Medical treatment of the super-rich - a psychiatrist's view

FMH responds below to a mildly annoying NYT article on psychiatrists who pander to their super-rich clientele. The discussion is relevant to so-called "concierge care", a modern mixture of luxury good and traditional service, but the temptation to seduce is perhaps strongest in psychiatry ...

Follow Me Here...: 2008/07/13 - 2008/07/20

... As a psychiatrist myself (who never, alas, treats the superrich), I was interested by the number of notable psychiatrists who seem to be making it their niche. True, treating the superrich overlaps with the issues, long considered very challenging in psychotherapy, of treating the very narcissistic. But the article is, I think, too polite about what I assume are added ingredients of a mix of therapists' voyeuristic and purely mercenary interests in taking on the extremely wealthy in particular. The patients and their struggles are not inherently more interesting; in fact, they are probably less so, on the whole, despite the pat statement quoted by a therapist of the rich that she "considered a rich person’s unhappiness or emotional anguish no less serious than anybody else’s". As the writer correctly points out, most of these patients have less of an impetus to work things through than the rest of us, and even than the rich patients of days past, more and more insulated from a recognition of personal dissatisfaction in an ever more materialistic and spiritually vacuous society as they are. Thus, a therapist treated more often as just another member of the client's personal entourage flirts with being readily disposed of if s/he too readily emphasizes unpleasant aspects of these clients' lives, which is after all what therapy is all about. And if the therapist refrains. s/he of necessity becomes a sycophantic supporter of self-indulgence...

It's very tough to be super-rich and not grow to love sycophants. If I'd been unfortunate enough to be wealthy (really, I wouldn't have survived the experience) I'd love 'em as much as any billionaire.

That's bad enough when the sycophant is your hair dresser, but it's much worse when the loyal servant is also your physician, your attorney, your accountant, or, perhaps especially, your psychiatrist. Sycophants are not only weak at delivering bad news, they become incapable of perceiving bad news. It's a necessary part of becoming a welcomed parasite ...