The Chinese character for “crisis” has two parts: one meaning danger and one meaning change point or opportunity. In my own life, my crisis came in young adulthood while I was in medical school, and it was indeed a change point that would set the course of my life’s work toward suicide prevention.
It’s for this reason that preventing physician suicide holds a special place in my heart. While suicide is a leading cause of death overall in the United States, certain professionals, such as physicians and nurses, experience higher rates of suicide. This alarming paradox calls attention to the need for changes within the culture of health professions and policies that will encourage rather than discourage help seeking.
This reminded me of my own earlier struggles and the serendipity that my path led to support, treatment and healing, and ultimately, a dedication to and passion for suicide prevention.
Growing up with a first-generation Chinese American father and Swedish American mother brought the high driving expectations of a tiger mom (or in my case, dad) and a nurturing but highly academic environment where discussions about quarks and relativity were the norm over the dinner table. My parents were intellectually curious, driven and also suspicious of American culture, which translated into the point of view that: you have your own bed so why would you sleep in anyone else’s house? (no sleepovers); and idleness and nefarious activities like dancing lead to nothing good (no school dances).
As a child, I internalized an impossibly high expectation of myself. For high achieving students, that inner dialogue is invisible, and the drive to succeed “works” – until it doesn’t. For me, the moment it stopped working was in medical school: as cliché as it was, not being at the top of my class led me to experience anxiety and, ultimately, develop an intense fear of failure. Without having built coping skills like the practice of processing fears, self-compassion, or flexibility, I only knew one way to keep going: buckle down and work even harder. The outcome was a serious mental health crisis that had been building over time and peaked after my second year of medical school, leading to a year-long break from school. During that year, I experienced intense struggle, questioning my self-worth, feeling petrified of and unfit for medicine. But I was also uncovering a key inner dialog – an inconsistency between how I viewed myself, versus how I viewed the rest of the world.
As painful and difficult as that period was, it was only such an extreme crisis that forced me to hit the pause button, get therapy, and do the gradual work that led me to a newfound sense that I get to live by the same rule I apply to others: that my life is valuable simply because I breathe air.
Going back into medical school after experiencing that transformation meant going back into a culture where, at the time, medical students and physicians rarely expressed any sign of distress, for fear of being seen as weak. By the time I was Chief Resident several years later, many trainees had shared their struggles with me, and I began to see the truth that all people, including doctors, have human struggles, and that many face significant mental health challenges. The denial and rationalization were apparent to me, and it became clear that not being able to address that part of our lives and our health not only didn’t make sense; I could see how it put individual physicians at risk and compromised our work as healers of others.
It became something of a mission for me to change the culture of medicine so that physicians could develop to their full potential. Based on my own personal experience, that meant taking care of our mental health. This is why I’m excited to be a part of the STREAM program which not only aims to improve mental health of individuals and the physician community but also identifies ways to tackle institutional problems that hinder mental health progress. You can start today by taking small steps to protect your own mental health and improve the environment where you work. For example, you might decide to cultivate daily self-care habits by being curious about “how you tick” and making sure to note activities that lead to positive outcomes. Or you might be transparent, communicating clearly about all of us having physical and mental health to take care of, and ensuring trainees know how mental health challenges are handled by the institution. Line ender We can’t underestimate how the little steps we take can make a huge difference for ourselves and for colleagues.
Physicians who are well deliver better patient care. We must start prioritizing the mental health of our own community members and encourage help-seeking behaviors for mental health concerns by reducing stigma, increasing resources, and having open conversations about mental health.