“Raise your hand if you said you wanted to become a doctor to help people during your medical school interview. I see practically every hand in the room raised. Keep them raised if you told your interviewer you also wanted to become a doctor to overcome personal trauma.”

Everyone lowered their hands.

“I’m dismayed there are no honest people here,” I joked to attendees at an annual meeting of the American Psychiatric Association (APA), where I conducted a workshop on “PTSD in Physicians” with two colleagues.

And so, I launched into my presentation to the standing-room-only crowd. Most of the attendees were psychiatrists. Psychiatrists suffer a relatively high rate of PTSD because they are exposed to aversive details of their patients’ traumatic experiences, not unlike first responders exposed to serious injury or death. Physicians from other specialties also attended the workshop; emergency medicine physicians and rural primary care physicians have much higher rates of PTSD compared with the general population.

Indirect exposure to trauma, also called vicarious or secondary traumatization, has long been overlooked by the medical profession as a possible cause of PTSD. However, according to a 2011 study published in the Archives of Surgery, nearly 80 percent of residents and physicians faced either an adverse event or a traumatic personal event in the preceding year. Whereas the lifetime prevalence of PTSD among U.S. adults is approximately 7 percent, it’s roughly twice that percentage for medical students, residents, and practicing physicians.

Previously, only individuals who suffered direct trauma (e.g., physical attacks, natural disasters, and severe motor vehicle accidents) were considered candidates for a diagnosis of PTSD. But following changes in the DSM-5 in conjunction with health threats associated with the coronavirus pandemic and the recent increase in mass shootings and killings in the U.S., including watching violent media coverage, the incidence of vicarious trauma appears to be on the rise.

When I asked for a show of hands by the workshop participants, it was unclear whether the type of trauma they might have considered was primary or secondary. I suspect both were in play, if for no other reason than I have personally experienced the effects of direct and indirect trauma.

I recently wrote that one of the main reasons I wanted to become a doctor was to acquire the skills and knowledge of a physician and apply it in a nonclinical field, for example, health insurance or “big pharma.” But reflecting on my past, I also felt pushed toward medicine – psychiatry, in particular – hoping I would learn how to deal with the trauma I suffered during childhood and adolescence.

Many aspiring medical students admit to being attracted to medicine because of personal, medically-related experiences such as a serious illness in themselves or a family member. I bet that personal trauma is also a factor, except few admit it, as witnessed in the workshop.

I searched “trauma as a motivation factor to become a doctor” and came up empty. Yet, medical school applications are replete with students’ accounts of surviving cancer and other near-death experiences. Perhaps the students don’t see it as trauma and instead justify their reasons for wanting to become a physician (apart from “helping others”) as “improving the quality of life” and “taking steps toward disease prevention.”

The trauma I suffered was nothing as serious as cancer or a life-threatening event, but it was life-changing. During my formative years, I endured the type of trauma that leaves a permanent scar on your psyche, takes away your confidence, and robs you of an identity. I’m talking about teasing, bullying, and peer rejection.

Some of it was due to my physical appearance; obesity can be insufferable, resulting in nicknames such as “rhino” and “plump pig.” I was targeted because of my religious beliefs and was physically assaulted while my attacker yelled, “dirty Jew.” I grew up with a sadistic older brother (we have since made amends). When he wasn’t calling me “Laz the load,” he coaxed me into fighting older children. I was a pawn in his scheme to test a hypothesis that weight and physical girth were superior to muscle mass and strength (it wasn’t).

Adverse childhood experiences are strongly correlated with PTSD. My first memory in life occurred when I was approximately six months old. It was traumatic. I remember being in an “old age” home with funky smells. My parents handed me off to my immigrant grandparents. I did not want to be with them. I immediately began crying. I found solace only when I was returned to the comforting outstretched arms of my mother.

Shortly afterward, at home, with my mother away and my father at work, our housekeeper put me in my crib for an afternoon nap. I wasn’t tired. I did not want to sleep. I began crying. The housekeeper slammed the door to my room. I cried myself asleep.

I guarantee these are not false memories, nor is it impossible to remember events as early as the first year of life. Many have a lingering effect. Although my experiences were traumatic, they were not unique. We all suffer psychologically damaging incidents growing up – some of us more than others – and we tend to keep them hidden. How many of us aspire to become doctors partly because, consciously or not, we seek to be healed of our trauma or learn how to render first-aid to ourselves?

When you add the trauma from our childhood plus the secondary trauma from practicing medicine, do we not see ourselves as wounded warriors? As physicians, we are considered worthy to serve the suffering, but are we not worthy of salvation? Any physician who has not yet dealt with trauma should run – not walk – to a trauma specialist and seek their help and guidance.

At the APA workshop, a young psychiatrist bravely shared a personal account. She had been working at a VA hospital for several years and was currently going through a divorce. She felt traumatized by what was happening at work and in her personal life. She was most upset about treating veterans and listening to the unimaginable horrors of combat. She broke down and started to cry as she related her story.

I have periodically kept in touch with this psychiatrist. I am happy to report she entered therapy, left her husband, and left practice for a nonclinical career. She is doing well.

However, a substantial proportion of patients who seek treatment for PTSD continue to remain symptomatic, with impaired levels of functioning. This lack of progress in PTSD treatment has been labeled as a national crisis, calling for an urgent need to find a more effective therapy. The first step, however, is recognizing that, as healers, we are highly vulnerable to trauma, beginning early in life and continuing throughout our practice years.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.