I probably set a record for the earliest a physician ever burned out: less than a year after earning my MD. Some may not call it burnout; it could just as well be called “internship.” I call it burnout because beyond the exhaustion and can’t-take-it-anymore, there was a gnawing sense that something fundamental was missing — something that no amount of time would fix.
Over the next year or so, the …
Physician burnout challenges our assumptions
When a person gets depressed over their divorce, they are said to have a mental illness. When a person becomes psychotic from a manic episode due to their bipolar disorder, they are also said to have a mental illness. But are both of these illnesses mental illnesses? The definition of mental is that which relates to cerebral, brain, cognitive or intellectual processes.
Many disorders occur from problems in the anatomy or …
Does psychiatry worsen mental illness stigma?
Imagine losing your grip on reality; your only place to turn is the local hospital. Once there, you give up your personal effects, your clothes, and often, your right to leave. You wear paper scrubs in a sparse room, lay on an uncomfortable bed, and have a guard nearby preventing your escape. In seeking help, you have become a prisoner. This is done for your and for the hospital personnel’s …
An inhumane way to help those in greatest need of immediate intervention
As the audience of medical students decried the experiences that defined their academic lives, my cohort of middle-aged doctors started to squirm. We knew these stories: Doctors mistreating medical students, nurses, and other doctors; learning to cope with brutally long work hours; the struggle to grasp vague and ever-changing expectations while quickly bouncing from one clinical rotation to the next.
The four of us had eagerly agreed to participate on the …
The battle against medical student and new-doctor burnout
Pamela Wible MD’s book, Physician Suicide Letters Answered, is a devastating view of raw pain, the pain of young, energetic, highly committed young people motivated to help and heal. These healers themselves have been plunged into the spiritual, physical, emotional, and intellectual hell of suicidal thought and action. Iatrogenic illness in action (iatrogenic illness being that which is caused by medical practitioners). Unfortunately, and tragically, the iatrogenic illness that …
Exposing medicine’s secret underbelly: Physician suicide
Prior to the release of DSM-5 in 2013, I referred at times to the pocket copy of DSM-IV parked in my office bookcase. The main reason was to enter the right diagnostic codes on insurance forms. I also sometimes quoted DSM criteria to show a patient that ADHD can’t arise in adulthood, that daily mood swings are not characteristic of bipolar disorder, or that six months of sobriety is still “Read more…
What is the true utility of the DSM?
I was treating John W., a psychiatric patient who was an insurance executive. He was angry about his work situation. He complained bitterly about his supervisor whom he felt singled him out for unfair criticism. Over the course of months, John’s complaints escalated to the point where he said, “I swear … if there was a chance I’d get away with it, I’d love to get rid of the guy.”
I …
The psychiatrist as a double agent
The New York Times and NPR recently published articles related to the Goldwater Rule. In short, a magazine sent a survey to over 12,000 psychiatrists in the U.S. with the single question of whether they thought presidential nominee Mr. Barry Goldwater was fit to serve as president. Few psychiatrists responded. Of those that did, more than half — still over 1,000 — said that …
Why psychiatrists should stop diagnosing presidential candidates
By the end of my first year of residency, I knew I was in trouble.
I was overwhelmed by the 15-hour days, the unbearable sadness of the tragedies I witnessed, my feelings of impotence and my fears of making a mistake.
My life was my work, and everything else seemed to be falling apart: my physical health, my relationships, my ability to sleep after months of night shifts.
Yet, I came to work …
To the doctors struggling with depression: You are not alone
Dear Pamela,
You’ll never guess what happened to me today. Hours after the National Day of Solidarity to Prevent Physician Suicide volunteer web page went live, I received an email stating that I am officially terminated from my psychiatry residency program.
On this web page, I spoke about the fact that I had become interested in this event during my …
Hospital fires doctor for having cancer
A recent research paper from the University of Virginia may pound the final nail into the coffin of the long-standing medical dogma which rigidly labels diseases as “organic” or “psychiatric.” UVA researchers have discovered a complex network of lymphatic vessels which service the brain, prompting a serious update of the concept of a highly selective “blood-brain barrier.”
When asked about methods to study the immune response of the brain and …
Exciting implications of the neuro-immune link no one is talking about
It is no secret that mental health conditions are prevalent, and recent years have seen an increase in the dialogue on their causes and consequences. However, we do ourselves a disservice when discussing mental health outside the context of the broader system in which care is provided, and the insurance constraints that drive shortcomings in health care delivery.
SAMHSA estimated that 58 percent of adults have a medical …
Insurance constraints drive shortcomings in health care delivery
I sat across from her and in my most official yet trusting psychiatrist’s tone gave the spiel I delivered many times.
“Amanda, I’d like to start you on a medication that might help your depression. Like every medication it can cause side effects, however, many people have no side effects or only have minor ones. This drug can cause weight gain, increased risk of diabetes, and increased risk of heart disease.”
A …
The psychiatrist with a psychiatrist
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Ms. C was one of my first patients with schizophrenia. I saw her on the inpatient unit of a psychiatric hospital where I was training as a psychiatry resident. Ms. C suffered terribly from what we call the negative symptoms of schizophrenia; she sat mute for much of the day in her bed, staring out of the window. She would occasionally respond to a question with a one-word response, but …
Psychiatry is a field in upheaval about diagnosis
Polypharmacy was once the exception in psychiatry; now it seems to have become the rule. Patients frequently are taking 3, 4, even 5 psych meds at one time. And often it’s primary care doctors, not psychiatrists, who are doing the prescribing — usually without adequate training in psychiatry.
Some polypharmacy is rational — e.g., a patient with bipolar disorder who receives the combination of antidepressant and mood stabilizer.
But most polypharmacy is …
The problem of polypharmacy in psychiatry
Psychiatry was my first clinical rotation, and I did not know what to expect when I began. When I initially got assigned to the dialectal behavioral therapy (DBT) team, I had no clue what that would entail beyond working with some borderline patients and that the preconception of borderline patients is that they can be “the most difficult” patients to help due to their intense emotional instability, chronic feelings of …
What a medical student learned during his psychiatry rotation
I’m looking at a pile of little boy clothes outside my back door this morning. It often looks like this if we forget to clean up. My kids shed their clothes almost as soon as they are home in search of water play of some sort: hose on the slide, sprinklers, water gun fights. They are supposed to put their clothes in the hamper. That obviously doesn’t always happen. This …
How to talk to your children about tragedy
Benjamin, Jr. was the apple of their eye. He was cute and inquisitive, and smart. Very, very smart. The minute he took his first breath into this world, his mom and dad had already ordained him as a future MD. He would become a doctor and follow in his father’s steps. No questions asked. He would become the second MD in the family. Every birthday, his parties were doctor-themed: kiddie …
The perfect son. The perfect doctor.
I grew up thinking an “illness” was either a fever or croup. Illness was a stuffy nose — a sick day, an excuse to miss a day of school. At 18 years old, “illness” took on an entirely different meaning. Illness meant waking up from a coma, learning that my stomach exploded, I had no digestive system, and I was to be stabilized with IV nutrition until surgeons could figure …
PTSD was the illness I couldn’t see
A primary care physician named Ashley Maltz recently discussed advantages and disadvantages of a cash-based practice. I appreciate her evenhanded tone: She prefers this model yet expressed concern for patients who can’t use it. In the comments section, several physicians extolled the virtues of cash-pay, but patients were mixed. It’s attractive for those who can afford it, while it worries, and maybe angers, those who can’t.
I enjoy the personal and patient benefits of a mostly cash-pay psychiatric practice (I …
How can patients accept cash-based practices?
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