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AT the time of writing this article, I am a trainee in my final year of psychiatry training and hold a PhD in psychology. I am speaking out about my experiences both as a loved one of someone with a mental illness and as someone who has experienced mental ill health, because my experience has shown me that these make us better doctors and better psychiatrists, in particular.
The content of my reflection is very personal and might be triggering for some readers. Stigma around mental health difficulties is rife in medicine, and I wish to set an example by speaking out to challenge this.
In 2019, Beyond Blue conducted a survey of doctors and medical students and found that 40% of doctors surveyed “felt that medical professionals with a history of mental health disorders were perceived as less competent than their peers, and 48% felt that these doctors were less likely to be appointed compared to doctors without a history of mental health problems.”
They also found that 59% of doctors felt that being a doctor who is a patient is embarrassing.
I argue that embarrassment is solely due to the “us–them” mentality that we have and the stigma that we continue to impose on mental health issues (as well as many medical conditions and disabilities more generally). When considering that 21% of all doctors surveyed had been diagnosed or treated for depression and nearly 25% of all doctors surveyed had had suicidal ideation in the past 12 months, stigma around mental health issues in the medical community is highly concerning.
In December 2021, I began experiencing a major depressive episode. I had someone very close to me starting to go through a major mental illness. That, along with stressors such as difficulties with Royal Australian and New Zealand College of Psychiatrists exam administration and moving to another town to complete my advanced training, led me to an existential crisis and a suicide plan.
I found an uncomfortable and ineffable peace in that plan and cried, not because I was sad about my circumstances, but because I felt suicide was necessary after having failed in life. The realisation that family members would be distraught and would suffer other negative consequences in the event of my death is why that plan was abandoned.
While I was functioning very well at work and found work to be enjoyable and protective, I more broadly lacked motivation, lost interest in hobbies, became apathetic, could not eat enough, was agitated, had difficulty sleeping, started smoking, and frequently had suicidal ideation.
I became angry that I had protective factors, because I did not want to go on. Secret suicidal ideation is dangerous, but I feared judgment and problems at work, as well as within the psychiatric and medical communities more widely. Even now writing this, I fear retribution by going public.
What is even more dangerous than keeping these things hidden away are the fear of mandatory reporting of practitioners to the Australian Health Practitioner Regulation Agency (AHPRA), and the fact that doctors know enough about the body, injuries and medications to complete suicide with lethal means. Medical students and junior doctors are at particularly high risk, with between 17.1% and 20.5% of medical students having had suicidal ideation in the previous 12 months (figure 13, page 86).
In March 2020, AHPRA changed its mandatory reporting requirements from “risk of harm” to “substantial risk of harm” to the public, in an effort to support practitioners in seeking health care (here and here). This was only following a spate of doctor suicides over the previous several years accompanied by years of lobbying (here and here). The likelihood of mandatory reporting is very low and only for when a practitioner is impaired in their work, not simply because they are experiencing a condition or could be a danger to themselves outside of work.
I did not know where to turn to get truly confidential help and was not comfortable calling a number that could be anyone on the other end of the line. As valuable as the doctors’ health lines are, this was not for me.
I did not seek help until February 2022, because of stigma, until I felt the burning need to tell a psychiatrist friend I trusted. That person validated my despair and provided companionship even when hope was not easy.
Soon after disclosing to my friend, I began trying to find a psychiatrist for medication and psychotherapy. I had always been hesitant about whether I would take psychotropic medications myself, but I recognised a major depressive episode in myself and that it was severe enough to need medication.
After a difficult week trying to find someone appropriate and facing waitlists for others who might be a good fit, I got lucky. My mentor connected me with someone who could see me soon, but so many people have to wait months to see a psychiatrist — and then months more if they are not a good fit.
Although I have had some ups and downs along the way, I have been able to access appropriate services and am recovering. Throughout my illness and recovery, I have continued to be, I believe, an excellent doctor and receive positive feedback from my peers, supervisors and patients. My service has been incredibly supportive as well, which has relieved many of my fears and given me the courage to speak openly.
