Psychiatric problems of physicians and their families.

Motivation for medicine is a complex issue, as is the motivation for other accomplishments in life. There are both conscious and unconscious factors that impel an individual to pursue the long and arduous training necessary to become a physician. Some of these factors meet neurotic needs of the individual and may set the stage for the later development of overt conflicts and psychiatric problems. The most common difficulties of physicians and their families are depression, alcohol and drug dependency, and marital conflicts. These and other issues may involve conflicts concerning unresolved dependency needs. Unfortunately, once problems develop in the physician, attempts at formal evaluation and therapy are often met with denial and resistance. An increased awareness of the problem, and guides for appropriate management of the psychiatrically ill physician by the American Medical Association Council on Mental Health and subsequent legislative changes in a few states, accompanied by an enlightened view by state medical boards, have helped in dealing with this difficult problem. Further, attempts to evaluate impaired physicians objectively and provide helpful and understanding therapy are needed. The prevention of psychiatric difficulties among physicians and their families is an important yet poorly studied area. Likewise, retirement poses special problems for many physicians and efforts should be made by organized medicine to develop educational programs directed toward the prevention of problems at all stages of the professional career.