Speak up

I turned on my computer and had no idea what this post was going to be about. But just now I was looking at the stats on this blog, and interestingly, someone found it by searching “leave of absence residency depression”. And now I’m all sorts of inspired. (At the bottom is a little update on me, if you’re up for reading my ramblings.)

First off, I’m glad whoever it was found this blog by searching those words. And it would definitely be the highlight of my day if it made that person feel like he/she was less alone in this world. I know how desperate it feels to search information, personal stories, or whatever related to depression in the health professions (specifically medicine). I mean, it’s kind of sad when you google a phrase related to taking a leave of absence from medical school and/or having depression and what pops up is your own blog (true story). And don’t even get me started on searching “borderline personality disorder medical student”.

Searching anything related to mental illness in medical school or in residency, like this person was searching, usually results in dead ends. I’ve found maybe 2 or 3 dead blogs where there was a single post dedicated to the topic, which usually can be summarized as “I’m a medical student and oh yeah, I had depression in first year but I’m over that now”.

It all begs the question: Why is this topic such taboo?

Honestly, it’s complicated. There’s really so many reasons. But I think the three most important reasons are the following (I speak from the medical school point-of-view, as that’s my only experience, but I’m sure this extends in some form or another into residency and eventually, clinical practice):

  1. The people – I know I’m making a ridiculous generalization here, but medicine tends to attract perfectionists. And usually, it’s perfectionists who are used to being top in everything. Mix that with the demands of medical school, and you have a time-bomb. Depression sets in as your self-esteem slowly dwindles, anxiety and panic attacks ensue in those who are prone to them, those with eating disordered thoughts give in to them, or the pressures and triggers send you into a manic episode, etc. Now, keep in mind that mental illness is one of the most (if not the most) stigmatized group of illnesses. People with mental illness are viewed as weak or faulty, among many other things. So, imagine a perfectionist medical student, who sets incredible standards for him/herself, suddenly being told by society that he/she is weak and/or faulty for being bipolar, or depressed, or having anxiety, or whatnot. Well, let’s just say, nobody wants to be viewed as weak or faulty, much less a perfectionist…and much, much less, a medical student, which brings me to #2…
  2. The culture – The high standards of medical school result in a dog-eat-dog culture where the slogan is literally “Survival of the fittest.” And if, by any chance, you don’t “survive”, what does that imply? That you’re not fit. Not fit to be a medical student. Not fit to be a doctor. Not fit to turn your dreams (or those of whomever has been pressuring you to become a doctor) into a reality. So, naturally, there’s this pervasive culture of “sucking it up” (I detest that phrase). You feeling depressed, anxious, binging every day, or whatnot? “Suck it up” and keep going. Everyone feels the same, they say. You’re already a medical student, might as well keep going at it, they say. (I could go on and on about the culture, but nobody will truly understand until they’re in that environment themselves. This is just the tip of the iceberg.) And last, but not least…
  3. The Fear – Just like in the “outside world” not many people speak about their personal accounts with mental illness out in the open for fear of stigma, those in the medical field are no exception. Mix that with the fact that disclosing your mental health issues can result in halting your dream career altogether, and well, nobody, and I mean nobody, is going to talk about it out in the open. 

Really, the point I want to get across with this post, is… We are many, we are afraid, and we are sick. Sure, some people fly by medical training and then working as a doctor without the extra baggage of mental illness. Kudos to them. But the statistics point to a very, very sad picture: suicide and mental illness in the medical profession is a very real problem. The problem is, if no one’s willing to talk about it, it’s not going to get any better.

So, first of all, if you are a medical student or doctor feeling miserable or “just not right” in any way, seek help. I can’t stress just how important this is. Not for society, not for your career, not even for your patients…but for you and your own well-being.

And, finally, if you are a medical student or doctor with mental illness, speak up. There’s more people like you battling the same demons closer to you than you think. Even if it’s under full anonymity, speak up. Others like you will listen…

And only then can change take place 😉

***

So here goes my update…

It’s been kind of rainy here lately, and that’s really been affecting my mood. Some moments I give in to being down and irritable, but I think I have to give myself some credit for forcing myself to stay active and not isolate. Still, I can’t help but give in to the thoughts about failure and feeling weak and frankly, pissed off at myself.

For example, the mere act of texting with my two best friends from med school makes me think about what they’re doing in their final rotations of third year, which makes me think Umm, yeah, I’m just hanging around home, which then takes me to Why was I not strong enough? Why am I so weak? Rationally, I recognize just how irrational these thoughts are, but it’s one story to recognize them, it’s a whole other story to consciously battle them (and win the battle!).

