidal patient.

I think you've got a valid question and a valid concern, and the process of training in any front line profession is partially designed to desensitize you enough to be able to perform the job that you need to do. All of your empathy is useless if you're too wrapped up in the situation to offer your expertise, and good training is always designed to further your ability to think critically about the situations you find yourself in.

As a related comment, I'm not sure where you're located, and what kind of research you've done into your choices, but I'd be sure to talk with a lot of psychiatrists about mixing psychiatry and psychotherapy as a professional choice. I'm a psychotherapist, and I know a lot of psychiatrists, and very few of them practice any kind of extensive psychotherapy. Even fewer had very much training in psychotherapy while in training to become a psychiatrist. The two pursuits are not mutually exclusive, but they are nowhere near as linked as during the days when psychiatry and psychoanalysis were in bed together. Feel free to contact me at the address in my profile if you want to chat about psychotherapy or if you need some letters of introduction to psychiatrists who combine both pursuits.
posted by OmieWise at 1:46 PM on January 16, 2007

i think ambrosia voyeur is on to something there- if you need a happy ending to be happy yourself, it might be tough- but if you can find at least some satisfaction in a job done as well as it could have been- separate from its outcome, then that should help. try to remind your emotional response that YOU are the one thing in the psychiatric equation you can actually control, and be accordingly gentle/tough with yourself when things get rough.
posted by twistofrhyme at 12:55 AM on January 17, 2007

I've always thought that it was something that sort of comes naturally. Depending on what you're doing, you have to be able to detach yourself and focus on the issue at hand. Example: I work part-time (20+ hours a week) as an EMT. In addition to the traumas & illnesses, we spend a lot of time shuffling dying folks from hospital to nursing home, nursing home to their home, hospital to hospital, and we also answer some 911 calls. If you see someone that's sick or hurt, you're not going to help them by attaching yourself. Your job is to be a health care professional.

The patients are looking to you for reassurance and to be the strong one when they are not, or cannot be strong.
posted by drstein at 9:44 PM on January 17, 2007