I feel that my experiences have made me a more humble, compassionate and empathetic doctor than I was even last year. For example, I used to feel that hopelessness was very difficult to manage. I have experienced the hopelessness that some of my patients experience. I now understand not only more about what they are feeling but can adjust my approach to be more helpful to them, and maybe instill some hope because I have felt hope from clinicians.
Self-disclosure can also be healing for and increase our connections with our patients. One of the most helpful things for me when I was feeling unsafe and considering inpatient admission was a clinician who told me they had had a major depressive episode 25 years ago and that there was light at the end of the tunnel.
I have talked with other registrars and consultants who have experienced mental health difficulties, particularly trainees experiencing depression and anxiety around the recent problems with administering fellowship exams. They think I am brave for sharing my experiences. I should not have to be brave to talk about these issues.
Stigma hurts us all. Life experience makes us who we are, both personally and professionally, and life experience makes us better at what we do.
Dr Israel Berger is a Child and Adolescent Psychiatry Advanced Trainee at Goulburn Valley Health and is involved in medical and public health education at the University of Sydney and Monash University.
If this article has raised issues for you please reach out to any of the following resources:
DRS4DRS: 1300 374 377
- NSW and ACT … 02 9437 6552
- Victoria … 03 9280 8712
- Tasmania … 1800 991 997
- Queensland … 07 3833 4352
- WA … 08 9321 3098
- SA and NT … 08 8366 0250
Medical benevolence funds
- NSW … https://www.mbansw.org.au/
- Queensland … https://mbaq.org.au/
- Victoria … https://www.vmba.org.au/
- South Australia … http://doctorshealthsa.com.au/resources/medical-benevolent-association-of-sa
AMA Peer Support Line … 1300 853 338 or 1800 991 997
Hand-n-Hand Peer Support … www.handnhand.org.au
If you or someone you know is having suicidal thoughts, there are people here to help. Please seek out help from one of the below contacts:
- Lifeline| 13 11 14 | 24-hour Australian crisis counselling service
- Suicide Call Back Service| 1300 659 467 | 24-hour Australian counselling service
- beyondblue| 1300 22 4636 | 24-hour phone support and online chat service and links to resources and apps
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
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I thought it wonderful of you to be so honest and open about your mental health.
I agree ..having gone through the experience one is far more equipped to understand and help others .
Unfortunately , having had dreadful experience with Psychiatrists ..
I don’t put my trust in the therapy offered.
Honest and authentic feedback and I respect your courage. Your lived experience deepens your compassion with others. The challenge comes in if a vexatious client puts a complaint in about you, and your own honesty and integrity is used against you in an investigation.
Thank you Israel for sharing your story. I am a peer worker in community mental health with a lived experience of PTSD, anxiety and depression and find consumers and colleagues connect on a deeper level with self disclosure of mental health challenges. We are a living example of hope for others and sharing our stories helps to shift the stigma surrounding mental illness. Keep on shining the beacon of hope.
Thank you so much for this article. I have worked in the trauma counselling industry for 40 years.
Working in sexual assault thirty years ago we were very aware of Trauma Exposure response : the effects of working with other peoples trauma and the importance of self care. As time has gone by I have observed less emphasis on worker care. It is spoken about but not really implemented. Working with other people’s trauma is now scientifically explained in Polyvagal Theory A lot of work has been done to apply that knowledge to help people attend to their nervous system.
All of us in the caring professions must be mindful of attending to not only our nervous systems but our spiritual wellbeing. I have found the work of Matt Licata helpful.
In my work as Bodymindspirit Connection I have facilitated workshops (when Helping You is Hurting Me) in workplaces and worked with individuals whose work has triggered their own trauma issues.
The statistics you quote do not surprise me. We are human beings with compassion and empathy. Compassion and empathy, the very thing our patients/client need, put us at great risk. We need to.be taught how to manage that risk by understanding the social engagement system.
