Mental Health: An Unwarranted Stigma

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As medical students, our baseline is to be stressed, anxious, and overwhelmed. We assume that those feelings simply come with the trade and that our futures will mostly be characterized by those negative emotions. We believe that the stress, anxiety, even depression, are sacrifices that must be made and endured to be able to achieve our long-awaited goal of helping others through medicine. We find ourselves considering “good days” to be those in which we are not sad or overwhelmed, when in reality, our “good days” should be those in which we are happy, motivated, and encouraged. We should, like many other professionals, have mostly good days. We should not accept these heavy emotions as “part of the job“, but the culture of the field has shaped our thinking so we believe that if we are not “tough” then we will not make it.

 

Suffering in Silence

There continues to be an unjustified mark of disgrace associated with mental health in medical careers. A recent meta-analysis showed that depression affects 1/3 of medical students across the globe, with only 15% of those students seeking medical help. Medical students, on average, have more depressive symptoms than non-medical students and are still less likely to seek help. Not only are medical students experiencing depression, but many are also experiencing burnout, anxiety, substance abuse, and suicidal ideations.

 

Why are Medical Students Experiencing Higher Rates of Depression than Non-Medical Peers?

The higher rates of depression in medical students can be attributed to the multifactorial stresses of the game. Let’s look at a few of the forces that might be at play.

The Transition to Medical School

We could consider the mere shock of taking on such intensive studies. Granted, the workload and demands are akin to stressors that come with many big changes in life and often leave people exhausted or in low moods. But even students acclimated to the stress are experiencing depression, with one study showing 10% of 4th-year medical students experience suicidal thoughts. If the observed depression and anxiety are not entirely due to life change, what else might be at play?

Defined by a Number

Consider the journey of becoming a doctor. We are bred to believe that our worth is defined by a number. Before we even apply to medical school, we are being told our chances of admission are based on our GPA and our MCAT score. We are asked to quantify our volunteer hours and shadowing hours, and now, even our personal and moral traits are being scored with tools such as the CASPer medical school pre-admission test. When we are accepted into medical school, we feel on top of the world. We finally realize our worth and our ability, realizing that acceptance into medical school means that we are deserving and qualified enough to begin the journey to become a doctor. That confidence begins to dwindle after the medical school exams begin. Once in medical school, you are again scored, ranked, and demoralized. If those numbers are not up to your standards, you start to question if you should even be there, wholeheartedly forgetting that you were accepted because you are qualified. National board exams breathe down your neck, taunting you with the minimum score you need for your desired specialty to even be a consideration. Then a few years later, you are ranked by residencies and continue to be tested.

Our Competitive Nature

We are bred to be competitive. These grades and scores force our motivation to be extrinsic, causing us to often forget why we even began this journey in the first place. Research shows that extrinsic motivation is correlated with higher susceptibility of depression than those who are intrinsically motivated.

Another factor which makes us so susceptible is that many medical students can be categorized as Type A. Type A behavior is defined as “an action–emotion complex, with individuals characterized by ambition, highly competitive attitudes toward achievement, an exaggerated sense of urgency with regard to time, preferring to spend it on things they deem as priorities, and possibly becoming aggressive, hostile, or impatient when frustrated.” Medical students feel the pressure to achieve at any cost. The medical profession culture makes us believe that this is what is expected and that any faltering in our mental toughness or achievement is a failure or weakness.

Of course, there are many other stressful factors outside of academics. Our schedules often put a strain on relationships with friends. We often feel unable to spend any sliver of our limited-time on self-care. Every day we face death and suffering of our patients. We feel the burden of debt piling on. We feel the pressure to fit a certain personality mold of our desired specialty. We live with uncertain futures.

 

The Problem

The problem is the lack of action toward fixing this epidemic. Our doctors and medical students are literally dying from the pressure that the culture of the medical profession imposes. These are the people who are training and have a yearning in their hearts, to keep others alive. But somehow we are struggling to keep our doctors and students healthy.

The problem is the continued stigma that we claim to not impose, but continue to do so in more discrete ways. We, as medical students and medical professionals, believe we just have to swallow our feelings and focus on the task at hand. But we do not need to hide away our feelings or turn a blind eye. Quite the opposite: we need to speak out against this.

Why is it acceptable for medical students or doctors to be treated for strep throat, but not to get psychiatric help? Why is it acceptable for us to receive flu shots to prevent us from getting the flu, but no prevention is implemented for our mental health?

The problem is we need to open our eyes to recognize this issue and then open our mouths to speak out against it, and to speak truth into the world.

 

Combating the Stigma

We need to share our stories, because not being okay, is okay; and we all need help and should seek help. Studies show that the most commonly reported barriers to medical students seeking counseling services are lack of time, lack of confidentiality, the stigma associated with using mental health services, costs, fear of documentation on their academic record, and fear of unwanted intervention. Medical students should not be afraid of being less likely to match into residency if they sought out counseling services. Even practicing physicians have been shown to report feeling the need to appear put-together when they are not feeling well because of the cultural belief that a physician’s health reflects his or her medical abilities.

Each year, an estimated 300 to 400 doctors commit suicide. We need to intervene at the medical student level and instill a new culture. A culture where seeking help or acknowledging mental health needs is not a flaw or weakness but is instead considered strong and normal. Our medical schools need to step up, our residency programs need to step up, and our hospitals need to step up. We as students and doctors can play our role by sharing our stories, but our institutions need to provide resources to help shatter this stigma.

 

Cultivating Our Own Mental Health

Being mentally healthy is more than not being sad or depressed; it is achieving mental wellness. We can help our mental health by protecting our brain and body from stress. Some easy ideas to turn into habits for our mental health include the following:

  • find social support

  • exercise

  • journaling

  • sleep

  • scheduling small achievable tasks (to avoid feeling overwhelmed)

  • eat a diet filled with antioxidants

  • schedule in breaks

  • talk to family

 

Ultimately, try to recognize this growing mental health stigma, and set the new precedent that mental wellness is necessary and not something to shy away from. Provide support to your peers that are struggling and if you are struggling, remember that you are not alone. Seek help to keep your mind and body healthy and provide help to those who need it. The journey to becoming a doctor is a demanding one, and you must be healthy to be able to care for others. Be proactive and make your mental health a priority so that medicine does not have to be a field known for its high rates of depression, but instead for the rewarding and serving field that it is.

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