There Should Be More to Life Than Medicine, Author Warns Workaholic Mds
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There should be more to life than medicine, author warns workaholic MDs Olga Lechky A ddiction to work is an im- portant and often unrecog- nized cause of high rates of alcoholism, drug addiction, di- vorce and suicide in the medical profession, a Toronto psychologist says. And although alcoholism and drug addiction are far from re- spectable in our society, working punishing hours and being con- sumed by one's work are often viewed as laudable traits by cor- porations and medical institutions alike. Indeed, workaholism has become so entrenched in our soci- ety that it is fostered and reward- ed at school and in the workplace. As a result, the term "workaholic" has become a badge of respect as more and more people begin to define themselves and others in terms of what and how much they do. In reality, says Barbara Kil- linger, PhD, workaholism is noth- ing to brag about. She says it is as destructive to individual addicts and their families as substance "Medical school is very much abuse. Her book Workaholics: The workaholic training." Respectable Addicts. A Family - Barbara Killinger, PhD Survival Guide (Key Porter Bks, Toronto, 1991) is based on clini- cal experience she gained while verely impaired judgement and an balance between work, play and treating workaholics and their inability to function effectively. family life. Workaholism occurs spouses and families during the She believes it may be one reason only when work and work-related last 12 years. for the growing number of investi- concerns dominate a person's life She says physicians, along gations and lawsuits being - in fact, become that life - and with dentists and clergy, are espe- launched against doctors for mal- lead to the exclusion of other cially prone to workaholism, and practice, negligence and sexual aspects of existence. have the highest rates among pro- abuse. Killinger says workaholism fessional groups. "A workaholic is a person has little to do with a true love of Killinger views workaholism who gradually becomes emotion- one's work or an honest desire to as an insidious and complex proc- ally crippled and addicted to con- make a positive contribution to a ess that eventually results in com- trol and power in a compulsive company, society or one's family. plete personality breakdown, se- drive' to gain approval and suc- It begins as perfectionism and, as cess," she writes. Working long outstanding performance is re- hours is not necessarily the mark warded, becomes an obsession or compulsion to take on an ever Olga Lechky is a freelance writer living in of a workaholic, she adds, because North York, Ont. a hard worker can maintain a greater workload. Leisure time be- OCTOBER 1, 1991 CAN MED ASSOC J 1991; 145 (7) 857 comes anxiety time as the wor- enormous. Students are given the kaholics enter treatment after the kaholic frets about not working. message that excessively long spouse presents with depression Eventually, rest and leisure are hours are normal and many con- and anxiety stemming from severe given up entirely, or leisure activi- tinue with a punishing schedule loneliness and alienation. "The ties such as sports become another throughout their professional ca- spouse is fighting for survival, for form of work, with an emphasis reers. Also, the independence of her own reality," says Killinger. on winning at all costs. It tends to having your own practice fosters "The workaholic is always right, is be a male affliction, but is affect- an excessive self-reliance, a need very critical of others and never ing a growing number of women. to always be in control and to accepts blame. Events for which The final stage of workahol- always be right. In your own prac- he is responsible, such as coming ism is narcissism, which is tice, the hours are infinitely ex- home late after promising to be on marked by a complete loss of pandable. time for dinner, get twisted so empathy and compassion. By this "Society places doctors on a that the spouse is the one who time denial is so entrenched the high pedestal of respect. The hier- started the argument. The wor- workaholic has no insight into his archical structure in a hospital kaholic completely loses sight of lack of regard and cruelty toward also encourages workaholism. The the initial cause of the argument. others. While fearing criticism doctor is kingpin and everyone "Over time, many spouses and judgement, the workaholic is else fits in underneath. The whole start to feel they're going crazy highly critical of others, blaming power structure in a hospital because they're always blamed them for the disasters he causes makes it very easy for doctors to and their experience is always de- and the emotional turmoil he feel special, different, superior. nied. They become the targets of spawns in the fatnily. But the Being boss, having your ideas ac- the negative feelings that the wor- workaholic does not emerge un- cepted