Waiting to get help to improve your life and relationship is like waiting for the cancer to spread. You feel a lump on your body. Do you wait a few months to see if it gets bigger? Do you make an appointment right away? Do you avoid making an appointment altogether and hope it just goes away on its own? Many times, we wait until after the divorce, after the accident, ...

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As doctors, we love to think we are intelligent, rational, thoughtful and caring human beings, and we take pride in our profession and the privilege and status it accords. We like to hold our heads high, puff out our chests, speak with authority and convey our hard-earned knowledge acquired over many years of undergraduate and post-graduate study. We like to think we know; we have answers; we can cope; we ...

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I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship." I call it burnout because beyond the exhaustion and can’t-take-it-anymore, there was a gnawing sense that something fundamental was missing -- something that no amount of time would fix. Over the next year or so, the ...

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In general, I would predict that the audience reading this blog knows about medicine’s suicide epidemic: Roughly 400 physicians and 150 medical students kill themselves each year in the United States. This means that every year, about a million Americans lose their doctors to suicide. This crisis is a public health issue. The puzzling question is: Why isn’t it publicly known? If one million Americans were affected each year by ...

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When a person gets depressed over their divorce, they are said to have a mental illness. When a person becomes psychotic from a manic episode due to their bipolar disorder, they are also said to have a mental illness. But are both of these illnesses mental illnesses? The definition of mental is that which relates to cerebral, brain, cognitive or intellectual processes. Many disorders occur from problems in the anatomy or ...

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Imagine losing your grip on reality; your only place to turn is the local hospital. Once there, you give up your personal effects, your clothes, and often, your right to leave. You wear paper scrubs in a sparse room, lay on an uncomfortable bed, and have a guard nearby preventing your escape. In seeking help, you have become a prisoner. This is done for your and for the hospital personnel’s ...

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As the audience of medical students decried the experiences that defined their academic lives, my cohort of middle-aged doctors started to squirm. We knew these stories: Doctors mistreating medical students, nurses, and other doctors; learning to cope with brutally long work hours; the struggle to grasp vague and ever-changing expectations while quickly bouncing from one clinical rotation to the next. The four of us had eagerly agreed to participate on the ...

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Pamela Wible MD’s book, Physician Suicide Letters Answered, is a devastating view of raw pain, the pain of young, energetic, highly committed young people motivated to help and heal. These healers themselves have been plunged into the spiritual, physical, emotional, and intellectual hell of suicidal thought and action. Iatrogenic illness in action (iatrogenic illness being that which is caused by medical practitioners). Unfortunately, and tragically, the iatrogenic illness that ...

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Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM-IV parked in my office bookcase.  The main reason was to enter the right diagnostic codes on insurance forms.  I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily mood swings are not characteristic of bipolar disorder, or that six months of sobriety is still “early” ...

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I was treating John W., a psychiatric patient who was an insurance executive. He was angry about his work situation. He complained bitterly about his supervisor whom he felt singled him out for unfair criticism. Over the course of months, John’s complaints escalated to the point where he said, “I swear … if there was a chance I’d get away with it, I’d love to get rid of the guy.” I ...

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