I was a junior doctor when I experienced my first episode. The strange thing is, that despite my medical training (I may have bunked off a few of the relevant lectures in medical school), I didn’t recognise the symptoms.
I had lost my appetite and had lost weight. I wasn’t sleeping and was irritable, angry and tired most of the time. Most disturbing to me was a feeling (despite being surrounded by work colleagues and friends most of the time) was that I felt emotionally cut off and removed from people. I had also become cynical and decidedly detached from my work responsibilities and, truth be told, had lost all empathy with my patients. Not a good combination for someone working in healthcare.
It took a conversation over coffee with a good friend of mine who is a psychiatrist to make me realise that I was depressed.
Although of course it is obvious to me in retrospect, I had no idea I was depressed at the time. Like many people, I had no clear sense of my mood on a day to day basis. Like most other doctors I just kept on going.
For the last 20 years, I’ve been on the receiving end of medical care from GP’s, psychiatrists and psychologists. I’ve learnt a lot about mental illness, its treatment and how to look after myself better.
I have also learned a lot about the stigma of mental illness in medicine and how to cope with it. Largely, it has to be said, by keeping quiet about it.
Mental illness is, for many affected doctors, a shameful secret. One that can affect how other doctors perceive your reliability as a clinician and also one which could affect your career. To admit to not coping in medicine is to be weak, to somehow let your community down, and to go against the macho code of invincibility that we have imposed on ourselves.
What’s ironic about the code of silence is that a significant proportion of doctors have experienced mental health problems. Up to a quarter of doctors will meet the criteria for a depressive illness by the end of their first year in training and other studies suggest that up to 51% of (female) doctors have a lifetime history of depression. Substance and alcohol abuse are common, burnout is common and suicide rates are higher than in other professions. Medicine is not as glamorous as it sounds.
At present, thanks to the medical care and advice I’ve received and the support of family I’m doing well. Most of the time. I’m more mindful of my own moods and more forgiving of myself when I make mistakes. I recognise the warning signs of an imminent crash and feel better equipped to deal with the symptoms when they come. I have learned to say no (and not feel guilty about it) and also to give myself the odd pat on the back and remind myself that I’m doing some good.
However awful I sometimes feel, I know that it will pass eventually. I also know, that on my worst day, I’m still a conscienscious and caring physician.
I also firmly believe that my experience of dealing with depression has made me a better doctor; It has helped me understand the healthcare system from a patient’s perspective and also helped me empathise more deeply with patients (as another patient) and to be a more compassionate.
It has made me much more attuned to psychiatric symptoms in my patients (even when may not be aware of them themselves) and to develop a language that allows me to engage them in discussions about their mental health in a non-threatening way. Although I have a better understanding of how an illness like depression can colour and skew patient perceptions of certain physical symptoms, I think I am also less likely to over-diagnose psychiatric illness in a patient who’s symptoms don’t easily fit into a neat medical model.
There. I’ve said it. Whats your story?
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Well and truly expressed Ronan. Not been there myself but rode shotgun for a few who were in the grip of the black dog and I have respect for those who can work with the depressed and anxious. not a life-skill I have sadly
D
Brave, honest, powerful and inspiring, thank you
Well done for writing this. Especially, as you say, many in your profession feel it’s something they cannot be open about, or even acknowledge. The more people can open up and talk about depression the less of a stigma will be attached. It’s also interesting to note that it has enabled you to empathise more with your patients and spot the signs of depression (so has actually improved your skills!). A friend of mine recently took her son to an orthodontist, who took her aside and said he thought the boy was depressed. Turns out he was right, and she discovered her son was being bullied in school. So, here’s to all professionals being in touch with their feelings.
Thanks for sharing Ronan. Beautifully written. Brave posts like these can only help lessen the stigma towards mental health, especially in the healthcare profession.
Every word of this rings true, and I salute your courage in writing this and in your struggles with depression.
I’m so glad you are speaking up about depression and your experience with it Ronan. That is such an act of courage and compassion. Depression is actually remarkably common, isn’t it. Sharing stories like you have, helps dissolve any stigma and provide an environment where people can feel comfortable and accepted in talking about vulnerabilities. Thanks again for writing this poignant and inspiring piece. You don’t know how many people will take comfort from your words
“However awful I sometimes feel, I know that it will pass eventually. I also know, that on my worst day, I’m still a conscienscious and caring physician”.
and feel hope that , they too, can come to know they are still valued members of society.
Thanks for sharing your story here. I also experienced that in healthcare professions, we are not encouraged to admit to any kind of mental illness ourselves. One of the most difficult parts for me with depression is how at first, I don’t recognize slipping into the depressed mood each time. But knowledge is power, and helps with pulling back up toward “normal” to enjoy life more fully. Your patients are lucky to have you as a better and more understanding doctor now, as you put it.
