DIT Diary: Lifting the stigma of mental illness

Since the end of my residency 18 months ago I have attended four funerals. Each was for a woman who took her own life. Two of whom were my friends and colleagues in basic physician training.

In this sad context I have been reflecting on the discussion about junior doctors’ mental health. This discussion feels long overdue and has been prompted by shocking revelations about bullying, sexual harassment, lack of access to leave and a suicide rate in the medical community unacceptably above the national average.

When we talk about doctors’ mental health there is often a heavy focus on workplace stress and exam pressure. However, I fear that blaming ‘the system’ alone risks an oversimplification.

Losing four people has shown me that each individual battle with mental illness is different. Some are intensely private with their struggles. Some more open. Many find training intensely stressful and I would be one of them.

Nevertheless, training is only one part of a bigger life. Work pressure as cause of death is perhaps the simplest narrative and if we accept it in the absolute it absolves us of the need to enquire further and ask more complicated questions. It lets us position ourselves as victims of the system instead of individual agents inside it who influence its culture.

Factors that contribute to high rates of mental illness in the medical community are legion. We are high achievers with high standards. Professional exams and key performance indicators inherently invite comparison with our peers. We work long and difficult hours and are exposed to the suffering of our patients which can leave us feeling powerless and defeated. We need sane working hours so we can reliably see our loved ones (or even sleep). But, I think there is also great opportunity for change in our personal attitudes to mental health.

I fear many colleagues have kept quiet about coping with depression, reasonably worried about how it might be perceived. A beyondblue enquiry into mental health in the medical profession identified stigma as a major source of harm. We must also open ourselves to a more frank discussion about mental health and remember that depression, anxiety and other mental health issues do not automatically equate to impairment.

Our peers have made an intimidating multitude of achievements in the fields of medicine, sport, political activism, research and social justice. It saddens me that we can still treat the mental illness of our colleagues as shameful, when in fact these feats were achieved through the adversity. The fact that we can achieve so much despite our struggles is something to be celebrated, not hidden.

I have had quiet conservations about the stress of work and training with colleagues. They were quiet because we didn’t want to be seen as a weak link. I now see how foolish that was and want to go forward with honesty and openness about how dark this job can sometimes feel.

We need to help each other and we need to be kind to those going through personal and professional battles. I worry that searching for simple, one size fits all answers to these events will leave us as empty as we are now. For myself, I know no one can give me a simple answer that reconciles these events, there is no one thing to blame. There is only loss.

Ironically it was the ‘system’ that I think gave the best advice. As I tried to reassure our network director I would ‘get over it’ soon and come back to work, he gently corrected me: “You’ll never get over it, but it will get easier … take all the time you need.”