Doctors sometimes treat patients in excruciating pain, rush to heal bodies shredded by gunshots, and deliver the most heartbreaking news to patients’ relatives. Many of them work long hours under intense pressure, striving to cure diseases and save lives. But doctors are human. They suffer depression, anxiety, burnout — all the same mental health issues that other people face. In fact, they sometimes suffer more.
One meta-analysis estimated the depression rate among medical residents at 29% — while the rate among nonphysicians was 8%. Physicians die by suicide at twice the rate of the general population. And in October 2020, 87% of emergency physicians reported feeling more stressed due to COVID-19, but 45% said they didn’t feel comfortable seeking treatment if needed.
Numerous concerns discourage suffering physicians from getting help: licensing worries, fears of lost work opportunities, and a professional culture that suggests that it’s unacceptable to appear “weak.”
But experts believe seeking care actually makes doctors better providers. What’s more, talking openly about mental health struggles can reduce shame and promote help-seeking.
“Stigma can cost lives, and sharing our personal struggles can help save them,” says Darrell Kirch, MD, president emeritus of the AAMC and co-chair of the National Academy of Medicine (NAM) Action Collaborative on Clinician Well-Being and Resilience.
AAMCNews spoke with four physicians about their personal mental health journeys. These physicians shared stories of depression, sexual abuse, substance use, and suicidal thoughts. But they also described healing, hope, strength, and a determination to serve patients with the greatest degree of compassion and the highest quality care.
Childhood trauma, decades of silence
When Darrell Kirch, MD, was 20, he witnessed an excruciating scene.
Kirch, now 73, was working on a surveying crew in Colorado’s Rocky Mountains when a 40-passenger plane suddenly crashed into the mountain above. A survivor came stumbling through the trees, his clothes and skin badly charred, and the surveyors quickly fashioned a makeshift sling to carry him to safety. Then they ran back to the scene to help others— but to little avail. Ultimately, 31 passengers perished.
Kirch, who later became a psychiatrist and a leader in academic medicine — he served as president and CEO of the AAMC — says that today a psychological debriefing would follow such an event. “Back then, this happened on a Friday, and I just went back to work on Monday.”
Unfortunately, that was not the first trauma Kirch suffered in his early years. As a very young child, he also experienced sexual abuse at the hands of a trusted adult.
This revelation in particular is one that Kirch does not make easily. “It’s very uncomfortable,” he says. “But I hope it can help people.”
The abuse as well as other factors — including genetics, he believes — led to a number of mental health issues, and Kirch coped largely by focusing on achieving academic success. Determined to help others, Kirch was thrilled when he was accepted to the University of Colorado School of Medicine in 1973.
But a major setback loomed.
While working with cadavers in anatomy class — bodies reminiscent of the crash victims — Kirch suffered extreme anxiety, including intense heart palpitations and hyperventilation. “I felt like I would die,” he recalls.
Kirch went to a medical school dean to say he needed to drop out. Instead, the dean encouraged him to seek psychiatric care. Kirch agreed. “I was desperate,” he says.
“I began to feel like I had to be more forthcoming. I felt that revealing personal stories was the only antidote to stigma.”
Treatment helped Kirch go on to a successful career. Among his numerous achievements are serving as dean at two medical schools and co-chairing the NAM’s Action Collaborative on Clinician Well-Being and Resilience.
“Medications and trauma-focused psychotherapy help me to this day,” he says.
For nearly his entire career, Kirch kept silent about his struggles. As he was co-leading the NAM work, though, “I began to feel like I had to be more forthcoming,” he says. “I felt that revealing personal stories was the only antidote to stigma.”
In fact, Kirch regrets not stepping forward sooner. “I was in a leadership position, but I didn’t show leadership on this front,” he says, recalling a number of learner suicides during his days as a dean. “I still think about that.”
Still, Kirch is deeply grateful for the opportunity to have an impact now.
“People often tell me … that to have somebody like me be so open was enormously helpful,” he says. “It made them feel encouraged to seek help and press forward in their careers, and that is especially gratifying to hear from learners who have so much of their careers ahead of them.”
A surgeon steps forward
“This is terrifying.” Those were among the first words Carrie Cunningham, MD, uttered while standing before 2,000 of her peers in February 2023.
Cunningham was presenting her concluding remarks as president of the Association for Academic Surgery (AAS) — and she was revealing decades of depression and anxiety as well as a recent diagnosis of a substance use disorder.
“I know that giving this address today will change my career path,” said the Harvard School of Medicine associate professor. “There will be people who see me as weak, emotional, and damaged.”
But, she added through her tears, “If I can prevent one of you … from dying by suicide or suffering alone, it will be worth it.”
Cunningham, 50, had long been a powerhouse. As a teenager, she was a world-class tennis pro and competed at Wimbledon five times.
But at 17, Cunningham began to experience a depression that would return over the years — during the rigors of residency, for example. She plowed through anyway. “I’m one of the toughest people I know, so I figured I could handle this.”
When a dear friend and fellow surgical resident died by suicide in 2012, though, Cunningham knew she needed help. After being prescribed antidepressants, “It was like a huge weight lifted.”
The medication continued to help until Cunningham’s marriage ended in 2021 — she’d been “Dr. Lubitz” for decades but reverted to her maiden name after the divorce — and she began a year-long spiral into depression.
“I know that … there will be people who see me as weak, emotional, and damaged.”
