When doctors become patients: Efforts to reduce the stigma of mental illness among the medical community

Thursday, September 20, 2018 - 4:35pm

In her second year of medical school at the University of Michigan, Rahael Gupta contemplated taking her own life. While Gupta got the help she needed and returned to school the following year, she uncovered a stigma among the medical community in which many physicians — and those in training — hide their depression for fear of professional consequences. Now, in her final year of medical school, Gupta is speaking out about her struggles with mental health and emphasize that, just like the patients for which they care, doctors are not immune to depression.

In Gupta’s second year of medical school, she began feeling fatigued and upset as she fell behind in school work. A dedicated worker, Gupta wanted to just focus on her studies and tried to ignore her increasing inability to function in school. She never considered she was suffering from depression until a trusted medical school counselor, whom she had visited at the time to try to defer a test, suggested she might be depressed.

“She was the one that recognized, ‘Okay, this student isn’t just having a hard time, there is something wrong here,’” Gupta said. “She was the first person to ask me, ‘Rahael, do you think you could be depressed?’ No one had asked me that before.”

For Gupta, her mental health had become a secondary concern to exam deadlines and school work, but as a result, her academic performance and her well-being diminished.

“I was so low and distraught — I was just happy that somebody was asking me about how I was doing instead of about my performance,” she said.

Gupta is not alone in suffering from depression. A 2016 study conducted by a team at Brigham and Women’s Hospital and the U-M Medical School found one in four medical students may develop depression. Though the intensity of medical school would seem to be an environment naturally rife with anxiety and stress for students, study co-author Srijan Sen explains there is a taboo concerning doctors who appear to suffer from such pressures.

“I think there’s a culture that we’re supposed to be strong and nothing can faze a doctor, and they can handle anything and continue on,” Sen said.

The team collected data from over 200 studies, which examined the mental health of 129,000 medical students in 47 countries. In addition, researchers found one in 10 students will contemplate suicide during medical school. Though there are disproportionate numbers of medical students suffering from depression and suicidal thoughts, results from the study show only 16 percent of those with depression are seeking help.

Sen has previously worked on other studies that examine the mental health of medical students and professionals. He visited study participants years after they graduated from medical school and completed their residences to observe similar rates of depression and reluctance to request mental health care later in the participants’ later career lives.

“Almost all of them feel like they are the only ones going through this struggle, that everyone around them is doing a perfect job with all their patients, working 16-hour days and then going home, exercising and making dinner, and getting everything right,” Sen said.

In a 2010 study Sen conducted to examine the mental health of 740 interns entering residency programs in 13 U.S. hospitals, intern depression increased from 3.9 percent before the internship to about 25.7 percent during the internship.

Sen, whose friend committed suicide when they were in medical school together, believes the mental illness stigma and ostracization of those who seek help contribute to a toxic problem within the medical community.

“It’s the unwillingness to reveal how much we’re struggling and talk about it with colleagues — that’s a big problem,” Sen said.

Though most medical schools offer mental health counselors and wellness centers, encouraging students to actually take advantage of these resources is a challenge.

2016 study of over 2,100 female physicians who had children found most who suffer from mental illness do not report their condition or seek help because they fear potential consequences.

Almost half of the study participants believed they experienced mental illness at some point in their career, but did not seek treatment. Two-thirds of this group reported the professional stigma within their community provoked their reluctance to seek treatment.

Lead study researcher Katherine Gold explains physicians fear sharing experiences with mental health because many state medical licensing boards require physicians to disclose any past or present mental illnesses. However, by disclosing mental health history, physicians risk receiving medical license restrictions.

“It has been the stigma compounded by the state licensing questions (which most prevents doctors from seeking help for depression),” Gold said. “People have a general fear of having to disclose this information publicly or a fear that they could lose their medical license just because say they sought treatment for postpartum depression five years ago.”

While licensing boards have different requirements and questions depending on the state, Gold believes these boards discourage doctors with mental illnesses out of fear that a physician’s prior mental health may affect their work; however, Gold proposes instead of looking for doctors with previous diagnoses of mental illness, board members should be more concerned with doctors presently exhibiting cautionary behaviors.

“The real concern is the behaviors — it’s not … (about having) a diagnosis of, say, depression,” Gold said. “If you have a diagnosis but you’re able to practice and do well with your patients, and you don’t have any citations or lawsuits or things like that, there isn’t any reason to think you’re not providing good care.”

Most female physicians who were surveyed in the study went to various lengths to conceal their depression from state licensing boards. Some of these activities included not seeking treatment, hiding medical bills for treatment from insurance companies or even writing their own prescriptions. In addition to fearing judgment by the medical community, Gold believes doctors who suffer from depression also fear not living up to their own expectations.

“There’s a lot of what we call ‘self-stigma,’ which is people feeling that if they have depression and they seek help, they will be seen as less capable than other people, and that makes it hard to get care,” Gold said. “So it’s not only that they might get ‘flagged’ (as having a mental illness) or lose their license, it’s also that they have very high self-expectations — we know this about physicians generally.”

Gupta knows firsthand what that stigma is like. After returning to school from her seven-month break during which she received treatment for her depression, Gupta was encouraged to not disclose her depression.

“Stigma is huge and I was absolutely terrified of people knowing,” Gupta said. “I didn’t talk about my depression for a very long time and I was kind of counseled by people not to talk about it, by mentors, by friends.”

Gupta did not discuss her struggle with depression for months out of fear that revealing her mental health history would affect others’ perceptions of her capabilities as a doctor.

“When you come in as a patient, and you’re requesting help about an urgent medical concern, most people want their doctor to be very confident and strong,” Gupta said. “They’re not necessarily looking for vulnerability from their physician.”

Gupta’s attitude changed last fall when the U-M Medical School lost one of its own residents to suicide. Gupta struggled with his death at a time when she was still recovering from her own experiences with depression.

“That could have been me,” Gupta said. “I just had a really difficult time dealing with his death.”

After processing her peer’s death, Gupta also heard from other physicians who admitted they suffered from similar feelings of withdrawal and loneliness. She realized she was not alone and started working on a video project titled Physicians Connected, which features several Medical students, residents and faculty reading a script in first-person about Gupta’s experience with depression.

“I know many people who struggle daily but don’t talk about it because of the stigma,” Gupta said. “For me it just felt like a necessity, there was an urgency in saying something and changing the culture — it really is a matter of life or death.”

One participant at the end of the video tearfully thanks Gupta for having the courage to speak about the stigma of depression among doctors.

“That’s why this is so brave of you because people don’t do this and it’s so common in third year especially, in fourth year and all throughout medical school; just never feeling good enough and admitting it is very hard. I applaud you. I am very touched by this (project).”

Gupta hopes the project will encourage other physicians, residents and Medical students to speak out about depression to let others know they are not suffering alone. Even as she graduates medical school next year and will advance to her residency, she hopes to remain an advocate for medical professionals with depression.

Currently, the University houses the House Officer Mental Health Program, which offers a range of mental health services for residents. HOMHP also has a sister center that offers comparable resources for University Medical students. For Gupta, she believes truly impactful mental health care has to start with changing the attitudes and prejudices doctors have against members of their own community who suffer from depression.

“I think that it’s really misguided to try to screen out individual people who have struggled with depression or who have self-disclosed because the reality is that depression already places a huge burden on the system and there are people all around you who are struggling,” Gupta said. “So a much more informed way to deal with it would be to examine the system and what could be precipitant in widespread depression.”