I grew up in the western suburbs of Chicago as the youngest of three boys. I experienced deep depression and suicidality at nineteen, after a childhood of anxiety that often left me paralyzed and physically sick. I was treated by an amazing psychiatrist and started on Prozac, which flipped me into mania. I had underlying bipolar I disorder, and substance-induced mania is not uncommon with it. My older brother shares the condition, and mental illness extends throughout our family tree. Having seen him descend into mania as a fourteen-year-old, I was familiar with it but thought it would never affect me. His mania coincided with the unraveling of our family, which I have come to see as rooted in fractures that predated him. This is not my parents’ fault; we grew up in a loving home. People forget that it is our parents’ first time being parents, so there is no playbook for how life unfolds.
After flipping into mania, I was started on lithium and became stable enough to return to my undergraduate studies. Though I was behind, I finished my degree on time. But before applying to medical school, I took a semester off and enrolled in two partial hospitalization programs. I was the youngest patient in both, and it was humbling to see grown adults break down in tears every day while I was just dealing with the pains of adulthood. When you are in that state, it is very difficult to share your experience with others, even with family or close friends. I was alone during that process, and during my mania, I burned a lot of bridges that are irreparable. I was not myself. You feel on top of the world and that everyone else is wrong. This is not to spite anyone, but simply my experience of ascending from that hole.
Though I was always on the pre-med track, this experience propelled me to fully commit to a life of service as a physician. I applied twice to medical school and was accepted the second time around. In my first cycle, my personal statement centered on being bipolar and how it affected my life and my motivation for medicine. Despite a competitive MCAT, strong GPA, and diversified resume, I received one interview and was rejected. Preparing for my second cycle, I sent my essay to physicians in my circle, and the one constant was that I needed to rewrite it, omitting anything about mental illness. I was distraught; this was the very thing that had propelled me down the long and arduous path to medicine. Taking their advice, I rewrote it and received five interviews. The experience left me jaded that a system so dedicated to helping people would disregard those with mental illness as incapable of becoming providers. If anything, going through it has equipped me to be a better physician, as I can more deeply empathize with patients and relate to their perspective of illness.
It amazes me that a profession that tops the charts for burnout and suicide is so unaccepting of mental illness. I have been told that one of the first questions on a residency or job application asks whether the applicant has a diagnosed mental illness. Depression and anxiety have become somewhat more accepted, but partly because everyone deals with those emotions from time to time. Because I have bipolar disorder, it is hard for others to understand that the organ you use to overcome these states is also the one that is diseased. If I could “pull” myself out of that state, I would gladly do it. Though therapy has its place, for bipolar disorder, pharmacologic therapy is truly the best treatment, and I can fully say my psychiatrist saved my life.
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To be told I must be on medication for the rest of my life to maintain my sanity was its own journey, one many others struggle with too. Taking a medication for ulcerative colitis is accepted, but a medication for mental illness somehow is not. I believe this is because “body” conditions have lab values, physical findings, and imaging, whereas mental illness deals in the abstract and is governed by criteria that can be subjective depending on the provider. That is why, when someone with mental illness is implicated in something, the first question is: What meds are they on? Are they off their meds?
I wouldn’t wish the internal dilemma I face every day on anyone, as I ask myself: Am I crazy? Am I flipping into mania? To have others constantly ask this is demoralizing. I am all for others being concerned for my welfare, but I have the best gauge of my mental health when I am in a stable state. When someone brings a concern to my family or psychiatrist, my autonomy as a patient gets restricted, as it is deemed that I lack the self-insight to see what is going on. My reality can be separate from what others see, which is frustrating and adds to the burden of daily life.
I don’t think anyone in my circle would guess that I am bipolar. I don’t make it my personality or lead with it. But when someone confides in me about their own mental health struggles, I always share my experience and let them know I can help in any way I can, having been through this isolating journey myself.
My hope is that medicine can evolve in line with the “evidence-based medicine” paradigm that defines my curriculum. In a world more divided than ever, relating to one another on a human level is essential to providing the best care for our patients, and for one another. I advocate for setting boundaries and looking out for the next generation of physicians, who are expected to master a vast and ever-growing body of medical knowledge. Given that medical school is the most competitive it has ever been, and the financial and life-course sacrifices it requires, I hope this profession can learn to look out for its own.
Tommy Pasternak is a second-year medical student at Loyola University Chicago Stritch School of Medicine, training in the Chicago communities where he grew up. He writes about mental illness, patient autonomy, and the stigma that still surrounds psychiatric diagnoses within medicine, drawing on his own experience living with bipolar disorder.
His work makes the case for a profession that extends to its trainees and colleagues the same compassion it offers its patients. He publishes essays at his Substack newsletter and shares updates on Instagram and LinkedIn.