Cunningham began drinking more, and after they witnessed her visibly drunk at a colleague’s party, friends finally decided to approach her boss.
“I was livid,” says Cunningham.
But that intervention began her healing process. With the help of her department leadership at Mass General Hospital, Cunningham soon connected with her state’s physician health program (PHP), the organization that provides confidential assessment and resources for providers’ mental health treatment.
Then, after in-depth psychiatric testing, she read the toughest sentence she had ever seen: “The assessment team is of the opinion that Dr. Lubitz is currently not fit to practice medicine.”
Cunningham voluntarily agreed to undergo three months of intensive treatment. She still takes a breathalyzer test three times daily, and she attends several therapy and support-group sessions every week.
Seeking help did not affect her medical license, and she returned to practice after the PHP cleared her.
“I’m the best I’ve ever been in my life, and I’m grateful to my friends for helping me get treatment,” she says.
Along the way Cunningham has learned many lessons, including one of her favorites, the notion that “self-care is a professional responsibility.”
Following her AAS remarks, listeners approached Cunningham to ask how they could help her. She says she had just one request: “Help each other.”
Stepping back from suicide
Christopher Veal had a plan. The second-year medical student would plow his car into a pole.
That would allow his family to think his death was an accident. They could easily believe that, since Burlington, where he was studying at the University of Vermont Larner College of Medicine, was thick with snow.
Veal had just come from a disturbing conversation with a medical school dean, having failed a remediation course he was required to take.
If he had to leave medical school, Veal worried, he would humiliate his family and possibly harm other young Black people’s chances of entering medicine.
“I was in such pain, I just wanted it to end,” recalls Veal, now a family medicine resident at Carle Foundation Hospital in Urbana, Illinois.
Instead, on that stormy night in 2018, Veal made a phone call. He contacted his godmother, a physician who had lost her own son to suicide. “She refused to hang up until I got home safely,” he recalls. That night, they decided he would take a medical leave of absence.
Veal soon began cognitive behavioral therapy, work that helped him reshape his darkest thoughts. After four months, he felt ready to return to school.
Looking back, Veal now believes numerous factors fueled his suicidal feelings.
As the only Black man in his class, he felt painfully isolated. He also felt disconnected from his family after having come out as gay, a fact some did not accept kindly. And ADHD made adjusting to medical school difficult.
In addition, Veal had suffered previously with untreated depression. “Where I was raised, therapy was for White people,” he says. “You were supposed to just push through the pain.”
Veal also bore a terrible fear of failure. “I grew up in an environment where failure can have dramatic consequences, like not being able to pay your rent or buy food,” he says.
“We need to recognize that vulnerabilities can make us more compassionate, and that compassion can help us improve the lives of our patients.”
Two years ago, Veal faced another turning point. After a fellow student died by suicide, Veal felt he had to shed his silence. He began asking around and found that other students felt intensely stressed. “It was a shared burden that no one was talking about,” he says.
So Veal shared his story in a powerful Academic Medicine essay. Since then, he’s been contacted by several students who said the piece helped when they were in a dark place.
Veal says his journey has highlighted the extent to which medicine is a culture where “vulnerabilities are considered liabilities,” and he urges leaders and learners to embrace a new vision. “We need to recognize that vulnerabilities can make us more compassionate, and that compassion can help us improve the lives of our patients.”
Caring for carers
Jessi Gold, MD, MS, had never gotten below an A in her entire life. But as an undergrad at the University of Pennsylvania, rigorous premed courses challenged her as never before.
“Getting a B was really hard for me, and people were saying you couldn’t get a B and continue on the path [to medicine],” recalls Gold, an assistant professor of psychiatry at the Washington University School of Medicine in St. Louis.
Gold, now 35, started skipping classes, hunkering down in her room, eating and sleeping more, and seeing friends less — a sure sign of trouble for the uber-extrovert.
Like many of her present-day patients — she mostly treats doctors — Gold at first thought she could handle her issues alone.
But then she began to worry about how her depressed mood might affect her grades, so Gold decided to seek help at the school clinic.
“They told me I wasn’t sick enough to get care there,” she says. “It was pretty invalidating.”
Gold finally got treatment during summer break, starting regular therapy sessions and antidepressants — and she has never stopped. “I am so grateful for this care. Life can get hard, and this helps me get through it more easily.”
Life certainly got harder during the pandemic, and Gold was beginning to burn out.
“I couldn’t stay awake after work, and I wasn’t answering texts or calls from friends,” says Gold. She also was feeling an outsized anger at work emails or presentation requests. “I felt I had nothing left to give.”
So she began monitoring her mood more, keeping a journal, and incorporating rituals to close out the workday instead of carrying its burden into the next one.
“I am so grateful for this care. Life can get hard, and this helps me get through it more easily.”
Gold has been fairly open about these and other aspects of her mental health journey — even writing about them on social media and in the popular press.
But she remained silent about taking medication. In 2020, for example, when other providers were revealing their medication use on Twitter, she shared only about therapy.
What was going on?, Gold wondered. “I realized that although I believed to my core what I told patients about medication, I had internalized a message that my taking medication meant a greater degree of illness.”
So she decided to disclose more. “I needed to tell [about medication] because I could see how far we have to go if someone like me who you’d think would be comfortable with this, is not.”
Gold acknowledges that sharing mental health details is not easy, but she notes that even small changes in the culture can make a big difference. “We can just say to someone, ‘Today was hard for me. What was it like for you?’”