Ever since I wrote about how going for therapy was my biggest gift to myself*, I’ve met with a few medical students to talk about the topic of mental health. Many of them were worried about their ability to make it through med school with their illness. Many were worried about the viability of a career in medicine with depression.
When I was a student, there was a rumour that students with mental illness would be excluded from the course. We were informed by our senior students, and they by theirs, and thus the rumour was propagated.
This may well have been one of the biggest reasons, besides financial accessibility, that I took so long to get help for my depression. (In case you’re still wondering, the rumour is false, as rumours are wont to be.)
The reality is that depressed medical students are often high functioning in nature. It’s the reason they get away without help for so long. It’s the reason their colleagues will say, “But we never knew.”
I got through most of medical school without therapy or medication. But I didn’t get through it happily, and I wish I had found help earlier. I’m still not sure if my brain has recovered from the years of deprivation.
Now that I am more open about my mental illness, I have met more doctors – young and old – who are open about theirs. We don’t advertise it, but if it comes up, we don’t shy away from it. So I can confidently tell my young friends that yes, you can be a depressed doctor. But try to be a depressed doctor in remission.
For medical students (and doctors!) with mental illness, I recommend finding a treatment team sooner rather than later.
Find a good psychiatrist – even if, for financial reasons, it means you find a government psychiatrist. Or maybe a really good family physician. If they suggest medication, take them religiously. Don’t be the stereotypical non-compliant doctor-patient. And, as hard as it may be, try to accept your role as a patient when you step into your psychiatrist’s office. Maintain involvement in your own treatment, but put some trust in the expertise of your doctor.
I don’t advocate pharmacological therapy on its own to my patients, and so I don’t recommend it to my friends. Therapy is another costly but valuable part of managing mental illness, and one I have found to be invaluable. Once you are a doctor, you’ll be able to afford it. As a student, you may need to pull some strings, put your name on a waiting list, or open up to your parents for funding.
As a doctor with depression, I have days that I can’t get myself out of bed. I have relapses. I have colleagues I trust, but I have days that I second-guess that trust, and days that I feel alone. I have days that I can’t connect with my patients, and days where the connection is too intense and I just want to cry.
I have not yet had days where my patient-care was compromised. But I am always on the lookout. And I know that my psychiatrist and therapist will step in if they think that is the case. This is also why I told my HoD – not for sympathy, but because it is important for her to know. Just as we know about our colleague with diabetes, in case he has a hypo and collapses at work.
I also know that I will never sign up for shift-based work like in the ER, because I don’t think my neurochemistry will be able to handle that. Being on call is hard enough. Some of my colleagues accept multiple shifts in a weekend so that they can have a greater total of uninterrupted weekends. I know that I can’t do this, because I know that my mood takes a dip.
Managing mental illness as a doctor has been challenging. Sometimes I stumble. Sometimes I fall. Sometimes I lie in the dust awhile before I get up. Sometimes, someone helps me up. But the more I strengthen my support systems, the less frequent the falls become.
We are not cookie-cutters. I cannot say that some doctors/medical students will not decide to leave the profession because they feel it is incompatible with their illness. But that is a decision that should only be made after careful thought. Probably also a decision that should not be made while experiencing a major episode.
Whatever you decide, don’t be driven by internalised stigma. And remember: you are not as alone as you feel.
*Strangely enough, the post in question has disappeared from my blog. A few of my posts mysteriously disappeared a few months ago. Quite annoying.
An additional benefit is having someone that loves you unconditionally and is prepared to be by your side during the ups and downs. These people can often lighten the burden and give a slight amount of light during the dark days.
Have to agree that getting help before the neural pathways become set is critical but often the stigma associated with depression keeps young people from speaking about it.
I really hope that your path to recovery is a successful one and it is great to hear that you took the steps towards getting treated.
You’re the best ! 💚😘💓
Really interesting post. Of course doctors can’t be immune to everything! Depression is a hard one though if the job makes it worse…
Your post hits me hard- as a nurse in an ICU. Our fight can often be a Godsend to our patients- in that we can understand what they are going through when it comes to mental health. I often times feel myself very strongly tied to the patients I see come through after a suicidal attempt. But- often times- the death I am surrounded by- can pull at me. I still worry about what people will say or think of me as a competent nurse- if they knew my mental battles. So- I refrain from sharing. My husband actually used it against me in our divorce saying that I was not a good parent because I slept too much. And now- it is on the internet for all the world to see. I fear that it will make it very unlikely for me
To get into anesthesia school.
You are right when u said that we as healthcare professionals- can be very good at hiding our struggles. I don’t know if that’s a good or a bad thing… 🤔
Thanks for this comment way back when, and I do hope that it has been going a little better with you ❤
How is your road to anaesthesia school going?
Hi Dr Megz.. Awesome read! Would like to ask, what do you think is the best way to find a therapist in Cape Town? Do you check online?
Hi Bandile. I’m so sorry that it has taken me this long to reply to you. It has been a terrible year in terms of admin and replying to questions. The way I found my therapist was by looking online. Initially I googled for therapists who specifically have experience with medical staff, but I couldn’t find a category like that.
I knew that I wanted a therapist who shared my views, and especially who was LGBTQ friendly. I googled a bit and researched various therapists. Then I asked around by friends and acquaintances. One therapist came up twice, and she was the one I had highlighted on my google search as well, so I went with her. I haven’t regretted it, she is very good.
So yes, online is the best, with verification from current or past clients.
Also, think about what you want in a therapist. I’m a big believer in people needing therapists who have similar backgrounds to them. Even so-called “superficial” things like race, sex, and sexual/romantic orientation. Some people, though, feel they will be judged by people from their own cultures and specifically go for professionals from very different backgrounds.
Try to figure out where on that spectrum you fall; because it will help you to narrow down your search too.
I hope you are well, and enjoying a bit of holiday!
Thank you so much, doc! Really appreciate it! Will look into that. Good luck with next year! Hopefully the DoH fixes itself in the coming years!
Yes, yes, and yes. And it can cause your spouse depression too. My husband is a doctor and I am a nurse. We have been married since he was in medical school and let me tell you there is a reason that healthcare workers especially doctors have a high suicide rate. there is a reason doctors get paid what some people think is unreasonable. It is mentally, emotionally, and physically rigorous. How many other jobs are you sleep deprived all year long, are constantly scrutinized under a microscope and always worried about the threat of lawsuit, paid $200,000 to be educated for but Dr. Google always trumps your education, and are constantly dealing with people dying, mental illness, and people that are emotionally raw and vulnerable. To be honest I think most doctors are depressed and I have met very few aren’t. They and their spouses are all ‘high functioning’ though so no one takes it seriously. *sigh* there need to be more help and emotional support available. There needs to be much more awareness. That’s part of why I started my blog too. https://lettersofhopefromthesoul.wordpress.com/ if you ever want to talk and swap stories I’ll be around wordpress 😉
I admire your bravery and honesty. I think it is important for people to understand that even medical professionals sometimes need medical professionals. It would be silly for us to assume that doctors are immune to the conditions they help treat. Thanks for pulling back the curtain.
You are very kind, Lauren. Thank you for posting this – I’m only replying now, but it meant a lot to me at the time as well!
I’m glad I found this post. It’s very comforting to know that balancing a stressful career along with depression (in remission too as you put it 🙂 ) is doable. That’s why I’ve been considering family medicine a bit more these days. My struggle is always through the shift-based rotations such as emergency medicine so I figure I’ll have the same struggle as a doctor. I can’t wait to graduate, complete my internship then choose a healthy niche in medicine for my neurochemistry.