Breaking the Stigma

“She’s just OCD.”

“He is anal.”

“She has been so depressed lately.”

“He just isn’t himself.”

“She is so skinny! I wish I could be like her.”

“How does he eat that much and not gain any weight?!”

You may be wondering why these statements are important. Let me tell you…These are NOT harmless statements. She has OCD; she is not OCD. He has OCD; he is not anal. S/He is, in fact, probably depressed, which means it is serious. She could potentially be battling anorexia nervosa. He could have a problem with bulimia nervosa.

These things exist. They are not the punch lines of jokes. They are not isolated to just one community. Men and women can be affected by an eating disorder. Caucasian, African American, Asian, Latino, etc can be affected by depression or bipolar disorder or OCD. Mental health disorders do not discriminate.

There is a stigma associated with mental health issues, which prevents people from seeking adequate care. This include medical students and practicing physicians. This includes me.

I have dealt with OCD as well as other mental health issues for the last decade. Maybe that is why I started this piece with “she’s just OCD.” I have been told to “get over it” or “move on already” more times than I can count. My clothes are organized by color, number of colors on the shirt, and length of sleeve. My socks are organized by length and colors. My movies are alphabetized as well as my books. One may say that I am just a neat freak, but that is not the case. The anxiety associated with these things being out of place is often unbearable, but the worst example of a ritual is my front door. The process of locking my door does not take less than 5 minutes, and if I am really stressed (Yo, test week- I’m talking about you) it can take upwards of 10 minutes to leave my apartment. Everything must be done in multiples of four, and if I break from the cycle I must start again. I have tried to fight the compulsion before. I have gotten in the car with my mom to go somewhere and I could not stop thinking about the fact that I did not check the handle the usual amount. Twenty miles down the road, my mom turned around just so I could check the handle. The peace that comes from completing the compulsion is amazing but short lived. There is always another compulsion… There is always another thing to obsess over…

My form of OCD is one of the milder ones, but I have friends with depression and anxiety that hinders their everyday life. Not only are they worried about how others will view them but they are also concerned with the cost of their medication and what happens when there is a mix up at the pharmacy. They are worried about how their mental health will affect their futures as doctors or lawyers or pharmacists or whatever career they are pursuing. The anxiety and negative thoughts associated with such illnesses can be too much for some people.

breaking-down-the-shame-of-male-depression-rm-722x406

The American Foundation for Suicide Prevention states there are, on average, 121 suicides per day in the United States. Roughly 1 death of those 121 is a practicing physician, and that does not account for the number of medical students. Roughly 10% of medical students experience suicidal ideation. That means out of my class of 230 here at UTMB, 23 students will contemplate ending their life. This is scary. This is a problem.

But remember depression and anxiety are not the only forms of mental health illness. Eating disorders are a prominent problem as well. Experts state that those in the medical field suffer from eating disorders at roughly the same rate as the general population, which means:

1% of females suffer from anorexia.

4% of females suffer from bulimia.

1% of females suffer from binge-eating.

2% of males suffer from bulimia.

Note: keep in mind there are subtypes of eating disorders and other behaviors such as excessive working out that are also associated with an eating disorder.

These numbers seem so low; why are they important? When you account for the population size of the United States, you come up with approximately 10 million women and 3 million men ACTIVELY battling an eating disorder. Ultimately, about 20 million women and 10 million men suffer from an eating disorder at some point in their life.

no-body-is-perfect

SO, WHAT?!

So I have provided a lot of statistics and related them to medical school or health care providers. The reality is the medical profession is hard. It is exhausting and demanding and frustrating. There is stress and lack of sleep and copious amounts of information. We are pushed to every limit, and we are still expected to be pleasant and professional and make well-informed decisions.

So what do we do about it?  Fortunately, the medical community is addressing the problem or at least starting to. Mental health is talked about. Mental health is being de-stigmatized. Medical schools are providing counseling and resources and encouragement. Physicians are providing support for struggling colleagues. Practicing physicians and educators are mentoring medical students and are talking about these issues.

I have been blessed with many discussions with mentors, peers, and physicians concerning depression, suicide, and mental health in general since beginning school here at UTMB. One of the lectures in the Practice of Medicine course every student takes is centered around mental health in medical school, which tragically, involved the story of a student who committed suicide while in attendance here. That lecture and the readings associated with that week’s coursework reminded me how blessed I am to have an amazing support system amongst my family and, surprisingly more importantly, my friends here at UTMB. Your family could be like mine: supportive, encouraging, present. However, they often do not understand what you are really going through. That is why your medical school friends are going to be so important. They are there with you through the ups and downs of your training. Bomb a test? They are there to pick you up and keep you going. Help deliver a baby? They are excited for you (and maybe a little jealous). Plus, you get to return the favor; you are there for them.

We all have our own obstacles. We have had our own challenges. They shape us into the people and, ultimately, the physicians we will become. We should not be ashamed of our challenges or issues. We are human. We get stressed out. We cry. We laugh in the face of exhaustion (or at least I do…).

Medical school is tough. Life is tough.

The important thing to remember is that there are options available. There are friends to talk with you. There is counseling to assist you. There is rehab to guide you. There are medications to help you.

THERE IS HELP. I am proof of that. Remember how I said I faced other battles besides OCD? Without going into too much detail, I would not be where I am today if it were not for those around me; my family and friends were the ones who identified I had a problem when I was in denial. I have a history of mental health issues, which I disclosed in my personal statement to medical school. I went on to discuss how my challenges changed me. My battles have shaped me into a better person. I am now more encouraging to my fellow beings. I am more observative of those around me. I now know the risk factors and indicators associated with depression and eating disorders and other issues, which allows me to help others the way so many others helped me.

Whether you have experienced mental health issues yourself or not, you know someone who has. Be mindful of what you say. Be aware of what you do. If you have experienced mental health issues, be not afraid.  You are not alone. Obviously, you do not have to disclose your issues on such a public forum as I have, but confide in someone. A supportive community is vital for your health, both physical and mental. We are all flawed. Every doctor is flawed. With adequate care by means of exercise or counseling or other hobbies and possible treatment, we can survive such a vigorous profession.

Here is to breaking the stigma and talking about issues that have been swept under the rug for far too long.

-Alyssa

shaff

P.S. I am providing a list of resources I used to write this piece.

https://www.amsa.org/staying-sane-addressing-the-growing-concern-of-mental-health-in-medical-students/

http://jamanetwork.com/journals/jama/fullarticle/2589328

https://afsp.org/about-suicide/suicide-statistics/

http://www.cnn.com/2016/12/06/health/med-students-depression-suicide/

http://journalofethics.ama-assn.org/2012/09/ecas3-1209.html

http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
Google for this images on Depression, Eating Disorders, and Mental Health in general.

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