Psychiatrists

I remember when I had my very first appointment with a psychiatrist. The whole process of meeting this man was surreal. Afterall, I had been told that I was “unwell”, but no one had told me that I had an actual mental illness.  My local Physician’s Health Program had actually asked me if I wanted to see a psychiatrist, and I did not know how to answer this question. A flurry of thoughts swirled around in my brain…would I get my job back if I didn’t see this man? Could I have a mental illness when I had been feeling the same way, albeit struggling, for such a long, long time? Was being told I was “unwell” the same as being burned out? Was that the same has having a mental illness? So much had transpired in my life over the last six years, both personally and professionally, so how on earth would one appointment with one physician really be able to help me? I felt that so much was weighing on this appointment. I was used to people not believing my story, so I had misgivings that this doctor would be any different. 

But, being in a state of apprehension about any kind of authority I said yes, I’d do the appointment. The sense of shame and failure was overwhelming leading up to it. I had to travel to a big city for it, and the journey there felt ominous, requiring a short plane ride followed by a city bus. I remember getting off the bus a little too early, and having to walk a couple of blocks to get to the nondescript looking building where the interview would be taking place. I was nervous, but that didn’t stop me from inhaling a quick coffee and part of a muffin in the lobby before heading up the elevator to what felt like my future.

As soon as I arrived, I was given a clipboard of papers to fill out: consent forms and psychiatric screening tests for depression, PTSD etc. I felt naked in a room of strangers.  I was so used to keeping my cards close to me and now all of a sudden, I was required to reveal all of them at once. If I recall correctly, the questions were measured from the perspective of the last two weeks of my life, and I distinctly recall thinking, “just two weeks?” Obviously, the questionnaires were screening tests, but in my state of mind I wondered if I had failed them.

The doctor was an older middle-aged man. He asked me my story, and to the best of my ability, I told it to him, all the while thinking that I must not miss any important detail, that I must be transparent and sell myself to him in some fashion. I never once thought I might be suffering from depression so it didn’t occur to me to even say those words to him, and to ask for help. I didn’t know if he was my ally or not. I knew I was afraid of some form of repercussions from my regulatory body, and I thought that whatever he reported on my might influence that. 

I do recall three things I heard from this man. Firstly, that I needed to exercise a minimum of 45 minutes every day.  He didn’t say why, just that I needed to do it. Secondly, as I was almost done, he wrote the word “mindfulness” on a yellow sticky pad, with the name of a US based online course on Mindfulness Based Stress Reduction I could take, and handed it to me. “You should try mindfulness” he said; I said ok, that I had heard of it and would be willing to try it. He recommended that I follow up with two physicians, one who was a life coach and would be able to assist me with organizational skills, which would reduce stress in the office. The other could help me with mindfulness. Thirdly, he never gave me a diagnosis. Maybe he couldn’t. Later, when I read his report it said that he thought I had a possible diagnosis of adjustment disorder with anxiety and depressive features.  Also, my story, “if …objectively true, would be an incredibly challenging situation to deal with”. If true. It sounded like he didn’t believe me. He did suggest that I apply for disability. But for what? What on earth was the matter with me? Was I just supposed to take time off “to get grounded” as he suggested in his report?

I felt like I was back at square one. I was apparently unwell, but did not have a clear diagnosis. I had no clear plan going forward, other than exercise and mindfulness. When I did read his report, I saw that there was a suggestion that I could be started on medication; he had never suggested this to me. He wanted to see me in follow up in a month, but no such plan was ever made. I floundered in the same state of mind for over a year; I attended two workshops in mindfulness in medicine for physicians, finding both of them extremely beneficial. But I didn’t feel any better or any worse. What did feel good was meeting other physicians who were burned out and broken for various reasons. Finally, I asked Physician’s Health if they had made that follow up appointment for me, and they had not, moreover, this doctor had switched jobs and was no longer available for follow up. My heart sunk. I would have to reinvent the wheel with another doctor. And indeed, that’s what happened.  I travelled several hours to see the new physician for what felt like talk therapy, where I would decompress emotionally. After some time of this, I asked her if I was clinically depressed. She was a good listener, but it was unclear to me what progress was being made with these visits. She said yes, she thought I was depressed. Then I asked her what the role of medications was, and if she thought I should consider them. 

This was the first time any professional had said to my face that they thought I was suffering from depression. And now, I was starting on medication, at my suggestion. I was frustrated, yet a bit hopeful too, that something would finally change. I had started mindfulness and meditation, I was running several times a week (and even participated in my first 10km race), but I felt exactly the same.  What I didn’t understand was that I was not only depressed, but that I had experienced trauma and that this needed to be unpacked by someone who was experienced in doing that. Fast forward to my third psychiatrist, a woman I moved to after my second one closed her practice. I have been with her for almost three years, and because of her I am on a path to wellness.  Finally. 

So, what have I learned? Simply put, medicine is not good at taking care of its own. I knew that from medical school. You had to be tough and have thick skin to adjust to a high stakes and demanding learning environment that could range from kind to humiliating. You had to be able to learn while completely exhausted from being up all night and hungry from missing countless meals. And you had to learn how to navigate with compassion the suffering experienced by your patients, without being absorbed by it. I had survived years of this kind of environment, and thrived. I was good at what I did. But after going through several traumatic events related to my workplace, I found my morale was decimated, and my usual attention to detail suffered. The system had failed me, and at my lowest, told me to my face to just put my head down and work hard, do my job and not make any mistakes. Yup, this is exactly what I was told. No wonder I lived in constant fear of any repercussions while feeling overwhelmed and struggling to keep on top of everything. 

Was I depressed? Yes. How did I not know this? Well, I liken it to the frog in the pot of water scenario. If you slowly heat up the water, the frog doesn’t notice the difference until it is too late. I was surrounded by so much distress and was expected to function in it, and in many ways I did. But I was slowly drowning. I didn’t know what was normal anymore, and what feeling good felt like. The other reason I didn’t know this is that “being unwell” from a mental perspective still carries untold stigma in the medical community. To seek help is to admit weakness. To admit failure. To maybe be told that you are not capable of practicing medicine anymore, which would be catastrophic and deleterious. For some, it might even be a tipping point that would send them over the edge to suicide, for a future without medicine, when you have devoted your whole life to it, is unimaginable. 

I have also learned that I am not alone.