Walking Out of the Darkness

January 31, 2019

Finding meaning helps to reframe the experiences of our own lives, not as events to hide in shame or guilt, but as experiences that made us physicians we are today.

For almost a decade of my life, I hid in the shadows. It was a sheltering shade from the perceptions and realities of personal and professional judgment. Selfishly, I hid away the truest aspects of myself in the desperations of protective darkness. I was ashamed and afraid of the ramifications and repercussions that might come but hoping one day I would be able to walk again in my own semblance of light.

A few years ago, I was still living in the dark when two medical colleagues died from suicide. In the initial moments after one such loss, a few colleagues and I were asked to console and provide a place to grieve for young students and other medical professionals with whom we worked. Shattering tears of a quaking heartache-misunderstood, perplexed, and even angry-I felt empty words roll off my tongue, speaking complicit platitudes of the appropriate things to say in such a time of loss. It was a measured professional grieving that could have offered so much more.

In moments of counsel, I was still hiding the truth of my own story. I attempted to provide comfort, while still hiding the depths of my own inner turmoil. The truth is, I have a history of depression, suicidal ideation, and I am a recovering alcoholic. I have spent several years in successful recovery. Modern medicine broke me to the core to reveal a personal identity crisis that spiraled into an apathetic loss of hope. I do not pretend to know any other individual person’s story, but I do have my own story. It is an experience that may help other people process, grieve, and understand. It is also one that may be able to shine a light on the evolving epidemic of caregiver suicide and distress. And out of this tragedy, I found the courage to stand up and start telling my story. I found a way to walk out of the darkness and back into the light.

It was a walk revealing a mental clarity that I had nothing left to lose by sharing my story. I went into medicine to help other people, to walk alongside individuals during their own times of navigating illness. I went into medicine to be a healer, a consoler, and a guide for other people during some of the most difficult times of their lives. Potential ramifications and repercussions were a small price to pay for the opportunity and blessing to help other people in their moments of need. I had a genuine opportunity to live true to the calling of the Hippocratic Oath.

I now live with a newfound perspective for helping other people. Finding meaning helped to reframe the experiences of my own life, not as events to hide in shame or guilt, but as experiences that made me the husband, father, and physician I am today. Recognizing that my own story has a value that can be used to connect other people during their times of need, I learned to open myself up to vulnerability and to embrace the strength revealed in authenticity. The rewards continue to grow day by day by simply being true to myself.

Overcoming the stigma in the medical workplace

Indeed, rewards have come through my ability now to have conversations with colleagues about seeking their own mental health assistance and in connecting to medical students about being proactive about their own mental health. They accrue in helping other alcoholics seek out treatment resources while connecting them to a recovery community, sitting empathically to hear about a friend’s struggle with anxiety, or offering a show of support for someone with a history of diversion in the medical workplace. Living openly has invited me into these spaces to share in other people’s stories, while offering opportunities to help and heal. Living openly has not been about promotion to an ideal; it simply revolves around attraction to a normalization that it is okay to seek out help. It embraces a utopian hope that we will view individuals with mental health conditions the same as anyone else.

Yet, the rewards of being invited into these spaces reveal the sobering chasms of the work we have left to do. A stairwell conversation often includes a colleague’s concerned diatribe about what will need to be disclosed on a state medical licensing form. There is the connection to an Alcoholics Anonymous group, earmarked by questions of reporting this to human resources and insurance malpractice carriers. The quiet conversation about anxiety escalates quickly to disclosures of gaps in medical employment if the individual needs to take time away from work to treat this condition. In medical schools across the country, questions arise about how such disclosures will influence opportunities for future employment.

“Will I be overlooked for a job because of taking an antidepressant during training?”

These side conversations matter deeply. The root of these conversations involves stigma and the fear of professional ramifications of living/working in medicine with a mental health condition. Some truths and some perpetuated cycles of fear still own a place in our cultural climate. The problem is partially due to a lack of transparency. We must continue efforts that will further progress a cultural movement to destigmatize these conditions so as to create a space safe enough for individuals to continue to come forward. We must band together the voices willing to take a larger stand to create a lasting cultural movement to normalize the greater conversation. And we must continue to attack these issues head on, without dancing around the roots of the systematic problems.

Fortunately, over the past few years, a lot has been written about caregiver distress and suicide in the medical workplace, shining a new light on this epidemic that has existed within medicine since long before I was born. Still, I worry about our medical culture spiraling toward bureaucratic solutions by simply building programs on top of a crumbling foundation, instead of lobbying for a larger systematic cultural change.

Programs and initiatives do have their own significant role, but they must not stand alone. Alone they are disingenuous and will vastly underserve the populations of individuals that truly need these resources. Program building without a cultural movement to destigmatize and remove punishments from mental health treatment will ultimately fail. Program building must be accompanied by a larger cultural movement in medicine to accept mental health conditions as medical conditions and that will strip away the hypocrisy of discriminating against our friends and colleagues for their own mental health conditions. Without a cultural movement, I fear we will fall short of our ideals.

Listening to the stories of other colleagues

This fear was buttressed through an experience of traveling the country to share my story, thus allowing an opportunity to hear other peoples’ stories and to view barriers and obstacles firsthand. While visiting a program on the East Coast, I met with several members of a hospital’s administration, as well as the residency and medical school leaders. These individuals were proud of the work they were doing in building resiliency programs and improving educational modules, lectures on self-care, and caregiver distress. Such efforts should be applauded. After one of our educational sessions, however, a young resident asked to meet with me privately. We found a quiet space and shut the door. She asked a few simple questions about my recovery as she tested the safety of the conversational waters. I listened for several minutes and offered a few small words of advice. And then she began to cry.

She shared, “Your story is a lot like my story.” She went on to explain that she was struggling with depression, anxiety, and coping with alcohol at night to help her to sleep, to numb away the feelings in her own life. I could have held up a mirror in those moments. She knew about the programs, the initiatives, and the efforts from her leadership to create supportive programs. Over time, she made several tangential, small inquiries to colleagues about seeking help for her mental health conditions.

She was counseled by colleagues to hide her struggles, to covertly conceal the depths of her own story. She heard that she would have to report herself to the medical board and that her license could be subject to probation or suspension. She would have to answer “yes” to questions on future credentialing paperwork for mental health treatment. She would have to disclose her medical history to the institution, which would dissolve any privacy about her own health. She had seen a fellow colleague from earlier in her career publicly shamed and judged for seeking help. Those memories formed a deep scar in her own psyche.

So, she stayed quiet. She tried to find ways to manage her medical condition. She resorted to self-medication to treat her anxiety and depression. She continued to spiral because of a fear of professional repercussions and the stigma attached to these underlying diseases.

This is her story. This is the story of countless individuals in our own institutions on a daily basis. And, at one time, this was my story too.

These stories magnify that the culture of medicine itself is still a barrier preventing many people from getting the help they need. Simple solutions alone will not fix this epidemic. I implore us all to listen empathically to these stories to learn how to move forward together. We need to embrace a cultural movement that will accept mental health treatment as appropriate medical interventions for medical conditions and not blemishes on a medical career that must be covered up and hidden away. We must pivot from models of punishment and shame toward pathways of acceptance and support. We must let this pivot be reflected in the policies and everyday practice of how we treat each other in medicine.

I hope we still work in medicine to take care of other people who are suffering. I hope we genuinely believe that it is okay to not be okay.

Because we all took the same oath to help other people, and I hope we can live up to it.

Disclosures:

Dr Hill is Division Chief of Pediatric Palliative Care and Assistant Professor of Pediatrics, Riley Hospital for Children, Indiana University Health, Indianapolis, IN.

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