Having depression and entering psychiatry

[betafish]

I'm planning on applying for a psychiatry residency and am wondering your thoughts on having a mood disorder and applying for a psych residency/being a psychiatrist.

I had to take a leave of absence for depression during medical school and am not sure if it's appropriate to mention that in the application process, like in the personal statement. Namely, the experience fueled my interest in psych but maybe it's not the place to be going into personal matters. If I'm entering a field where I'm hoping to decrease the stigma of mental illness it seems like the best approach is honesty. I don't want to be a naive idealist, however, and I'm not sure if it will affect my competetiveness (eg preferring "stable" applicants). I'm not sure if its right to mention specifically that I took a leave for depression or say "a medical leave".

It's possible that I'll have another episode during residency and I might have to take time off, so I'm not sure how to approach this. I figure the question of why I took time off will come up in the interview, as well as probing my reasons for entering psychiatry. I'm debating if I should make everything clear in my personal statement, or address the issue during an interview or after being accepted into residency.

Thanks.

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[jjbmsiv]

I think some private things are meant to be private. I've heard from a psych PD that it's never terribly surprising to learn that one or two of their new interns has a psychiatric problem. Sometimes it's unknown to the intern, and those sleepless nights of long call trigger that first manic episode. Comes with the territory, I guess.

I would counsel you to be honest above all else, _but_ I don't think it's a sin of omission to not mention it. In fact, your Personal Statement is about the worst place to reveal such information. You and/or your statement can easily become typcast as the trite "I'm entering psych because I have a psych history..." blah blah blah, and I don't think that is what you want. Absolutely, write about the reason why you've chosen this profession, but if your condition is not the biggest motivator, then don't feel the need to make it such in your statement!

 

[whopper]

I'm not aware of any studies concerning this issue, but a number of program directors I've seen have stated that they've noticed that people with psychiatric disorders tend to go into psychiatry. Unfortunately, some of them have viewed upon this negatively.

One particular attending during an interview accused me of having bipoliar (I don't have it) as if it were a reason for him to blacklist me from that program. He accused me of having it because I took a year off from medschool, and my grades before the time off were much worse (mostly Cs) from the time after I restarted (mostly As).

This had upset me. Aside from the obvious that he's in a profession where he's supposed to treat people with this disorder and he obviously had no problems prejudicing himself against someone he thought may have had a disorder that he's supposed to treat. As long as someone has a disorder or no, as long as they can do the job reliably and well, that's all that matters.

I thought to myself, if he has such a low opinion of people with psychiatric disorders, he really shouldn't have gone into the field himself.

There was a specific resident in my own program that was dismissed that had actually a few psychiatric disorders. The fact that she had a disorder was not held against her. She was fired because she was making a number of false accussations and was medicating patients with meds without informing the attendings of her decisions (e.g. gave a Class D med to a pregnant female). I believe some of the above was due to her disorder, but she was given a fair chance, and several of her deficiencies were due to Cluster B traits, not Axis I traits. (I'm convinced she had both Borderline & Histrionic DO).

I'm sure there are several program directors that won't hold being depressed against you, but I think the number that will hold it against you perhaps outweigh the number who won't care.

 

[Chianti]

I WOULD NOT mention it ANYWHERE on your application or at ANYTIME during an interview. It will automatically make you a far less competitive applicant and some competitive programs probably won't rank you because of it. That sucks, but thats the reality.

 

[alina_s]

Having interviewed people with gaps in their job history, I would be much more reassured if you did talk about it. While there is the chance that some people would have a problem with an applicant with a psych history, it seems like that program might be less understanding if it became an issue while you were working there and you don't want to be in that program. But it can be quite awkward talking to someone with a huge gap in their history who offers absolutely no explanation. Here's my own bias: the applicant's silence made me wonder if there was a legal/substance abuse problem and I would be more hesitant about substance abuse than a mood disorder because there is some choice involved in substance abuse relapse.

 

[sunlioness]

I think honesty is always the best policy. If you HADN'T had to take time off during med school, I might advise not mentioning it. But you did have to and residency programs are going to want to know why. I know at my program they would not look down on you for it. I mentioned a bout with depression in my interview and since starting here have become a lot more open about my own psych hx (which is actually more PTSD than depression) and it's been received very well. I also know of some of our residents who have had to go on LOA for mental health reasons now and in the past and they've been very supportive of that and have worked with the residents to make sure they got the care they needed and were integrated back into the program. Like anything, I know programs would rather not have to deal with things like that, but it's part of life and understandable.

 

[swanny]

Program directors will want to know why you had to take time off during medical school. I believe it is best to be honest about that during the application and interview process. As a program director, I am much more likely to consider an applicant with gaps in education if they are forthcoming about the reasons. I think that psychiatry residency programs would be very understanding about your reason. We have taken several applicants with depression in the past, and things have worked out well. The only other question I really need to have answered during the interview is whether or not you'll need any accomodations in scheduling/training. If you do need accomodations, it is best to make this known so that you can be sure that the program will work with you. You don't want to match at a program that can't or won't work with you. Of course, sometimes you may not know what accomodations might need to be made-just say so, and explore whether the program is understanding. Good luck!

 

[jjbmsiv]

Well, this is an interesting dichotomy: The PDs are advising you to be forthright about your illness, and the students (me included) are telling you to run and hide from it at all costs!

