All in the mind

We probably all know a physician who has committed suicide.

By “we” I refer to the world of Filipino doctors, that little sliver of the population among whom mortalities are discussed with relish.

Suicides of doctors hold a particular resonance, as though we become sharers in the grief that belongs to family and friends, spectators united only by profession. Speculation abounds. What pushed her to do it? What made him finally pull the trigger? Was it the rigors of internship? Was it the suffocating inescapability of life as a resident? Was it the long hours, the distance away from her family, the irreparably damaged relationship with his girlfriend? Was it that time she got yelled at by one of her seniors?

Buried in the speculation is also the victim-blaming question: Why didn’t they seek help sooner?

In the aftermath the news explodes like the abrupt sound of a gunshot echoing in a household, impossible to miss. It then follows each of us around as both an urban legend and a cautionary tale. For a time hospitals are on high alert and residency programs become just a tiny bit more sensitive to the human needs of its members, until eventually, like any other bit of news, the story and its impact dwindle for all except the most closely affected.

I propose another statistic: Chances are we all know a physician who is depressed.

We’ve all heard it: Statistics may vary slightly across different studies, but a review of evidence will show that either the rate or prevalence of depression among medical students and residents is higher than in the general population, and that we are at increased risk of suicide.

Suicide becomes a kind of endpoint for physicians to avoid: We can, supposedly, be weak enough to be sad, but not weak enough to commit suicide for it. Most of us are self-aware enough to diagnose ourselves—all it takes is a second-year medical school class in psychiatry, an inquisitive mind and the criteria from the Diagnostic and Statistical Manual for Mental Disorders. However, chances are we wouldn’t disclose it or seek treatment for our chronic unhappiness.

One would think that a doctor dealing with depression is better off than a depressed layman. We have the benefit of both self-knowledge and of free visits to the psychiatrist. It would also seem that health professionals suffering from depression or other psychosocial difficulties can expect their colleagues to be more understanding of, and more detached from, the topic of mental health. After all, the brain is an organ like any other.

I would argue, however, that there is something lacking in the medical community members’ approach to their colleagues’ mental health. A resident physician taking a leave from work for depression, rather than earning the sympathy (or even the benefit of the doubt) from her colleagues, instead becomes the subject of derision. “Depressed ba talaga yon?” her colleagues scoff. Residency, after all, is a unique world where sick days do not exist and you would have to be at death’s door for your colleagues to respect your right to take a break from work. Stomachaches or the flu, whether real or imagined, become, in our colleagues’ minds, excuses for taking on less work, excuses for tardiness, excuses for slacking off.

There is something wrong, deep-rooted and possibly non-addressable in the system of medical training that fosters thinking along the lines of: “Bakit, malungkot din naman ako ah, and I’m still here!” or “I once went on 48-hour duty attached to an IV line for hydration while I was bleeding from every orifice from dengue. My colleague has no right to take a day off just because she’s sick.” And if pregnancy or acute gastroenteritis isn’t considered a good enough excuse to take a day off from work, what more depression? It’s a way of thinking that makes sense in theory but fails due to the assumption of knowing more than we do about any person’s interior life, however close they might be as colleagues. We cannot see into anyone else’s mind; we cannot know how close they are to falling at any given moment.

I would then also argue that it is this very attitude that causes certain physicians—those deep in the throes of mental health problems—to keep holding on, enduring more than they should be expected to. They endure until, stretched to their limits, they end up with one of two outcomes: They quit, or they commit suicide.

It puts me in mind of Helga Pataki, nine-year-old antihero of Nickelodeon’s 1990s show “Hey Arnold!,” who—afraid of discovery—once went to an appointment with her psychiatrist dressed in the cartoonish disguise of a trench coat and dark glasses. It’s all right for our patients to be depressed and to take a leave from work, but for us doctors to do the same would be unthinkable. It’s all right for our patients to deal with the stigma of people finding out about their mental problems, but for us it would be beyond the pale to be caught in line at the pharmacy buying escitalopram or to be the subject of hospital gossip.

Something has got to give; among doctors there should be a different kind of disaster prevention. If indeed the brain is an organ like any other, physicians should be able to understand when that organ is sick; we should be able to understand mental illness without stigmatizing or romanticizing it. The general public’s views on mental health may be another matter, but surely among health professionals, we should be able to start the change and to give mental illness due attention and compassion. Doctors, unlike the Helga Patakis of the world, should be able to leave their trench coats at home.

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