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Behavioral healthcare as a labor of love

August 29, 2013
by H. Steven Moffic, MD
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It's Labor Day time of the year, though I doubt that we who work in behavioral healthcare consider ourselves as laborers in any of the usual sense of that term. There are probably historical reasons for that, but I would suggest that there is something more. Our work, to reach its potential, needs to be more than an everyday labor. It needs to be a labor of love of sorts.

Why? One set of reasons has to do with all the obstacles we face in our field. Many are external. Stigma may be the most powerful. Not only are patients stigmatized, but those of us who work with them are also. There is fear of the mentally ill, including an overestimation of their violence potential, but also a fear of caregivers. Who would be "crazy" enough to work in this field? Can you read my mind? Usually, in social situations, I'll tell others that I am a physician, and only a psychiatrist reluctantly.

Then, probably due in large part to the stigma, there is the continuing underfunding of behavioral healthcare. Ever increasingly, we have to do more in less time. That pressure surely increases our stress.

To balance this out, the antidote is to love our patients. Not in a sexual way, mind you. That is ethically prohibited, as it should be. This is love for humanity in all its varieties, in all its vulnerabilities. It is respectful love for the dignity of all. It is the caring love of wanting to help those most in need.

Such love makes its major impact in the therapeutic relationship. Study after study indicates that a positive therapeutic alliance is the major variable contributing to patient improvement. More than psychotherapy. More than medication. And likely more than the principles of recovery, though all of these add their own impact.

Yet, even this kind of love takes its toll. The empathy necessary to understand the pain of our patients can be very draining, often leading to burnout. Any sustainable love needs to be rekindled, often over and over. Some of this rekindling needs to be done in our relationships, vacations, and hobbies away from work.

I fortunately recognized this early in my career. I felt more drained from 8 hours of psychiatry than 24 hours of general medical work. Now that I am retired from clinical work, I'm so much emotionally lighter, so much so that the beauties of everyday life, almost every minute of them, come through now more readily to the deepest levels of my consciousness.

This is why it is so important that leaders of systems find ways to support and value their "laborers." And staff needs to support one another. We need a work alliance as much as our patients need a therapeutic alliance. Otherwise, to protect ourselves, we may work as if in a factory, say, doing one 15 minute med check after another, viewing each almost indistinguishably.

Perhaps the precipitant for these reflections is that this year the Jewish High Holy Days begin early, given the yearly variability of the Jewish calendar, only two days after our secular Labor Day. They remind one that at best our labor of love is a spiritual calling to help those in need. These High Holy Days are also a time to ask for forgiveness for where we have fallen short in our relationships with others, whether that be family, friends, strangers, patients, co-workers, and even those who have hurt us.

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H. Steven Moffic

H. Steven Moffic

H. Steven Moffic, M.D. retired from the clinical practice of psychiatry and his tenured...