Mental Health Workers Battle Their Own Emotional Demons

There are no clues in her gray-blue eyes, no suggestion in her ferocious intelligence or her matter-of-fact beauty. But the facts are clear.

Kay Jamison, eminent psychologist, once tried to kill herself.

Therein lies the Kay Paradox. An expert on manic depression at one of the world’s most renowned medical schools, Jamison has suffered from an intense form of the disease most of her life. For almost 20 years, the Johns Hopkins psychiatry professor has taken lithium daily to level her moods and keep her illness under control.

But the Kay Paradox doesn’t belong exclusively to Jamison. It is also a professional paradox. Many mental health professionals--psychiatrists, psychologists, therapists, nurses--have waged, or are waging, their own battles against a mental disease or disorder.

“My God, if therapists with personal problems didn’t treat patients, we wouldn’t have therapists at all,” said Bruce Hillowe, a Mineola, N.Y., private attorney and psychologist who handles psychiatric malpractice cases.

Studies have found that psychiatrists have the highest suicide rate among physicians. And a 1994 survey of psychologists found almost two-thirds had battled clinical depression.

Jamison is not alone in having battled a mental illness. But she is almost alone in coming out of the closet and sharing it with the world.

For fear of professional ostracism, most practitioners keep their personal mental battles private. Jamison did just that for more than 20 years, hiding her disease from all but her closest friends and colleagues.

But last year, in the book “An Unquiet Mind,” she told her story to the world.

“I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide,” she writes in the book’s prologue. “One is what one is.”

The book clearly had an audience; it spent seven weeks on the New York Times’ best-seller list. A large part of that audience has been among fellow mental health practitioners who share her disease.

Among the hundreds of letters she has received are stacks from mental health professionals at different stages of their careers. There are the ones from medical students put on probation or asked to leave medical school for discussing their illness. And there are letters from colleagues at more advanced stages of their careers, guarding their secret tightly.

Dr. Daniel Fisher hears from those people also.

Hospitalized three times for schizophrenia, the psychiatrist has organized conferences on the subject, peer-support groups. He still travels to talk about his own illness with fellow psychiatrists.

“I still am struck by how many people will come up to me after a talk and say, ‘Yeah, I’ve been there,’ ” said Fisher, director of the National Empowerment Center, a Lawrence, Mass., advocacy group for the mentally ill.

But most of those colleagues--like those who write to Jamison--retain their secret, and Fisher knows why.

“It’s taken me a long time to gain acceptance to my disclosure,” said Fisher, who first went public with his own experience with schizophrenia on a Boston television talk show in 1980.

Though professional groups preach acceptance, many of his colleagues in the field have a difficult time accepting his past battles, Fisher said.

What little evidence there is of mental illness among psychiatrists and psychologists points to a problem.

A 1994 study of psychologists found that 61% had had at least one bout with clinical depression and 84% had spent time in therapy. Many mental health professionals consider being in therapy good training, but the study also found that 29% of psychologists had felt suicidal at some point.

A 1987 study of doctors in all fields, published in the Journal of the American Medical Assn., found that psychiatrists had the highest suicide rate among doctors.

Experts say extreme cases of mental illness like Jamison’s are rare among therapists. But more benign cases are common--more common than in the general population, said Hillowe, the Long Island attorney who represents clients on both sides of psychiatric malpractice suits.

The theory often repeated is that their own neuroses or mental problems, or those of people close to them, are what attract psychologists, psychiatrists and psychotherapists to their fields.

Jamison entered college intent on becoming a physician, but chose psychology instead, at least in part, she writes, because of the “instability and restlessness of my temperament.”

Had it not been for his battles with schizophrenia, Fisher says, he would still be a biochemist.

And, it was a personal battle with a psychological disorder that sent Freda Smith Vittone back to school to become a psychotherapist.

In 1983, while working as a journalist, she developed agoraphobia, a constant panic that crippled her social and professional lives.

“I started not being able to drive, then not being able to go into restaurants,” Vittone said. “My world became very small very quickly, until I became housebound.”

Now, Vittone treats patients who have the same disorder at the same Washington clinic where she underwent treatment.

“I’ve had it; I can identify with their symptoms,” she said.

Vittone and Fisher are open with their patients about their illness and both say most patients appreciate that. But many other mental health professionals aren’t.

Jamison isn’t taking any new patients now. And even if she were, Jamison says, she still wouldn’t tell them, even though she’s gone public.

Neither the American Psychological Assn. nor the American Psychiatric Assn. requires practitioners to tell patients if they themselves have suffered from a mental illness or disorder. Ethicists say a blanket disclosure requirement for mental health professionals would be impractical and unfair.

In some cases, therapists telling patients about their problems can lead to the perception that they’re putting their own issues ahead of patients’, said Thomas Geutheil, a professor of psychiatry at Harvard Medical School who consults on ethical complaints.

“You don’t burden your patients with personal problems,” he said.

In all cases, the key issue is impairment. If a practitioner can’t do the job because of manic depression, he or she shouldn’t try.

But except in the most severe cases, when colleagues or regulatory boards step in, it is up to the professional to decide if he or she can perform.

Discussing her depression, Jamison’s conversation often veers to things such as support teams and making sure that her internist and psychiatrist are in touch. Her friends and family, she says, have clear instructions to put her through electric shock therapy if she ever sinks into a deep depression again.

Part of that practicality is rooted in fear.

To this day, trouble falling asleep will make her wonder if all is well. Could a bout of mania be just around the corner? Could another of those deep dark depressions follow?

“You have to be insane, more insane than I’ve ever been--and I’ve been pretty insane--not to fear it,” she said. “The thought that I would get sick again is terrifying.”