and rarely challenged, pro- kaholic so carefully hides at work. scathed. The high price of repress- motes feelings of self-importance. They are the recipients of uncon- ing overwhelming feelings of guilt, The high regard of patients and trollable outbursts of rage which anxiety and anger shows up in a colleagues is the reward that feeds are often denied later by the wor- growing number of depressive epi- a compulsion to accomplish more kaholic. As the need for power sodes, panic attacks, incapacitat- and more." and control grow and more and ing fatigue and physical ailments. Despite the heavy demands more negative feelings mount, the Cross-addiction to alcohol and of medical training, only some workaholic increasingly projects other drugs is common and sui- physicians are destined to become these threatening feelings on the cide becomes a possibility as the workaholics. For instance, Killin- spouse. Dishonesty grows to the emotionally crippled workaholic's ger says growing up in a dysfunc- point that the workaholic becomes professional and family life turns tional family is a prerequisite for extremely secretive about any- to shambles. workaholism. In these families thing that may reflect negatively "Physicians are especially perfectionism takes root because on him. Workaholics tell a lot of vulnerable to workaholism for a children are not recognized for lies, but it's also important to number of reasons," Killinger told who they are, but only on the realize that the absence of truth is CMAJ. "First of all, medicine basis of their performance and the same as an outright lie. As a tends to attract idealistic and per- accomplishments. Such condition- result, the spouse suffers severe fectionistic personalities. A young al love does not allow for the emotional and psychological physician usually starts out mean- development of a sense of self, abuse. She loses her capacity to ing well and tries to be empathetic and the child learns to seek affir- trust. She may suffer for years in and compassionate, but gradually mation by pleasing others. Feel- silence, actually enabling the wor- issues such as serving on lots of ings of anger and guilt are re- kaholic's behaviour by playing the committees, publishing, expand- pressed as the child compulsively role of codependant." ing a practice, or attaining a high struggles to win parental approval. In the later stages of compul- hospital or academic appointment In most cases, one or both parents sion, when narcissism is starting may become more important. Sci- are narcissistic workaholics, alco- to dominate the personality, the entific and professional concerns holics or drug addicts who see the workaholic has a harder time pro- may start to overshadow concerns child merely as an extension of jecting the "nice guy" or "nice about patients and family. their own needs and desires. gal" image at work. Secretaries "Medical school is very much Although the workaholic may and other subordinates become workaholic training," she adds. be held in extremely high regard the targets of rage and abuse as "The pressures to succeed against at work, at least initially, his fami- the workaholic loses his grip Qn gruelling long hours and an im- ly life will start to unwind under the multitude of self-imposed mense amount of material are increasing pressure. Most wor- commitments he has made. As 860 CAN MED ASSOC J 1991; 145 (7) LE IerOCTOBRE 1991 0- performance plummets and judge- left solely responsible for the fa- counterproductive because this ment becomes impaired, the sec- mily's intimacy and social life. just further blunts feelings in a retary often plays the role of code- Whenever guests were invited, she person who is already seriously pendant by covering up her boss's did all the preparation while Josh- out of touch with his or her feel- blunders and cleaning up the fall- ua hung about the kitchen super- ings. This type of approach just out resulting from his offensive vising her efforts, barking out gets the workaholic from crisis to behaviour. commands, criticizing and gener- crisis and does nothing about ad- During the narcissistic phase, ally exerting control over all the dressing the underlying addic- the workaholic's career is eventu- cooking, even though he knew tion." ally jeopardized as it becomes in- little about preparing food. These Since workaholism is difficult creasingly obvious that he can no scenes made Sally so nervous and to treat, says Killinger, greater longer cope with the simplest resentful that she eventually emphasis should be placed on pre- tasks, yet refuses to accept respon- stopped entertaining. That was vention. In medicine, for exam- sibility for serious errors. just as well for Joshua, whose ple, "a lot more education is need- In her book Killinger presents increasing fatigue made it impos- ed in medical school about main- the case of "Joshua," a successful sible for him to even think about taining a balanced life and a surgeon who prides himself on not the extra demands and anxiety healthy perspective.