First, you’re not alone; and I don’t mean that in some bullshit condescending cliche way.
In fact not only are you not alone but you’re surrounded daily by others in similar emotional, social, financial, familial, professional states not unlike you’re own. You probably walk right by them in the mornings or sit next to them in traffic on the freeway.
Let’s begin with some statistics (remember this is a medical blog written by someone with a scientific, evidence-based mindset—who can also put sentences together. Plus statistics help put complicated issues into perspective) then I’ll share my own personal struggles that might alleviate any pain you yourself might be struggling with. Even if you’ve been fortunate enough to have never personally experienced depression or crippling anxiety or panic attacks or thought-racing or impulsivity or relationship issues, you should know how fortunate you are and you SHOULD educate yourself about mental illness and develop empathy and compassion for those who have struggled with mental paralysis.
Also know that if you are struggling mentally, psychiatrically, this doesn’t place you at the bottom of the totem pole. Some of the mostly successful members of society—leaders, parents, politicians, entrepreneurs, doctors, lawyers, business owners, teachers—suffer daily from some form of mental illness. But it doesn’t have to define you. Just as Diabetes Mellitus Type I doesn’t define someone who needs Insulin daily.
OK so the statistics: Mental Health in Numbers.
First, 43.8 million adults experience mental illness each year. This means:
- 1 in 5 American adults struggle with mental illness annually
- 1 in 25 (nearly 10 million people) adults in America live with a serious mental illness
Prevalence by diagnosis:
- 1 in 100 (2.4 million) adults in the US suffer from schizophrenia
- 6.1 million adults in America (2.6%) live with bipolar disorder
- 16 million American adults live with major depression–this represents 6.9% of the population
- 42 million adults in the US (18.1% of all US adults) battle anxiety disorders daily
These numbers are significant. What are the consequences and impact of this high prevalence of adults struggling with mental illness?
- #1: Depression is the leading cause of disability worldwide, and is a major contributor to the global burden of disease.
- -$193 BILLION: Serious mental illness costs America $193.2 BILLION in lost earnings each year.
- 90%: percentage of those who die by suicide have an underlying mental illness.
- #10: Suicide is the 10th leading cause of death in the United States.
Are these Americans being treated? What help are they receiving?
- 60%: the percentage of Americans with a mental illness who DID NOT receive mental health services the previous year.
Why the stigma? Why are we isolating those already isolated? Fear? Disregard? Inability to relate? Using them as scapegoats? Projecting our own problems onto the most vulnerable individuals in our society? Confusion or miseducation about mental illness?
During medical school in my third year, on rounds, whether during my internal medicine rotation or my surgery rotation, I saw interns and residents recoil when we learned a patient with a mental illness had been admitted and assigned to our team. They often sighed and exchanged glances amongst each other. I get it–they aren’t psychiatrists. In these other specialties, physicians are not trained to deal with mental illness and, to them, it “gets in the way” of tackling the medical conditions that do fall within their realm of expertise. What I didn’t endorse or tolerate was the occasional laughter in the resident rooms or swapping of “crazy patient” stories. It bothered me. It bothered me because I’ve struggled with mental illness and my mother suffers from Borderline Personality Disorder. How dare you chuckle and take pleasure from someone else’s suffering. It infuriated me.
This should NOT stop you from seeking help. Again, this blog is a critique of the medical system, its shortcomings, what improvements should be made, and a blunt description of the reality of living in the medical world–what med students do and think, what residents do and think, etc.
You should reach out for help if you’re struggling with anything that is keeping you from becoming the best version of you. Or that’s how I convinced myself to get the help I needed. I felt I wasn’t living life, I was trapped, and I was missing out. I didn’t want to look back in 20 years and feel that life had passed me by because I was too afraid of what others thought of me.
There are physicians who will listen and do sincerely care; many aren’t just putting on a show during your visit and rolling their eyes and laughing when you leave. You just need to do the research. Find the psychiatrists who take the time to listen to you. They are out there.
The anxiety started in medical school during my first year. It came on so suddenly that it was like being hit by a giant wave you didn’t see coming, at night, when you’re waist-high in the ocean. Standardized Patient Examinations were every Friday. Basically, my medical school (and every other US medical school) hires actors and pays them to pretend to be patients afflicted with something we had learned about the previous week. The mock appointments took place in rooms that were set-up to look like your standard family practice examination room–with a table, a stool, a sink, cotton balls, the works. One caveat: in each room (there were about 10 of these pseudo-doctor rooms) a camera was positioned in the farthest corner of the room, opposite from the door you entered through to begin your theatrical performance. Behind these rooms was a larger room and in that room sat our professors, watching us through the cameras, watching us walk through a typical physician-patient “appointment.”
I didn’t see it this way. I saw the room as a stage, the camera as judgment, and knew there was an audience watching me through that camera waiting for me to fuck up, or critiquing my every word and movement, and on that second Friday of my first year I panicked. The standardized patient got out of character and, in addition to being surprisingly different in demeanor from the patient she was playing, helped me sit down on a plastic chair against the wall, my head down between my knees.
it was awful. I was shaking, my tongue went numb from hyperventilating, and all I could think about was that video camera and then then the thoughts of overwhelming embarrassment began to infect my mind. I felt like it would never end. The thoughts just kept racing: “what if this keeps going? What if they think I can’t be a doctor now? They are probably all watching. I fucked up. I’m screwed.” And the thoughts made the panic worse and I had to think of my favorite Bob Dylan song and tried to sing it in my head to distract the flood of thoughts that were keeping me paralyzed in that chair. Anything to “Ativan” the thoughts in my head.