Consider it this way: it is in the PD's best interest to know everything about you as an applicant, both Good and Bad. I don't mean that is bad to have a psych history, but rather, I believe there will always be fear by the PD of encountering future periods of illness with you in the future, and they will weigh that (future, possible) strain on the residency department accordingly. As such, to think then that the Bad will have ZERO negative impact (however large or small) on the PD's mind seems a bit risky, and perhaps moreso just plain naieve- I don't care what they say in a post on the internet to the contrary. *shrugs*

On the other hand, are we students just paranoid about the whole affair, applications, interviews, et al.? Probably. Hell, of course we are! But this is natural anxiety born out of not being in that residency admissions meeting at whatever programs you've applied to. You aren't there to defend yourself in that room, and thus a lot of things that would otherwise be stated are left undone.

In your specific case, though, I feel this way- having an unexplained gap in your education is much more damning than an explained (and perfectly reasonable) one. I believe now that it would be much worse to ignore the damage that such a leave of abscence with no reason would have on a PD's mind. As for how much you should tell them, well, that's up to you... but it's probably, in your case, for the best to be forthcoming. In general, though, if you had no such LOA, I would keep quiet.

 

[sunlioness]

Well, this is an interesting dichotomy: The PDs are advising you to be forthright about your illness, and the students (me included) are telling you to run and hide from it at all costs!

I'm a resident actually. And I know Swanny's telling the truth, because he happens to be MY program director. Now in my case, I never needed to take time off in med school or during my internship for any reason, mental health or otherwise so I decided NOT to mention my own issues. The problem with that came up in that it was my experiences as a patient that really showed me my love for psychiatry and without that, I didn't really have a good reason for wanting to change fields. It sounded like a complete untested whim. I made up some stuff about gravitating toward my patients with mental health issues in my primary care clinic. Wrote my personal statement about diagnosing and managing somatoform disorder in one of my clinic patients and how much I loved it while my attendings and colleagues all felt sorry for me for landing her. True? Oh, yes. But not the whole truth, and on its own not really sufficient.

One of the attendings who interviewed me was really sharp and not at all shy and continually asked me how I had tested my desire to go into psych. So I hedged and told her PART of the truth. That I suffered some depression/anxiety in medical school, that it had been managed with SSRIs, and that it had not caused my education to suffer. This was all absolutely true. (The REAL truth; however, is that later during my internship, I started having panic attacks almost daily during an inpatient heme-onc rotation, and got referred to a psychiatrist by my program director of all people --she had been my PCP during med school and I hadn't seen my new one yet. The psychiatrist referred me to therapy and I got slapped with the diagnoses of PTSD and DDNOS. It was working with my therapist that sparked the passion for psychiatry in general and trauma/dissociation in particular. My program knows this now --I disclosed it now that my treatment is winding down in order to shed light on the involved issues, but didn't then and think that was the right decision.) But anyway, the point is that disclosing depression/anxiety didn't hurt me. You could argue that since I was not going through the match and they really needed someone to fill an upper level spot that they would be inclined to overlook that and take their chances, but that wasn't the sense I got. What Swanny said to me was exactly what he claims to say in his post above. And I also know of a resident within the past several years who was diagnosed with ADHD in medical school and had to repeat a year of medical school because of it, and I think failed step 1 the first time through. He explained the circumstances and matched here no problem. So granted that's only one program, but these issues are SO common (for all that no one talks about them openly) that I really do think that if you have to explain something like a gap in your education, openness and honesty is really the way to go.

What's funny is that the attending who interviewed me said to me last Spring . . . "You know when I interviewed you I didn't think you had a good reason for becoming a psychiatrist, but I still liked you. And now that you're here and I've worked with you, you definitely belong here." It was really nice to hear.

 

[fpforever]

hi beta,

I also have a bipolar and did apply to psychiatry and family practice. I was honest about my illness to all of my interviewers. I had a better overall response from FP than psych. I also thought that having bp would help me as a future psychiatrist. However, I am sticking with FP. My reasons are that there is alot of mood/ personality disorders in FP patients and FP has a tendency to treat patients holistically, not as a diagnosis. I agree if they don't ask, then don' t tell. But, I was asked and did tell. Depression probably is the more acceptable psychiatric disorder than bp. I encourage you to pursue your interests in psychiatry nevertheless. But, from my experiences, you will probably encounter some negative responses. If you truly believe you want to become a psychiatrist, then don't be swayed by the negative experiences and apply to many programs and hope for the best.

fp

 

[CariBeaner]

I really wouldnt say anything about it. I can't see it helping you and it certainly could haunt you. You arent lying by not disclosing the info- and I think its a personal matter. Thats just me.

 

[EMDO2018]

I ran across this story. A Johns Hopkins psychiatrist killed herself and her 13 year old son. says she was "strangled by debt." I understand she had a special needs child, but she was a doctor and authored 2 books how could she be strangled by debt? She was divorced so maybe she had alimony payments. I remember watching the show her son was on. This makes me wonder if being around mental illness a lot increase your chances of mental illness.


Also who does a psychiatrist see when they are having problems? Another psychiatrist?

http://www.dailymail.co.uk/news/art...For-15-son-turning-gun-left-suicide-note.html

 

[jno]

Also who does a psychiatrist see when they are having problems? Another psychiatrist?

Yes.

 

[Shikima]

Indeed. All physicians should have some kind of psychotherapy, particularly those in management positions within federal/state institutions.

 

[Doctor Bagel]

Holy necrobump! About who a psychiatrist sees, I'd add a very experienced psychiatrist. I imagine we're tricky patients.

 

[Shikima]

Even necro threads need love.