Discussing Personal and Family Mental Illness in Personal Statement and During Interviews

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Should it be done? The thread most closely addressing this is from 2009 so I'm interested to see if maybe there has been a shift in opinion. The majority opinion seemed to be that it is best to not mention it, which seems to make sense. It's easy to imagine how having a personal mental illness would be seen as a liability, an unattractive and undesirable trait, as a reason why a person might have difficulties during intern year and the whole of their residency training.

What if someone asks you directly at some point during your interviewing? How should you answer them? Should you expect to be asked if you or any family members have any mental illnesses? I've already had a psych resident at my school ask me if I had any during my psych rotation, which felt inappropriate to me and kind of shocked me that he would ask. I ended up telling him even though I didn't really want to because I didn't want to lie (basically MDD with a pretty interesting, i.e. full of adversity, life history).

And what if you already have one or more red flags, e.g. failed courses, that a mental illness played a role in? If you're already going to be looked at unfavorably anyways, does that make things different?

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It was inappropriate that you were asked that by a psych resident. Any chance your behavior was off? Not trying to be mean just wondering why the heck someone would ask you that. There is no way I would disclose this kind of personal information in an interview or to colleagues for that matter. With regard to therapy I'm personally not a fan of self disclosure in almost all cases as I believe it takes the focus off the patient and puts it on the clinician. It is more common in the addictions arena but in general unless done by a very skilled clinician probably not a good idea. Just my opinion though.
 
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it is unlawful to be asked if you have a mental illness in your interview, unless you specifically mention it in your application in which case anyone can ask whatever questions they like. This is not a college admissions essay. You are not applying to school. You are writing a cover letter for a job. you want to sound professional and employable, not like someone who can't stop talking about their problems. The personal statement is primarily used as fodder for interviews. If you want to spend your interviews talking about your problems and knowing that someone no one could reasonable ask about has given way to "anything goes" then go ahead. I might be inclined to assume that you have nothing interesting to say about yourself, and have no filter if you spend your personal statement prattling on about your depression and life adversity. some people might assume you have a personality disorder.

Psychiatrists tend to be quite nosey, and in some fields (like psychoanalysis) some element of personal confession/disclosure is encouraged during the application process because they already assume that you damaged in someway. Some of the more analytically inclined interviewers can't tell the difference between a therapy session and an interview. This also means that you are likely to received a mixed reception - some people might really like you writing about this, but others will absolutely hate it. It is actually fairly common (one of the six types of personal statements) given that a large proportion of psychiatry residents are emotionally disturbed. That also means it's pretty cliched. It is more common for people to write about a "family member" than one's personal mental illness but it is still common enough. I think I was the only one in my class in residency who wasn't in therapy and/or on psych meds (and that was because I was too avoidant about having my own therapy).
 
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I agree that it was not appropriate for the resident to ask you about mental illness. Personally, I would not blame you for lying about it. You're entitled to privacy about medical
conditions, mental or physical. Whether we like it or not, there is a stigma about mental illness. While I do feel those of us who go into Psych should be comfortable accepting the burden of that stigma (since it often ends up getting transferred to those of us who simply care for the mentally ill even if we have no personal mental illness), I do not think it is right to force someone to disclose something that is stigmatized like that when it's not their choice to do so. If a med student or resident functions well enough that I can't tell that they are mentally ill without them telling me so, then I don't see any reason why I need to know about their mental illness at all.

To me, talking about a (for example) diagnosis of Borderline personality disorder in an interview for psych residency would be like talking at an interview for urology residency about a personal experience with erectile dysfunction or premature ejaculation. In some cases, an open-minded interviewer might respond well to such a disclosure - but there is a huge risk that others will find the topic inappropriate. It's not that the condition is something to be ashamed of - it's just that some things that may be appropriate to discuss with your own doctor in private are not necessarily appropriate to talk about with professional colleagues.

