Psychiatrists are depressed, but none of them attribute their own feelings to brain chemical imbalances

Dr Jess explores shocking new findings that psychiatrists are depressed, don’t attribute their feelings to mental disorders, and are frightened of being pathologised…

An insightful new report from Medscape was published yesterday - and the findings have fascinated me.

As I’ve said in the title of this article, psychiatrists report feeling totally burned out, overwhelmed and depressed, but none of them attributed their valid trauma responses to the biomedical model theory of ‘brain chemical imbalances’.

Further than that, none of them reported wanting to take antidepressants, and many of them feared that they would be pathologised if they admitted how they were feeling to their employer or their colleagues. As if that wasn’t enough, psychiatrists reported that they were using exercise, spending time with loved ones, meditation, and self-care to cope with their thoughts and feelings of overwhelm and depression - whilst the public are told that these approaches won’t work (or worse, the approaches are actively mocked by psychiatrists and mental health professionals who see them as useless or dangerous).

What does this all mean? Why are members of the public told by their psychiatrist that their ‘depression’ is biochemical, but psychiatrists are looking to their environment and their traumas to understand their own experiences?

Over 9000 practicing psychiatrists took part, and the findings reveal deep cognitive dissonance in the profession.

I will outline some key findings here, and then discuss them from an anti-pathology, trauma-informed lens (APTI).

Before I begin though, I would just like to say that whilst this article will focus on the dissonance, hypocrisy, and conflict of the anonymous answers of psychiatrists versus the narratives of psychiatry, I do accept and believe that psychiatrists are burned out, suffering, struggling, and feeling pretty terrible in their lives and their roles. Their trauma, distress and burnout is real, and it is valid. They are fellow humans, exposed to human suffering every day, and they also play a role in causing it. It is likely they will be harmed by their work, in addition to their own personal traumas (whether they admit to them or not).

The key findings I would like to discuss here are as follows:

• Psychiatrists named nine top issues that were causing their depression, and none of them were biological, and they stated that 99% of their depression and burnout was caused by their jobs - but none of them reported or spoke of serotonin, brain chemicals, or biological causes

• Only 1% of psychiatrists said that their depression and burnout did not interfere with their daily lives

• 79% of psychiatrists reported that their feelings of depression and burnout negatively affected their personal relationships

• Whilst 40% of psychiatrists said that it would help them if they were able to talk about how they felt with their colleagues, they were sceptical and/or cynical as to whether they would actually get any support from them

• The most common coping mechanisms used by psychiatrists for their depression and burnout were non-medical and non-therapeutic

• Psychiatrists are frightened of being pathologised and judged by their own profession

• 55% of psychiatrists stated that they would not seek any help for their feelings of depression and burnout. Of those, 34% of psychiatrists reported that they had never sought help for their depression and burnout, and they would not seek any help in the future either

Finding 1: Psychiatrists named nine top issues that were causing their depression, and none of them were biological.

By far, one of the most important findings in this report pertains to the way psychiatrists seem to be able to identify the distress and trauma in their own lives to explain their own depression, and do not see themselves as having biochemical imbalances or disorders of the mind that require medication.

Psychiatrists were asked what issues were significantly contributing to their depression, and they reported the following:

Job burnout - 66%

Physician responsibilities - 48%

Health issues - 26%

Finance issues - 26%

World events - 23%

Romantic relationship issues - 17%

Personality - 16%

Their own insecurities - 15%

Family issues - 15%

What is utterly fascinating about these answers, is the way psychiatrists are able to attribute their own suffering to external (absolutely valid) factors such as their jobs, finances, world events, relationship issues, health problems and family conflict - but millions of their own patients are being told that their depression is caused by low serotonin levels in the brain, genetic risk, and biological issues that require medication and sedation.

As an anti-pathology, trauma-informed, psychologist myself, I believe these psychiatrists have correctly identified the real sources of their ‘depression’. But why have they found it so simple to do for themselves, and so hard to validate for their patients and clients?

Why are they able to come up with a list of external distress, stressors and traumas that are causing their feelings, but attribute the suffering of their clients and patients to a set of abstract mental illnesses?

Why are patients and clients being told that their depression is a mental illness caused by biological factors?

Finding 2: Only 1% of psychiatrists said that their depression and burnout did not interfere with their lives

This finding interested me due to the way that psychiatrists will often define a ‘mental disorder’ as a feeling or experience that is so severe that it ‘interferes with our day-to-day lives’. Only 1% of psychiatrists said their feelings did not interfere with their day-to-day lives.

It seems such a simple, obvious point - and that’s because it is. So much of human suffering is simple - and if someone is suffering, it is going to impact their day-to-day life. This does not mean they have a mental illness, and yet this is one of the ways we define them.

When I teach critical perspectives of psychiatry and psychology, I often tell my students that this is one of the biggest flaws of this discipline. There are no norms, averages, tests, upper or lower limits of anything - so everything is based on subjective observation and self-report measures. ‘Does this feeling interfere with your day-to-day life?’ is going to result in extremely high positives, because most suffering impacts us on a daily basis. This doesn’t make it evidence of an illness. It doesn’t mean anything, really.

