I Revealed That I Take Medication for My Mental Health to Millions Online. Here’s What Happened.

Psychiatric Times, Vol 39, Issue 3,

"When I was very young and dreaming of becoming a doctor, I never witnessed a physician open up about their mental health, let alone admit to taking medication for it..."

COMMENTARY

On the night of December 5, 2021, I posted the following message on social media: “My name is Dr Jake, I’m a physician who treats mental illness, and I take meds for my mental health. And by the way, I’m proud of it.” The post was accompanied by a selfie of me in scrubs, holding a pill in my mouth, and an explanation for the photo.

Within 24 hours, the post was seen by millions and shared around the world. Although it received mostly supportive comments from individuals sharing their own struggles with mental health and thanking me for my vulnerability, I also received hate mail and threatening comments. The post struck a nerve.

Many of you reading this may not know who I am, but if you ask a premed or medical student who has TikTok or Instagram, there is a good chance that they do. As one of the most-followed doctors on social media, I create content for more than 1.6 million followers, educating them about mental health and demystifying the medical field for future health care professionals.

When I was very young and dreaming of becoming a doctor, I never witnessed a physician open up about their mental health, let alone admit to taking medication for it. Not even on TV shows or movies. Never. I grew up believing that doctors were like superheroes—by working exceedingly long hours in stressful environments, they built up a protective armor that shielded them from mental health issues.

Fast forward a decade or so, and I was in my last year of medical school in the midst of a global pandemic. I was a student in the emergency room the first time I saw someone die of COVID-19 complications. I stood at the foot of the bed during the code, holding my breath while wearing an N95 mask, hot sweat pouring down my face shield, watching a person no older than my parents receive chest compressions, the sounds of cracking ribs exploding in my ears. Then the compressions stopped, someone cursed, the patient was pronounced dead, and the team stormed out of the room, leaving me staring at a lifeless body—a human being who was walking, talking, and living their life only days before. There was no process group, no roundtable huddle with the care team, no debrief. Twenty minutes later, I was interviewing a patient who had chest pain in the next room as I held back tears and tried to remain strong.

Medicine is a demanding and sometimes traumatic profession. Doctors in training know this before entering the field. We know that we will work incredibly long hours, take on hundreds of thousands of dollars in debt, and be with people in their darkest moments. If there is any predisposition for mental health issues, medical training is a pressure cooker that can and will bring it out.

A Culture of Silence

Over the past few years, we have seen the devastating impact that burnout, untreated mental health issues, and a culture of silence have had on medical students and resident doctors in this country.

A recent meta-analysis examined the overall prevalence of depression among medical students found a depression rate of 27.2%, with an overall prevalence of suicidal ideation of 11.1%.1 Let’s think about this: One in 9 future doctors have seriously considered ending their life. What is perhaps even more startling is that only 15.7% of medical students who screened positive for depression pursued mental health treatment. Another meta-analysis that examined the prevalence of depression and depressive symptoms among resident physicians estimated the depression rate at 28.8%.2

Physicians have one of the highest suicide rates of any profession.3 Recently, Lorna Breen, MD, medical director of the emergency department at NewYork Presbyterian Allen Hospital, ended her life after telling loved ones she desperately feared seeking treatment for mental health issues. Despite the staggering statistics about the mental health of doctors and our knowledge of the dire costs of untreated mental illness, we are afraid to ask for help.

Why?

I believe there are 3 main barriers (although others exist) that prevent doctors in training from seeking help:

1. Fear that peers or employers will see us differently and view us as weak or damaged.

2. A culture, beginning in medical school (maybe premed), that physicians must perform at the highest level in the most stressful situations with superhuman strength and composure.

3. Fear that we will be unable to receive medical licenses in states that require doctors to disclose if they have ever received treatment for a mental illness.

According to a study published in 2017, nearly 40% of physicians reported that they would be hesitant to seek treatment for mental health issues due to fear of potential repercussions in obtaining their medical licensure.4

We are afraid for social, cultural, and legal/professional reasons.

Why I Shared My Story

I do not have all the answers to fix this crisis. There are many activists who are working tirelessly to reduce the discrimination and stigma and to advocate for legislation to help doctors seek lifesaving treatment. Moving forward, I plan on utilizing my platform to become involved in these legislative efforts. In the meantime, I am using my voice in other ways.

So why did I post this? It would have been easier (with significantly less drama) to continue posting about mental health from a distance, never implicating myself in the messiness. I shared my story to be the doctor I needed to see when I was young, dreaming about what my life would look like as a physician.

I am no superhero—I am a doctor. I am a human being, and I have struggled with mental health issues. Believe it or not, there are many aspiring medical students and doctors who look up to me as my younger self once regarded my pediatrician, our family doctor, and the other doctors I met. I wanted to show them what a real doctor looks like.

Courage is not the absence of fear in a stressful situation; it is doing what you believe even when you are afraid of what might happen or of the resulting criticisms. It is taking the hard road when the easy path would be so much simpler. Real superheroes know when to reach out for help and are not afraid of stigma or discrimination. I hope I showed them that you do not need to be some kind of machine, impervious to pain or doubt or weakness, to be a doctor. I did it for them. I did it for me. I did it to move the culture.

The rest of my post reads:

“The stigma is rampant in the medical field. Opening up about your mental health as a medical professional, especially as a doctor who treats mental illness, can be taboo. As a doctor training to be a psychiatrist, most in the field would counsel me to not post this. Some would view it as a risk for my career. But I didn’t join this field to continue the status quo. I am part of a generation of doctors, nurses, and other health care professionals [who] are not afraid to be vulnerable and discuss mental health. Many consider me a leader in this generation. So here’s me leading by example.
My name is Dr Jake, I’m a physician who treats mental illness, and I take medication for my mental health. And by the way, I’m proud of it. Medications aren’t for everyone, but they can be a powerful tool in combination with therapy and other self-care techniques to treat mental health issues. If this post helped you, please consider sharing it with a friend or loved one.”

Dr Goodman is a psychiatry resident in Miami, Florida. Dr Goodman’s views are his own and do not reflect the views of his university or employer.

References

1. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-2236.

2. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383.

3. Anderson P. Physicians experience highest suicide rate of any profession. Medscape. May 7, 2018. Accessed January 24, 2022. https://www.medscape.com/viewarticle/896257

4. Dyrbye LN, West CP, Sinsky CA, et al. Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clin Proc. 2017;92(10):1486-1493. ❒