Treatment problems of the hospitalized physician

Treatment problems arise both when the physician or other health care professional must be hospitalized for psychiatric disturbance and, even prior to hospitalization, in the process by which the physician comes to recognize and accept in himself an emotional illness of severe proportions. Hospitalization can represent a severe narcissistic trauma, which entails a radical role reversal (from caretaker to patient) and severely undermines the physician-patient's sense of personal and professional identity. Conflicts around these issues tend to become externalized within the hospital setting up characteristic patterns of conflict within the therapy (between patient and therapist) and within the ward community (between patient and ward staff, as well as between treating physician and ward staff). The expression of these conflicts and patterns of interaction are discussed in two cases-both psychotic and suicidal physicians-who, though the patterns of resistance and externalization took divergent forms, nonetheless expressed the same underlying issues.