"Physician, Heal Thyself."

I was sitting with my new psychiatrist, driven by desperation after yet another medication failure and the intrusive thoughts that disturbed me.  My daily goal for the last few years were to: 1. Do my job,  and 2. Keep it together.  But it was getting more and more difficult to function. This was a psychiatrist that I had traveled four hours to see – making this appointment a literal “mental health day.”   One of the first things she said to me was, “You’re so lucky to be in the medical field, it’s so easy for you to get help!”

Uh, no.

I had to block off a whole day of appointments. When my colleague/supervisor/primary care provider asked me what my appointment was for, I just flatly said, “psych.” I couldn’t lie because – being in the military – we have an electronic medical record system that allows all  physicians, physician assistants, and nurse practitioners to see each other’s records.

I am a military medical provider, which complicates dealing with Major Depressive Disorder. There are some stigmas that I have to get over. Officer.  Female.  Medical  provider. Combat arms. No one wants to think that their depressed doc will “freak out” as they treat a shotgun wound or a mass casualty in a war zone, (I actually have an unusual ability to stay calm in extremely stressful situations).

I tried doing the casual request to my colleague of, “Hey, can you put me in for a refill?” He would go on to talk about “burnout” and would recall jokingly that during his residency that, “Yeah, I wondered what would happen if I just ran into this tree…” Then everything became about “burnout.”

 “Are you okay? Are you burned out?”  

It’s not burnout, I know the difference. I haven’t always been like this. Even when I was going through my medical training, other than the usual anxiety and bruised self-esteem, I never had to deal with this parasitic brain mold and the gradual corrosion of my mind. A brain that has been the source of intelligence, humor, and creativity was now my worst enemy as it was seeking to destroy me from the inside out.

It’s not just one colleague.  Mental health stigma and misconceptions exist among medical providers. I opened up to a couple of other colleagues why I could not pass a flight physical – my antidepressant  waiver was denied. They jokingly talked about their stress coping mechanisms -  usually a beer or two at the end of the day or an occasional tirade of profanity to “let it all out.”

A prior psychiatrist suggested that I added counseling to my treatment. This would lead to more records at risk of being seen by colleagues, so I pay out of pocket for online therapy .  Online therapy is actually a really good fit for me and my schedule.

Then there are those forms for licensing renewal   and credentialing that ask the question, “Have you been under the care of a physician for a mental illness?” Again, my records are open to the physicians of the credentialing staff of the hospital. You could imagine my anxiety when it seemed like my credentialing paperwork was taking longer than usual to process.

Medical providers are still human. We are some of the most resilient people on Earth but we are not invincible. “Physician, heal thyself,” can only go so  far.  We need understanding and compassion not only from our patients and families, but our colleagues and supervisors as well.

Clincal Depression: It's Not About Resiliency

     One of the things that irritates me about the stigma of clinical depression - that makes it even harder to seek help and open up to others - is when people misinterpret depression as a lack of resiliency or coping skills. It often gets confused with adjustment disorder and situational depression. I have seen this a lot.

     A couple years ago I submitted a waiver for an Army flight physical due to being on an antidepressant. I had to  pass this physical in order to qualify for some positions I was applying for  that could propel my career forward and likely guarantee me promotion.  It was rejected, though likely not even looked at as a couple people told me. The stinging comment at the end of the waiver denial statement was that I could apply again, "when the condition clears up."

     I have seen this stigma perpetuated amongst my colleagues, even when they are in the medical field. Some people in response shared their "coping mechanisms" of having a beer at the end of the day, or just being brutally honest, 'instead of keeping my feelings down inside' like my colleague said last week when I mentioned my waiver rejection.

     During my time in the military I have sat through dozens of hours of mandatory resiliency training - both in-person with large groups and  mandatory on-line training. One time it was directed towards medical providers, and the only thing my stressed out colleagues and I could think about was all of the work that we felt burdened with and the charting that we had to get back to. The focus on resiliency, while helpful to some, can be dangerous to those who suffer deep chemical imbalance, and this is why: It puts the focus on healing based on what someone is presumed to lack, and not what they truly need. This stigmatizes depression even more as a weakness, a sign of emotional immaturity, and a  character flaw.