As for the whole leave of absence shitfest (yeah, I’m so sick of it that I decided to call it that), I think the rational side of me wants to take a break. However, it’s fear of making a decision that’s holding me back. I made an updated list of pros and cons, which I might get around to publishing here, and it just left me more confused. But I think I’ve been moving toward just taking the time off. Let’s see.

Meanwhile, 5 days ago was the 1 month anniversary of my hospitalization (Yay! Let’s bring out the cake! -Ahem. Sarcasm, much?- ). The sad part about all of this is that I got discharged with such a clear mind, with clear goals…but 1 month down the road I feel like the hospitalization never happened. Frankly, I don’t know if I’m blocking my emotions, or what it is, but it’s been bothering me terribly and I think it’s what’s been keeping me from making the feared decision.

Oh, tomorrow I’m seeing the psychologist (yeah, the one I was referred to from the hospital, remember her?), and in the afternoon I’m seeing M. That is, unless she cancels (ok, that was definitely the borderline in me speaking).

Sorry for the ridiculously long post.

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5 comments
  1. Anonymous said:

    Hi,
    I just got discharged from the Johns Hopkins Hosp, psych. floor for mood disorders and substance abusers after three months of an involuntary commitment. Totally sucked. I've been reading and catching up on your blog since I got home. I'm so sorry to hear that things are shitty for you right now. I was fired from my job as Chief of Staff at the veterinary hospital where I worked in June 2010 because of my mental illness. Since then, I've kept my veterinary license active by going to conferences and lectures, but to be honest, I don't believe I could safely practice medicine at this moment. While you're still young and have your whole life ahead of you, I'm 57 years old and believe my life is over. My advice, such that it is, is : if you feel that taking the time off now to get better is your best option, then that's what you should do. Fuck everybody else and their notions of decreased worth and ability. I know about the stigma attached to mental illness but, it doesn't matter what anybody else thinks – it's ONLY about how you feel. Currently, I'm having a terrible time trying to readjust to life on the outside. 3 months was a fucking long time to be completely controlled and managed plus I had 13 sessions of ECT and my short and long term memory has been majorly damaged. It took me an hour to remember how my cell phone worked and figure out how to charge it yesterday. All the stress and frustration led me to self-harm (cut) yesterday and today I have to try and find some other way to cope. Don't sell yourself short. Do what you need to do now before your illness gets harder to treat and the possibility of self harm increases. Hope today is a better day for both of us. Take care, Doc.

    Like

  2. Hi Doc,

    Great to see you back here. I've too been keeping up with your blog 😉 Do you find the hospitalization did you any good? I really hope that with time you can recover your memory.

    I think you should be less severe with yourself. At this moment you've gone through a life-altering event. (I mean, my hospitalization only lasted a week and it feels like everything's changed now, I couldn't imagine what it would be like with 3 months). I completely relate to the stress and frustration you mention. As for the self-harming, I really hope you can find another way to cope. Remember there's more options out there than you think, cutting can feel like “the only thing that will make me feel better”, but that's really not true. Try to not give in to those thoughts. When I feel urges to cut I ask myself “Why would I do this to myself?” and usually I have no logical answer to that question, so that gives me some time to try and find something else to control the negative emotions I'm feeling. It's sort of a way to buy yourself time.

    I might not know you personally, but I can tell that you are so much stronger than this. I really hope today was a better day for you.

    Take care,

    Like

  3. Hi,

    Wow, a lot of what you write here makes so much sense with regards to the medical community. It is a brutal environment with not much compassion for our colleagues. I have encountered on a few forms (and one that I had to fill out for my residency) the question: “Do you have any medical problems which would interfere with your ability reasonably to perform the work for which you have applied?” I understand why that is a concern, but I also think that is so hard to predict and therefore to answer truthfully!

    In truth, I would be lying is I said “No”. But of course that's what I answered.

    How did the appointment with the therapist and M go? How are you feeling?

    xoxo,
    K

    Like

  4. K,

    Ugh, I hate that question! I too understand why it is a concern, but like you said it's so hard to predict. I mean, do they really expect anyone to be honest in that question? Of course everyone will answer No.

    Like

  5. F68.10 said:

    My mother, a psychiatrist, a borderline, went through a major depression that lasted for a decade with a lawsuit on top of it. That followed the suicide of her first patient, a long time ago. When she was in psych residency.
    The whole situation has evolved to the current situation which really darn looks like factitious illness imposed on another. And that’s really really ugly.
    Self harm is one thing. Harming your kids is another. And there’s kind of a confusion between the two in borderline PD, isn’t there?
    I hate being judgemental, but I really wish to get a point through. Maybe because you may be in the best position to reflect on the issue.
    Depression in psych residency should be talked about. Discussed. Not shoved under the carpet.
    It all makes me want to cry.

    Like

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