The patient within — psychopathology in the helping professions

Richard Tillett is a consultant psychiatrist/psychotherapist at Wonford House Hospital, Exeter EX2 5AF, UK and has a long-standing interest in the psychological problems of health professionals.

Doctors, like other health professionals, show increased rates of psychological morbidity, including anxiety, depression, suicide, drug and alcohol misuse and professional exhaustion (burnout). This might be due in part to the pressures of clinical work, but might also reflect Malan’s ‘helping profession syndrome’, in which an individual chooses, usually unconsciously, to work as a carer as a response to personal vulnerability, or ‘the patient within’. This paper reviews the literature relating to the complex relationship that health professionals have with their work role, discusses the implications for the profession, and proposes areas of prophylactic or remedial action.