The Case of Ruth Daughtery: Navigating Catastrophic Illness in a Family Member

  • Anna L. DickermanEmail author


Illness in a relative or loved one is a challenging experience, and in some ways, uniquely challenging for physicians. The role transition from doctor to family member often provokes anxiety and, in some instances, leads to the emergence of adjustment disorders or even frank mood episodes. Common defense mechanisms seen in these cases include denial and intellectualization. Physicians may struggle with balancing the multiple potentially competing interests that can arise during these periods: the needs of their colleagues and patients, the expectations of their families, and their own mental health and well-being. When indications for a leave of absence arise, doctors may struggle with feelings of guilt and shame about this. Overidentification is a common reaction experienced by the treater in such cases and is best handled with mindful use of psychotherapeutic techniques which foster therapeutic alliance while also helping the patient maximize adaptive coping.


Physician mental health Illness in physician and family Role transitions Work-life balance Adjustment disorders Brief psychotherapies 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    Carta MG, Balestrieri M, Murru A, Hardoy MC. Adjustment disorder: epidemiology, diagnosis and treatment. Clin Pract Epidemiol Ment Health. 2009;5:15.CrossRefGoogle Scholar
  3. 3.
    Maina G, Forner F, Bogetto F. Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychother Psychosom. 2005;74(1):43–50.CrossRefGoogle Scholar
  4. 4.
    Markowitz JC, Kocsis JH, Fishman B, Spielman LA, Jacobsberg LB, Frances AJ, Klerman GL, Perry SW. Treatment of depressive symptoms in human immunodeficiency virus-positive patients. Arch Gen Psychiatry. 1998;55(5):452–7.CrossRefGoogle Scholar
  5. 5.
    Van der Klink JJL, Blonk RWB, et al. Reducing long term sickness absence by an activating intervention in adjustment disorders: a cluster randomized controlled design. Occup Environ Med. 2003;60:429–37.CrossRefGoogle Scholar
  6. 6.
    Schneck S. “Doctoring” doctors and their families. JAMA. 1998;280:2039–42.CrossRefGoogle Scholar
  7. 7.
    Chen FM, Feudtner C, Rhodes LA, Green LA. Role conflicts of physicians and their family members: rules but no rulebook. West J Med. 2001;175(4):236–9.CrossRefGoogle Scholar
  8. 8.
    Ellard J. The disease of being a doctor. Med J Aust. 1974;2:318–23.PubMedGoogle Scholar
  9. 9.
    Misch DA. Basic strategies of dynamic supportive therapy. J Psychother Pract Res. 2000;9(4):173–89.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Gabbard GO. The role of compulsiveness in the normal physician. JAMA. 1985;254:2926–9.CrossRefGoogle Scholar
  11. 11.
    Vaillant GE, Sobowale NC, McArthur C. Some psychologic vulnerabilities of physicians. N Engl J Med. 1972;287:372–5.CrossRefGoogle Scholar
  12. 12.
    Waring EM. Psychiatric illness in physicians: a review. Compr Psychiatry. 1974;15:519–30.CrossRefGoogle Scholar
  13. 13.
    Meissner WW, Wohlauer P. Treatment problems of the hospitalized physician. Int J Psychoanal Psychother. 1978–1979;7:437–67.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Weill Cornell Medical College/New York-Presbyterian HospitalNew YorkUSA

Personalised recommendations