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Widening the Discussion of Mental Health in Medical School and Beyond

This piece is part of in-Training Mental Health Week.

I was up late in the midst of an intense infectious disease cram session when my phone buzzed alive. Glancing down at the light of my iPhone, I noted the caller’s name with surprise — it was a friend across the country with whom I had not spoken with in months. I wondered why he was calling now; maybe it was a butt dial?

“Hello?” I asked questioningly. The voice that responded was calm and polite as usual, but also embarrassed: “Hey, sorry to bother you … I’m at the hospital, but don’t worry, I’m okay. Can I just talk to you for a second?”

My heart sank with the comprehension that I would probably be pulling an all-nighter, but despite the cavalier tone and apologetic chuckles coming through the phone, there was a nervous uneasiness to my friend’s voice that caught my attention; this was not a phone call I could turn down. “Yeah sure, of course. What’s up?”

The Jay I knew in high school had always been a wallflower — someone who ambled through high school with decent grades and a few leadership positions, never all that ambitious, but not for lack of intelligence — it was just his personality to be mild-mannered. In our gigantic class of 800-plus competitive students, Jay blended right in, somewhere in the top 10 percent, but nothing outstanding. We were close friends, but drifted in opposite directions after graduation. I moved out of state, graduated college early and stayed out of state for medical school; Jay attended community college for two years before transferring to a larger state university.

As a transfer student, Jay struggled to fit in. Academics were tough, but it was his social life that really took a hit. Many students had bonded as freshmen in the dorms and had already discovered their own niches in clubs and extracurricular activities. Cliques had formed. People were polite enough, but he was the new kid on the block — on the outside looking in.

Seeking camaraderie and exercise, Jay joined the judo club. The first few club sessions went well; the basic framework for new friendships and judo were laid down. Unfortunately, at the third session, the club members were teamed up to practice throws, during which Jay was thrown forcefully over his partner’s back, landing awkwardly with his foot smacking the floor off the mat. Subsequent x-rays showed a lateral malleolus fracture, and Jay had to take a break from judo. Budding friendships shriveled up, and he found himself lying in bed with a cast on his left ankle, unable now to even climb the expansive hilly campus to his classes. Assignments and tests passed quickly, and Jay’s grades plummeted. At the end of the quarter, Jay was put on academic probation, which threatened not only his status as a provisional transfer student, but also his financial aid.

Pills, a bridge, a gun? No, he wasn’t going to shoot himself, but in desperation, Jay found himself spewing suicidal thoughts in his student counselor’s office, where he was subsequently given the choice to either commit himself to the hospital’s psychiatric ward voluntarily or in restraints; either way, a police escort was involved. Jay described the ride through campus in the police car as surreal. He made small talk with the police officers who apologized for the hassle: Sorry, kid, for the embarrassment. You aren’t allowed to walk to the hospital yourself — strict protocol. Hours of waiting, paperwork and orientation later, Jay was finally left to himself in the quiet of his own patient room. A couple of days later, he called me.

Jay was discharged on SSRIs, with orders to see a therapist weekly. He returned to school briefly, but the stress of classes, therapy, his still-broken foot and financial aid probation was too much — Jay decided to drop out of school for a while. He and I stayed in touch through phone calls and met up whenever I was home on break from school. He always seemed so calm and unaltered on the surface, but deeper probing would reveal still gaping holes in confidence and happiness.

In a sense, what happened to Jay could have happened to anyone. There was nothing to be ashamed of, yet I saw how easy it was for friends and family to avoid talking about the taboo subject, act as if nothing happened and move on with their own lives. Even those friends like me, who wanted to be supportive, were busy with our own stressful lives, and it was easy to go months without talking about the issue, which made me wonder.

Why is mental health faced with such silence? Why is it that students like Jay are not warned or made adequately aware of the immense toll that academic studies and social pressures can take on the mind, to the point that the first indication of anything out of the ordinary is emergent hospitalization, or even worse, suicide? According to the National Institute of Mental Health, in 2014, about 6.7 percent of US adults experienced at least one major depressive episode in the past year. So why is it that even in the cases of completed suicide today, the overwhelming reaction is still disbelief, as if mental illness is rare?

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.

This student writer argued that, “if medical students are just expected to show signs of depression at some point during their education, there’s something wrong with the system.” And, while I echo that statement wholeheartedly, I would additionally argue that medical student or not, no one should ever be expected to show signs of depression for the sake of self-development or career training. No one deserves to fall through the cracks. And, when someone like Jay falls victim to mental illness, the situation deserves attention, not a taboo label. We all suffer varying degrees of mental stress from our paths in life, and it is time that we start to talk about it.

At my medical school, there has been a huge push from the student health and wellness department to break the stigma of mental health. All students are allowed three free consultations with a psychologist, and efforts are made to promote mindfulness meditation, a balanced lifestyle and other methods for stress relief. Even so, and even among medical students who should arguably be some of the most aware people on mental health issues, the pressures of academia trump balanced lifestyles, and the stigma of mental illness remains very real. Medical students remain afraid to use certain services for fear of negative repercussions. Who knows what could be written or seen by someone through the electronic medical record? What if a residency director somehow found out about a mental health diagnosis? True or not, horror stories are passed around of admissions committees flat out refusing to review residency applicants’ files after finding out about certain medical conditions. The potential repercussions are too risky to seek mental help. And yet, if even we as future health care workers — with all the evidence-based medicine and education to back us up — cannot confront the stigma associated with mental illness and demand the help we need, how can we ever expect our patients to do it?

A fellow classmate suggested that all students be mandated to attend at least one session with a psychiatrist simply to demystify the experience, as well as destigmatize the process for students who want to see a psychiatrist but fear judgment. In my opinion, this may not be a bad idea. I understand that not everyone wants or needs to talk about their struggles, but in an education system where we spend so many hours studying and agonizing over grades, a one-hour break to check in with a caring, nonjudgmental health care professional could do everyone some good.

Society is constantly reminded to eat healthily and exercise to take care of one’s body. In comparison, when was the last time you seriously talked to someone about improving their mental health? If social media and the movements on my campus are any indicator, the door to discussing mental health has been opened, but it is impossible to deny that further progress still needs to be made. We all need to be more self-aware of any unhealthiness we bear in our minds, to reexamine our thoughts and to be honest about our approaches to mental stress. Whether in a group setting or an internal dialogue, it is time to be courageous and widen the discussion — how are you truly doing today?

Kathleen Tzan Kathleen Tzan (2 Posts)

Contributing Writer

Sidney Kimmel Medical College

Kathleen is a third-year medical student at Sidney Kimmel Medical College in Philadelphia. She is strongly interested in holistic and alternative medicine with a focus on primary care and is planning on pursuing a career in Family Medicine.