“When I was very young and dreamed of becoming a doctor, I never saw a doctor open up about his mental health, let alone admit that he was taking medication for it…”
On the night of December 5, 2021, I posted the following message on social media: “My name is Dr Jake, I am a doctor who treats mental illnesses and I take medication for my mental health. And by the way, I’m proud of it. The post was accompanied by a selfie of me in a lab coat, holding a pill in my mouth and an explanation for the photo.
Within 24 hours, the post was seen by millions of people and shared around the world. While he received mostly supportive comments from people sharing their own mental health issues and thanking me for my vulnerability, I also received hate messages and threatening comments. The message struck a chord.
Many of you reading this may not know who I am, but if you ask any med or medical student who has TikTok or Instagram, chances are they do. As one of the most followed doctors on social media, I create content for over 1.6 million followers, educating them about mental health and demystifying the medical field for future medical professionals.
When I was very young and dreamed of becoming a doctor, I never saw a doctor open up about his mental health, let alone admit that he was taking medication for it. Not even in TV shows or movies. Never. I grew up thinking that doctors were like superheroes – by working very long hours in stressful environments, they built protective armor that protected them from mental health issues.
Fast forward a decade, and I was in my final year of medical school in the midst of a global pandemic. I was an ER student the first time I saw someone die of complications from COVID-19. I stood at the foot of the bed during the code, holding my breath while wearing an N95 mask, hot sweat running down my face shield, watching someone no older than my parents receiving chest compressions, the sound of ribs creaking exploding in my ears. Then the compressions stopped, someone swore, the patient was pronounced dead and the team stormed out of the room, leaving me to stare at a lifeless body – a human being who walked, talked and lived his life. a few days earlier. There was no process group, no round table with the care team, no debriefing. Twenty minutes later, I was interviewing a patient who had chest pains in the next room as I held back tears and tried to stay strong.
Medicine is a demanding and sometimes traumatic profession. Doctors in training know this before entering the field. We know we’re going to work incredibly long hours, run into hundreds of thousands of dollars in debt, and be with people in their darkest times. If there is a predisposition to mental health issues, medical training is a pressure cooker that can and will bring it out.
A culture of silence
Over the past few years, we have seen the devastating impact that burnout, untreated mental health issues, and a culture of silence have had on medical students and residents in this country.
A recent meta-analysis examining the overall prevalence of depression among medical students found a depression rate of 27.2%, with an overall prevalence of suicidal ideation of 11.1%.1 Consider this: 1 in 9 future physicians have seriously considered ending their life. Perhaps even more surprising is that only 15.7% of medical students who screened positive for depression received mental health treatment. Another meta-analysis that looked at the prevalence of depression and depressive symptoms among medical residents estimated the rate of depression at 28.8%.2
Doctors have one of the highest suicide rates of any profession.3 Recently, Lorna Breen, MD, medical director of the emergency department at New York Presbyterian Allen Hospital, took her own life after telling loved ones that she was desperate to seek treatment for mental health issues. Despite the staggering mental health statistics from doctors and our knowledge of the enormous costs of untreated mental illness, we are afraid to seek help.
I believe there are 3 main barriers (although there are others) that keep doctors in training from seeking help:
1. Fear that our peers or employers will see us differently and see us as weak or damaged.
2. A culture, beginning in medical school (perhaps pre-med), that physicians must perform at the highest level in the most stressful situations with superhuman strength and composure.
3. Fear that we may not receive medical licenses in states that require doctors to disclose if they have ever received treatment for a mental illness.
According to a study published in 2017, nearly 40% of physicians said they would be reluctant to seek treatment for mental health issues for fear of potential repercussions on obtaining their license to practice.4
We are afraid for social, cultural and legal/professional reasons.
Why I shared my story
I don’t have all the answers to solve this crisis. Many activists are working tirelessly to reduce discrimination and stigma and to advocate for legislation to help doctors seek lifesaving treatment. Going forward, I plan to use my platform to get involved in these legislative efforts. In the meantime, I use my voice in other ways.
So why did I post this? It would have been easier (with a lot less drama) to continue posting about mental health from a distance, without ever getting involved in the mess. I shared my story of being the doctor I needed to see when I was young, dreaming of what my life as a doctor would be like.
I’m not a superhero, I’m a doctor. I am human and have struggled with mental health issues. Believe it or not, there are a lot of medical students and aspiring doctors who look at me as my young self once considered my pediatrician, our family doctor, and the other doctors I’ve met. I wanted to show them what a real doctor looks like.
Courage is not the absence of fear in a stressful situation; it’s doing what you believe in even when you’re afraid of what might happen or the resulting criticism. It’s taking the difficult path when the easy path would be so much simpler. Real superheroes know when to ask for help and aren’t afraid of stigma or discrimination. I hope I’ve shown them that you don’t have to be some kind of painless, doubtful, or weak machine to be a doctor. I did it for them. I did it for me. I did it to shake up the culture.
The rest of my post reads as follows:
“Stigma is endemic in the medical field. Opening up about your mental health as a medical professional, especially as a doctor who treats mental illness, can be taboo. As a doctor training to be a psychiatrist, most people in the field would advise me not to post this. Some would see it as a risk to my career. But I did not join this domain to continue the status quo. I am part of a generation of doctors, nurses and other health professionals [who] are not afraid to be vulnerable and discuss mental health. Many consider me a leader of this generation. So here I am leading by example.
My name is Dr. Jake, I am a doctor who treats mental illnesses and I take medication for my mental health. And besides, I’m proud of it. Medication isn’t for everyone, but it can be a powerful tool in combination with therapy and other self-care techniques to address mental health issues. If this post helped you, please consider sharing it with a friend or loved one.
Dr. Goodman is a psychiatric resident in Miami, Florida. The views of Dr. Goodman are his own and do not reflect the views of his university or his employer.
1. Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-2236.
2. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among medical residents: a systematic review and meta-analysis. JAMA. 2015;314(22):2373-2383.
3. Anderson P. Physicians have the highest suicide rate of any profession. medical landscape. May 7, 2018. Accessed January 24, 2022. https://www.medscape.com/viewarticle/896257
4. Dyrbye LN, West CP, Sinsky CA, et al. Licensure issues and physician reluctance to seek treatment for mental health issues. Mayo ClinProc. 2017;92(10):1486-1493. ❒