I do recall back when I was interviewing for residency there were a couple of times in interviews when interviewers tried to use the "Why psychiatry?" question to probe into if I myself had experienced mental illness, so do try to prepare that it might come up again. I don't think the people who asked me meant anything bad by it, but it's just that often the people who do interviews are just whoever was willing to volunteer a little time and they are not trained at all in what questions are off-limits.
I think that people sometimes just assume that someone who is interested in Psych likely has firsthand experience with mental illness. I suppose that does make sense in a way since people do sometimes get interested in a specialty because of personal experiences with the specialty. I myself thought about going into oncology because of a family member's experience with cancer. Now that I have experienced pregnancy and parenthood firsthand I have more appreciation for OB/gyn and pediatrics than I did back when I was a nulliparous med student. I might even consider going into those specialties if I were doing it all over again (but the way that most people on SDN talk about their ob/gyn rotations, I feel like my rotation through ob was unusually benign, so really it's probably for the best that I wound up in Psych)

Oh, and similar to splik, I also encountered a few psychoanalytic types who made the interview seem like a therapy session. In one case it was done with such a skillful and positive approach that I was actually really impressed and thought the doctor who was doing it would be an excellent person to learn interview and therapy skills from (I believe that was at the University of Rochester where the PD at the time was known for doing this to applicants, so it didn't totally catch me off guard). At a different school, though, it was a bit of an awkward experience and I think both the interviewer and I ended up being very unimpressed with each other. :p
 
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I would avoid personal disclosures about mental or medical illness.
 
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I think I was the only one in my class in residency who wasn't in therapy and/or on psych meds (and that was because I was too avoidant about having my own therapy).

Don't diss therapy. It has its uses. Some people need to go to therapy just to vent about their deranged fellow psychiatry residents, not to mention your more weirdo psych attendings and PD types. Once people graduate they realize what an Alice in Wonderland experience they've just been through. I never met more strange and messed up people than when I was in psych residency. And it wasn't the patients.
 
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I've already had a psych resident at my school ask me if I had any during my psych rotation, which felt inappropriate to me and kind of shocked me that he would ask. I ended up telling him even though I didn't really want to because I didn't want to lie.

Just stop right there. You weren't under oath. You weren't being interviewed for a job with the CIA which means you weren't undergoing a polygraph. Why did you feel it would be bad to lie? Lying is necessary a whole lot of the time. In fact, you should assume that most people are lying, most of the time. This false compulsion to be "totally honest" has no place in the professional world. Learn that, and move on.
 
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1. I can understand getting caught off guard by the question the resident asked you. You did have every right to lie, but as most med students are high strung, risk averse, and harm avoidant, I can see why you told the truth. That said, I would have reported the resident to his/her program director because that was inappropriate and should not go unchecked. Normally, the med student is wrong in most situations, but in this case the resident f*d up. Does the resident need to be fired? Likely not, but he or she should have a "talking to" from the PD.

2. Disclosure- As everyone above said, this generally a bad idea. It comes across as false bravado and will NOT make you unique. Plus the two groups of people who absolutely DO NOT need to know your business are 1) your patients and 2) your residency program (faculty, co residents, staff). Psychiatrists treat people with mental illness, but they do not want their colleagues to have the illnesses they treat (even though a good amount do as already mentioned). This is especially true for alcoholics/addicts in Recovery (particularly if the med student/physician has stayed sober through a 12 Step Program).

The only situation in which disclosure *might* be necessary is if you experienced your illness during med school to the point where it was severe enough that you had to take time off for treatment and ultimately enroll in a state physician health monitoring program. This mostly applies to addiction problems, but some states have mental health programs as well. In this case, depending on how intrusive the questions on the state licensure application are (sometimes they are ambiguous so talk to a lawyer if you need to), you may need to disclose that you are being/have been monitored by a PHP or are currently under treatment, which theoretically delay you getting your training license and being able to start July 1. The question then becomes... do you put this on your application during interview season as a courtesy to potential, future PDs at the same time likely vastly limiting your options? Or do you bury it and then if you can't start mid June/July 1 because your license app is held up risk the wrath of an irritated PD?

As I've said before repeatedly, in residency, if you need mental health treatment, get it OUTSIDE of your department (with an in network provider). My department is probably the least analytic department in the country, but there is no effing way I would let someone who would be evaluating and teaching me know all of my personal business.
 
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Thank you all for your input. I wish we could speak truthfully and openly about these things, especially with psychiatrists.

It was inappropriate that you were asked that by a psych resident. Any chance your behavior was off?.

I'm not sure. I can't remember anything specifically that might've prompted him to ask, but my memory isn't the greatest sometimes and this was a while ago. I typically try to keep up a facade of not appearing depressed even though I am, but I'm sure there are times where it shows. I doubt I did anything extraordinarily bizarre though and I don't think this resident is the most socially adept.
 
