Why do I think it is important to discuss mental wellness in regards to medical school? Because a publication from December 2016 says 27.2 percent of medical students demonstrate depression or depressive symptoms and 11.1 percent indicate suicidal ideation. Because a 2015 publication says 28.8 percent of resident physicians experience depression or depressive symptoms. Most of these people suffer silently. Too afraid to speak up because others might see them as weak or trouble or incapable of doing their jobs. There is a long-running stigma towards mental illnesses not only in the medical community, but in our society as a whole.

A psychiatrist friend said, “becoming a physician is something of a unique experience. In other areas, once you graduate life gets somewhat less stressful until you start taking on my responsibilities. With medicine, every year is more stressful than the last because you are given more and more responsibilities without any sort of break.” It can be demoralizing and demeaning.

Now to share a little bit about me: I have been a procrastinator most of my life and a perfectionist for all of it. I can’t sit still and constantly shift or fidget. I have always been very quick to pick up concepts, but I struggled with small details. I can learn, but I have a really tough time memorizing. The bigger problem has been that as I go further in school examinations become more about small details. Over time that frustration turns to doubt. I’ve never considered myself as smart as the people I’m usually around. I know I’m pretty intelligent on the grand scale of people, but I don’t see it. Over years this doubt eats away at you. So many times I’ve fallen short of my goals and not for lack of effort or caring.

After the start of the second year of medical school I developed test anxiety. I would be OK going into an exam and then start dreading the moment when I would have to hit submit on the test. I came to accept that getting B’s anymore was just not a thing I could do. And I hated myself for it. Intensely. I changed up my study habits after every exam and it just didn’t seem to make any difference and my studying was horribly unproductive because I just couldn’t get the things done I wanted.

I had no intention of quitting, but it began creeping into the back of my mind that I may not have a choice. How can I possibly do well on boards if I can’t even get a B on a school exam? I’m going to fail and I’ve tried everything I know to do. This isn’t working, and I need help from someone, because I have exhausted my own personal resources. I can’t get out of this despair by myself.

Luckily, one of the faculty shared a TED talk about procrastination. I rewatched the talk with the usual glee and empathy and decided to read the blog that inspired it. It’s quite empowering to read a blog about abstract ideas and see exactly yourself in every page. I reached out to my professor and asked if he had time to talk about it since he had expressed similar empathy. I knew what I was doing at the time was simply not going to work for me when it came time to studying for the almighty Step 1 and I needed some guidance. When I told him about how much trouble I had staying focused, he suggested I might get tested for ADHD.

At first I thought, “this is crazy, that’s something kids get.” I mentioned it to my mom and she said “you know, that would make a lot of things make sense.” I was able to get evaluated and yes, I was definitely positive for ADHD. Can you imagine the relief I felt to hear a professional say “you actually are pretty smart and capable and there are test results to prove it”?

I don’t get any superhuman focus from my medication, it simply takes the edge off enough that the changes I have made up to this point actually work. And more importantly, having a specific reason why I’ve struggled so much has helped me refocus how I approach my problems. I have to get creative. I also have to constantly be mindful of what I’m doing and how things are affecting me because I can be really susceptible to flashy instant gratification that comes with things all over the Internet.

This brings me to an important point that is growing in gravity amongst behavioral researchers: mindfulness. Being mindful, in simple terms, is being aware of your immediate experiences in the “here and now.” For me that has centered around writing and talking. In the past I would journal a lot as a way to remember important lessons from experiences or to process feelings I didn’t understand. Sometimes I just need to vent to friends. Usually by the end I come to a great revelation and move on. I see mindfulness as putting words to the internal chaos. By taking the time to think about what those words mean to you, you are being mindful.

That’s my challenge to you, dear reader. Everyone suffers from something at some point. Put words to what it is you’re feeling. If you can write about it or talk about it then over time you can understand it. Once you understand it, maybe you’ll realize things aren’t as bad as they felt or maybe you’ll realize something really needs to change. Sometimes the problem may not even be your fault, but it is your responsibility to deal with the situation as best as you can. The only way to get rid of a stigma about something is to start talking about it in a meaningful way and so I challenge you to start the conversation.

Eric Peeler is a medical student.  A version of this article appeared in Facebook.

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