Several decades ago, it was inconceivable for physicians to admit they were gay, mainly because it was tantamount to career suicide. Sure, there were personal reasons to hide homosexuality -- the stigma attached to gay and lesbian people was insufferable -- but the that homosexual doctors were mentally ill and not fit to practice medicine. The term "homosexuality" was not fully removed from the Diagnostic and Statistical Manual of Mental Disorders until 1987. Until then, gay and lesbian doctors were denied residencies and university-based positions if their sexual orientation became known. Of course, a hiring bias against the LGBTQ+ community and other forms of discrimination remain today, but at the very least, these individuals are no longer considered mentally ill.
The same cannot be said of physicians who have openly admitted they have suffered from mental illness and have written about their experiences. I applaud those physicians for sharing their stories and having the courage to "come out" and tackle mental health stigma head on. No one should be defined by a singular event in their life, whether it be a suicide attempt or psychiatric hospitalization, or by a lifetime struggle with depression or substance use. Once treated, unwell physicians as other physicians. I have been impressed with the accounts of recovered physicians and their efforts to shine a light on mental illness so that others can be led out of darkness. Lately, I have seen a spate of self-reflections published in medical journals and on social media. I recount several of them here -- all published in June and July of 2021 -- to help raise awareness lest psychiatrically diagnosed doctors become shunned by the medical community as were their gay counterparts.
A Medical Student
A medical student on KevinMD about their nearly 2-decade struggle with depression, including several suicide attempts. The medical school administration shamed the student into silence and made no special provisions for help other than routine wellness initiatives. "Who do you talk to when your trusted advisers weaponize your mental illness as a weakness that should prevent you from becoming a doctor?" the student asked. Citing compelling statistics from -- the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1% -- the medical student offered several recommendations for medical schools:
- Designate a cadre of psychotherapists to treat medical students; ensure all therapists have diversity training to treat marginalized populations (i.e., Black, indigenous, LGBTQ+, etc.)
- Separate the electronic medical record for mental health treatment from records of the hospital and medical school
- Adopt a "help first" mentality and avoid punitive measures for students with mental illness
- Educate the medical school faculty (and students) specifically about mental illnesses in students and provide relevant resources internal and external to the institution
A Resident
In an in JAMA, psychiatric resident Katherine A. Termini, MD, recalled how she deliberately overdosed at age 16 and, at the advice of her mentors, withheld her psychiatric history when she applied to medical school -- her so-called "lie by omission." Termini continued her silence through medical school and residency interviews, fearing what a confession would do to her career, and also because clinicians made disparaging or dubious comments about suicidal patients. She "came out" early in residency, no longer able to reconcile her shrouded past with her desire to become a psychiatrist and mental health advocate. Termini concluded: "Mental health stigma and the culture of self-sufficiency within medicine contribute to the continued suffering of physicians and trainees. Colleagues will continue to endure this injustice if this is not addressed on multiple fronts, from systemic changes to personal shifts in mentality and behavior."
A Physician
A appeared on Doximity and was told by Mukund Gnanadesikan, MD, a psychiatrist, novelist, and poet. Gnanadesikan has experienced anxiety, depression, and suicidal ideation since college, although his worst suffering is far behind him. He readily shares aspects of his physical health with patients, but his psychiatric history is "one door [that] never opens...Who wants a doctor with a history of cerebral hiccups?" Gnanadesikan admits he has the same fear as his patients: The fear of being negatively judged for having a psychiatric history. Nevertheless, he believes his case is "proof that [mental] illness can be transcended, that those who consider themselves broken may one day heal others." A moving message no doubt, one that should instill hope in distressed physicians and inspire them to come forward.
What about me, you may ask? What is my interest in this topic? I "came out" in 2014, nearly 30 years after I suffered emotional trauma related to a patient's suicide attempt -- trauma that resulted in chronic anxiety and depression. I've about my experience elsewhere. Only by writing freely about mental health issues affecting the physician workforce can we encourage acceptance of mental illness among our patients and each other, and identify effective strategies for preventing and treating psychiatric disorders among physicians and those in training.
Arthur Lazarus, MD, MBA, is a member of the Physician Leadership Journal editorial board and an adjunct professor of psychiatry in the Lewis Katz School of Medicine at Temple University in Philadelphia.