Mental Health in Medical School

[gossmer]

What kind of mental health services do you have at your school? Do you think they work? What would you like to see change? Do you have someone in charge of mental health and student wellness?

I ask because my school has now had two deaths in a year and half and I'd really like to find some solutions.

---

Members don't see this ad.

 

[rachmoninov3]

wow. i'm sorry to hear about your classmates.

I've long suspected that the increased stress of medical school goes unnoticed. While my school does have counseling services, I don't know how useful they are b/c my friends who have used them haven't had much success. They were just given SSRIs and sent on their merry ways.

As to finding solutions, here are my hypothesis as to why students find it hard to cope with medical school.

#1 the student who always wanted to become a doctor, but now that they're in medical school they aren't so sure. Perhaps this is because they failed a test, or they finally realized how long the road realy is, or that they just don't need an MD to be happy. There are many posts like this on SDN, I'd check them out for raw data if you're serious about this.

#2 (my own personal hypothesis) Neuropsych docs will tell you that the brain is just like any other part of the body, and something like brain surgery is no different from having a knee replaced, the brain needs rest and rehab too. Now throw in the fact that in medical school you're asked to use your brain more than ever before, and there's nothing even the most intelligent med student can do to prepare for the work load in med school. It'd be the equivalent of someone who's used to running 10Ks decide to run a marathon without training...they're bound to get hurt. The brain is no different, push it to the max and the psyche is bound to get hurt.

#3 A simple solution would be to make sure first years do not take scaples and blades home with them/have access to them outside of anatomy lab. Of course med school's will not like the added $1000 or so this brings with each class, but it might help prevent certain suicides.

 

[Noeljan]

I am very sorry to hear

Although I have not attended yet (so I don't know the exact details) but my school started a student run support group which I have heard good things about. They have meetings like one night a week which are confidential. Maybe your school can start something like that. Sometimes it helps to have people (like fellow students) to relate to (that are going through the same experiences) so you don't feel so alone.
Also, maybe you guys/gals could talk with your advisor. Sometimes that could help (and they will understand more of the curriculum and events than a counselor). But counseling can definately help a lot.

 

[DonkeyD]

#3 A simple solution would be to make sure first years do not take scaples and blades home with them/have access to them outside of anatomy lab. Of course med school's will not like the added $1000 or so this brings with each class, but it might help prevent certain suicides.

Um, I don't think having a scalpel laying around is the thing pushing these people over the edge. Once you actually start looking around for something to off yourself with you've crossed a line and it doesn't matter what you find if you're determined enough. Are you going to ban M-1's from having steak knives as well? What about cars? Unrestricted access to tall buildings? Alcohol? I'm an M-1 and I have a shotgun in my apartment, should my school come take it away so I don't make a bad decision?

Point is there are plenty of things we use on a daily basis that can be deadly if used improperly (or properly depending on your point of view)...you can't ban everything, just get help to the people that need it.

 

[Bartelby]

#1 the student who always wanted to become a doctor, but now that they're in medical school they aren't so sure. Perhaps this is because they failed a test, or they finally realized how long the road realy is, or that they just don't need an MD to be happy. There are many posts like this on SDN, I'd check them out for raw data if you're serious about this.

A very insightful post. I am not one of those "always wanted to be a doctor" people, but I thought med school (at least years one and two) would be a lot more like college than it is. I am also really struck by how long I will be working constantly-- through my entire twenties (I am twenty three now). When you are in the middle of things it does get overwhelming sometimes. I am not actually depressed over it, but it does bum me out a little and I can see how someone could get depressed over the above factors especially if they don't like what they are learning.

 

[thedelicatessen]

I'm really sorry for your loss. Several years ago, before I became a med student, there was a rash of suicides on our campus, from a med student to a physician on faculty. Since then, I think my school has really stepped up the emphasis on mental health awareness, especially among the med students.

We have a faculty psychiatrist who's director of student/faculty mental health where they offer free counseling. We also have a selected few students in each class that we can go to with any concerns. During orientation, they told us A LOT about all the services they offer and about recognizing the big picture. I have never used any of the mental health services, but it's comforting to know that the services are available.

 

[cobalt314]

I think a huge thing would be making leaves of absences easier to obtain (and making sure they don't have any huge detrimental consequences linked with taking them). If people are feeling trapped in their situations, an opportunity to physically leave could be very helpful.

In terms of mental health offerings, I think a lot of med schools that offer things tend to offer only just sufficient resources to make it look like they are doing something vs. actually implementing anything effective. The purpose is usually to make the 'problems' appear to go away, or if they don't, at least allow the institution to cover themselves.

I think a lot of aspects of medical training are demanding enough to cause most mentally healthy students to become frustrated or even depressed at times. Yet, at least where I am, we're still expected to have this relatively positive outlook on it all vs. feeling free to express our frustrations or feeling normal in being extremely frustrated at times. If you ever go "too far" in voicing dissatisfaction, then "obviously" you don't want to be here enough and don't have the right motivations.

