Doctors, Medical students and Mental Illness
“If my colleagues knew that I was bipolar, I fear that I would never again be taken seriously, that I would be viewed as the ‘impaired physician’ who, at a display of passion or emotion, would be seen as having an ‘episode.’ My hard-earned credibility would be gone. My right to express even normal anger or irritability, happiness or my effervescent sense of humor would be suspected as pathological. I would lose the right to just have a bad day.
If I had lost a breast to cancer or had Parkinson disease, I would have the concern and sympathy of my community. But this illness is perhaps harder to bear because it is yoked with shame and secrecy. I am not missing a body part nor do I have a resting tremor. Yet I still struggle with a chronic and debilitating illness associated with a high morbidity and mortality rate…
If I continue to live pretending to be other than who and what I am, how can I hope the world will evolve and become a better place … It is time to give mental illness a name, a face, a story. Only in doing so will the stigma of this disease lose its power.” Dr Suzanna Fiala speaking about her life as a doctor with bipolar affective disorder.
These words by Fiala really resonate with me. Her last two lines capture what I am trying to do in order to raise awareness about mental health illness in the medical profession. I speak candidly about suffering from anorexia nervosa, depression and anxiety in order to eradicate the stigma.
Mental health illness does not discriminate. It leaves no one out. This includes doctors alike. But truth be told, doctors have higher rates of depression and anxiety and it has been estimated that at least 10-20% of doctors will suffer from depression at some stage in their careers. Female doctors have a suicide rate 25% higher than that of the general population. It has been estimated that approximately 10% of physicians will develop a substance-related disorder at some point in their life.
The stigma surrounding mental health in general is highly damaging, however the stigma surrounding doctors and mental health may in my opinion be ten times worse. There is a huge fear amongst medical professionals that speaking out about mental health illness may cost them their jobs and credibility. I too have felt anxious over whether speaking out about my mental health illness would cost me my future career, but I now know that I will prove these negative and anxious thoughts wrong. It is time that we allow doctors to be patients without the anxiety of sanctions or blame. We must treat doctors with the same empathy and compassion as they give their own patients on a daily basis.
“Resilience isn’t taught but it is expected, and we come to expect it in ourselves and each other. Therefore, to admit a problem is to admit that we are, somehow, less than and not equal to our peers. We feel shame and we fear being judged and stigmatised so we tend to suffer in silence and carry on in a profession that prides itself on stoicism and bravado.” Carr.
“Despite the biological substrate of clinical depression or the genetic underpinnings of alcoholism, many physicians still believe these disorders are evidence of a lapse of will or moral failure, especially when they appear in other physicians.” Myers.
In the general population there is a stigma associated with seeking help for mental health illness. It is often perceived as a failure and that it makes us weak as individuals. However I believe this stigma is even truer for medical professionals. A study found that only 22% of medical students who screened positive for depression, used mental health services and only 42 percent of those with suicidal ideation received treatment. Let that sink in. Over 50% of medical students with thoughts of ending their life, did not receive professional support or treatment.
I was privileged to be able to speak to a wonderful volunteer at The Listening Place from March to May 2020, to speak about my suicidal thoughts. The Listening Place is a charity in London which trains volunteers to be able to listen to people suffering from suicidal ideation. It makes me feel extremely worried to know that over 50% of medical students in that study potentially didn’t have anyone they could talk to. I personally found it extremely difficult to speak to loved ones about my suicidal thoughts as it was very upsetting for them to hear how I was feeling, understandably. That is why the volunteer I spoke to every fortnight played a huge part in saving my life alongside my parents, boyfriend and friends. I truly hope that in the future a service similar to The Listening Place will be accessible for everyone in both terms of the organisation existing as well as people feeling able to seek their help and support.
Whilst doing my research for writing this blog post, I have been hugely inspired by the words of Prof Clare Gerada. Throughout our training we are told that the patient always comes first, however when does our own mental health need to take first place? Prof Gerada urges doctors to “pull one’s own oxygen mask down first”, as this is better for both doctors and the patients they care for.
Support Services
Here are some resources that may be useful for now, for later or for a loved one. Please click on the name of the service to be taken to their website.
Doc Health : A specialist psychotherapeutic service for doctors. All doctors in the UK are able to self refer to this service.
NHS Practitioner Health: Self Referral for any doctor or dentist in England. 24 hour crisis support is also available.
BMA Counselling and peer support for doctors and medical students : 24/7 open to all doctors and medical students (regardless of BMA membership) and their partners and dependents, on 0330 123 1245. Confidential and free of charge. You can also contact the counselling service by live chat or email. There is always someone to talk to, whether you require the 6 counselling sessions or just a peer support doctor to discuss your issues with.
Sick Doctors Trust Helpline: A 24 hour helpline where callers may remain anonymous for any doctor suffering from addiction .
CamDocUK (Association of Cameroonian Doctors in the UK)
APPNE (Association of Pakistani Physicians of Northern Europe)
BAPIO (British Association of Physicians of Indian Origin)
GLADD (Gay & Lesbian Doctors and Dentists Association)
MANSAG (Medical Association of Nigerians across Great Britain)