Battered Psychiatrists

Psychiatrists are supposed to be society's healers--comforting guides for the confused, pacifiers of the violent. Sometimes, though, they do not seem to be caretakers of the disturbed so much as their targets. Whether or not attacks by patients on psychiatrists are on the rise nationwide, concern about them seems to be more widespread today than ever before. At one institution, the Massachusetts Mental Health Center in Boston, assaults on doctors have risen by 20% to 30% in the past two years. To judge by recent reports of broken noses, stab wounds, fractured jaws and other injuries to therapists in big hospitals and high-priced private practices alike, the battered psychiatrist may become a new social phenomenon.

Psychiatrists offer all sorts of explanations for the violence. As a result of the growing concern for civil liberties, dangerous patients who once would have been sent to hospitals for the criminally insane are now being assigned to regular mental institutions. Public intoxication is no longer a crime in many localities, so police often take bellicose drunks to psychiatric emergency rooms rather than to jail. But some students of violence are finding a less expected cause for attacks on psychiatrists: the doctors themselves.

In a new study, Drs. Denis Madden, John Lion and Manoel Penna of the University of Maryland School of Medicine conclude that psychiatrists may have a definite tendency to stir violence in their patients. In a poll of 115 psychiatrists working in hospitals, clinics and in private practice, the Maryland team found that no fewer than 48 admitted that they had been assaulted by patients on one or more occasions. Most of the psychiatrists agreed that upon reflection, they themselves had probably, if unwittingly, provoked the attacks.

Not that psychiatrists are aggressive by nature. Far from it. Maryland's Madden notes that most of the analysts studied seemed "attracted to psychiatry by its contemplative nature and its use of verbal skills rather than any kind of physical management." Madden believes that psychiatrists as a breed are frequently so put off by violence that they repress awareness of it.

And that, say the Maryland researchers, is part of their problem. Because they tend to avoid aggression, some psychiatrists miss signs that their patients may be violent--and hence do nothing to head off approaching trouble. In fact, the Maryland study found that psychiatrists as a rule dislike discussing violence with their patients, or even with each other. When Dr. Madden and his colleagues first asked their psychiatrist-subjects if they had ever been assaulted, the response was "no." Only when pressed did they admit to being attacked.

Too Probing. In mentally dismissing the possibility of violence, a psychiatrist can take missteps with a patient that might bring on an assault. For instance, an emergency-room doctor may start a ruckus merely by coming at a patient with a hypodermic filled with a sedative, which the patient may perceive as an attack. Or an analyst can probe too insistently into a patient's emotional troubles, sparking uncontrollable anger.

Another mistake is looking scared. Explains Dr. Toksoz B. Karasu, clinical director of psychiatry at the Bronx (N.Y.) Municipal Hospital Center: "Many aggressive patients are frightening. If the patient sees fear in the psychiatrist, he perceives it as a weakness. He feels the doctor is out of control, becomes more anxious, and may grow violent." On the other hand, psychiatrists can also be attacked when they are seen as authority figures. At Boston State Hospital, a wildly disturbed patient began firing a smuggled-in pistol randomly. Then he saw a staff psychiatrist and dropped him with a fatal shot.

How can psychiatrists cure their own problems with violence? At the Maryland medical school hospital, medical students and psychiatric residents are taught how to deal with belligerent patients at a special violence clinic. Dr. Shervert Frazier, psychiatrist in chief at McLean Hospital in Belmont, Mass., insists on having assault-prone patients treated by teams of therapists, preferably including women, who, he finds, have a "calming effect."

Most important, psychiatrists must stop denying the existence of violence. Frazier, for one, believes in going straight back for a long talk with a patient after an attack. Says he: "If somebody hits me, I want to find out why."

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