     I consider myself a pretty resilient person. I had a challenging undergraduate degree and  I endured difficult medical training. I have treated victims of homicide and patients of failed attempted suicides.  I have deployed to Afghanistan in a volatile area. I have lived in another country that had at the time been recently affected by economic and political disaster, and I struggled to learn its language. I substitute taught high school. I have had a couple experiences where I could have nearly died. Someone once tried to rob me at gunpoint. My hands have been inside a person's chest more than once - desperately trying all attempts to save them from the inevitable.  I have traveled on my own to six different countries where English is not the primary language. I have ran multiple marathons and half-marathons. I have been to many funerals of friends and family who ranged from young children to young adults to the frail elderly.

I think I am a pretty resilient person;  but resiliency out of my own efforts could only do so much. The feeling of my brain decomposing  and the gravity of a  downward spiral cannot be changed with 'happy thoughts.' I believe in exercise, but it's difficult when it takes 15 minutes just to put on my shoes - if I even do get out of the house. Intrusive thoughts cannot always be calmed with a gratitude journal. Watching a comedy does not always bring back a laugh that has been silent for several months.

     There is a need of resiliency for  everyone, but  for those who struggle with clinical mental illness, sometimes it's just a Band-Aid on an amputated limb.

Leaving Gethsemane

       I reached the point during my last depression crash where I was desperate for some relief. My medication had not really been working for me anymore and I was already on the maximum dose. I was disturbed by some of the intrusive thoughts I was experiencing. I pushed myself - more like dragged- to open up about this with my psychologist colleague, asking for psychiatry consult. It was a  drag to the cliff and then a jump into the unknown. What I said was said. A new path of uncertainty, but possible hope, had just opened up.

     Just before my appointment I said to myself, "I'm ready to leave this Gethsemane."

     Gethsemane, referring to the Garden of Gethsemane, is the place where Jesus Christ prayed, taking upon him all of the sins and pains of the world. He too, asked for "the bitter cup" to be removed if possible.  Gethsemane has been a symbol of grief, suffering, and darkness in many Christian writings.  There's a hymn called, "Where Can I Turn for Peace?" by Emma Lou Thayne and there's a lyric that goes:

     "He answers privately. 
      Reaches my reaching
      In my Gethsemane, Savior and Friend."

I was ready to leave this dark, heavy place.

    One of the actual positive things to come out of depression is that I gained a better understanding of Christ's sacrifice. There is a scripture in the Book of Mormon that says,

"And He shall go forth, suffering pains and afflictions and temptations of every kind; and this that the word might be fulfilled which saith He will take upon him the pains and sicknesses of His people...and he will take upon Him their infirmities, that his bowels may be filled with mercy, according to the flesh, that he may know according to the flesh how to succor His people according to their infirmities." (Alma 7:11-12)

     Jesus Christ had to come to Earth, in a body capable of feeling pain, hunger, and fatigue, to be able to experience every possible feeling that had been felt and will be felt. I don't know how he did this,  especially in the culminating act of the night prior to His crucifixion. However, I did learn something about this.

     I, in my own way and through the past several years that I have struggled with depression, was able in an extremely small way to develop  a  more empathetic heart to the struggles of others. While I know that the choices of others may not be in alignment with human laws or divine commandments, I learned how Christ, in his infinite love, can feel what someone is going through, and love that person as the child of God that they are.

      I knew what it felt like to be frustrated with anhedonia (inability to feel emotion). I had this force field that would not allow any positive emotions to penetrate me. I missed laughing. I just wanted to feel something. One morning I  came to the realization that I could understand why some people addicted to drugs seek them out prior to it becoming a physical addiction. I remember thinking to myself, "Man, if only I could legally get high without ruining my career." Some people seek that physical high to be able to feel something they deem as positive, and sometimes they seek the refuge of drugs or alcohol to find calmness or to dull their pain.  I remember feeling such sympathy upon hearing about the suicide of Robin Williams, the struggle that he had with his mental health as he fought the devastating onset of dementia. I could relate to the feeling of losing one's mind - how scary that it is - and observe its progressive nature without a feeling of hope for recovery. I could find some similarity between myself and a woman who struggles with depression and makes poor decisions in regards to intimacy and morality.  They find someone who finds pleasure in their existence - in their body - when they themselves  struggle with finding pleasure in their own existence. Humility, empathy,  and love is what I learned. Seeing someone a little better through God's perspective - loving the child and not seeing them just for the choices they make. It's a hard price to learn such a lesson, but I find it as something positive  as a product of adversity.

     It was a short stroll through Gethsemane for me, but I know I will return again and again. It's the nature of chronic illness. I will return multiple times and sometimes I will be with someone as they walk through their own Gethsemane. Hopefully they will not have to walk that garden path alone.