mental illness

Doctors and Mental Health

Robyn, , , , , , , 6 Comments

The lives of medical professionals (at least the part of our lives that we choose to share with the public) are a lot like Instagram posts: lots of happy, successful moments to build the image of being competent and caring. But just like Instagram, real life is never as perfect as that carefully curated snapshot.

If you remember my last post about the things we don’t talk about, there was one really important topic I left off that list:  mental health. Just like physical health, our psychological well-being is integral to the way we function. But while we won’t hesitate to get ourselves checked at the first sign of illness, we balk at the idea of talking about our feelings or worse, spending time in therapy.

Sometimes we don’t talk about it because we feel our patients need to believe that their doctor is operating at peak performance. Discussing our mental health issues openly, or even acknowledging them can have a detrimental impact on the physician-patient relationship. Patients tend to think of doctors as superhuman, somehow immune to the struggles that plague the average person. In reality, doctors have the same problems as everyone else. But we don’t like to be reminded of that. We buy into the con, believing that we are somehow capable of feats no one else can do.

Sometimes that’s allowed, even expected – not everyone can perform brain surgery or resuscitate newborn babies – but other times we overreach. Doctors frequently pull stunts like trying to function normally after 36-48 hours with no sleep. We sweep treatable issues like depression under the rug because of course we can handle it, self-medicating with substance use or else ignoring the problem entirely until it can no longer be contained.

The medical profession carries one of the highest rates of suicide (1.4-2.3 times the rate of the general population). But discussing an issue that can call into question your fitness to practice is absolutely off-limits. In the most ideal and ethical situation, doctors would put the patient’s interest ahead of their own security, but we are human first, driven by the same fears and needs as everyone else. And there is a very real fear that any perceived disability will end or permanently blight our careers.

On top of this is the associated stigma of mental illness that is so very rampant in Jamaica and the Caribbean. No patient wants to see the “mad” doctor who “tried to kill himself”. But if any progress is to be made in erasing this stigma we physicians have to be the pioneers. And since this stigma persists even among doctors, we are the first hurdle we have to clear. After that, education and sensitization of the wider society.

Even though no one seems ready to talk about it* (Megz over at Barefoot Medz is one of the few, doing a really great job) mental health is a discussion we need to have. In such an emotionally draining and psychologically demanding profession it isn’t fair to anyone to have doctors fumbling to look after their mental health alone.

We need to catch mental health issues among physicians from early, as early as medical school even. Mandatory psychological screening for depression, anxiety and PTSD among others should be instituted for all the high risk professions: doctors, police officers, firefighters. We shouldn’t have to wait until a doctor commits suicide or a policeman kills his spouse before doing something. Prevention or at least early detection is paramount.

There’s a lot of work to be done. Efforts have started but they’re halfhearted at best and the government offers little in the way of support. We must be our own advocates and work with other key players to remind the public that there is no good health without good mental health.

*

Further reading: a pediatrician’s experience with psychosis, and a GP’s experience with depression.

*After writing this post, I discovered Dr. Eric Levi an ENT surgeon who is also making strides in the discussion on mental health in doctors. 

Psych

Robyn, , , , , Leave a comment

My dear readers, forgive me. I have been utterly remiss in my med student blogging. But do not despair, you haven’t missed anything important. I can’t remember the last time we spoke, so I’ll just pick up from Psychiatry.

My rotation through the Psychiatry department at the University Hospital of the West Indies was illuminating in more ways than one.

Psychiatrists are a strange lot. More than any other physician, these consultants understand the blurring of lines that makes illness so hard to diagnose and yet their method of diagnosis is one of the most rigid I’ve seen.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) is the most black and white layout of disease that exists, with clearly defined criteria for each psychiatric problem. It offers absolutely no middle ground. As if human ailment has ever presented itself in neatly packaged boxes. It bothers me that this book is their bible and that they continue to diagnose based on preconceived dictates rather than the individual patient.

Perhaps Psychiatry has the potential to become so uncontrolled a discipline that these criteria are there to ensure that no one gets labelled “mad” without sufficient reason. If this is the case I think they might have gone to the other extreme.

While I disagreed with the consultants, I was absolutely enthralled by the patients.

Psych patients are very convincing orators, and the more time I spent interacting with them the more I found myself wondering if these people really needed to be in the hospital, if they weren’t just some eccentric variation of normalcy. I have had some of their thoughts, have said some of the things they say. If a Psych consultant was to catch me on one of my stranger days, I’d probably be getting Haldol too.

Of course there are the obviously dangerous, disruptive patients who need to be rehabilitated enough to be functional. But then there are utterly fascinating ones who travel the world and want to become international rap sensations. Sure he believes that everyone in his native country loves him and the daily news is always talking about him BUT everyone has dreams. . . and fantasies.

Ultimately, the discipline of Psychiatry had less to offer me than the patients themselves. I don’t think I could work in a field where I’d be constantly questioning my own sanity.