Table Of ContentDOCTORS'
MARRIAGES
A Look at the Problems
and Their Solutions
SECOND EDITION
DOCTORS'
MARRIAGES
A Look at the Problems
and Their Solutions
SECOND EDITION
Michael F. Myers, M.D.
St. Paul's Hospital
and University of British Columbia
Vancouver, British Columbia, Canada
With a Foreword by
Carol C. Nadelson, M.D.
SPRINGER SCIENCE+B USINESS MEDIA) LLC
Library of Congress Cataloging-in-Publication Data
Myers. Michael F.
Doctors' marriages : a look at the problems and their solutions /
Michael F. Myers ; with a foreword by Carol C. Nadelson. — 2nd ed.
p. cm.
Includes bibliographical references and index.
1. Physicians—Family relationships. 2. Medical students—Family
relationships. 3. Marital psychotherapy—Case studies. I. Title.
P.707.2.M94 1994
61u.69'6—dc20 94-100
CIP
ISBN 978-1-4899-1009-7 ISBN 978-1-4899-1007-3 (eBook)
DOI 10.1007/978-1-4899-1007-3
© 1994, 1988 Springer Science+Business Media New York
Originally published by Plenum Publishing Corporation in 1994
Softcover reprint of the hardcover 2nd edition 1994
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
For my mother and late father,
who share this day
And for Joice, who made this day possible
FOREWORD
A book entitled Doctors' Marriages implies that doctors' marriages are
special or different from marriages of other people. Why a book, espe
cially a second edition, on this topic?
The profusion of literature about doctors' marriages sustains a con
viction that there is a substantial degree of marital dysfunction and
conflict among doctors. This is often connected to beliefs that the per
sonality attributes of physicians lead to problems with intimacy, and
that the stresses of medical practice, coupled with rigid, compulsive
personality styles, contribute to the higher incidence of marital prob
lems, as well as psychopathology, in physicians. While one can wonder
at the reasons for the intense interest, and for the perpetuation of these
assumptions, a close look at the data fails to substantiate their validity.
Instead, one finds a more optimistic picture of satisfaction and fulfill
ment in physician marriages.
Lewis et al.l note that it is difficult to reconcile this positive view
with evidence that one out of four physician-spouse couples reports
participation in marital or family therapy. Difficult, that is, unless one
acknowledges that seeking therapy does not necessarily imply severe
dysfunction, but may instead represent a search for better adaptation
and happiness. Alternatively, the discrepancies between assumption and
reality may come from the fact that we are dealing with different sam
ples; those who are the objects of clinical reports and those responding
to questionnaires may not be the same people who are seeking therapy.
Nevertheless, the realities of contemporary life are stressful for all of
us, and physicians are no exception. The results of our complex and
conflicted lives can be seen in many areas, including the escalating rates
of family violence and divorce. Although marriages last the same length
of time as they did a century ago, divorce rather than death more often
ends them now. Reconfigurations of families often occur in an acrimoni
ous context and families may be drawn into intense loyalty conflicts and
rancorous altercations, which sometimes lead to violence, well in ad-
vii
viii FOREWORD
vance of divorce itself. There are often no good solutions, only accept
able ones, and all family members bear the burden.
Among the changes that have been blamed for family strife is the
"disintegration" of the "traditional" family. That is, the family with two
parents, one working at home, caring for children and other family
members, and one working outside the home. This description now fits
less than 10% of American families. Neither the cause nor the effect of
family disruption is clear, but physicians and their families are also
experiencing this "disintegration."
We no longer encounter many one-career, two-person partnerships, with
hard-working physician-husbands and se1f-sacrificing, stay-at-home wives.
Instead, we see dual-career couples with relationships flexible enough to
answer the needs and constraints of both partners, while allowing priority
setting and decision making to occur without a "wife at home." The nature
of physicians' relationships, commitments, and marriages has continued to
change, and the kinds of partnerships that Dr. Myers describes bear little
likeness to the "traditional" model of the medical marriage. Today, most
physicians, especially women physicians, are in dual-career marriages.
In this book, Dr. Myers has succeeded in presenting an insightful
description and providing a rich clinical matrix that enlivens it. He has
allowed us to see the skill and sensitivity that he brings to his work
with a diversity of physicians and medical students, presenting the array
of problems, concerns, and symptoms with which his patients deal. He has
also brought us into the world of today's and tomorrow's physicians by
taking account of the changing world of medicine and the increasing
complexity and differing stresses of physicians' lives. He has defined mar
riage in broader terms to include a range of committed relationships. In
Doctors' Marriages, Dr. Myers speaks eloquently, and more broadly, of the
turmoil in many marriages, touching a wider audience than doctors.
Carol C. Nadelson, M.D.
Past President
American Psychiatric Association
Washington, D.C. and
Professor of Psychiatry
Tufts Medical School
Boston, Massachusetts
REFERENCE
1. J. M. Lewis, F. D. Barnhart, E. P. Nace, D. I. Carson, and B. 1. Howard, "Marital Satisfaction
in the Lives of Physicians," Bulletin of the Menninger Clinic 57(4, 1993), 458-465.
INTRODUCTION
Although I did not realize it at the time, I began this book on doc
tors and their marriages during my childhood. Neither of my parents
was a physician, nor do I come from medical ancestry. My father was
a lawyer; my mother was a secretary who, like most women of her
day, became a full-time homemaker and mother after marriage. Theirs
was a typical male professional's marriage of the 1940s and 1950s-my
father worked incessantly and was the breadwinner, and my mother did
all of the unpaid labor of running the home, raising five children.
