Life before death. Strength before weakness. Journey before destination.
I will protect those who cannot protect themselves.”
– Ideals of the Knights Radiant, The Stormlight Archives by Brandon Sanderson
My steps are light as I walk the streets of San Francisco underneath a sky of deepening night. While my headphones play songs by my favourite Kpop group of all time – 9Muses – an unconscious smile spreads across my face. I’m an African-American, gay male in my first year of child and adolescent psychiatry fellowship, dancing down the street, not caring how it looks to do so. My spirit hasn’t been this calm in seven years.
Unbidden, but not completely unexpected, other thoughts arise. Ones from which I’m not sure I’ll ever be completely free. Musings that take me out of the moment of evening tranquillity.
‘When will the suicidal thoughts come back?’ There’s the possibility they may never return. ‘You’ve been lured into that trap before. You need to be prepared.’ Why can’t I simply enjoy not being depressed finally? ‘Because you thought the depression was gone but you saw what happened in medical school then again in residency.’ The past doesn’t portend the present or future. ‘Who knows when you’ll have to deal with overt daily racism, homophobia, and bigotry again though? It’s everywhere.’ But I’m safe now. I’m far safer than before. ‘Are you?’
Though I continue my stroll, my steps change. Slow. My mind becomes more pensive.
You see, I never expected to make it to thirty-one years of age.
Honestly, when I was younger, I was pretty sure I would be dead before I reached college.
I’ve lived with depression and suicidal thoughts since seventh grade. The daily thoughts and sometimes plans of killing myself lasted all the way through college, when I entered a two-year period during my master’s there that would later be known as The Golden Years. A two-year period where I didn’t have a single depressive symptom. Because of the environment at MIT, where I got to see what a world actively moving beyond bigotry could look like, being a student there changed my life. The friends there, the life we crafted together by doing what we could to lift each other up, gifted me with two years where I didn’t have a single depressive symptom.
I left MIT believing the world was ready for an African-American, gay individual who was so much more than those facets. I left a world that was not perfect, but was the closest I’ve been to perfection. I left for medical school with the internal assurance that my depression was gone, never to return.
That supposition would turn out to be a fanciful wish. I’ll never know specifically what broke me. Maybe it was when a classmate said in front of a preceptor and other classmates that a standardised patient acting as though they had manic symptoms was like what the class had to deal with me. Perhaps it was when an administrator coldly said: ‘It’s better to fail than scrape by,’ when I confided in them my concerns that I had failed an examination; an exam that I did fail, a few months before we found out I was having daily panic attacks and exam anxiety because of the racism and homophobia I experienced every day in medical school. Perchance it was regularly hearing disparaging comments around diversity from people who were to become future doctors. Most likely it was the culmination of far too many such instances.
No matter the reason, less than six months into medical school my depression, anxiety, and daily suicidality returned, more dangerous than ever before. I’d banish those forces back into partial remission at the end of my third year with the help of therapy, medications, old friendships, and new allies, but it was not a perfect remission. Symptoms flared anytime I experienced racism, homophobia, or bullying. Those nightmarish experiences and many more led to my fleeing back to Boston for psychiatry residency, never wanting to look back. All I wanted was to be safe, to be with my friends, to put myself back together, to find a way back to a perfect remission.
Residency had other ideas. I was told my answers were wrong when I quoted directly from a book chapter written by faculty at the university. I was told I was unprofessional, oft dismissed when I brought up instances of bigotry. Once more, others and myself faced continued instances of daily discrimination. I only made it three months before I was suicidal again.
Sure, I’d once again manoeuvre through. Every day was a chess game I knew how to play, and play well. Sure, changes came and some apologies occurred. In the end, though, I realised I didn’t fit the university even with my and other’s efforts to make it a more accepting place. So, I left. I left on a hope that I could find a place where it was safe to be an African-American, gay physician in medicine. I left on a wish that, if I found such a place, I’d enter remission again.
My story as a physician with suicidal thoughts is not uncommon. Physicians suffer from high rates of suicide and have since 1858. Every day one physician suicides in the US. There are various reasons for this, including work hours that are beyond what humans are meant to work, stigma and backlash from disclosing one’s mental health, and the process of training itself. The rate of suicide among male physicians is 1.41 times higher than the general male population, while for women it is 2.27 times greater.
Nor is my story an uncommon one for minoritised trainees. Over 50% of women trainees in medicine reported either witnessing or experiencing sexual harassment. Students that identify as lesbian, gay, or bisexual report the highest rates of mistreatment, with 43.5% reporting at least one episode of mistreatment, compared to 23.6% for heterosexual students. Approximately 38% of students nationwide from racial and ethnic groups reported maltreatment. These episodes of discrimination lead to burnout, depression, and suicidality.
I could have easily become one of those statistics about suicide in the medical field. Yet, here I am. On this walk. Alive. Alive, with my depression and anxiety in partial remission. Alive, with my depression and anxiety headed for complete remission.
Which means that I can allow my mind to invariably turn to questions I’ve pondered a multitude of times since I left residency and my mind began healing:
What does it mean for a mind to heal? What does it mean to wake up every day without the thought: ‘Today might be the day I die’? What does that all mean for the future? Who am I now after all that and who will I become? What does it mean to be a physician in remission?
My depression and suicidal ideation stem directly from minority stress, thus, I’ll spin the answers to those questions through the lens of what it’s meant to not be forced to deal with daily discrimination in the months since I began fellowship.
I noted myself randomly smiling first. A type of smile so unlike the ones I had often plastered on to hide the tumult inside, a pure expression of the joy without the once seemingly incessant pain. Spontaneous dances in the shower to Gaga’s Chromatica came soon after; impromptu dance routines because I’m excited to go to work instead of terrified. As the nightmares about residency and medical school that once often woke me in the night started to fade, I began to be able to sleep through the night without waking up screaming.
I no longer rush to the bathroom in the morning before rounds with a gastrointestinal upset from anxiety about how to navigate certain staff and attendings. Now that I don’t have to constantly calculate how to contend with racism and homophobia every moment of every day, I have started to figure out who I want to be as a physician. Instead of having to discuss why not wearing a tie isn’t unprofessional, I spend my time discussing minority stress and identity with the children I have the privilege of working with. I write op-eds around mental health for minoritized populations and wrote a memoir to hopefully reach those who have been made to feel alone. Things are not perfect – for there still a bigoted country to contend with – but to have a mind that is healing has meant everything.
And I often remind myself that it will take time to heal and that is OK.
So many other things that have changed too, but to speak about those facets is enough for now.
I’m still me. I’m still the same guy who, once upon a time in college, promised my friends I would forever work to help leave the world a better place. I’m still the same person who will eternally advocate for my friends, family, patients, colleagues, and our world’s best self. I’m still the same guy who was nicknamed a unicorn-phoenix by his friends, who constantly tries to see the best in others. I’m still the same person whose main goal is to hold and foster the dreams others hold inside.
With the depression fading because I’m finally in a safer environment, I’m just able to be that person more fully now.
On my walk, those thoughts, that knowledge, spirals through my mind. That brief discussion with myself reinforces what I know to be fact. And with my heart filled with magic and dreams, I continue skipping down the street, the music in my ears matching the symphony of the night.
Chase T.M. Anderson MD is a fellow in child and adolescent psychiatry at the University of California, San Francisco. You can connect with him on Twitter @ChaseTMAnderson
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