'I'm struggling'—When doctors discuss their mental illness

I first encountered a healthcare professional with mental illness during medical school.

My best friend among my classmates was diagnosed with depression during high school. He took his medication and met virtually with his therapist regularly. Still, he was scared to tell any classmates or professors out of fear he’d be judged, and his applications for residency might be jeopardized.

His depression would worsen during board exams, and he’d use alcohol and drugs to numb his feelings. I was beyond worried, and at one point, I called his parents out of desperation.

He was kind, brilliant, funny, and driven, and seeing him lose control broke my heart. He lived with this deep, dark secret throughout medical school and matched into a highly competitive surgery residency where he excelled, despite his struggles.

During his third year, his mother called to tell me he’d ended his life by suicide. She permitted me to share his story with you now to spread awareness about the severity of mental illness and the unfair stigma it carries within our profession.

The ‘superhuman’ myth

Depression, anxiety, bipolar disorder, and other mental health disorders are nothing to be ashamed of. But still, there's a superficial, false mindset that physicians are supposed to be “superhuman.”

As a result, when they have a mental health disorder and experience rough waters during their career, they have a tendency to hide their issues for fear of being judged by colleagues, patients, and the medical board.

Changing this mindset is crucial work we have to do in the house of medicine. No one can fix it but us.

The truth is in the numbers. Research shows just how common mental illness is in our line of work:

• Mental health disorders such as depression and anxiety have always been occupational hazards for healthcare providers, specifically physicians. A systematic review of 31 studies published in the Journal of the American Medical Association found that 29% of practicing physicians reported dealing with major depressive disorder.^[] This rate is more than double that of the general adult US population.^[]

• Recent studies suggest that rates of depression and anxiety have increased among medical trainees since the beginning of the COVID-19 pandemic in March 2020, with nearly half of medical residents now having depression or anxiety.^[]

• Across all countries, physicians have a much higher suicide rate than the general population and those of similar socioeconomic status.^[]

• Many physicians are reticent to disclose mental health disorders out of fear they may not receive or renew their medical license, according to a 2017 study.^[]

Why are we reluctant to seek help?

One of the most well-known physician suicides was that of Lorna Breen, MD, medical director of the ER at New York-Presbyterian Allen Hospital, who ended her life in April 2020 after telling loved ones that she felt useless and hopeless while treating patients during the early days of COVID-19. She desperately feared seeking mental health treatment.

This reluctance to seek help is often rooted in fear about reputation damage and loss of privacy, along with worries about paying more for—or losing—malpractice insurance, or being unable to obtain or renew a medical license.

Licensing boards and mental health

For many years, state licensing boards asked a wide range of open-ended questions about mental health, often including past treatment. Answering yes to any of these could potentially trigger an invasive process that could cost one's medical license.

Thankfully, since the 2018 recommendations from the Federation of State Medical Boards, many state boards have changed how they ask about impairments that could affect your ability to do your job.^[] Questions about a mental health diagnosis now violate the American Disabilities Act.

Protecting our mental health

As physicians, we need to start normalizing mental health and taking care of ourselves, especially now that state medical boards support this. The more we talk about the dark side of medicine and our daily struggles, the more we can break down these barriers.

We deserve to be able to have bad days and go through deep, dark waters. We can start helping ourselves (and colleagues) by:

• Supporting one another

• Practicing self-care daily

• Saying “no” in situations where we feel uncomfortable, such as working too many hours or call shifts—and taking more time off

• Talking about the reality of medicine on social media

• Seeking treatment for mental health disorders

We need to band together and speak up for ourselves, because nobody else will. If you or a fellow physician is struggling with mental health, acknowledge it, care for yourself, and seek treatment.