If something is causing students unnecessary unhappiness (i.e. lots of time/effort required, little or no educational payoff), there's rarely ever going to be a discussion about whether anything can be changed to improve it (i.e. scut? well, we've always had that. no reason to stop now). Instead, it's "there's tons of students who didn't get into med school that would love to be in your shoes." Or, "suck it up, it only gets worse as you proceed throughout medical training so you gotta learn how to deal with it now."

Being hard-working and displaying professionalism are just cover words for becoming workaholic / one-dimensional and for learning to suppress all negative emotion in any situation (even if it may be warranted).

 

[gossmer]

Deli, would you mind PMing me and telling me where you go to school? I'd really like to contact a med school that has already dealt with suicide so I can present what they do to my school.

I'm really sorry for your loss. Several years ago, before I became a med student, there was a rash of suicides on our campus, from a med student to a physician on faculty. Since then, I think my school has really stepped up the emphasis on mental health awareness, especially among the med students.

We have a faculty psychiatrist who's director of student/faculty mental health where they offer free counseling. We also have a selected few students in each class that we can go to with any concerns. During orientation, they told us A LOT about all the services they offer and about recognizing the big picture. I have never used any of the mental health services, but it's comforting to know that the services are available.

 

[Dr Roboto]

"Medical student stress and burnout leave some with thoughts of suicide"

http://www.ama-assn.org/amednews/2008/10/20/prsb1020.htm

 

[peerie]

The University of Washington looks like they have an excellent program for counseling; anyone there who can comment on it?

No real program at my school.

If I could design a medical school, I would include really awesome private, off-campus counseling for students and their families. It would be low-cost or free and would start with the assumption that med school is damn stressful. Too often medicine denies the reality of its own stress producing behavior. I mean, it's ok for patients to 'seek help' but if we do then we are sort of ostracized or it is held against us. There is also a dark history of using psychological stress as a sign of weakness in physicians, whether warranted or not. It has been used to punish or 'correct' people in medicine, as well.*

It would be great if that could all change and be replaced with a healthier environment. I am sorry to hear about your classmates, that is very sad.

*[Some recent posts on the residents thread.]

 

[psych22]

dr robotos sig says it all

"

"Too few residents emerge from training thankful for the opportunity to practice in a fascinating and intellectually challenging field. Instead, many believe that the world owes them something for what they've been through."

- Timothy McCall, "The Impact of Long Working Hours on Resident Physicians," The New England Journal of Medicine, 1988

"

 

[silas2642]

dr robotos sig says it all

"

"Too few residents emerge from training thankful for the opportunity to practice in a fascinating and intellectually challenging field. Instead, many believe that the world owes them something for what they've been through."

- Timothy McCall, "The Impact of Long Working Hours on Resident Physicians," The New England Journal of Medicine, 1988

"

It's kind of an ignorant quote-- medicine is certainly a fascinating and intellectually challenging field, but there is far more to it than that. I think that if physicians could just go to work and treat grateful patients without all the crap that comes with it (i.e. administration, insurances, etc) then you would see much happier doctors with perhaps fewer depression and suicide rates. However, medicine has changed even since 1988.

It's hard to know what med school is like unless you've been in med school. The volume of work is enormous, there is a constant pressure on some, you're constantly trying to find a balance between having a life and learning the material you'll need to be a good physician.

People have this rosey view of medicine and medical school-- it's not glamorous. It's dirty sometimes and it's really hard work. At times it's like being in a pressure cooker. Couple that with a history of depression or other mental illness and you have a recipe for a person at high risk for suicide.

 

[psych22]

It's kind of an ignorant quote-- medicine is certainly a fascinating and intellectually challenging field, but there is far more to it than that. I think that if physicians could just go to work and treat grateful patients without all the crap that comes with it (i.e. administration, insurances, etc) then you would see much happier doctors with perhaps fewer depression and suicide rates. However, medicine has changed even since 1988.

It's hard to know what med school is like unless you've been in med school. The volume of work is enormous, there is a constant pressure on some, you're constantly trying to find a balance between having a life and learning the material you'll need to be a good physician.

People have this rosey view of medicine and medical school-- it's not glamorous. It's dirty sometimes and it's really hard work. At times it's like being in a pressure cooker. Couple that with a history of depression or other mental illness and you have a recipe for a person at high risk for suicide.

silas,

not sure if you see what i'm seeing.. but don't you think that quote absolutely epitomizes the toll that medical school takes on the mental health of students?

in the following sense:
these institutions take in healthy individuals who are trying to actualise (one of the highest needs of a healthy individual, according to Abraham Maslow) but the output is physicians with personality disorders / sense of entitlement issues (a chief trait of Narcissistic Personality Disorder and other personality disorders, according to DSM-IV).

[input] mental health --> [med school] --> [output] mental disorder

 

[DwyaneWade]

Unfortunately there is still a huge stigma attached to depression, or seeking help. No matter how many have to die before our society changes.

I know from talking to friends throughout medical school that while when someone was down they would kind of entertain the idea of going to the free psych visits offered by our school, it was never really a serious option. Plus, word gets around pretty quick through administration etc. and again the bias against mental health is everpresent.