See Stephen Porges and Deb Dana The Clinical Applications of Polyvagal Theory. The article by Bonnie Badenoch very helpful.
It seems to.me a lot needs to be done to help oractitiinsers understand their own humanity and how their work impacts on them. Thank you for contributing to the change in attitudes and awareness of the impact another persons ill heath can have on us, let alone working in systems that don’t value and provide for worker care. The need for change in these systems is urgent. We have already lost too many talented lives.
Thank you again. This is such an important issue.
Add to that the impact of the pandemic where normal social interactions and touch have been curtailed. And the extra stress on general practitioners. We must all continue to reflect on and monitor our metal and spiritual health and recognise how our work impacts bon us.
I pray with all my heart that there will be change within the medical system to value practitioner well being.
Thank you everyone for your positive feedback. I have heard from a lot of people privately, and I am glad this article has been able to help people either to not feel alone or to seek help themselves. Well done everyone out there.
Thank you Israel Berger for this vulnerable and courageous article. I agree with you. You should not have to be brave to share your lived experience. Yet we have much work to do. Only when we start to shift and see mental health is our health (like dental care is our health) and normalise it, maybe then more people, including medical and health professionals will be able to have the conversation about their black dog and the heavy blanket depression is. You will connect, relate and have the insight into your patients in a way that only having ‘lived experience’ allows. So good to hear your colleagues and organisation have been there for you.
Two observations: In “Games People Play”, Eric Berne wrote about Psychiatry as a life game, where, once you are in the game you can change roles, but never leave. Secondly, I’ve long thought that child psychiatry was simply parent psychiatry in disguise, not to mention pet psychiatry being owner psychiatry in disguise.
There are several other ego games that all too many doctors play with their supposed colleagues. It can be exhausting just trying to cope if you don’t want to “play the game”. I’m glad to be retired, after way too many slings and arrows of outrageous fortune.
Would anyone care to discuss this?
Bravo and thank you Israel, for your courage in being open and and honest about your experiences, confronting the stigma and shame that many others have felt silently, during their own suffering. Hopefully this will encourage those suffering in silence to seek help too. So good that you were able to reach out to a helpful colleague – mentor/friend -who helped you access appropriate care, and that you are recovering.
The RANZCP’s examination malfunctions and Covid have made training much more challenging than usual, especially for advanced CAP trainees. I have been mentoring (informally) three of our local CAP trainees which I find a rewarding process in my late career years.
You will be a very good C&A psychiatrist I am sure.
Well done Israel. It sounds like you’ve got what it takes to make a great psychiatrist – insight, authenticity, reflection & compassion. Wishing you all the very best.
Thank you for shining light on this topic Israel. I have been privileged work with you if only briefly, and your disclosure only increases my respect for you. I would love to have a conversation with you at some point about the differences between psychiatry and psychology models. The medical system does seem to place an extraordinary amount of pressure on doctors. I am glad you found the right help and agree that it shouldn’t be so difficult to do so.
Fantastic Article
this needs to be talked about more.
A brave article
Thank you
Thank you so much for sharing your experience – it is all too common but as you say, far too rarely discussed. Bravo. We are all better doctors for having been patients ourselves.
Israel thankyou for your article.
As you have stated suicidal thoughts and despair are very common in all branches of medicine.
There is always help available but some doctors talk themselves out of going for help.
Its a humbling experience but always useful to be a patient!?
Well done Israel.
Certainly being a patient makes you a better doctor.
Great article Israel. It’s very eye opening for all healthcare workers and also encouraging them to seek help when in crisis. This article will help them to understand the pressure medical personnel feel all time during their lifespan ( not only during training but also after training during their practice years). Well done.
Thank you for your insight Israel. Long may you continue to instil hope in the lives of your patients, colleagues and loved ones, as it was for you.
Good for you Israel Berger. Your success in conquering the illness, and in confronting the stigma is commendable.
Yours: Stigma around mental health difficulties is rife in medicine…
The reality: Teaching there is a stigma around mental health difficulties is rife in medicine…
Indeed it is.
Harold A Maio