There is an interesting and sometimes unfortunate phenomenon that occurs in the lives of physicians that I think requires more study. It pertains to observations I have made over the last 20 years in my conversations with physicians who have committed themselves to very demanding practices.

I have noticed very busy physicians often find themselves challenged with someone in their own family, usually a spouse, who succumbs to some form of chronic illness (usually a mental illness). At first one might simply explain this away by saying that this can happen to anyone. Yes, that is true however it is my hypothesis that an epidemiological study of this phenomenon in the lives of physicians might reveal an incidence that is somewhat higher than in the general population.

After giving some thought to this I am concluding that physicians are at greater risk of this phenomenon occurring in their lives. I hope to explain why this should be.

It has been my experience that some physicians tend to, knowingly or unknowingly, draw to themselves individuals who are unconsciously looking to them for emotional rescue. It appears to be the nature of the profession for physicians to become, if they are not careful, lightening rods for drawing individuals with immature personality characteristics who are skilled enough in eliciting sympathy from them. Physicians who themselves are narcissistically invested in being able to rescue others are at greatest risk for such unfortunate occurrences.

Early on in a relationship, as in many relationships, the full form of the dysfunctionality that is to manifest remains dormant. Infatuation and romance often leaves a trail of naivet that many only become aware of much later, if at all.

As the years move on and the physician becomes drawn increasingly into his/her practice this creates an increasing strain on the spousal relationship and more often than not, if it doesnt end for this reason, the non-physician spouse will often develop some form of mental illness.

When relationships do end, ironically, this is often a sign of the mental health of the non-physician spouse in refusing to tolerate the ongoing absence of the physician spouse in the relationship.

When it doesn't end however it's almost as if the ill spouse is conveying a message to the physician spouse that more attention is needed from them. Although neither partner realized it consciously earlier on, it becomes clear that the main foundation for the relationship is based on the need of the ill spouse to be cared for by the physician spouse. This is the so-called "unconscious contract" that was made by the lovers.

As the ill spouse becomes progressively more ill this places increasing pressure on the physician spouse to "re-enter" the relationship and to care for the ill spouse. Whether this actually happens however often depends on two significant factors (although not the only two) a) the amount of guilt the physician spouse can tolerate in not responding to the ill spouse's needs and b) the degree to which the physician spouse can tolerate feelings of intimacy.

What often happens is that the physician spouse begins to feel trapped in an untenable situation which only adds to the energy drain that they are experiencing.

Interestingly the energy drain is also driven by the narcissistic investment or "need" the physician has in "rescuing others". Such a pattern is conditioned in early childhood when a child is left in the unfortunate position of having to care for an emotionally ill parent.

This sets up a need in the child to help the parent "survive" so that they themselves can ward off feeling their own inner feelings of sadness and annihilation that threaten to emerge. They then become conditioned with a fear of feeling sadness or emotional pain coming from within.

The fear becomes enacted through compulsive behaviors of rescuing those (i.e. one's patients in later life) who evoke feelings of emotional pain in the growing child. Through the rescuing behavior the child is also hoping to evoke loving appreciation and security for themselves from the ill parent.

The rescuing pattern in the physicians adult relationships (i.e. marital and patient relationships) simply repeats the relationship they had as a child with their ill parent.

The sad part about all of this is that the physician feels trapped in the rescuing pattern themselves. Trapped because they cant tolerate the feelings of sadness they experience when others around them are ill, yet they cant leave because their own emotional integrity depends on being able to help the other.

So many physicians caught under such a strain often are tormented with feelings of guilt about wanting to leave. Such guilt paralyzes them and undermines their health in serious ways.

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