It is a fascinating paradox that the very motivation which drives someone become a therapist and study the mind can often be the thing that prevents them from seeing the person right in front of them.
One might wonder why are some medical school graduates are drawn to the specialty of psychiatry – in particular those in what might be deemed the “cold organic” camp? Here are the primary drivers often discussed in clinical literature and sociological studies of the profession:
The Defense of Intellectualization
Many enter the field to process personal or familial trauma. For the cold scientist type, intellectualization acts as a sophisticated defense mechanism. By reducing human suffering to neurotransmitters and DSM-5-TR criteria, they create a “clinical buffer” that protects them from the emotional contagion of a patient’s pain. This can be a subconscious shield against their own unexamined or traumatic history.
The Lure of “The Great Decoder”
Some are attracted to the complexity of the puzzle rather than the person. Psychiatry offers the unique intellectual challenge of mapping the most complex organ in the universe. For those lacking insight into their own motives, the profession provides a sense of mastery and control. Turning a chaotic emotional experience into a rigid diagnosis provides a static answer that satisfies a need for order in an inherently messy world.
Power and the Asymmetrical Relationship
The cold analytic type of individual may be drawn to the inherent power imbalance. In a rigid medical model, the psychiatrist holds the “truth” (the diagnosis) while the patient holds the “pathology.” For a survivor of trauma who felt powerless in the past, the authority to pigeonhole others can be an unconscious way to reclaim a sense of dominance.
Biological Reductionism as a Safe Harbor
The shift toward biological psychiatry over the last few decades has provided a professional home for those who are uncomfortable with emotional nuance. For someone eager for answers but insensitive to subtlety, the pharmaceutical model is highly attractive. It offers a clear protocol: Symptom → Diagnosis → Prescription. This allows them to feel effective without having to engage in the exhausting work of genuine psychotherapy with its demand for empathy and the risk of vicarious trauma.
The Wounded Healer
Psychiatrists overwhelmed by their own traumatic background and lack of boundaries is problematic in terms of their capacity to help their patients. Further, it puts the patients at great risk when their therapist’s personal needs are injected into the therapeutic alliance and process.
The Importance of Protectors
Given the issues raised above, once again I want to remind therapists that DID patients’ internal protectors are likely evaluating therapists for these and other risks. Therapists always need to remember that the entire system is listening whenever they interact with any part of the system. And for those with DID, I encourage their protectors to remain vigilant without being trapped in hyper-vigilance.