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I don't think the residents behavior was out of line (but then I know of residents who tried to strangle med students or were sexually harassing them etc and I definitely would not bring it up with the residents PD) but the fact that you do suggests that you would not feel comfortable with all the residents in your future program knowing about your psych history and thus you should refrain from discussing it in your personal statement
 
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How was the resident's behavior not out of line? That question had no relevance to the med student's clinical education and was inappropriately intrusive. While I like to constantly point out how (on this board and in real life) how most med students are entitled, pampered, and don't know anything practical (all true for me when I was a med student btw), asking about history of psychiatric illness crosses the line.
 
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1. I can understand getting caught off guard by the question the resident asked you. You did have every right to lie, but as most med students are high strung, risk averse, and harm avoidant, I can see why you told the truth.

In other words, they would make very poor spies!

That said, I would have reported the resident to his/her program director because that was inappropriate and should not go unchecked. Normally, the med student is wrong in most situations, but in this case the resident f*d up. Does the resident need to be fired? Likely not, but he or she should have a "talking to" from the PD.

I agree with you, but sadly, there are some psychiatry departments in this country where the culture is really messed up, and very unprofessional. You can't blame a resident for asking an inappropriate question if all they're doing is essentially emulating the people around them. My own PD went around "diagnosing" residents left and right. If a resident complained about anything, they were deemed "anxious" and referred to therapy. If an interpersonal conflict arose, it was never addressed directly, but instead the complaining party would be encouraged to "empathize." That kind of crap. It was also a very analytical department that included some of the most esteemed psychoanalysts in this country, and they had the usual poor boundaries and awkward conversational skills which I have since come to realize are almost synonymous with that line of work. (And I actually respect analysts, by the way.)

Residents of course pick up those habits. I remember one particularly patronizing upper level resident asking a med student (who was ten times smarter than the resident) WHICH cognitive error from a CBT handout the med student was committing, when all the med student did was make a humorous self deprecating comment. The lack of self awareness, humor, nuance and irony was stunning. Multiply that by a whole department, and you have an army of people who go around basically applying psychiatric "assessment" to situations where it shouldn't be applied. These people are so clueless. They have no idea why no one wants to sit next to them on airplanes. Most probably know better than to inquire directly about a med student's past psych history, but you can hardly blame the ones who don't.

Psychiatrists treat people with mental illness, but they do not want their colleagues to have the illnesses they treat (even though a good amount do as already mentioned). This is especially true for alcoholics/addicts in Recovery (particularly if the med student/physician has stayed sober through a 12 Step Program).

There's an exception to this. Addiction medicine (maybe less so addiction psychiatry?) is full of out of physicians who are openly in recovery. Some of their conferences have 12-step meetings as part of the conference.
 
Uh, guys, we have no context on how the question (Asked while ON ROTATION and not on interview) came up. If the med student expressed an interest in psych and the resident said 'oh do you have any personal experience with mental illnes?' then I think that would be reasonable.

As for the interview, don't disclose unless you have to. If it harmed your med school process enough, then DO disclose, candidly without making excuses and talk about what you are doing proactively to stay healthy.

I don't have issues with mental illness but I do have issues with medical illness, that due to adverse action I DO have to disclose on my applications. I've made a point of being upfront about it which has been helpful. I also interview residents and I get skeptical when they get cagey about their red flags or they mention 'an illness' when I ask 'what happened during this *whatever*' which is usually after I tell them (to set them at ease) that I've had red flags myself.
 
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There's an exception to this. Addiction medicine (maybe less so addiction psychiatry?) is full of out of physicians who are openly in recovery. Some of their conferences have 12-step meetings as part of the conference.

Addiction Medicine. *shudder*
 
There's an exception to this. Addiction medicine (maybe less so addiction psychiatry?) is full of out of physicians who are openly in recovery. Some of their conferences have 12-step meetings as part of the conference.

Addiction psychiatry (meaning AAAP) HATES this. While ASAM is a really strong organization with lots of great literature/conferences/CMEs, addiction medicine as a specialty is not taken very seriously (objective statement). My medical school had one of the first addiction medicine programs/fellowships in the country, and while the attending in charge was stellar (ex pediatrician, sober a long time, very well respected in ASAM), most of the "fellows" were washed up MDs not allowed to practice their primary specialty with an average sobriety time of ~2 years. Mostly they end up professionalizing their Recoveries (and some end up relapsing because of it!). I used to think psychiatry had addiction all wrong (see my posts from a few years ago), but is addiction medicine doing any better? Not really...