With the help of a classmate who said, “don’t worry I was feeling the exact same way,” the panic dissipated, but slowly. I left the building as quickly as I could, my head down in shame, avoiding eye contact with everyone I passed. I wanted to get home, be alone, and cry. So I sped-walked home, re-playing what had happened over and over in my head like a tape recording, unlocked my apartment door, locked it, tossed my books on the couch then sat on the floor and cried for an hour.
All I could think about the entire rest of the evening, well into the night, the next morning, the next day, the next night was: this is going to happen again. And just as quickly as an intramuscular injection of epinephrine fuels the heart to the point of tachycardia (fast beating,) so did the anticipation of future panic attacks instigate their monstrous reappearance.
I later learned, through a psychiatrist and once I entered third year and completed my psychiatry rotation, that I was indeed not alone. What had happened to me happens to thousands of people everyday and is a classified disorder in DSM IV (and now V)–the Bible of psychiatry.
Panic Disorder. An anxiety disorder. DSM V is the system psychiatrists use to diagnose mental health disorders–basically the psychiatry rule book. Panic disorder–this type of anxiety disorder–is based primarily on the occurrence of panic attacks, which are recurrent and often unexpected. Further, at least one attack is followed by one month or more of the person fearing that they will have more attacks. This causes the victim to change his or her behavior, which often includes avoiding situations that might induce an attack.
Since panic attacks are key to a panic disorder diagnosis, they are specific and well defined for psychiatrists. This is where the updates in DSM-5 are significant. The previous version classified panic attacks into three categories: situationally bound/cued, situationally predisposed, or unexpected/uncued. DSM-5 has simplified it into two very clear categories: expected and unexpected panic attacks.
Expected panic attacks are those associated with a specific fear, like that of flying or spiders or clowns or birds. Unexpected panic attacks have no apparent trigger or cue, and may appear to occur out of the blue–great for me right?
According to DSM-5, a panic attack is characterized by four or more of the following symptoms:
- Palpitations. In essence, a rapidly beating heart, which is what I had experienced.
- Sweating
- Trembling or shaking. Again, something else that incapacitated my body that day with the camera watching like Big Brother.
- Shortness of breath or smothering. Yup that happened too.
- A feeling of choking. That’s what it felt like when my tongue went numb.
- Chest pain
- Nausea or stomach pain
- Dizziness or feeling like you might pass out. Check. That’s why I had to sit in that plastic chair, my body bent in half, my head below my knees.
- Feelings of unreality (derealization) or being detached from oneself (depersonalization.) I’ll be honest, I don’t even know how you can classify that, it seems so subjective. But I definitely didn’t feel present in the moment; all I could think about were those cameras and everyone watching.
- Fear of losing control or going crazy. I didn’t think I was going to go crazy. I just thought I was crazy.
- Fear of dying. This is a big one. This is what a lot of people feel when they experience a panic attack. But I knew it was a panic attack. I knew I wasn’t going to die. I just didn’t know when it would end or if it would end.
- Numbness or tingling sensations (paresthesias.) That too. My fingertips tingled and I couldn’t feel anything below my knees. Once the panic started to fade back into the shadows it felt like I had been walking on tiny little pinpricks, like walking on recently mowed grass.
- Chills or hot flushes.
It’s important to note: the presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack and agoraphobia (or social anxiety, which I’ll discuss in another post) now stands alone in a separate classification. I will share, though, that after I had experienced several panic attacks over the course of the few weeks following the initial attack I did develop agoraphobia. Who wouldn’t? I could never predict these attacks and the embarrassment that followed them made me want to hide in a darkened padded cell, locked from the inside and me with the key. After all, I was crazy. Wasn’t I? I must be.
What I went through to obtain treatment for these attacks was horrendous and only added to my anxiety. I did feel alone. No one–except that one classmate that one day–ever sympathized with me nor did any classmate ever open up to me about their struggles with mental illness (even when I found out secondhand or by a slip of their own tongue.) It was hush-hush. I felt like the only medical student in the world with panic disorder. But I later learned I wasn’t.
So the panic attacks turned into agoraphobia and they also congealed into depression. In future posts I will discuss the road I took to finding treatment and getting my panic attacks under control. I will also share with you the agoraphobia I experienced and, finally, the ever deepening, dark, cold, empty pit of depression I eventually fell in to and didn’t even want to find a way out of.
If you need help now, you probably already know the numbers to call. I’m going to spare you that pre-recorded sales pitch. But I will say: any reader can contact me anytime if you’d like to discuss anything you may be dealing with. You know the drill: “Menu” then “Contact Me.” There’s my email address: I’m always online. I’ll be the med school dropout non-MD consultant who will always listen.
Pulling the Plug on American Medicine 