From the Editor
“My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic.”
So begins this week’s selection, which is an essay written with remarkable candor and honesty.
In this Reading, Dr. Adam Hill writes in The New England Journal of Medicine about his struggle with mental illness.
It is moving and important.
Stigma and Care
“Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery”
Adam B. Hill
The New England Journal of Medicine, 23 March 2017
My name is Adam. I am a human being, a husband, a father, a pediatric palliative care physician, and an associate residency director. I have a history of depression and suicidal ideation and am a recovering alcoholic. Several years ago, I found myself sitting in a state park 45 minutes from my home, on a beautiful fall night under a canopy of ash trees, with a plan to never come home. For several months, I had been feeling abused, overworked, neglected, and underappreciated. I felt I had lost my identity. I had slipped into a deep depression and relied on going home at night and having a handful of drinks just to fall asleep. Yet mine is a story of recovery: I am a survivor of an ongoing national epidemic of neglect of physicians’ mental health.
So opens a paper by Dr. Adam Hill.
Dr. Hill describes his own journey, and the decision to speak out.
I delivered a grand-rounds lecture to 200 people at my hospital, telling my own story of addiction, depression, and recovery. The audience was quiet, respectful, and compassionate and gave me a standing ovation. Afterward, hundreds of e-mails poured in from people sharing their own stories, struggles, and triumphs. A floodgate of human connection opened up. I had been living in fear, ashamed of my own mental health history. When I embraced my own vulnerability, I found that many others also want to be heard — enough of us to start a cultural revolution.
He notes several “lessons” learned. I summarize three of the six:
He notes the importance of caring for himself. “Personally, I use counseling, meditation and mindfulness activities, exercise, deep breathing, support groups, and hot showers.”
He describes the basic lesson learned: “I learned that I must take care of myself before I can care for anyone else.”
“It’s ironic that mental health conditions are so stigmatized in the medical profession, given that physicians long fought to categorize them as medical diagnoses.” He speaks about his own experience of having to write the state licensing board to explain his mental health problems and treatment, which he feels is “an archaic practice of public shaming.”
“We are to be ashamed not only of the condition, but of seeking treatment for it, which our culture views as a sign of weakness. This attitude is pervasive and detrimental — it is killing our friends and colleagues.”
Professional and patient safety.
He notes the importance of patient safety but also notes that: “Physicians who are successfully engaged in a treatment program are actually the safest, thanks to their own self-care plans and support and accountability programs.”
“Instead of stigmatizing physicians who have sought treatment, we need to break down the barriers we’ve erected between our colleagues who are standing on the edge of the cliff and treatment and recovery.”
A few thoughts:
1. This paper is personal – and thoughtful and well crafted.
2. Dr. Hill has done us a great service.
3. And what a comment on our times that such a piece would be published, and published in The New England Journal of Medicine, no less.
Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.