But for a med student applying to a psychiatry residency with a history of an addiction problem now in Recovery, absent an otherwise stellar application, I would guess most PDs would look down on him/her. Really, as long as the applicant is stable in his/her Recovery, it shouldn't matter, but the stigma and biases towards addiction and especially 12 Step Programs remains.
 
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Addiction psychiatry (meaning AAAP) HATES this. While ASAM is a really strong organization with lots of great literature/conferences/CMEs, addiction medicine as a specialty is not taken very seriously (objective statement). My medical school had one of the first addiction medicine programs/fellowships in the country, and while the attending in charge was stellar (ex pediatrician, sober a long time, very well respected in ASAM), most of the "fellows" were washed up MDs not allowed to practice their primary specialty with an average sobriety time of ~2 years. Mostly they end up professionalizing their Recoveries (and some end up relapsing because of it!). I used to think psychiatry had addiction all wrong (see my posts from a few years ago), but is addiction medicine doing any better? Not really.../

I am 90% sure I train at this institution now and share a building with them. It's nothing less than horrifying. I love how personality disorders rage everywhere and eveyrthing becomes about the addiction and when patients try to bring up childhood traumas or underlying anxiety, they get shouted at.

But for a med student applying to a psychiatry residency with a history of an addiction problem now in Recovery, absent an otherwise stellar application, I would guess most PDs would look down on him/her. Really, as long as the applicant is stable in his/her Recovery, it shouldn't matter, but the stigma and biases towards addiction and especially 12 Step Programs remains.

I think the bigger problem here is that you're looking at someone who is in their mid-late 20s, whose already developed an addiction problem and will be shortly entering the most stressful period of their life professionally (and in many cases personally as well). I haven't personally been in a place to make a decision on someone in that situation, but it seems to me the real problem isn't so much the stigma, but that even after you pare that away, there's still a lack of history factor to consider.
 
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But for a med student applying to a psychiatry residency with a history of an addiction problem now in Recovery, absent an otherwise stellar application, I would guess most PDs would look down on him/her. Really, as long as the applicant is stable in his/her Recovery, it shouldn't matter, but the stigma and biases towards addiction and especially 12 Step Programs remains.

First, of all, that's illegal. Ever heard of the ADA? Yeah, it applies. If it can be proven that psych PDs are openly descriminating, they can be sued, and I hope they will be. If anyone has an experience like that, I hope they talk to a lawyer.

And second, who cares what some psych PD thinks of substance abusers? Students with that kind of history should just go apply in other fields, if that's how these overly judgmental psychiatry PDs feel. You can rest assured no med student on a derm rotation is being asked "Do you have experience with mental illness?" So guess what? The subject will never come up, as it shouldn't.

There was a guy in my med school who had a distant but acknowledged substance abuse history. Somehow or other, he got himself into med school, and somehow or other, he got himself into a very top ranked IM residency, and guess where he is now? Doing an IM subspecialty. If you can make it into an IM subspecialty with that history, you can eat the average psychiatry PD for lunch.
 
Addiction psychiatry (meaning AAAP) HATES this. While ASAM is a really strong organization with lots of great literature/conferences/CMEs, addiction medicine as a specialty is not taken very seriously (objective statement). My medical school had one of the first addiction medicine programs/fellowships in the country, and while the attending in charge was stellar (ex pediatrician, sober a long time, very well respected in ASAM), most of the "fellows" were washed up MDs not allowed to practice their primary specialty with an average sobriety time of ~2 years. Mostly they end up professionalizing their Recoveries (and some end up relapsing because of it!). I used to think psychiatry had addiction all wrong (see my posts from a few years ago), but is addiction medicine doing any better? Not really...

I'm sorry to say, but I don't really think the opinion of the average "addiction psychiatrist" is exactly up there with the surgeon general. Who cares if AAAP hates ASAM? You're talking about an obscure debate among two already marginalized and relatively insignificant branches of medicine. Probably the only people who even care about their rivalry have already posted in this thread.

In any case, I wasn't advocating for people becoming addition medicine specialists. I wasn't defending their field. I was merely pointing out that the there is in fact, a decent contingent of people within medicine who acknowledge having a substance abuse history and yet have managed to have successful careers. Your post actually underscores that, and in fact, you highlight an example of a stellar ex pediatrician who was sober a long time. If a former pediatrician with a history of substance abuse can have that kind of respect, why can't a psychiatry resident?
 
