Personal resilience for psychiatrists: systematic review

I read with interest this article¹ which explores the factors that promote and maintain psychiatrists’ well-being, particularly personal, workplace and non-work-related factors such as increased self-awareness, extending job roles, discrete work activities, and/or support from family or social environment.

John. D. Yoon and Brendan M. Daley, studying the association between a sense of calling and physician well-being,² reported that a higher sense of calling in primary care physicians and psychiatrists was associated with an increased level of job satisfaction and resilience from burn-out. This reflects the deeper sense of meaning and purpose that work can bring, which generates and even sustains motivation and enables working with vision. However, there are reported challenges relating to the bureaucratic and technological demands that physicians experience, which mean the sense of calling can be hard to sustain.

A report from the Association of American Medical Colleges published in February 2019 highlights the misalignment between practitioners’ values and practices and those of organisations, which can contribute to burn-out and diminished well-being.

Authors Adam M. Brenner and John Coverdale, in their update on trainee wellness,³ report on voluntary resident-led peer group reflective practice for medical students as an intervention for social connectedness. Although the study was of small sample size and lacked a control group, social belonging appeared to be a positive predictor of well-being, diminished imposter syndrome and tolerance of diverse perspectives, suggesting that this model deserves further attention as a potential means of improving resilience in trainees and professionals or psychiatrists.

The authors quote in their update Winston Churchill's famous saying: ‘Now this is not the end. It is not even the beginning of the end. but it is, perhaps, the end of the beginning’. These words express hope for momentum towards victory; we are still in the early stages of addressing burn-out and improving well-being, but perhaps we are moving in the right direction.

Christine Montross, in her book Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis,⁴ describes ‘patients who are so difficult to diagnose or treat – uncertainty it arises’, ‘I hold my trust in medicine up to the light, I see that it is full of cracks and seams. In some places it is luminous. In others it is opaque. And yet I practice’. She discusses how over time she has developed trust in the daily work of talking, treating and attempting to heal: ‘you have to be anchored to the shore – to the people and things that are central to your own life’.