You want students to start talking about mental health in medicine?
Start by challenging these two rules.
There are two implicit rules I learned as soon as I stepped into medical school. One: do not challenge the status quo. And two: do not show your vulnerabilities.
It’s not that anyone in particular ever verbalized those rules to me. It’s just that through comments, behaviors, and omissions from both my peers and my seniors, I have observed these principles take shape in a variety of forms over the past year and a half of my medical training.
One: do not challenge the status quo. Do not question the establishment. Always, always, always be faithful to the hand that feeds you. This doesn’t mean you should not give feedback or suggest ways in which the system can be improved. It means that you should never give feedback outside of established internal routes. You still have a voice, as long as you whisper. And whatever you do, do not speak up in the public sphere.
Two: do not show your vulnerabilities. This stems in part from the fact that we, as a society but more importantly as a professional group, tend to think that doctors need to be superhuman to do their job. Under this line of reasoning, being flawed means being a bad doctor. But who wants a physician who is afraid of reaching out for help when most needed? Who wants a doctor who waits until the point of breakdown to admit something is wrong? No one, except us, members of the medical community—or so it often seems.
Taken together, these two principles conspire to prevent us from having honest conversations about mental health problems among medical trainees—conversations that could potentially be life-saving.
To be effective, these conversations need to take place outside of the established framework and closed doors of western medicine as an institution. They also need to question the core of what we consider to be effective medical school education. In an environment where we are taught to never bite the hand that feeds us, how can we carry out these conversations?
Honest conversations about mental illness also require us to come forward with our personal stories of struggle. If we are constantly told—even implicitly—that we should be invincible and infallible, how can we even initiate these critical discussions?
We want students to start talking about mental health in medicine? Great. But it is our collective responsibility to give students the tool and the social capital to carry these conversations in a way that will not injure their career or standing within the medical profession.