To the Editor.—I found the special article by Butterfield1 in the June 1988 issue of the Archives to be one of the best and most perceptive I have yet seen.
Several points struck home, even though I completed my residency in the 1950s. First of all, I would agree that anger is (and was) significantly more common (and dangerous) than depression. The anger was (and is) often turned on patients, each other, spouses, the outside world, and, ultimately, directed inwardly against oneself in the form of depression. This is especially well delineated by Shem in The House of God.2
Second, the point made that inadequate personal time, lack of time, lack of adequate coping resources, and interference with social support may have been more stressful than sleep deprivation deserves emphasis. Even though current house staff have fewer nights on call and work fewer hours than did preceding