I had the pleasure of sitting down with John Tamerin, M.D., and Mike Myers, M.D. to discuss the psychiatric needs of mental health clinicians. Dr. Tamerin has a private practice in Greenwich, Connecticut and is Clinical Associate Professor at Weill Cornell College of Medicine in New York City. He has been running a support group for those living with (and affected by) mental health conditions for over twenty years. Dr. Myers is a national expert on physician health, has authored 8 books and is Professor of Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry and Behavioral Sciences at SUNY Downstate in Brooklyn, New York.
Dr. Myers moderates the session and introduces the discussion by saying
“The sad irony is that many (physicians) do not receive the care that they so sefflessly give to others and that they need and deserve for themselves.”
When I finally admitted to myself that I had bipolar disorder and was clinically stable, I made the decision to disclose my diagnosis. I did so in a very public way at the International Conference of Bipolar Disorders. After I approached the podium, the first words I said were: “I am a psychiatrist and I am also a psychiatric patient. I have bipolar disorder.” It is uncommon for a physician to disclose their mental health diagnosis.
The reaction of my patients
When I did disclose, I was still practicing. My greatest concern in doing so was not the reactions of family and colleagues. I was worried about what might happen if my patients were to become aware of my diagnosis. I hoped that I hid my symptoms from patients over the years, but can I be sure this was the case? I believed that for some patients, knowing my diagnosis wouldn’t matter at all. Others might see me as empathic since I was living with a psychiatric disorder. But I had to conclude that my care of some patients would be impacted in a detrimental way. I was sure that some patients would be angry that I had withheld this information and would terminate their care with me. This was a sobering realization since I took the Hippocratic oath as a physician to “First, do no harm”.
Why I disclosed
I was unmedicated for most of the years that I practiced, so there might be those who believe that I should have taken medical leave each time I cycled up or down. Or, perhaps there are those who believe that I should have left the profession entirely. But given the prevalence of mental health conditions within the physician community, I don’t think the best course is to exorcise all of us who have been unwell. I recognize that other clinicians might have made a different choice than the one I did. Despite my certainty that I would negatively impact the treatment of some patients, I made the decision to disclose my diagnosis for two reasons. First, it was an act of self-healing. Perhaps selfish on my part. Second, I thought there might a greater good for my fellow clinicians in the medical community to foster a conversation about physician health. If I had to do it over again, I would make the same choice.
Reasonable people may have different views about whether clinicians who have psychiatric disorders should practice. This is fair to question. I would suggest that these are exactly the kinds of conversations we should be having. We need people of good will to come together and speak about these important issues. Then we can find common ground in our efforts to balance caring for our colleagues in need and, at the same time, placing a premium on delivering excellent care to our patients.
What do you think about my decision to publicly disclose my diagnosis?
I grew up watching Superman. Impressive man…leaping tall buildings and all that. Just the kinda thing a young kid wants to do. Fast forward. During my psychiatry residency, I was having periods of clinical depression. It was weird to awaken in the morning with endless loops of suicidal ideation in my head and then that afternoon, hospitalize patients with the very same symptoms. But, I told no one.
Stigma about professional consequences
Too many physicians living with psychiatric disorders shun treatment. They pay a terribly high price in morbidity and mortality. The rate of physician suicide is way high. We can understand how doctors avoid care given all the worries about professional consequences. Stigma against doctors is quite prevalent. Examples of professional consequences include collegial disapproval and concerns about the potential impact on medical licensure. These are the reasons that doctors eschew treatment, and these fears are real. Engaging in care and public disclosure are fraught with stigma. This stigma arises in a status quo of secrecy and silence deeply ingrained in the medical community.
Our culture lauds physicians who are uber-competent and stoic. However, we expect practitioners to soldier on despite the unacceptably heavy burden they carry. Similarly, we like our doctors to stop speeding bullets. But the intense pressures to perform can have the unintended effect of battering the psyche. So, it can feel like kryptonite is all around us, every day. Because of this, many suffer in silence. “Physician, heal thyself” becomes advice unattainable. So, care givers have difficulty training our healing focus on ourselves and on our colleagues in need.
My antidote: humanity
Currently, doctors can disrupt this stasis of demoralizing shame and challenge the destructive, avoidant status quo. After many years of trying hard to be Superman, I have finally arrived at a place of acceptance and well being. I found a way to navigate a pathway from being a care giver to becoming a care receiver. I did this by recognizing and integrating a healthier and humane inner story line.
My humanity became the essential vehicle for my recovery. So, mine is a story of success and provides a template for other doctors. It’s also a template for anyone who remains locked in the grips of untreated psychiatric disorders. I created a pathway to wellness and leaping tall buildings and to stopping speeding bullets What exactly the opposite of what I needed to do.
Do you have a Superman story? Let me know
If you are a doctor and would be interested in knowing what i would say to you, please click here