The Gift of Self-Disclosure

This piece is a salute to Dr. Quinn Leslie, a resident in Emergency Medicine, who has written a moving article about her hospitalization for bipolar illness during medical school. She describes the frightening symptoms of her mixed mood state, her involuntary hospitalization, her treatment with medication and psychotherapy and—most tellingly—the sense of shame and fearful loss of her dream of becoming a physician. Dr. Leslie explains her struggle with that ubiquitous trait in all of us —perfectionism—and how she has come to accept being “good enough.” Like most doctors who have been laid low by a psychiatric illness and are now well, she recounts how she has grown as a person and has become a more empathic physician.

Let me explain why I consider Dr. Leslie’s revelatory story a gift. First, this is a present to herself. By making such a public disclosure, she has freed herself from the shackles of self castigation, judgment, and tarnished self regard. She is popping the lid on a secret, and secrets are often about things that we beat ourselves up about. It is a measure of self-acceptance and worthiness. It is a volley against internalized stigma—that interior sense of self-discrimination and disgrace about living with a mental illness—a societal blemish worldwide, but especially so in doctors.

Second, this is a gift to her residency program, a program that she thanks under Additional Contributions at the end of the article. It is heartwarming to know that she is a resident in a university setting that cares personally about their trainees. All residents deserve this, but unfortunately not all residents in this country receive this. I was reminded of the love and encouragement that Dr. Kay Redfield Jamison received by her Chair at Johns Hopkins Medical Center when she made the brave decision to write openly about her bipolar illness.

Third, her story is a gift to all physicians. Like other doctors before her who have “come out of the closet” with their personal accounts of living with a psychiatric illness, her words will guide and light the way for those unnamed medical students and physicians who are struggling alone and privately. I know this first hand. For over a dozen years, Dr. Leah Dickstein (Professor Emerita University of Louisville) and I co-facilitated a workshop (initially with the National Alliance on Mental Illness) at the annual spring meeting of the American Psychiatric Association with the generic title “Psychiatrists Living With a Psychiatric Illness: Their Stories.” Each year four psychiatrists, including residents, would share their personal experiences and challenges with self-acceptance, healing, colleagues’ reactions, conflicts with licensing boards and insurance carriers, statements of loss, and resilience. The take home message was always the same—you are not alone and you must walk with dignity.

Fourth, Dr. Leslie’s story is a gift to all of us in the mental health field. We work in a stigmatized branch of medicine. Whenever someone writes openly about living with a psychiatric illness, in this case bipolar disorder, I believe that societal stigma is diminished ever so slightly. In essence, the world is being told something that we know but many don’t, that these diseases are no different than cancer and heart disease, and that our treatments work.

Finally, this is a huge gift to those of us in the physician health movement. We have yet another courageous story for our tool box, one that we can share in the clinical setting, with that frightened new patient before us: the sobbing medical student who is terrified of what his illness might mean; the self-conscious resident who feels totally alone with her eating disorder; the early career anesthesiologist facing residential treatment for fentanyl abuse; and the aging internist struggling to accept his crippling yet fully treatable major depressive disorder.

Please take the time to read Dr. Leslie’s story in the January 2015 issue of JAMA.

Thank you Dr. Leslie!

 References 

1. Leslie Q. Take a look at me now. A Piece of My Mind. JAMA 2015;313,Number 2: 137-138
2. Jamison KR. Nothing Was the Same: A Memoir. Knopf. New York. 2009
3. Nuland SB. Lost in America: A Journey With My Father. Knopf. New York. 2003
4. Cournos F. City of One: A Memoir. WW Norton & Company. New York. 1999
5. Miles SH. A Challenge to Licensing Boards: The Stigma of Mental Illness. JAMA 1998;280:865
6. NAMI 2007 Convention. An Interview with Suzanne Vogel-Scibilia.
7. Baxter EA. Personal accounts: the turn of the tide. Psychiatric Services 1998;49:1297-1298

Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.