I was first diagnosed with major depressive disorder as a preteen after my teenage sister died. I attempted suicide three years later. This would be the first of several attempts and the first of countless times I felt my life was not worth living. But I am not unique. According to the Centers for Disease Control (CDC), 1 person dies by suicide every 11 minutes. My depression is like a chronic autoimmune disease — constitutively present at a low level with flares. But there’s no Humira for depression. At baseline, I am exhausted, anxious, lacking motivation, and full of self-doubt. When severely depressed, I am at the bottom of the sea, struggling to breathe and unable to swim. I am paralyzed by a high-pressure, heavy and humid darkness. Through physical or mental isolation, I may not see another living creature for hours, days or weeks. I can look up and see the sun shining beyond the water surface, but the surface is miles beyond my reach. I must physically force myself to breathe as my mind tells me to stop. Trying to take a test, see patients or study can prove impossible. But, I have to show up and perform. My career depends on it, especially as a person from a historically oppressed community. So, I force myself out of bed and go. In the back of my mind is the third-year orientation in which we were effectively told if we needed to be excused for a funeral, we better have the death certificate. The benefit of living with a medical condition for almost two decades is that I have learned to work around it. I earned multiple degrees with varying levels of depression. As an already severely depressed college student, I was assaulted multiple times — once was a week after I went to a bridge with the intention to jump. After a long period of intensive treatment, I graduated with the help of a team of university-based professionals. Had they not supported me and guided me through that time, I would certainly be dead. I wish that support was available for all medical students, but it’s not. Schools would first have to acknowledge that many of their medical students are struggling. The downside to living with depression for almost two decades is that I have learned to succeed in spite of it by putting my health last. But in medical school, we are rewarded for this behavior. We are expected to prioritize school to succeed, spending long hours in classes, anatomy lab, or the hospital — leaving minimal time to study, let alone rest, eat or seek joy. In my preclinical years, I was able to work therapy into my class schedule. But when rotations started, I had to stop until I found a therapist willing to meet late at night. And, even this required me to tell clerkship directors that I had a “doctor’s” appointment every week that I could not miss. As medical students, we often sacrifice time with people and things we love for school. This forced isolation can worsen depression as well as foster anxiety, stress and burnout. Though I have felt alone, the data show I am not. Medical students have abysmally high rates of depression and suicide, 27 percent and 11 percent, respectively. The data is not much better for residents: Almost 30 percent are depressed, and from 2000-2014, suicide was the second highest cause of death. By comparison, the CDC reports an 8.1 percent prevalence of depression in adults over 20. Medical school educates us about our own physiology and mental illness, but little is done to help. So we live in shame. Maybe this is secondary to the outdated notion that since previous students suffered, so should we. In fact, I have personally had faculty and classmates question my intelligence and tell me that I am not enough. I have even had my mental illness used against me in academic settings. These “trusted voices” mirrored the negative thoughts with which my depression had already filled my mind. As a result, I began to rethink my career choice, developed poor test-taking and low confidence that has extended to my clinical decision-making. I often wonder, how many students like me reach out just to be shut down? Just as Naomi Osaka experienced with her self-disclosure, medical students who seek help put themselves at risk of penalty and negative career effects. No one should be punished for protecting their health, particularly in health care. So, what do you do when you reach out for help and your administration shames you into silence? Who do you talk to when your trusted advisers weaponize your mental illness as a weakness that should prevent you from becoming a doctor? Medical schools regularly create programs to address burnout like lectures, wellness days, or mandated yoga — but none of these treat or cure mental illness. Our personal experiences with depression and mental illness allow us to uniquely connect with patients. As students, we are made to feel that our mental illness is our fault and weakens us. Medical school is difficult enough without the pressure to hide our struggles simply to appeal to an unrealistic standard of perfection. Medical schools need to choose to support students with mental illness if they want to stop losing us to depression and its consequences, including suicide. Because even with our illness, we are adults deserving of the same respect and empathy we give our patients. We are humans first. Steps that medical schools could take to support students with mental illness: 1. Hire dedicated psychotherapists for medical students, particularly some from marginalized communities (i.e., Black, Indigenous, LGBTQ+, etc.). 2. Ensure that the counseling and psychological services have a separate EMR from the hospital and medical school. 3. Avoid punitive measures for mental illness and instead assist students to find the help they need. 4. Educate faculty and students about mental illness in medical school and resources available to them at and outside of the institution. Free and cheap resources medical students can take advantage of: 1. The Physician Support Line is a free dedicated support line for physicians and medical students who need to speak with a psychiatrist to navigate mental health struggles. 2. The Loveland Foundation is an organization that helps Black women and girls access free therapy and healing. 3. The Suicide Prevention Lifeline is a free phone line and online chat geared to help people considering suicide. 4. The National Directory of Black Psychiatrists was created and compiled by the American Psychiatric Association Black Caucus. 5. Inclusive Therapists provides listings for Black, Indigenous, People of Color, and LGBTQ+ identifying therapists throughout the U.S. The author is an anonymous medical student. Source