Despite material comfort, I felt personally and emotionally frustrated
within this family matrix, and this frustration became evident as ideas
and dreams of my own future began to germinate. I knew I didn't want
to be a lawyer! Interestingly, my friends whose fathers were hard-work
ing doctors (and with whom it was a relief to gripe) didn't want to
become doctors!
As the son of a dedicated, honest, and striving professional man,
I grew up feeling shortchanged of my father's time and companionship.
His was a general practice of law, with frequent night and weekend
calls-someone on his deathbed wanted to change his will, someone
at the city jail needed legal counsel-an endless number of anxious
clients who couldn't be accommodated during regular business hours.
Although my father was not home most of the time, the constant tele
phone calls of people trying to reach him made his presence felt. My
mother never faltered in her defense of his commitment to work and ab
sence from home. To this day her words echo in my ears: "Your father's
work is very important-it's not a nine-to-five job." My friends whose
fathers were physicians heard similar statements from their mothers. We
agreed on two points: None of us took any solace in our mothers'
attempts to appease us, and we all felt guilty for complaining and
feeling sorry for ourselves.
When I decided to become a doctor, I vowed to myself that I would
do it differently; I would strike a balance between my work and my
ix
x INTRODUCTION
family. How soon I learned that despite one's best intentions, it is no
simple matter to get away from the hospital or office at a reasonable
hour with a sense of certainty that one's work is done for the day.
I married early in my residency; my wife and I began a family toward
the end of those training years. I found it a continuous struggle to
meet the needs of my patients, the medical students I was teaching,
my wife, and my young daughter-plus prepare for fellowship (i.e.,
board) examinations.
My first exposure to psychiatric distress in the medical profession
had occurred much earlier, when one of my roommates in medical
school committed suicide. We were both first-year medical students.
Although his tragic death was not felt to be related to academic or social
stress at medical school, it was impossible not to be guiltily introspec
tive. I will never forget standing before my class the following day and
announcing that my roommate had died. I remember my trembling legs
and quivering voice and the ashen faces of my classmates. Little more
was said about the suicide; I suspect that most of us went underground
with our feelings and fears as we threw ourselves into anatomy, bio
chemistry, and other courses.
While a resident in psychiatry, I gained my earliest experience with
patients who were doctors, their spouses (usually wives in those days),
and their children. Doctor-patients and their families always make resi
dents nervous, and I was no exception. I experienced a sense of naked
visibility and all the other insecurities of being a trainee, yet at the same
time I always felt touched by the respect I was accorded and the grati
tude paid to me for my efforts. Their attitudes toward me sparked and
nurtured the intense curiosity and concern I felt for these doctors and
their families whose lives, at least for that moment, were not going well.
Whatever the diagnosis, from the most damaging to the most benign,
I was fascinated by its dynamic interplay with the profession of medi
cine. Who became doctors and why? What vulnerabilities do people
who study medicine bring with them? Does the practice of medicine
make doctors ill? Can anything be done preventively? These were all
questions that excited the curiosity of the scientist in me, but simulta
neously frightened the ordinary human in me. They threatened my
personal and professional equilibrium, for after all I was a physician,
too. As I listened to the stories of a middle-aged ophthalmologist de
scribing his depressive symptoms, a doctor's wife struggling with alco
holism, or a doctor's son coming off drugs, my thoughts raced ahead. Is
this me in fifteen years? My wife? My son?
Once I completed my residency and opened a private practice I began
to see another spectrum of physician ailments-their marital problems.
INTRODUCTION xi
Not only was I unprepared for the number of doctors interested in
marital help, but I felt ill equipped to treat them. Most residency train
ing programs do not offer a lot of supervised experience in marital
therapy; those that do may not have many distressed couples who are
doctors referred. As is the case with many aspects of medicine, experi
ence is the best teacher, and that experience (coupled with continuing
medical education courses and the wisdom of senior consultants) has
stimulated and fostered my continued professional interest in doctors
and their marriages.
This book is the product of my work. The "data base" that forms its
substance includes the more than 130 medical student or physician cou
ples that I have treated over fifteen years of clinical practice. An addi
tional seventy-five medical students and physicians have been treated
individually for relationship concerns that include separation and ad
justment to divorce. Most of these individuals were treated in my pri
vate practice, but a few have been treated in my supervisory work
with medical students and psychiatric residents in a teaching setting.
Although most couples were married, a few couples (apart from gay
male and lesbian couples) were cohabiting for a year or more before
seeking help.
My purpose in writing this book transcends the detached documen
tation of the common marital problems of medical students and physi
cians or the perspective of one clinician toward the eradication of these
problems. I have written from a position of uneasiness-an uneasiness
about the present state of medicine in North America and about the
difficulty many medical students and doctors are having with their
marriages. We are living and working in an era of extremely high
marital breakdown with only minimal letup in sight, and the psycholog
ical impact for all family members is serious. I hope that this book
will be of help, both preventively and therapeutically, to the interested
reader-particularly medical students and doctors, their spouses and
partners, and their age-appropriate children. I also hope that it will
attract therapists to this subject and offer new knowledge to those ther
apists already working with physicians and their families.
I have organized this book in chapters beginning with medical
student marriages, then resident physician marriages, male physician
marriages, and so forth. This division of subject was somewhat arbitrar
ily chosen for clarity and for progression through the marital life cycle.
However, there is overlap from one chapter to the next; to avoid being
redundant I have tried to cover certain themes more thoroughly in one
place than another. For example, if you are a doctor married to another
doctor, you will be interested in the chapters on male phYSician mar-