Lots of calling mental trauma and distress an illness, which fits it into the medical model ie drugs. If I feel down there is usually a reason for it. I believe in talk therapy, yoga, meditation, diet, hydration, exercise etc I was prescribed “anti-depressants” by a GP for panic attacks and ended up with Bipolar disorder. I was abused by our so called “mental health system” and Psychiatry. I was locked away like a common criminal, even though I had done nothing wrong. It had a serious impact on the last 4.5 years of my life and ruined my career. I was turned into a prescription drug addict, until I finally became “enlightened”. I now rarely take medication for the “Bipolar” that was triggered by medication in the first place. A turning point for me was going to see Professor Ivor Browne and to be told the TRUTH. And to connecting to doctors like Dr Terry Lynch or Professor David Healy. [Never stop or change medication without consulting a good doctor, due to the dangers of withdrawal]
I’m sorry to hear of your experience Lisa. I have been lucky enough to have had a very positive experience of mental health professionals. Although I had side effects on some meds, I’m sure I wouldn’t have survived had it not been for psychiatry and medications. Talking and lifestyle have proved essential in maintaining my wellness but meds dug me out of a hole. Not all patients have the same experience.
Well written and well said Ronan! Being there and experiencing depression first hand makes you a BETTER doctor! I enjoyed your blog and how it reminds us that drs are human too… So many people forget that….
Keep up the good work and the excellent blog… I need to get back to mine one day…. Kim
Great piece and the honesty is inspiring. You also show how you have accepted it as part of yourself and do not let it affect your world or your personal relationships as much as possible. Have family member who I think is depressed but reacts with anger and hostility if it is suggested – she is victim and everyone else is at fault for her unhappiness – think this is due to historical stigma. More depression is in open realm the better. Well done Ronan.
fantastic – i see myself in every word you write. i was always open about my depression and, rather than feel ashamed, I felt proud of coming through it with the help of docs and medicines. keep up the great work you do in “outing” this illness!
Thank you for sharing your story – it’s a beautiful post.
Very well said Ronan, I’ve not been there but I think I’m never too far away sometimes! DC
Great post, mental illness is a really big problem in Ireland with so many who feel lost & hopeless, this article will give hope to many – well done. True strength can only come through great adversity & you are lion
Bravo Ronan, I am so impressed with your honesty and so proud of you as a doctor. As a psychotherapist I know how common ‘depression’ is and how much we still struggle with being open and real about it. I have had my own dark times and i believe most people have – whatever the trigger may be. Mostly, we need to be gentler and more compassionate with ourselves and know and accept our limitations but I also believe that we need to embrace the spiritual more. Not in any religious sense – but in a ‘soul’ sense of the word. Whether its music, poetry, nature, art, yoga or dancing – the lack of emphasis on tending to our sense of joy and fun at that level can make the world a serious and dark place. So keep up the work with the arts and music – it is clearly a deep part of your creativity and joy.
Irene
Great post Ronan. Very inspiring. I must say that I think I had some mild depression over the past few months. For me it was the professional isolation of living and working in the country. I might collect some thoughts and write a small piece later in the year. I wouldn’t have considered writing it (or this comment) if not for your experience. Cheers, Gerry
One of our bloggers at FacingCancer.ca, Don of Riding Shotgun, has also shared his story of dealing with depression. He touched on similar points, particularly the pressure to hide depression, which I think everyone feels . . . to live up to the image of the capable doctor, the supportive care-giver, the speedily recovering cancer patient, but how can that be helpful?
Through sharing stories like yours and Don’s, the taboo slowly crumbles. This is a great post, and hopefully it reaches others who felt unable to cope. ~Catherine
Well done Ronan, its great to have the confidence and insight to write that now, but it must have been a lot worse than it sounds during the dark days. Two SHOs in Tallaght committed suicide last few months.
It is a pity that many of us don’t recognize and support our colleagues when needed, and poor performance is sometimes met with criticism and comment rather than treated as a signal that there are problems deeper down.
In the current health service there is even more pressure than ever before and juniors in particular need to be watched carefully.
Brilliantly written Ronan. Thanks for sharing it.
I was a consultant in an acute specialty and had my contract terminated due to depression partly caused by the trust’s handling of my return to work after family traumas. I think that you are quite right that having a mental health condition makes you a better doctor. But I think that in the medical profession, particularly in the more macho specialties, we are not allowed to be ill and specifically not permitted to have a mental health problem. It feels a bit like how cancer used to be referred to 30 years ago. I still hope to have the opportunity of using my considerable medical experience and newly added human experience of illness in the future in some capacity.
Odd–while on a walk this morning with my wife I was ranting about grappling mental health issues while still in medical school. You see, I had literally just emerged from a rather deep episode, and was really concerned about the (perceived?) fact that my thoughts and my brain don’t mesh well with our system of medicine. I am here in the USA, but I can imagine that the culture of masochism and machismo is a shared experience. I am constantly reminded of the ways in which the way my mind pieced together is perceived by my peers and my professors. I remember an instance early in my medical education where, just before entering a room where a patient with Bipolar was waiting, the physician I was following that day turned to me and said, “This one is going to be tough. This person is literally crazy!” I was taken aback! Thank you for this post…I hope that we can build a community of providers where mental health is considered fully and appropriately!
