Nathaniel P. Morris is a student at Harvard Medical School.
In medical school, we take dozens of tests. But I’ll never forget a multiple-choice quiz that I once took on my own. It wasn’t assigned, and I didn’t want anyone to know I was taking it.
I locked the door and drew the shades. I changed my browser setting to private on my laptop and clicked away in the dark, answering questions about my sleep and my energy, my goals and my appetite. When I finished, I held my breath and clicked “submit.” A pop-up appeared.
It said I met criteria for depression.
Numerous studies show medical training can have serious effects on the mind. Surveys suggest roughly 1 in 5 medical students suffers from depression, a rate 15 to 30 percent greater than the broader population. A study in the Annals of Internal Medicine found more than 10 percent of medical students think about suicide within a given year.
We often talk about depression and medical education in terms of these numbers and percentages. But what goes on inside the mind of a future doctor in anguish?
Let me tell you. Prior to medical school, I had no history of anxiety or depression. But by the end of my second year, something had gone wrong.
My mind was a tempest. Pangs of anxiety came and went, and I clenched my fists with fright. At night I would lie in bed and stare at the wall. In the morning I was exhausted.
As a doctor-in-training, I know I should have sought help right away. I’ve read the literature on medical trainee burnout and depression. My girlfriend told me to talk to someone. My parents urged me to make an appointment with my doctor.
But I refused. Because in medicine, asking for help is often seen as failure. We teach trainees about resilience and look down on those who can’t tough it out. We’re told to give everything to our patients. So medical students, doctors and nurses frequently say nothing, suffering silently and alone.
I hid how I was feeling. I smiled during rounds and took on more patients. I studied harder and received great clinical evaluations. All the while, my symptoms worsened, and I fell deeper into the abyss.
Then, one afternoon, I had a routine check-in with an adviser. He invited me into his office with a warm handshake and a smile. As we sunk into comfortable chairs, he asked me how everything was going.
I stared back at him, silent for a moment. Then I covered my face and cried.
That’s when my recovery began. I followed up with other advisers and doctors. They greeted me with open arms, compassion and respect. Through a mix of talk therapy and low-dose medication, I got back on my feet. It never affected my grades, and I didn’t have to take any time off. I was one of the lucky ones.
Now that I’m back to my old self, I often wonder where that despair came from.
Maybe it came from sleep deprivation, a mainstay in medical school. Perhaps it stemmed from medicine’s long-standing culture of abusing trainees, such as when a surgeon nicknamed me “Helen Keller” because of my suturing skills. Genetics probably played a part; depression runs in my extended family.
As I look back, though, the most difficult part of this experience has been keeping it a secret. Even after I came forward to get care, I feared repercussions from what I’d done. What if my classmates found out? Would I get into a residency program? Would it affect my medical license?
Mental-health experts often refer to two types of mental-health stigma. There’s public stigma, or how people can look down on those with mental illness. Then there’s self-stigma, or how people with mental illness can look down on themselves.
I’m no longer depressed, but I still worry about this. I worry my friends and family won’t look at me the same way after they read this article. I worry patients might think I’m not fit to be their doctor. I worry future colleagues won’t trust my judgment.
I can fight the public stigma. Next week, I’ll graduate from medical school, and I’ve decided to pursue residency training in psychiatry. I hope to give my patients great care, and I hope that I can be an advocate for mental health in the medical community and the public.
It’s the self-stigma that’s hardest to conquer. How do you overcome the inner shame of the diagnosis, the sense of being less than everyone else?
But then I remember the words of Kay Redfield Jamison, the Johns Hopkins psychologist who has talked about her struggles with bipolar disorder. She once wrote, “I have no idea what the long-term effects of discussing such issues so openly will be on my personal and professional life, but, whatever the consequences, they are bound to be better than continuing to be silent.”
She’s right. I’m opening up because medicine falters when its caregivers struggle in the shadows. No one should be afraid to speak up when they need help. If health-care providers can’t overcome the stigma of mental illness, who will?
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