What is most curious though, is that whilst psychiatrists recognised that their own depression and burnout was affecting them every day, the report doesn’t suggest that any of them have a mental disorder.

Finding 3: 79% of psychiatrists reported that their feelings of depression and burnout negatively affected their personal relationships

I noted with interest that the majority of psychiatrists reported that their feelings of depression and burnout were impacting their personal relationships - and it made me think about the way issues with relationships are used in psychiatry to diagnose (predominantly women) with personality disorders, attachment disorders and bipolar disorder.

I have personally met many women who have been diagnosed with EUPD and BPD based on their ‘dysfunctional’ relationships, lack of intimacy, trust, connection, safety in their relationship and relationship breakdown. They have been told by their psychiatrist that they are fundamentally disordered, and that their relationships are suffering because of their mental health issues. I’ve seen this happen repeatedly, even when women report serious trauma and distresses in their lives that are clearly impacting their relationships.

Again, why are psychiatrists able to recognise that their vicarious trauma and burnout from their jobs and their lives are impacting their relationships but don’t seem to be able to do this with their own clients? Do they believe they have developed personality disorders and attachment disorders too?

Seems not.

Finding 4: Whilst 40% of psychiatrists said that it would help them if they were able to talk about how they felt with their colleagues, they were sceptical and/or cynical as to whether they would actually get any support from them

I wanted to raise this finding because I have plenty of friends and colleagues who work in psychiatry, and none of them trust the people around them. I have friends who are HCAs and nurses in mental health wards, and I have friends who are medical doctors, clinical psychologists and even a few psychiatrists who have told me many times that they wouldn’t trust their colleagues, their their work environment is toxic, that bullying is rife, and that they don’t speak to their colleagues about anything personal.

In an industry that is supposedly about opening up about your struggles, it is rather telling that the professionals themselves don’t trust each other, and witness bullying and abuse of each other regularly. 60% of psychiatrists stated that it wouldn’t help them to talk openly about their feelings of depression and burnout at work, and the authors noted high skepticism and cynicism in psychiatrists towards their colleagues and teams.

What use is a mental health team who are hiding who they really are, and how they really feel, from each other? How can these wards and services be safe for people to disclose their feelings, when the professionals can’t even do this safely?

Finding 5: The most common coping mechanisms used by psychiatrists for their depression and burnout were non-medical and non-therapeutic

One of the most interesting findings in this report was the way psychiatrists are trying to cope with their feelings of depression and burnout. Are they taking SSRIs? Are they having endless CBT?

No. They are not. Instead of traditional pharmacological approaches, or therapeutic interventions, psychiatrists reported the following:

Talking with my family or friends - 52%

Sleeping more - 49%

Spending time alone - 48%

Exercise - 40%

Play or listen to music - 38%

Eat junk food - 35%

Meditation - 30%

Binge eat - 18%

Drink alcohol - 16%

Use prescription drugs - 9%

Smoking cigarettes - 6%

Smoking weed - 2%

There is so much to say about these findings, I could write a whole article on them. Firstly, I was surprised to see such holistic approaches from a group of people who reject holistic approaches so loudly and so publicly. Only last month, a nasty argument broke out on mental health Twitter because a professional posted that exercise was extremely effective for depression. She was mocked, trolled, and rebutted by psychiatrists for over a week. She was called dangerous. She was positioned as an idiot.

But according to this survey of over 9000 practicing psychiatrists, exercise is one of their most common approaches to their own depression and burnout. In fact, their most common approaches to dealing with their depression and burnout were anti-pathology, trauma-informed - and were not remotely psychiatric. Even if we looked at the 9% of psychiatrists who said they were using prescription drugs, this answer was nowhere near as common as the others (and we can’t be sure which drugs these were, as they could be sleeping pills, painkillers, or antidepressants/antipsychotics).

So why don’t psychiatrists practice what they preach? Why don’t they assume that their depression is caused by their ‘low levels of serotonin’ and take ever-increasing dosages of SSRIs for decades? Why do they exercise, if they ridicule it in public? Why do they increase their sleep? Why do they meditate, if that is just hippy woo-woo bullshit as they so often claim?

Could it be because deep down, they know that their depression and burnout is caused by real external stressors, and they know that they need support, help, sleep, peace, support, and exercise to feel better?

Or could it be that their see their patients as below them? Broken? No-hopers who need to shut up, take their pills and stop wasting their time?

How is this dissonance happening? How is it being maintained?

Finding 6: Psychiatrists are frightened of being pathologised and judged by their own profession

As the psychologist who has been banging on about the power of pathologisation for years - I was absolutely blown away to read the results to this question. Over 9000 psychiatrists were asked why they don’t tell anyone about their depression.

