Written by Michelle Bui
“And what is suicidal ideation if it is not the aspiration to kill off the unfulfilled aspects of oneself, the aspects that render one inescapably imperfect, mortal?” – Dr. Lynn Kitchen
Towards the end of 2016, The Journal of the American Medical Association (JAMA) published a study concluding that over a quarter of all medical students experience depression [4]. Around the same time, medical school graduate Nathaniel Morris published several articles in The Washington Post recounting his own experiences in medical school and struggles with depression. Currently a resident at Stanford, he is one of the lucky ones.
Suicide is the second leading cause of death among medical students and often results from their well-hidden but self-destructive depression [1]. Although the results of the study in JAMA came as a surprise to the public, making CNN headlines, its conclusions are nothing new. The opening quote for this article came from Dr. Lynn Kitchen, who published a paper in 1978 detailing the reasons behind depression among medical students and graduates. At the time, suicide was already the second leading cause of death among medical students. One of the main problems she points out is the obsession with being perfect. Even before students enter medical school, they envision themselves as mentally sharp and stable individuals, with an uncompromising determination towards their goals and unrelenting self-discipline that pushes for perfection.
This self-induced pressure is only multiplied in the medical school setting. Not only are students surrounded by intimidating professors and erudite individuals, which are enough to make anyone feel inadequate, but they are constantly swallowing an exorbitant amount of information, eventually struggling to choke it all down when confronted with their examinations. Even though a large proportion of students find this hard to handle, most remain silent about their suffering. It is as if a glass wall stands between them and the imperfect and troubled individuals they are becoming, and they would rather not admit to the cracks forming in it, threatening to shatter their well constructed and polished world.
This self-imposed stigmatization against imperfection, in tandem with societal views, makes talking about depression and suicide among medical students rare and difficult. Morris, before publishing his articles in The Washington Post, was afraid of what his peers and mentors would think of him for speaking out about his struggles.
But the results were both surprising and hopeful. Morris writes that he received “nothing but support from colleagues and mentors.” He also discovered other physicians who were writing about their experiences. Nearly forty years after Kitchen published her article on depression and suicide, people are finally acknowledging the difficult reality of becoming a caregiver.
But talking about an issue is not enough to solve it. Kitchen herself claimed depression and death should be “dealt with by physician role models at all levels of the medical school hierarchy on a day-to-day basis.” Recognizing this, many medical schools have adopted programs to teach students and faculty about living a balanced life and encourage pursuing passions outside of medicine [1]. Rather than training physicians, they have started to train healthy individuals who, along with giving care to others, can accept care for themselves.
“Medicine falters when its caregivers struggle in the shadows. No one should be afraid to speak up when they need help. If healthcare providers can’t overcome the stigma of mental illness, who will?” – Dr. Nathaniel Morris
References:
1. Grossman, Dana Cook. “Reducing the Stigma: Faculty Speak Out About Suicide Rates
Among Medical Students, Physicians.” Association of American Medical Colleges. 27
September 2016. Web. 27 January 2017.
2. Kitchen, Lynn. “Suicide Among Medical Students.” The Western Journal of Medicine. November 1978. Web. 27 January 2017.
3. Morris, Nathaniel. “Medical School Can be Brutal, and It’s Making Many of Us Suicidal.” The Washington Post, 9 October 2016. Web. 27 January 2017.
4. Rotenstein, Lisa S., Marco A. Ramos, Matthew Torre. “Prevalence of Depression and Suicidal
Ideation Among Medical Students.” The Journal of the American Medical Association, 6
December 2016. Web. 27 January 2017.