I am 90% sure I train at this institution now and share a building with them. It's nothing less than horrifying. I love how personality disorders rage everywhere and eveyrthing becomes about the addiction and when patients try to bring up childhood traumas or underlying anxiety, they get shouted at.

If we were talking about the PTSD lobby, you could change that to: "I love how personality disorders rage everywhere and when patients try to bring up drug use [or antisocial behavior, or whatever] everything becomes about childhood trauma."
 
First, of all, that's illegal. Ever heard of the ADA? Yeah, it applies. If it can be proven that psych PDs are openly descriminating, they can be sued, and I hope they will be. If anyone has an experience like that, I hope they talk to a lawyer.
actually, this is not quite correct. there are enough exclusionary criteria in the ADA and its interpretation in court cases has been so restrictive as to not afford as much protection to addicts as other protected classes, particularly if we are talking about drug vs alcohol abuse, especially for physicians. For example, if someone has claimed disability benefits for their addiction, they are not covered by the ADA (though again this becomes a little complicated). Also, the ADA does not afford protections to individuals who are seen to be a danger to themselves or others as a result of their addictions. So lawyer or not, it would be very difficult for a psychiatry resident to successfully sue in these cases, the courts will find in favor of the defendant in cases where patient safety is brought up or where it is claimed that the person is a danger to themselves by virtue of working in the field of psychiatry. Finally, the likelihood of proving that psychiatrists are openly discriminating is low in the first place. It would be very difficult indeed to do so.

On the flip side once you're in residency the level of collusion and institutional denial is so great that you could be drunk and smell of alcohol and no one would even say anything. sometimes with tragic consequences.
 
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First, of all, that's illegal. Ever heard of the ADA? Yeah, it applies. If it can be proven that psych PDs are openly descriminating, they can be sued, and I hope they will be. If anyone has an experience like that, I hope they talk to a lawyer.

And second, who cares what some psych PD thinks of substance abusers? Students with that kind of history should just go apply in other fields, if that's how these overly judgmental psychiatry PDs feel. You can rest assured no med student on a derm rotation is being asked "Do you have experience with mental illness?" So guess what? The subject will never come up, as it shouldn't.

There was a guy in my med school who had a distant but acknowledged substance abuse history. Somehow or other, he got himself into med school, and somehow or other, he got himself into a very top ranked IM residency, and guess where he is now? Doing an IM subspecialty. If you can make it into an IM subspecialty with that history, you can eat the average psychiatry PD for lunch.

First, what Splik said notwithstanding, a PD who gets >1000 apps for 100 interview spots to get 10-16 matched residents can very easily justify not inviting someone for an interview if for whatever reason the PD wants. Second, largely because of the former chair at the department of psychiatry at my med school (who is one of the Godfathers of addiction medicine), interventions on med students were not unusual (maybe 1-2 every few years- more common for residents though) and they had to subsequently enroll in the state PHP in order to be monitored. Obviously if they needed time off to go to rehab the gap would have to be explained, but in the people I know, especially the ones applying to competitive specialties "medical leave of absence" was sufficient and did not draw further questions. Whether or not they disclosed this on their apps was up to them (weighing risking getting rejected for interviews vs making a future PD extremely irritated if for whatever reason there is a holdup with the training license).
 
I'm sorry to say, but I don't really think the opinion of the average "addiction psychiatrist" is exactly up there with the surgeon general. Who cares if AAAP hates ASAM? You're talking about an obscure debate among two already marginalized and relatively insignificant branches of medicine. Probably the only people who even care about their rivalry have already posted in this thread.

In any case, I wasn't advocating for people becoming addition medicine specialists. I wasn't defending their field. I was merely pointing out that the there is in fact, a decent contingent of people within medicine who acknowledge having a substance abuse history and yet have managed to have successful careers. Your post actually underscores that, and in fact, you highlight an example of a stellar ex pediatrician who was sober a long time. If a former pediatrician with a history of substance abuse can have that kind of respect, why can't a psychiatry resident?

My point was that addiction medicine doctors are mostly non psychiatrists and that the "establishment" AAAP looks down on them (irrespective of how successful one may be). You wondered if addiction psychiatry was as accepting, and I can tell you as having a reasonable familiarity with the field and both organizations, it isn't (that Nora Volkow, Robert DuPont, Marc Galanter are usually regulars at ASAM notwithstanding). My point was that a med student who for whatever reason is open about a past substance history (see above post) is going to have a harder time getting interviews.
 
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