I can finally say I’m in my last year of medical school. It has been a bumpy ride, but only one clerkship, a research project and an OSCE separate me from graduating. I remember receiving my acceptance letter eight years ago.
Growing up in an Asian American immigrant household, I frequently encountered and grappled with my parents’ reserved manner of expressing themselves. Instead of using words to communicate their sadness or anger, my parents would barricade themselves in their room and refuse to say a word.
During our psychiatry block, I learned how the aching sadness within me curls through my brain. It begins in the thalamus, amygdala, and hippocampus — three points that sit like stars in my body’s sky.
Despite the fact that it’s fairly warm for this time of year, I was feeling in the spirit to try a winter-themed activity that wouldn’t require travel or cost a significant amount of money. The most obvious activity, given those requirements, was ice-skating.
If you remember, about one year ago I had published a story about coming to terms with my mental illness on in-Training. Soon thereafter, I asked for the publication to be removed. I would like to re-publish my story with a very important addition.
Like poker, medicine has certain rules — patterns of clinical symptoms and lab findings each correlating with a specific spectrum of prognoses that vary in likelihood, the differential diagnosis. Physicians are like seasoned card players, trained to maintain composure and incorporate numerous variables into logical, calculated decisions at what seems like a “dealer’s table” of outcomes. Sometimes, we hedge our bets that the patient will self-resolve, so we elect not to treat; other times, we act conservatively with a battery of tests and pre-emptive therapy.
A fellow student writer recently wrote that she wondered if depression were “just part of life as a medical student.” One of her professors had given a lecture on depression asking students to “think of how many people we knew with the signs of depression listed on his lecture slide” — excluding medical students of course, “because you’ve all got some of these.” There is something so terribly and inherently wrong with that statement.
I have always toyed with the idea that I may have depression. Numerous times I have looked over the various depression diagnoses and their criteria. But then I settle on the idea that my thoughts and emotions and struggle are not severe enough. Everyone experiences sadness. Everyone experiences grief.
Medical schools and hospitals across the nation proudly claim to be “starting a conversation” about mental health in medicine. I could lose the residency of my dreams for taking part in it.
It should be no surprise that when I asked my fellow medical students their suggestions for ways to de-stress, one of the first answers I heard from all of them was: “Yoga.” I should admit that I have always been a bit skeptical of yoga — I enjoyed cardio-based workouts far more. However, after doing some research, I found a study by Bansal et al. which found that medical students in India who did yoga every day for just one month showed significant improvements in both their general and mental wellbeing.
My medical school, Indiana University, is one of the largest in the country with over 300 students in each graduating class. Sadly, each year it seems we lose one of our classmates to suicide. The surprising part? These numbers might be lower than the national average. In the United States, approximately 300 to 400 physicians commit suicide each year. A 2009 study in Academic Medicine reported that 12 percent of medical students had major depression and nearly six percent experienced suicide ideation. To visualize these numbers, in my class alone, statistically, 18 students have experienced suicide ideation and approximately 36 have major depression.
Medical school is a notoriously challenging experience during which students undergo tremendous personal change and professional growth. Though the stressors that come along with this are varied and unique to each student’s context and experience, they may be categorized within a few common themes. Harvard psychiatrist Raymond Laurie has previously described the concept of “role strain” with respect to negotiating relationships with their families, friends, partners, peers, attending physicians and patients. Additionally, with regard to students’ concept of themselves, individuals who have high achievement may be challenged in new ways both intellectually and emotionally.