My double life: Mental illness in the health care


I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have carried the diagnosis of major depressive disorder since I was 11 years old. My family noticed something was wrong well before I was actually diagnosed, and after a few years of going to therapy and not improving, I was taken to a doctor and started on medication. I have been on medication ever since that day, and I know for a fact that those seemingly insignificant prescriptions allowed the family to function again; it gave me my life back, and in doing so, it gave the life back to those in my family.

Like any chronic medical condition, major depression requires you to go to monthly follow-up appointments with physicians. It requires adjustments to doses and even changes in types of medications depending on how you are feeling and managing your symptoms. It can even require weekly therapy.

However — perhaps most importantly — it requires you to understand and acknowledge when you are having a “flare” and need help. Flares can present themselves with either increasing and ongoing sadness or feelings of worthlessness, significant irritability or tearfulness. At their worst, flares present as ongoing thoughts or plans of death or suicide, and needless to say I experienced many more flares since I was 13 years old. Many of them occurred in high school, and I even developed superimposed anorexia nervosa when I was 16. The summer after my freshman year of college the first friend I had made committed suicide, and five months later I had to call the campus police while another one of my friends confessed to plans of ending his life through fatal overdose. But it wasn’t until my senior year of college when I started thinking of death and suicide in relation to myself. I never told anyone because I was too afraid of appearing weak, hysterical, and incompetent. I was afraid of people doubting my ability to be successful.

It was not until after I had graduated with my master’s degree in English and chose to pursue a career in the medical field that I was truly able to acknowledge that I needed help. I was a medical scribe in the emergency department with intentions of eventually becoming a physician assistant or a social worker. While I never constructed any plans to end my own life, I spent an alarming amount of time thinking about death and suicide itself. I was afraid of the fact that if my depression got any worse, I knew exactly how death was medically and physiologically accomplished. I never allowed anyone to suspect that I was in trouble because I needed to appear infallible and competent; I felt that if one is to work in the medical field one is never allowed to let one’s coworkers suspect any weakness.

How could I ever admit that I was in trouble — that I needed help — if I heard providers routinely comment on how “psych patients are always just trying to manipulate the system” or how someone who is actively schizophrenic or suicidal is “faking it to get attention”? The amount of work and energy involved in presenting myself as “OK” slowly eroded my tough and infallible exterior, and there were two separate times when we were finished documenting and caring for a coding patient I needed to take 5 minutes in the bathroom to get myself back together.

Instead of asking me directly if I was OK, instead of asking if I needed help, the physicians I was working with reported my “anxiety problem” to my one of my managers, and he confronted about the “numerous complaints about anxiety” from physicians. I barely held myself together to explain that I “was very sick” for the past few months. After he left, all facades I once maintained were destroyed; I dissolved into hysterical tears and started hyperventilating, and I was eventually admitted to the psychiatric ED. I had come to work as part of the treatment team only to then become the patient.

While the medical community has made immense strides in promoting the general health and well-being of all employees and team members, it seems reluctant to acknowledge that the need of mental health care is anything but an indication of weakness that needs to be concealed. If a physician or a nurse I was working with took it upon him or herself to ask these awkward questions — if I was OK, if I needed help — would I have spiraled into a meltdown? If it was more acceptable for one to look anything other than infallible, would he or she have been more willing to ask me those questions? If I had needed to take a break to self-administer insulin, would I have been reported? With psychiatric diseases, there are no lab results to obtain, and there is no “hard data to confirm genuine illness,” and as a profession primarily concerned with irrefutable evidence, psychiatric cases have another level of complexity that many find tedious and frustrating. Psychiatric cases require more direct (and at times awkward) conversations rather than blood samples and x-rays.

When I look at someone who is mentally ill, suicidal, or struggling with addiction, I don’t necessarily see someone who is lazy or willingly throwing away his or her life. I see someone who hit rock bottom and is struggling to get back up. Perhaps I am somewhat less inclined to dismiss or become irritated by those who are in trouble because of alcohol, drugs, poverty, genetics, or brain chemistry because I see pieces of myself reflected in them. I see someone who could have easily been me with a slight twist of fate.

While society needs to start recognizing that mental illnesses are not any different from physical illnesses, it is even more important for those in the health care field to do so. Taking medication to control major depression, anxiety, schizophrenia, and bipolar disorder is not any different from taking medication to control diabetes, hypertension, or hyperlipidemia. It needs to be acceptable for someone to ask if you are OK or ask if you are in trouble. That simple question could begin an important conversation, and that conversation could be the very beginning of the healing process. Perhaps if the health care community — and society as a whole — starts recognizing the synergistic power of language and the science of medicine, a collective healing can occur that sets many people free from their inner demons.

Kristen Beatty is pursuing a career as a mental health counselor.

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