Really excellent article Ronan. Nice to hear someone discussing what often appear as taboo topics in the medical world. Hopefully more brave articles like this will change the attitudes that doctors must appear as superhumans that are never ill and can’t suffer in the same way our patients do.
All the best,
Joe
The article has been quoted and recommended elsewhere
http://www.medicalindependent.ie/blog-post.aspx?title=going_forward_looking_back
very inspiring content Ronan …. i myself a pre-final year medical student suffered from major depressive episode in my first year ….but at present am quite out of it …. and going on without any anti-deps for over an year but one thing that upsets me is that i havent been able to deliver my maximum productivity or talent i can wen it comes to studies like i did before i had my episode..i feel the potential of my mind has come down…. i wish i would hav that edge that makes you more than what many are….
I came across this last night which might help a little. http://www.imt.ie/features-opinion/2012/12/helping-the-wounded-healer-to-heal-the-wounded-patient.html
I’m the social media specialist for an academic hospital system. I’ve had clinical depression since I was a child, going on thirty-plus years now. Being an actively depressed person definitely ensures that my empathy stays squarely on the patients’ side; at times, when I see coworkers in marketing and other communications disciplines fail time after time to understand what it’s like to be a scared, confused, lonely, impatient patient who feels hopeless, insulted, ignored and misunderstood, it’s the one time in my life that I wish others could feel what I do.
Because if there’s a gift hidden inside depression, it’s that it amplifies feelings when it isn’t shutting them off. I feel everything so much more keenly than I otherwise might, and I feel that it helps me hone in on what our patients are asking of us.
Yet I don’t think depression is a job requirement. I don’t understand how those in my line of work can be so consistently tone-deaf when it comes to understanding patients’ needs and fears. Aren’t we all patients? Haven’t we all been scared, worried or in pain? How have those who speak for hospitals become so disconnected from those who need them?
Right now I’m trying to find a way to educate my peers about how to write – and listen – in the most empathetic and patient-centric way – but as I have to do it one conference room or article at a time, it’s slow going. How do you think I can do this better?
Thanks Minna. Not sure I have the answers for you. Most people going into medicine have plenty of empathy and caring but somehow, the system tends to knock it out of them. I sometimes think that those who care most suffer most. If I had any advice, it would be too live a life parallel to medicine and develop interests of your own. Medicine is like a jealous girlfriend (or boyfriend..) and will eat up all of your mental an emotional energy if you let it. Having a rich and varied life outside medicine allows you a perspective that you might not have expected. Its not essential for people to write about it either, although doing so has helped me. Have a look at this – it was sent to me by a dutch rheumatologist (Michiel Zandbelt) and might help a bit… http://www.compassionforcare.com/en/charter-of-compassion-for-care
Also – this http://well.blogs.nytimes.com/2013/02/04/finding-poetry-in-cancer/?hpw
After unsuccessful bilateral leg surgeries in 2000-2001, I was homebound and became depressed. I also practiced law. I sought mental health help. But, unlike you, I did not recover promptly. My legal clients suffered. I was suspended from the practice of law for one year. That was 2002. In many parts of the US, depression is still considered a disease that makes a person “defective.” I was shunned by my attorney peers.
After my suspension, I was diagnosed with cancer and the leg surgeries turned into osteomyelitis. At the same time, my dad was diagnosed with cancer and ironically also osteomyelitis. But, even with health challenges, I did not suffer additional depression. I became stronger.
God had a different plan for me. He needed me to be available to care for dad until he died. I don’t even want to practice law again. I now devote my life to advocating for elderly patients and working with politicians to help change the medical system in the US (to strengthen the physician-patient relationship without government intervention).
God bless you for bravely and beautifully telling your stories. People with depression can be professionals too. :-D
Extremely well written, it was very brave of you to speak out well done. There needs to be more people like you. I myself have social phobia and find it is often hard to tell people for fear of the stigma and the fact that people see it as a weakness. Also scared that people will and do treat me differently when they find out about it. It makes it hard to engage people in a meaningful conversation about it. I am lucky I have some great support from my Mum and some of my fabulous friends however other members of my family my Dad and sister in particular are not supportive and deny it and make fun of me so I find it easier not to discuss this issue with those members of my family.
I am amazed that you have the courage to write about depression and when you say that no matter how bad it is that it will pass is the best advice as that is the one fear when in the throes of a depression – will I ever feel normal again. In my own experience there is still unfortunately a lot of ignorance and lack of empathy in this country about depression. I was recently part of a conversation and the subject of suicide came up. This woman threw in her tuppence by saying she thought “they are all selfish and if they did a bit of work they wouldnt have time to be depressed”. Unfortunately this is not the first time I have heard this sentiment expressed. However little by little things may change if people are willing to talk about it. However right now this minute I would not be able to tell my boss that I suffer from intermittent depression and she is a Medic. I would be afraid that once I opened my mouth I would be thought of differently so for me I prefer to hide it from others as I have done for the last thirty years except for a very select group of friends…………