One of the episodes of the Walking Dead was titled “JSS.” In this brutal episode, one learned by the end of the show that one of the characters, then others after her, had learned that all they could expect to do for the moment was JSS, or just survive somehow.
I met a patient recently who embodied that mantra.
Small, petite, with stringy hair and sun-browned skin, she did not look the …
My patients all want to just survive somehow
This past month I had the opportunity to present at a medical conference; my research topic was burnout and depression in osteopathic family medicine residents. A variety of attending physicians and residents stopped by my poster, excited to see this topic being brought to light. With the recent rise in physician dissatisfaction and suicide, there has been increased attention to finally start addressing this issue.
I was super excited about giving …
Why it’s not OK for older doctors to dismiss physician burnout
Again and again in therapy I find myself emphasizing the distinction between feeling an emotion and acting on it. Many patients, and non-patients too, take undue responsibility for their emotions, as though feelings were volitional behaviors, the result of a choice. Often there is a stated or implied should: “I should feel this, not that.” Note how commonly people blame themselves for feeling, or not feeling, a certain emotion:
“I should be more grateful after all she’s done for me.”
“It’s wrong of …
Choose your actions, not your feelings
Mental health issues are something I’m passionate about and have a lot of experience with, both professionally and personally. One of the biggest lessons I’ve learned over the years is how complicated and broken our mental health system is. When one or even multiple parts aren’t functioning at their highest level, we end up with a fractured system and patients falling through the cracks.
One chasm in our mental health care …
Systemic racism and racial bias in mental health care
A reader I respect asked me for my thoughts on trigger warnings.
Per Wikipedia, trigger warnings are “warnings that the ensuing content contains strong writing or images which could unsettle those with mental health difficulties.”
Let’s put aside the last part of that definition, “those with mental health difficulties”, as some articles suggest that trigger warnings are not limited to those with mental health difficulties. Part of …
The controversy that surrounds trigger warnings
Now that I’m getting ready to turn 70, I thought I’d summarize what I’ve learned since I finished my residency, when I was 28. Of course, I didn’t learn all this only by being a psychiatrist, since I would hope that most folks have also learned lots in the last 41 years.
1. Psychotherapy is important, particularly if the patient is on the right medication. I won’t do “med checks,” since I …
What I learned after 41 years of practicing psychiatry
Almost every day over the last few years, someone has written about physician burnout or depression.
The problems begin in medical school. A recent paper featured drawings that medical students had done depicting faculty as monsters. One student felt so intimidated during a teaching session that she drew a picture of her urinating herself.
The paper equated faculty and residents supervising students …
Could talking about physician burnout create more burnout?
I settle into the bent-wicker chair on my lanai and try to relax. It’s a perfect island day, the temperature warm, the breeze cool, and I gaze out over the pool to the tops of the coastal mangroves. I’ve just come home from a shift at the local free clinic, and my mind is occupied by the work we did today. My fourth-year medical students encountered some difficult patients, and …
I thank my father for the gift of freeze-frame
I was 13 years old when I first had thoughts related to suicide. While my thoughts never really included calculated ways of ending my life, I remember such a profoundly overwhelming desire to be anesthetized to all of my emotions and worries. In the medical field, that kind of thinking is classified under the label of “suicidal ideation,” which is often accompanied by other diagnoses of mental illness. I have …
My double life: Mental illness in the health care
I recall during my freshman year in medical school, sitting in class and listening to what were supposed to be 50-minute lectures from people who’d been teaching the same course for years. These were highly educated and intelligent folks; they knew how much material they could cover in 50 minutes. Yet, they frequently went past their time; encroaching on what was for some a badly needed bathroom break, and for …
Every physician is a wounded healer
Hi Pamela,
I’m a medical student in the UK. Though I’ve only been in med school since September, it has already taken its toll on me. Before I started, I was so in touch with my emotions, spirituality, and nature. Now I feel so empty and desensitized. I hate that when faced with the horrible circumstances of another person, I just don’t feel …
Medical school has killed my soul. What can I do?
It is exactly 49 steps from my bedroom to my garage. It is a 23-mile drive to the hospital and 75 steps to the unit. It takes 10 seconds to walk to the nursing station. I can measure what it takes to get me to work each morning with absolute certainty. I know because I have measured it a million times hoping something will prevent me from reaching my destination. …
This doctor quit medicine. But she really tried to make it work.
I saw a patient last week for her chest pain. A 60-year-old woman came into the hospital because her chest tightened every time she went running. The pain would last about 20 minutes, centered on the left side of her chest, and radiated to her left arm. It lasted until she would finally take a break from running and sit down.
“This is classic,” I thought. “Stable angina.” I could now …
It’s time to treat mental illness as seriously as we treat heart disease
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Pamela Wible, M.D., takes on physician suicide in her TEDMED talk (delivered on November 18, 2015). Learn more about Dr. Wible and her talk at TEDMED.com. Full transcription below:
I love the three things that people fear the most: death, disease, and public speaking. Here’s how it all started. At four, I was so talkative (and bossy) no babysitter would stay with me. So I tagged along with Mom, …
In the hour after I heard the news, I experienced the full spectrum of typical reactions to a physician suicide.
One end of the spectrum came from the attending in a clinic, who when asked if the residents could go home and mourn their friend who just committed suicide, proceeded to tell me a story of how when her grandpa died before a final exam in medical school. She decided to …
A medical resident commits suicide. Here’s how one colleague mourns.
I’m not sure when it happened, but driving into the parking lot that cold winter day, I knew it had. Tears welled in red eyes, snot dripped out of my nose. I felt so alone and lost. My whole life I’d wanted this — the drive to the hospital and wondering whether I would change a life. But as I sat in my car, engine off, I didn’t want that …
If this medical student was a test question, the answer would be depression
Almost two years ago I went to the funeral of a medical school classmate. A little more than three weeks before he had jumped from a parking garage after finishing his clinic. He had a loving wife and three young children. He had the respect of his colleagues and the love of his patients. There was nothing out of the ordinary in his financial or personal life. It didn’t make …
How many more physicians will we lose to suicide?
Mental illness has long been associated with shame and stigma. Although progress has been made through the efforts of global celebrities like Stephen Fry and many others to de-stigmatize mental illness — many are still ashamed to admit to it, and the stigma is far from being annihilated.
Nowhere is this stigma more entrenched than within the medical profession itself. A fact that should shock us out of our judgmental slumbers …
We are human beings before we are doctors
Dear Pamela,
Question for you in regards to disclosure about mental illness. In every job that I have applied for, as part of the credentialing process, there are questions about felonies, treatment for drug/alcohol abuse and mental illness. Why are mental health questions still allowed to be on there? I have had postpartum anxiety/depression three times now, and I feel like it is …
Why are mental health questions still allowed on physician job applications?
I know your secrets. I keep secrets for a living.
I know about the eye opener before your shift; the Adderall prescribed for your son that you take in the morning; the Xanax a colleague gave you for upcoming air travel that that you take at night; the near DUI that you got out of by showing your hospital badge, the letters “Dr.” prominent on the left side; your wife who …
The psychiatric secrets that harm physicians
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