I won’t judge you for asking for help because that is how I hope you treat me.
It took me five years to accept the fact that I needed help. As I pursued athletic endeavors at the highest level in high school and college, my mind developed a twisted, compulsive mindset towards eating to control my life, navigate my cultural heritage, and succeed in my sport. For those five years, I suppressed my greatest shame in hopes of reaching “success,” i.e., that successful student-athlete accepted into medical school. Still, internally I was exhausted from carrying this burden of self-hatred. For years I was too ashamed to say anything. I didn’t want people to look at me as a failure, the plight of a student-athlete who is not self-assured, not confident.
I am so thankful to attend a medical school that values open discussions on the importance of mental health. Having these conversations is easier than actual practice though, especially in the context of medicine. In medical school, there are times when the day is so packed, I am forced to finish a meal in five minutes, directly contradictory to what my therapist and I worked on for so long. There are times when I’ve been stressed before an exam, and I find myself engaging in negative habits. As I start moving forward into my clinical rotations of medical school, I am nervous about the little autonomy and the disregard for our bodily functions that exist. As a result, I might turn toward habits that I’m still trying to unlearn as a means to bring back control.
The high stakes and the need for perfectionism in medicine encourage abusive relationships with one’s body and mind. Add on top of that the variable schedules physicians have — long surgeries, and high patient volume — when do we have time to sit down, take care, and nurture ourselves?
There is little room for forgiveness and error in medicine that goes hand in hand with the little room that exists for physicians with outspoken mental health conditions. Reluctance to seek help has been documented amongst physicians due to fear of losing licensing, judgment from colleagues or supervisors, stigma, and concerns about confidentiality. There are 24 states with medical boards that inquire about current and previous diagnoses of mental health conditions. These fears are worse in medical trainees. There are extremely low rates of medical student disclosure of mental health conditions on ERAS due to fear of stigma, not matching, and being perceived as “less competitive.”
When I was applying to medical school, I had very similar thoughts. I wanted to show how my eating disorder shaped me and furthered my motivation to become a doctor. However, after reading various admissions blogs and forums, the consensus stated doing so would expose myself as a weak liability. Out of fear of risk and rejection, I decided not to express my true self, which supposedly did not fit in the rigid mold of medicine. I questioned if I really wanted to join a field that cultivated a culture of struggling with mental health in silence.
Although I’m proud of my progress in my recovery, I’m still wary about revealing this information to mentors, faculty, admissions committees, or anyone who holds power over me as a trainee, in fear that one day they will hold this information over my head. I hope trainees will be less afraid to speak about and embrace the challenges previously faced or faced regarding mental health. I hope structural barriers are dismantled so that we do not have to live in fear of being punished and judged for seeking help. Being taught to remain silent, starting from the admissions process through medical school itself and into residency applications, instills more shame and fear in us that we will carry through our careers. Dismantling mental health stigma and developing a culture of healing requires instilling these values, starting with medical trainees and even at the applicant level.
The author is an anonymous medical student.