Behind the mask: Physician heal thyself…..or not: Part II

Last week in Part I of this series, we introduced the topic with a famous physician suicide on the African continent which has caused shock waves within the medical community. Some feedback from readers have indicated that the thrust of the article appeared to suggest that I was either blaming him for not seeking help; or blaming the medical community for not identifying his distress and providing him with the support he needed.

That was not the intention. I simply used it as an introduction, because it was topical; but the focus of my write-up was a generic discussion that is aimed at reducing stigma and encouraging health seeking behaviour among physicians. This week, we focus on the challenges to seeking care and what we can do to help.

Why is it so difficult to identify or seek for help when physicians have mental health issues?

The barriers to seeking care are often compounded by the use of deflections and defense mechanisms. ‘Oh, I know I am stressed; I will just rest awhile and I will be fine’. ‘I am in control, not to worry, thank you’. All sorts of intelligent defense mechanisms are deployed to protect us from any hint of vulnerability.

The high level of intellectual functioning makes it doubly difficult as they can easily predict where you are headed and cut you off with denials and dismissive behaviour. In essence, physicians are adept at hiding behind a mask, while presenting the façade of everything being under control….even while experiencing great emotional pain and turmoil.

Doctors are trained to provide help and to be resilient. It is therefore, very difficult to admit to coping poorly or to functioning sub-optimally – due to emotional difficulties. Furthermore, they tend to be people with unrealistically high standards of expectations for themselves; which makes failure, or falling short at any task/assignment to easily translate into an overwhelming feeling of despondency, shame and guilt.

It is especially worse, for those who have had an excellent track record of career success; and are suddenly confronted with failure for the first time. Such perceived failings may be in any domain: family life, social, political or career aspirations. And suddenly, they are left floundering, and in need of emotional crutches.

Lastly, our world is increasingly becoming cold and impersonal. So people may appear high-functioning, show up at work, go through the motions, and then go back home to an empty home or to a family where everyone is in his or her own bubble with minimal emotional connection or bonding. And the typical physician has the ready-made excuse of work load to shy away from engaging.

Thus, we all work in large hospitals and academic departments where we hardly truly know each other; or the personal lives and challenges that colleagues are going through.And this feeling of isolation and loneliness is one of the most critical risk factors for suicidal behaviour – a perceived lack of support.

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What can we do?

We can help ourselves (and others too) in the three major domains of family and social life, as well as the work environment.

Family: The family or home environment should be the first line of defense against emotional difficulties. While it is true that we should all work on building our emotional resilience as individuals, the reality is that we may sometimes not be aware that we have become very irritable and cranky or miserable. It takes a close and nurturing spouse or family member to notice subtle changes and bring it to our attention. At which point, some introspection may be useful.

Social life: Engagement in extra-curricular activities such as sports, community service, social engagements and a network of close friends and associates are helpful for de-stressing and shifting focus from the everyday challenges of career and clinical practice. It is also very helpful for maintaining balance and coping with the high-octane pressures of academic medicine.

Work environment: Many doctors have woven their personal identities to their professional work and therefore become especially vulnerable when faced with work-related problems and stressors. While the risk factors for suicidal behaviour may be exacerbated by sudden losses such as divorce, loss of loved ones, litigation or disciplinary issues, financial losses or challenges; there are clear warning signs to watch out for.

These include – increased substance (alcohol or drug) use; feeling or expressing that there is no reason for living; no sense of purpose in life; anxiety, agitation, difficulty sleeping; feeling trapped, like there’s no way out; hopelessness; withdrawal from friends, family and society; threatening to hurt or kill oneself or talking about wanting to hurt or kill oneself.

And if you suspect a colleague is experiencing distress, please, do not hold back. Talk to them and express your concern about their well-being. Let them know you are concerned and there for them if they need any help.

Conclusion

The work environment should facilitate talking about emotional needs, make it easy to access help and create a support system for everyone: young and old, junior and senior, that is appropriate, confidential and acceptable.