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Doctors are unsympathetic to colleagues who are psychologically vulnerable EDITOR Clark's article on why people become doctors is of interest not only for her understanding of doctors' vulnerability to life and career vicissitudes. More generally it highlights the fact that although there is a relatively high level of psychopathology in the profession, this is not reflected in doctors' use of psychotherapy for themselves. Doctors seem to have difficulty acknowledging that they are vulnerable, like everyone else, to psychological distress and would benefit from the psychotherapy they prescribe for others. Equally, their colleagues seem unsympathetic to their need for psychotherapy. It remains shameful to be depressed, anxious, or not coping with pressures. I recently had a rare referral (for an NHS consultation) of a doctor. He had had two serious breakdowns and was still receiving treatment from a consultant psychiatrist. In our handful of meetings he often spoke of the difficulties his mental health caused with colleagues, particularly senior colleagues, and the threat it presented to his career. During his training no allowance had been made for his psychological vulnerability. Tiredness meant that he was less able to function well. The occasional allowance for his need not to be on call was, he felt, an impossibility. He either carried on and completed the same duties as his colleagues, knowing he was risking a further breakdown, or he gave up his career. When I saw him his duties meant that appointments with me could be arranged when he was on duty. Despite requests apparently agreed to not to be on call at the time of our appointments he was repeatedly unable to attend because he was on call. Colleagues made it clear that appointments for psychological treatment were frowned on. He was forced to conclude that it was acceptable to be an alcoholic doctor but not one who recognised that he was psychologically vulnerable and sought help to overcome his difficulties. It may be considered that my patient's problems in attending sessions are in his own mind and that he is blaming his colleagues for his own reluctance to attend. Doctors tend to be more resistant than other patients, and my patient was no exception. I think, though, that he would have attended if he had been supported by his colleagues. I also believed his report that he had been a good student academically and that his clinical work was satisfactory, although a breakdown had meant that one post had been unfinished. When I saw him he was functioning well. Doctors should be setting an example in having treatment for psychological problems and not stigmatising anyone showing emotional vulnerability, particularly if they seek help. G N Bolsover, chartered clinical psychologist. Psychology Services, Hull and East Riding Community NHS Trust, Hull HU2 8TD [log in to unmask] BMJ 2000;321:635 ( 9 September ) http://bmj.com/cgi/content/full/321/7261/635/a (keywords: clinical depression: suicide) janet paterson 53 now / 44 dx cd / 43 onset cd / 41 dx pd / 37 onset pd tel: 613 256 8340 url: "http://www.geocities.com/janet313/" email: [log in to unmask] smail: POBox 171 Almonte Ontario K0A 1A0 Canada