Physicians are trained, above all, to project steadiness. Long before we feel it, we learn to perform it. The lesson begins early in training. The pager goes off, a room fills with urgency, and the expectation is unspoken but unmistakable: Remain calm. Do not let uncertainty show. Do not let fear show. Patients need confidence. Teams need direction. Over time, the composure stops feeling like a performance. It becomes a habit, something closer to a professional instinct than a conscious choice. Eventually, the mask feels less like something we wear and more like something we are. After enough years in practice, it becomes difficult to remember when we first put it on.
Reading a recent essay by psychiatrist Jessi Gold, MD, MS, on KevinMD made me consider an uncomfortable question: What happens when the mask physicians wear for their patients becomes a cage for themselves? Gold is hardly a marginal voice in medicine. She serves as the chief wellness officer for the University of Tennessee System and is an associate professor of psychiatry at the University of Tennessee Health Science Center. Much of her work focuses on physician well-being, the very issue medical institutions increasingly claim to prioritize. And yet in her essay, she revealed something she had kept private for more than a decade: Since her training, she has taken a stable daily dose of Wellbutrin. To most people outside medicine, the disclosure might seem unremarkable. Physicians prescribe antidepressants every day. But within the profession, the admission touches a quiet fault line.
Medicine has made visible progress in destigmatizing therapy. It is now common to hear a colleague mention seeing a therapist after a difficult case or during a punishing stretch of clinical work. Therapy is often framed as maintenance, no different, in theory, from exercise or sleep, and a physician seeing a therapist may even be interpreted as evidence of insight. Medication, however, still occupies a different psychological territory. Gold writes that although she believed deeply in prescribing medication for patients, she privately regarded needing it herself as evidence of something more serious. Therapy was acceptable. Medication suggested illness. The distinction was never formally taught, yet it was widely internalized. She worried that if colleagues knew she relied on a prescription to maintain her equilibrium, they might see her differently, less capable, less stable, and less deserving of the authority medicine demands.
This is the quiet paradox of physician wellness. The profession acknowledges mental health in principle while maintaining subtle boundaries around how much vulnerability is permissible. Talking about stress is acceptable. Admitting to biology, acknowledging that one’s own neurotransmitters may require treatment, still carries an undercurrent of unease. Part of this instinct has intellectual roots. In psychiatry and psychotherapy, the clinician has often been expected to function as a kind of blank slate, a professional presence defined more by listening than by self-disclosure. There is also a legitimate ethical concern that lived experience, if handled poorly, can drift into self-indulgence.
But the cost of maintaining that blankness can be considerable. When even a system-level chief wellness officer feels compelled to hide a successful, life-stabilizing treatment for 13 years, the message becomes clear: Professional survival still depends on the performance of perfection. We all know, intellectually, that this perfection is fiction. Yet medicine continues to reward the appearance of invulnerability. The consequences extend beyond individual physicians. They shape what the next generation learns about the profession.
Medical students and residents watch closely. They are learning not only how to diagnose disease, but how a physician is expected to live. If the physicians who train them present only the polished version of themselves, the version that never struggles, never seeks help, and never requires treatment, then the lesson becomes unmistakable. Their own struggles must remain hidden. Their own limits must be concealed. And secrecy has a way of turning ordinary difficulties into private burdens.
Gold’s disclosure matters precisely because it is so ordinary. She remains what she was before: an academic psychiatrist, a physician leader, and a prolific writer. The medication did not diminish her professional identity; it helped sustain it. The lesson her story offers is deceptively simple. Professional dignity does not require professional perfection. Physicians are subject to the same biological realities as the patients they treat. Sometimes therapy helps. Sometimes medication helps. Often, both do. Acknowledging that truth does not weaken the profession. If anything, it will strengthen it by replacing the quiet fiction of physician invulnerability with something far more durable: the simple honesty of being human.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
