Customer Reviews

Children of Psychiatrists: And Other Psychotherapists

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One of the first things that I noticed, after deciding on Psychiatry as my specialty, was how free people felt to tell me that I my children would be nuts. Apparently, the children of psychiatrists are all crazy, and this is a well-known and accepted fact. That was typically the second comment people would make. The first would be some kind of awkward joke either about needing my services or the fear that somehow, by deciding to go into psychiatry, I had suddenly developed the ability to read their minds. It surprised me how uncomfortable it made people. The reaction I get when I tell people what I do is still surprising to me.

I'm as guilty as anyone actually. Until arriving in Boston (where it seems half the population are descendants of therapists), I only knew two people who had Psychiatrists for fathers, and they were both on the odd and/or angry side. Sorry Trav and Geof. But I've since been relieved to meet many Psychiatrists who appear to be wonderful parents, good role-models, and seem to have healthy, thriving children. And, true, I've also seen some kids that do fit the more negative stereotype.

I was happy to stumble upon this book at the library. Though slightly dated, it is interesting to see someone address this perception in a systematic fashion. Thomas Maeder, himself the child of a psychiatrist as well as a psychotherapist, starts with this notion that the children of psychiatrists and other therapists are qualitatively different than children of other professionals, and asks, 'is this even true?' And if so, what is that difference? What accounts for this difference? Rather than merely debate this, he decided to study it, interviewing many therapists and many children of therapists. This is mostly qualitative data, and by its nature, as Maeder admits, it can't be normed. There are no control groups, no double-blinding. One can only describe subjective experiences. No one can accurately assess how they would be different if they had different parents or if their parents had different occupations. It's anecdotal but generates thoughtful discussion.

The conclusions? It is mostly, but not entirely, a myth. Maeder sees it as evolving by extension from the myth that all psychiatrists are actually crazy. (Crazy people would naturally have crazy kids.) Maeder believes this derives from the projected needs of the believer: "People ridicule things that make them uncomfortable. How better can one ridicule psychiatrists than to say that they are crazy and that, far from being frighteningly adept at understanding other people, they can't even raise their own kids."

Yet he acknowledges that within the myth is a kernel of truth. And here is where the discussion gets interesting.

Psychotherapy is not just another job. It is a skill in which the training requires one to unlearn normal ways of interacting and learn to listen and observe people differently. "The psychiatrist must, for example, learn to maintain an unusual degree of objectivity and poise in the face of emotional crises, to elicit deep confessions from relatively casual acquaintances, to refrain from standard socially dictated responses, to visualize people in terms of their family histories and unconscious motivations, to discern the importance of seemingly insignificant verbal or postural clues, and to scrutinize his own feelings while dealing with patients and, perhaps, everyone else." Viewed from this lens, that psychiatric training inescapably permeates all parts of ones life, "it would be surprising if psychiatrists did not exert an unusual influence on their children, whether beneficial or not." The debate on this last point, whether the differences are overall positive or negative, is not resolved, but the breadth of opinions elicited makes for good reading. The crux of the argument seems to rest on whether or not it is healthy for a child to have a parent given to overvaluing the need to enter into their child's emotional life, overvaluing the importance of real empathic intrusion, and probably overestimating their abilities for true understanding.

This raises another issue, also given a thoughtful treatment: how much of this results not from psychiatric training but to the selection bias of the people that are drawn to the profession in the first place? Are people typically drawn to the profession because they themselves are psychologically wounded? Or is it a narcissistic desire to save people?

Along the way, Maeder touches on many related topics, such as the differences between the different professions that practice psychotherapy (psychiatrists, psychologists, social workers), the different approaches (psychotherapists vs. psychoanalysts), some forays into more existential and epistemological themes that we all grapple with, and there are segues into relevant historical perspectives on the treatment of mental illness in this country.

But it is the stories we learn directly from the children interviewed that make for the most compelling reading. The permutations include children of therapists who become therapists themselves and children of therapists who are sent to therapists as patients.

Good stuff. Good reading.

But I'm not sure what I can do with this information from a practical point of view. Parenting is already an overwhelming task. You can prepare intellectually, but mostly it is a game of reactions, and the more confounders bouncing around your head the duller your reactions. I don't think I have the shrewdness to parent as a therapist attempting to not think like a therapist.

So it is what it is.
Hope for a happy ending.

"My Uncle Stu"'s review captures Maeder's terrific book; I would add that so many of the remarks made by the children of clinicians, both in the book and in my practice (here in New York, which is obviously another of the handful of therapeutic outposts where one encounters pts. in this population with modest regularity), indicate that they do believe their clinician parent(s) to have been more neurotic than the average parent. Maeder's highlighting the way clinicians can, unfortunately, see through their children a bit too easily--which surely punctures proper mirroring, among other regrettable sequelae--and at times compulsively, as a way to avoid the fundamental uncertainty and anxiety of being a parent, is worth the book's (discounted) price right off. [I picked up the book years ago on a remainder table.] I recommended it just today to a patient...and had to come to amazon to find the full info for him because MY therapist hasn't returned it since I loaned it to him a few months ago.