Medicine has created a culture where public embarrassment, bullying, and passive-aggression have become pedagogy. How can we seek to care for others, when we treat our own so cruelly?
I recently met Angie (name changed), a young university student who had entered the clinical years of medical school. Like many, she was introduced to medicine as a naive, excited teen immediately out of high school — a high achiever with the usual romantic notions of medicine. She aspired to weave the mythical healing powers of medicine, giving hope to those who had lost theirs. In six brief months, as she was met with the medical coalface, these notions were shattered; her bubbly, positive attitude replaced with cynicism and anxiety. An unending cycle of anxiety and panic had become her routine — a daily fight to survive what seemed like never-ending lashes of taunts and humiliation heaped upon her.
“Who was this person?” I inquired upon seeing her distress. Her initial confusion of how to respond had me perplexed. Quickly, it dawned on me. This was not a rogue consultant dishing out abuse, this was a reaction to the very delivery of her education. She was facing a constant struggle with the subtle digs, the perpetual feelings of inadequacy, the constant interrogative nature of medical teaching. Angie had spent months experiencing nearly daily panic attacks, constant negative thoughts, and suicidal ideation. Her self-esteem was shattered. The feeling that she was letting everyone down simply consumed her. The burden of her inadequacies so frequently laid bare had become unbearable.
Angie is sadly not alone. Not even close. The mental health of medical students and junior doctors is horrific. Half of all medical students report symptoms of psychological distress. A quarter experience suicidal thoughts every year, as opposed to one in 50 in the general population. Further, armed with our medical knowledge, we are exceedingly efficient in completing suicide attempt. Our colleagues in the U.S. lose the equivalent of an entire graduating medical school worth of physicians every single year to suicide.
Despite the soaring levels of psychological distress, more than half of our profession still believe that seeking help for mental illness is a failure. Doctors with a history of mental illness are seen as less competent, less reliable and less trustworthy. Let us not forget the impact that this has on medical professionals and their patients. These attitudes seek only to compound the suffering already experienced. Combined with a culture that frowns upon the utilization of sick leave, we have distressed, unfocused doctors treating patients. It is not hyperbole to suggest that this culture could be killing those we are paid to treat and protect. If doctors do not feel safe to seek help for their illness, it is impossible for this not to impact upon patient outcomes.
It is clear. We are failing one another. We prematurely pat ourselves on the back for simply talking about mental health, with hospital-wide programs citing the usual suspects of “resilience” and “wellness” while failing to address the punishing conditions junior doctors work under — as if these alone will remedy mental illness and rectify the culture of stigma, guilt, and secrecy. The reality is that we have framed mental health as a big picture talking point, while those individuals continually fighting with it still feel an obligation to do so in secret.
Despite all our decrying and organization-level self-congratulations, we have not overcome the undercurrent that mental illness is somehow a character defect. Until our caring profession ceases viewing mental illness as seducing only the weak and incapable, highly intelligent, caring doctors will continue to end their own lives. The stigma that surrounds mental illness can only be shattered by people telling their story and giving an identity to this silent epidemic.
There is a reluctance in our profession to genuinely fight the determinants of such disastrous statistics. We parrot about mental health, as opposed to viewing mental illness as a normal part of life that can be treated as much as any physical illness. We lament our failings, yet struggle to implement lasting, effective interventions to arrest them. Broad generalities and percentages are glossed over in colorful graphs, without focusing on the individual.
Those individuals brave enough to speak out are generally consultants, having flown under the radar until reaching a level of protection sufficient for “coming out.” The many iterations of Angie within our ranks still speak in hushed tones and must often suffer in silence. Sadly, for now, stigma reigns supreme.
Kieran Allen is a psychiatry resident in Australia.
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