A love letter to the physician with depression


We’ve never met, but I’ll bet you could use some encouragement right about now. This has been a tough year.  Maybe for you, like me, depression feels like an old song that keeps getting played and stuck in your head over and over through the years. Or maybe this is the first time you’re experiencing the weight of it in your body, the diminishing physical and emotional energy, the infuriating way that even a sunny sky seems dim.  The way your thoughts stray into the dark, unbidden.  There’s some evidence supporting the assertion that people with depression and other mental illnesses often wait 10 years or more before seeking treatment.  I suspect physicians often wait longer. I waited for 25. You can probably guess many of the reasons why – you may have some of them yourself – but talking about this, bringing it into the light, reduces its power and helps move us all closer to wholeness.

About a month ago, I started noticing a familiar pressure at my throat, the invisible hand playing the first notes of the old song I hate. It scared me, disappointed me, but when I reflected on the past few months, it wasn’t a surprise.  The safety mechanisms I have put into place over the years, the early warning systems, have been turned off one by one since the pandemic began.  Had this happened several years ago, I would’ve just given in.  A desperate surrender to something I didn’t think I had any influence over.  I’ve learned that this assumed powerlessness is part of the problem.  The point I want to make crystal clear to you is that there is hope here.  There are things you can do to feel better and to thrive.  Take it from an old pro.

First, I want to make a distinction between depression and burnout.  There is an undeniable connection between the two, but burnout isn’t the condition I’m addressing here (I’ll save that for another time). Burnout might have contributed to your dysphoria turning into a full-fledged major depression, and solutions for either may help both, but they aren’t the same thing.  It may be easier for us to say we are burned out than the truth that we have major depression.  That’s understandable but risky.  The treatment for depression is not the same as treatment for burnout, and the consequence of misdiagnosis can be fatal. Are you having trouble sleeping or wanting to sleep all the time? Are you eating compulsively or skipping meals because of stress?  Are you finding it difficult to feel pleasure? Do you often feel guilt? Has it become more difficult to focus? Do your thoughts stray to death more often than you’d like to admit?

For me, it was internalized cultural ideas about independence and self-sufficiency that almost killed me.  These values were present in me well before entering medicine, but medical training reinforced it (I hope those of you who are early in your careers have found out how bankrupt the shame-based and individualistic traditional medical culture is/was and are changing it).  I waited so long to seek treatment because of all that.  The most important lesson I’ve learned, the thing that contributed most to getting better and becoming whole, was that deep connection with other people is not optional.  Before I learned better, if I had my way, I wouldn’t need to cry on anyone’s shoulder, apologize, share my deepest desires, talk about something embarrassing, have my ideas scrutinized, or play and dance and look silly.  But the truth is, we don’t get to opt-out of our human need for love and belonging and significance. (Wait a second, she said love? In an article about doctors?)  The need is built into us whether we like it or not. I finally accepted this, kicking and screaming, while reading  E.O. Wilson’s The Origins of Creativity. That book was the straw that broke the proverbial camel’s back for me. It isn’t some sappy societal trope that we need each other (because Dr. Wilson does not bullshit).  One of the reasons humans have been so successful as a species is that we sit right in the middle of the social continuum between hive insects and bears. Humans flourish because we are at once independent and connected.  Not only can we function well in the company of other humans, but we also stop functioning optimally when we are deprived of it (by choice or by chance).  Without real connection to other humans, we start to feel off.  Our prevailing mood darkens. We find it difficult to be happy.  We become chronically depressed.

What to do about this? For me, it was taking a risk and asking some friends to talk.  I knew if I didn’t start making some real, deep, connected friendships with people other than my husband, I wasn’t gonna make it.  It was these talks that eventually led me to seek out a therapist and get treatment for my depression.  It saved me. Maybe for you, this will look like an employee assistance program for counseling, a physician support group, or just finding a friend who will listen.  That’s the first thing.  Take that one step, and the next steps will start to become clearer.

In my case, the next steps were medication, learning the lesson of allowing myself the time and energy to take care of myself, learning to have riotous fun, disconnecting my sense of self-worth from my productivity, and finding ways to express creativity (another thing Dr. Wilson points out is a fundamental part of the human experience). I can’t overemphasize the effect Dr. Brene Brown’s 10 Guideposts in her book The Gifts of Imperfection have had on me. She studies people who are not just “OK” but who are wholehearted, as she calls it, and found that they do certain things differently. They laugh and play, they admit their imperfections, they disconnect their sense of worth from the opinions of others or their productivity, and they make deep connections with others. The good news is that you aren’t born this way – you can practice these things and find yourself more whole in the process.

When I began to feel the symptoms of depression return this summer, I had a whole arsenal at hand to choose from.  Socially distanced silent disco party? Check. A couple of days off work by the pool? Check. Zoom calls with friends to check-in and support each other? Check.  A guitar and a few favorite songs? Check.  The hand at my throat has loosened.

I see you over there, head down, and plugging through.  You deserve to be well.  You deserve to have a different song playing in your head.  I have every bit of confidence in your ability to recover and live wholeheartedly.  Take that first step, whichever seems best to you, and we will all be better for it.

Rebecca W. Lauderdale is an internal medicine physician.

Image credit: Shutterstock.com


Leave a Comment

Most Popular

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories