Statistics and I have little in common: I wouldn’t ask them to dinner, offer them rides, or admire their children (who, though possibly handsome, are only more statistics). But here are a few I have brought home recently:
In a recent survey, 50 percent of physicians reported increased anxiety and depression since beginning to work in the coronavirus pandemic. In another survey, 87 percent of emergency room doctors struggle with sequelae of stress. Yet, though they might recommend it to their patients, more than 60 percent said they would never seek mental health treatment for themselves.
Even before the pandemic, doctors were sadly wary. When some 2,000 women doctors were surveyed a few years ago, half reported they had struggled with a mental health issue during their career, and kept it to themselves. Two-thirds of the non-seekers feared stigma. In particular, they feared questions on medical licensure applications that would force an admission of therapy or medication. They were terrified of consequences.
Depending on the state and the Board of Registration in Medicine, consequences can be intrusive and profound: A board may require a competency letter from the physician’s physician, or demand records of psychiatric treatment, or require an applicant to appear and explain themselves, or even pay for a board-appointed psychiatrist’s evaluation. Implicit in these requirements is the threat of license restriction or loss. Too much is at stake. Acknowledgement is confession. Confession is punishable. Better to suffer alone, until that is impossible.
In Massachusetts, the application query is gently non-specific, asking about “a medical or physical condition,” followed by a paragraph highlighted in asterisks and dark colors on “physician wellness.” But on a national help line where I volunteer, doctors calling in feel neither comfort nor protection. Admitting to therapy or medication can be career-endangering. Callers are clear about that; they are calling in part because this is an anonymous forum where they don’t need to identify themselves. We never ask for their names, ages, genders, practice locations, or personal details. We do ask — though don’t push — for the state they call from. This is for demographic purposes only, but still, I’ve come to recognize the long pause. Years and years, midnights and dawns, costs beyond measure have gone into professional immersion. Any whiff of imperfection or perceived weakness is full of risk.
Depression and anxiety in the face of global trauma — or for that matter, in the face of post-partum depression, divorce, crushing debt — are not major mental illness. They are natural responses to crises. Therapeutic options should be offered without fear of career cost, and statistics, though poor dinner companions, have described the problem clearly. Every physician in every state should be guaranteed safety when they seek help. They should seek help so that — using their hard-won, often astonishing expertise — they can help the rest of us.
Elissa Ely is a psychiatrist.