Psychiatrists’ Fear of Death Linked to Negative Feelings Towards Certain Patients

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A survey of 120 psychiatrists published in Psychiatry Research found that the more psychiatrists fear death, the more negative emotions they have towards people diagnosed with borderline personality disorder.

A team of Israeli researchers conducted statistical analyses on answers from psychiatrists to survey questions about their attitudes towards death generally and to suicide, and about their attitudes towards patients diagnosed with borderline personality disorder. “In line with the hypothesis that fear of death would contribute to negative emotions toward BPD patients, psychiatrists’ fear of death greatly contributed to negative emotions toward BPD, as it explained half of the variance of the entire model, even after controlling for professional experience with BPD and for attitudes toward suicide and death,” they write.

The researchers suggest that people diagnosed with borderline personality disorder are people who often present particular types of challenges to psychiatrists. “Among the psychiatric diagnoses, suicide mortality in borderline personality disorder (BPD) is similar to that of mood disorders,” they write. “However, while clinicians perceive mood disorders as curable and sympathy-evoking illnesses, BPD patients are considered more problematic, and are held accountable for their suicidal behaviors. Such patients often tend to undermine the therapeutic process, may turn members of staff against each other, have high drop-out rates from therapy, and exhibit acting out episodes that may cause psychiatrists a sense of professional impotence.”

“(W)e suggest that psychiatrists’ ability to compensate for their fear of death by curing their patients is being hampered among psychiatrists with high death anxiety, when it is activated by their frustrating encounter with BPD patients,” they comment. “These patients impede psychiatrists’ need to compensate their own fear of death through professional achievement, by frequently creating hostility and violence, dropping out of treatment, and above all – by the possibility of committing suicide. Hence, when psychiatrists’ fear of death is high, their professional impotence also increases when treating BPD, and they react to them with negative emotions.”

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Bodner, Ehud, Amit Shrira, Hagai Hermesh, Menachem Ben-Ezra, and Iulian Iancu. “Psychiatrists’ Fear of Death Is Associated with Negative Emotions toward Borderline Personality Disorder Patients.” Psychiatry Research. Accessed July 5, 2015. doi:10.1016/j.psychres.2015.06.010. (Abstract)

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9 COMMENTS

  1. Interesting article. It also explains why many psychiatrists may send too many patients who reveal suicidal feelings to hospital and also over prescribe medications. One should not practice psychiatry defensively, either through overt fear of a person attempting suicide, or as this study brings out, more subconscious fears of death. It is crucial to help people who are in distress to be able to sit with intense painful feelings. This means not feeling one has to “do something” to protect oneself against liability or to protect the patient. Especially when treating people who have been traumatized, like many who psychiatrists fit into the diagnosis of borderline personality, change occurs over the long term by helping a person with their most intense painful feelings. This article brings to mind Maltsberger’s seminal article “Countertransference Hate in the Treatment of Suicidal Patients. (http://archpsyc.jamanetwork.com/article.aspx?articleid=491132 ). It’s interesting that 40 years after that article was written, there is a study substantiating the basic points in that article.

  2. I have always thought that diagnosis is one of the most bullshit of all. That is, until I personally received what amounts to death threats from someone who would fit that diagnosis.

    Some people with psychiatric labels really ARE dangerous, and if you are on the receiving end of their threats and you are afraid of dying, yes, you are not going to be sympathetic to their behavior.

    When I was representing people at commitment hearings, there were almost no people who really fit the commitment standard of “danger to others.” But when I had to represent the small handful of such people, I was really frightened. I remember insisting that I sit next to the door of the hearing room, and that the door be open. Fortunately, the people I am talking about did things like say “kill, kill” to the hearing officer . I don’t know what I would have done if I had to argue that they be released, knowing that they were almost sure to attack someone, including maybe me, if they were released.

    • True, but being a psychopath is not a mental illness. Some people are just evil and calling them sick is a disservice to anyone. Also psychopaths have rights too. If they don’t commit crimes then they should be left alone – when they do they should be punished to the fullest extend of the law but not beyond it. Even we have a legal standard and a justice system that is applied evenly to everyone or we don’t.

      Btw, I’m not naive on that. I know a person who is not overtly violent but without a shadow of a doubt highly psychopathic and perfectly happy to cause havoc in other people’s lives (including mine). Nonetheless I’d defend his liberty and human rights just I do for anyone else.

  3. I appreciate your honesty and insight. It reminded me of the following quote from a psychiatrist given in reply to my question about what he thought of a colleague leaving a comment on his blog calling him an antidote. Note that none of us know each other; it is all on the web.

    I am an antidote to naysayers because I (like my colleagues) have been wandering the hallways of a crummy psychiatric hospital all night long trying to take care of desperate problems and make sure the staff is safe. We are the ones worried more about the drunks, drug addicts and psychotics and what happens to them. By the time we see them nobody else wants them around. I am the last bridge to be burned and nobody has been able to do that yet.

    Many here would say he is an egotistical jerk but I don’t read it like that. I accept people’s experiences here and accept his just the same. I don’t I see him as a savior, simply a human being, but I do think he interacts with those most have given up on.

  4. There will always be people who fit diagnoses as,after all, DSM diagnoses are just lists of symptoms and behaviours. Then there are psychiatrists who try to fit people into diagnoses, which is usually problematic as most people don’t fit simply into one list of symptoms. The only possible value of the DSM is it’s use as a rough guide. As Ted points out sometimes it can be helpful to be able to put a description to peoples’ behaviour. The dangers in how the DSM has been used though far outweigh any value it may have. Certainly BPD is often used as a go to label for people psychiatrists or doctors don’t like. That observation actually supports the findings in the study, and would imply that psychiatrists with heightened fear of death may be more likely to label people as BPD inappropriately.

  5. The aggression of people with Borderline Personality Disorder toward psychiatrists may be viewed as entirely appropriate. Borderline Personality Disorder victims can eliminate all symptoms of their illness by chewing pheromone gum. Pheromone gum can be obtained from any healthy adult male volunteer donor. Buy a new, fresh pack of gum (Wrigley’s), rub the gum all over your donor’s face, using both sides of the piece of gum. A male face will lace about 5 pieces of chewing gum. Do another 5 sticks of gum at 12 hour or 24 hour intervals until 1/4th gram is accumulated (usually about 15 pieces of chewing gum). Then have the BPD patient chew the gum. Instant cure, which persists for years.
    There is a side effect, jealousy, which can mostly be avoided when the BPD patient chews the gum alone at a distance from providers, otherwise the providers will also be affected. While the gum has wonderful behavioral effects with oral exposure to 250 mg, apparently the side effects can be felt by osculation partners and non-osculation partners via the air, which is very cool.

  6. The whole of Western society is terrified of death. Kubler-Ross tried to make this clear many years ago when she approached the subject. I think it’s clear to point out that, as a society, we fear death and it isn’t just in psychiatry. Psychiatry has the power to torment people who do anything contrary to this accepted ideal however. The fear of death is a great generator of medical services and revenue in the US.