The findings confirm everything I have ever said about pathologisation, but also raise some questions. Let’s have a look at their answers:

50% of psychiatrists said they didn’t tell anyone about their depression because they were worried that their ‘medical board or their employer would find out’

48% said they didn’t tell anyone because ‘people might doubt their abilities as a physician’

27% said they didn’t tell anyone because ‘people will think less of me’

27% said they didn’t tell anyone because ‘it makes a negative statement about me personally’

6% said ‘I consider depression to be a weakness’

So, a LOT to discuss here.

My first thoughts were that psychiatrists know how stigmatising mental disorder diagnoses are, and they are clearly frightened of them. They are working in an industry that they are ultimately scared of. They don’t want their employer knowing they are struggling, they don’t want to be pathologised, they don’t want to be seen as inferior or incapable, they don’t want to be judged, and they perceive their own completely valid feelings as weaknesses and negative.

It saddens me to read this, actually. Thousands of intelligent, capable professionals, struggling with their own feelings and thoughts, too scared to admit it because they know their own discipline will frame them as mentally ill.

The dissonance. They hypocrisy. The conflict. The utter internal chaos.

How can we possibly believe that psychiatry is good humankind, when the people who work in it every day are so frightened of it? They know what will happen if they admit they are not coping. They know what happens if they admit their own suffering and trauma. Is that a safe working environment?

Pathologisation is rife in psychiatry - not only towards clients and patients, but towards each other. I’ve said this many times before, and I will say it again here: there is no such thing as ‘ending mental health stigma’, unless we completely depathologise human suffering, and reject psychiatry as a concept. Distressed humans are not mentally disordered.

We’ve built a house of cards, and the psychiatrists are inside it.

Finding 7: 55% of psychiatrists stated that they would not seek any help for their feelings of depression and burnout. Of those, 34% of psychiatrists reported that they had never sought help for their depression and burnout, and they would not seek any help in the future either

The final finding I would like to discuss is the amount of psychiatrists who reported that they would not seek any help for their feelings. I wanted to raise this one because I think it is important to normalise how many people (even psychiatrists) do not feel able to talk about their feelings, or seek help. Our professions (psychiatry, psychology and mental health) have chanted mantras about seeking help, talking to someone, going to a doctor or seeking therapy for years - and yet many professionals do not follow their own advice.

Further, lots of professionals have had terrible experiences with therapies, medications, and seeking support - but daren’t say it out loud, for fear of tarnishing their own industry. I follow a woman who talks about bad therapy, harmful psychotherapy, and harmful approaches to trauma - and she is consistently criticised by therapists and psychologists who claim she is harming the industry, and attacking the profession. It seems even admitting that our fields can cause great harm is forbidden, let alone admitting that we as professionals are likely to also have had such bad experiences of seeking help, that we avoid it in future.

What Would Jess Say?

My final thoughts on this keep coming back to the validity of psychiatry as a concept, as a discipline, as a service for humans in distress. The biomedical model is not fit for purpose. Convincing distressed humans that their experiences are irrelevant, and instead, that they are mentally ill, in need of long term intervention, and could even be ‘treatment resistant’ - is gaslighting them. Psychiatrists seem to look outside themselves for the cause of their suffering, but inside others for the cause of their suffering.

This reminds me of a theory of cognitive psychology that I teach regularly, called ‘fundamental attribution error’. FAE is a cognitive phenomenon in which a person attributes external reasons to their own suffering, but internal reasons to the suffering of others. For example, they might believe that their relationships keep failing because their exes are all pricks - but might conclude that their patients’ relationships keep failing because they have a personality disorder.

What is left of psychiatry and the biomedical model, if psychiatrists do not apply it to themselves?

Why are safe, trauma-informed approaches to depression and distress being ridiculed by psychiatrists on social media, but being used in private?

Why are harmful and addictive medications being doled out to millions of people who are depressed and burned out, but not used by psychiatrists themselves?

Why are psychiatrists pushing to diagnose millions of people with more and more mental disorders, but don’t want anyone to diagnose them with a mental disorder, because they are frightened of being pathologised?

My work is criticised and ridiculed every day. Mainly by psychiatrists, clinical psychologists and people who work within mental health services. I suggest that human distress is valid and real, but mental disorders are not. I argue that pathologisation is a form of stigma, oppression and labelling that has a profound impact on people. I suggest that there are better approaches to human suffering than medication and psychiatric diagnosis.

I even talk openly and consistently about vicarious trauma and burnout in the workplace, and how professionals are being pathologised, and are too frightened to seek support for fear of being seen as inferior.

It appears that this report has confirmed every single thing I say, and this time, the results came from 9000 psychiatrists.

So, now what?

Do we tell the psychiatrists to shut up, take their pills, and fix their serotonin imbalances? Should we label them and pathologise them, too? Gaslight them that they need to be more resilient at work? Send them for useless CBT? Suggest that they have ADHD and they need stimulants so they can keep up at work?

Or do we help them to address their valid feelings, their toxic work environments, and their utter burnout, in an ethical, anti-oppressive, anti-pathology, trauma-informed approach?

I know which one I would prefer.

Report by Medscape: Psychiatrist Burnout and Depression Report 2024

Sample size: 9266

Recruitment period: 5th July 2023 - 9th October 2023

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