 

[GZA]

silas,

not sure if you see what i'm seeing.. but don't you think that quote absolutely epitomizes the toll that medical school takes on the mental health of students?

in the following sense:
these institutions take in healthy individuals who are trying to actualise (one of the highest needs of a healthy individual, according to Abraham Maslow) but the output is physicians with personality disorders / sense of entitlement issues (a chief trait of Narcissistic Personality Disorder and other personality disorders, according to DSM-IV).

[input] mental health --> [med school] --> [output] mental disorder

It is that rudimentary!
To reverse the arrows!
Oh, the speldor . . . !

 

[peerie]

It would be great if all this was changed into a more healthy environment. Maybe we can be the ones to change it.

 

[Jwax]

It'd be the equivalent of someone who's used to running 10Ks decide to run a marathon without training...they're bound to get hurt. The brain is no different, push it to the max and the psyche is bound to get hurt.

More like getting a couch potato to run a marathon without training.

Our school actually has a pretty good counseling system set up that is free to all the health sciences center's students (we've got med, pharm, dental, etc on our campus, too). How high of quality treatment they receive I don't know (I'm hesistant to believe it is very high quality if it is anything like our resident-run family med clinic that is free for students). They are pretty active in letting us know that it is available. Our student council president has even openly admitted to using it's services and has spread awareness and acceptance of counseling through his position, which I think is pretty amazing. I think change starts from the top and works its way down and being able to say, wow, our Stuco president is openly okay with counseling, so it would be okay for me, too. Another thing that my school did for us during our first year is during our human behavior class they held a physician's recovery panel where they had three docs and a resident come in and talk for an hour or two about their history of alcoholism and drug addiction and the whirl-wind of events that went with that lifestyle and getting caught.

After hearing you guys talk about how it seems your schools are doing the bare minimum, I'm actually a lot more impressed with my school. Aww they really do care about us .

 

[silas2642]

silas,

not sure if you see what i'm seeing.. but don't you think that quote absolutely epitomizes the toll that medical school takes on the mental health of students?

in the following sense:
these institutions take in healthy individuals who are trying to actualise (one of the highest needs of a healthy individual, according to Abraham Maslow) but the output is physicians with personality disorders / sense of entitlement issues (a chief trait of Narcissistic Personality Disorder and other personality disorders, according to DSM-IV).

[input] mental health --> [med school] --> [output] mental disorder

Uhhh... no, I definitely don't see what you're seeing. I'm pretty certain that med school doesn't cause healthy people to develop personality disorders. I think that certain stressors that occur during medical school like failing an exam, criticism from an attending, etc. can exacerbate personality d/o traits, but the vast majority of people with healthy ego defenses do not all of a sudden develop an Axis II disorder due to the fact that they signed up for medical school.

Again, I think that people have to use a lot of defense mechanisms during medical training and in medicine in general to deal with the immense amount of stress (I don't think that you can even begin to understand this unless you're in med school, but maybe I'm wrong). I think that's why you see people's "true colors" come out-- aspects of narcissism, borderline traits, neuroses, etc. all of these become apparent. Some people use humor to deal with their stress, others use alcohol, exercise... we're all different.

But medical school definitely does not cause mental illness.

 

[DwyaneWade]

Uhhh... no, I definitely don't see what you're seeing. I'm pretty certain that med school doesn't cause healthy people to develop personality disorders. I think that certain stressors that occur during medical school like failing an exam, criticism from an attending, etc. can exacerbate personality d/o traits, but the vast majority of people with healthy ego defenses do not all of a sudden develop an Axis II disorder due to the fact that they signed up for medical school.

Again, I think that people have to use a lot of defense mechanisms during medical training and in medicine in general to deal with the immense amount of stress (I don't think that you can even begin to understand this unless you're in med school, but maybe I'm wrong). I think that's why you see people's "true colors" come out-- aspects of narcissism, borderline traits, neuroses, etc. all of these become apparent. Some people use humor to deal with their stress, others use alcohol, exercise... we're all different.

But medical school definitely does not cause mental illness.

It does not cause it. But it certainly increases your risk for it, and therefore in common jargon, one could argue that it is a "cause" of mental illness. Just like smoking increases ones risk of cancer, therefore it "causes" lung cancer.

Regardless of semantics, anytime you take intelligent people out of the real world, place them in the sleep-deprived bubble that is the wards and slowly wear them down physically, emotionally, and mentally you will have casualties.

 

[GreenShirt]

I'm sorry about your school's loss.

My school is very bare bones in terms of mental health. We have just one individual who's in charge of mental health/learning education/time management type stuff. Although, I'm in a new program so things aren't quite as developed.

I think any school should have some sort of resource center for mental health that is well advertised. Even if they don't have licensed social workers on campus they should at least have a list of resources in the area where students can go. Med school itself is quite stressful, people are entering that age where marriage/divorce/family happens and all together it can create quite a mess. I think because so much sacrifice goes into getting into med school people are reluctant to admit that it may not be working for them.