The other day I came across this article, and it really made me think. A quick summary of the article– a medical student decided to be completely up-front in her med school application about her long struggles with depression, anxiety, and suicide attempts. She was accepted into a program and was lucky enough to be matched with a really understanding and compassionate advisor. However, she struggled pretty severely from the start, failing an exam in the first two weeks and having frequent panic attacks that prevented her from fully participating in the program. The school let her re-take exams she ran out of and decided to let her do her second year of coursework over two years instead of one.
I’ll admit, my first reaction to reading this was, “Shit, maybe she’s not cut out to be a doctor if she’s already having this much trouble in her first year of med school. I imagine the workload and stress is even greater down the road. How will she handle that??” This may seem like a judgmental reaction, especially coming from someone like me who should be more sensitive to these kinds of things, right? Well, I disagree. I’ve seen similar situations play out before, where someone with a mental illness claims to be a victim of discrimination when to me it doesn’t seem like discrimination. Medical school is very demanding and not everyone makes it through in one piece, mental illness or no mental illness. Residency and eventually working as a doctor (depending on the specialty) can be even more stressful and may require sacrificing sleep and working 70-80 hour weeks. That’s hard enough for a completely healthy person to handle, but for someone with a serious mental illness, it may be irresponsible or even impossible. To me, discrimination based on a mental illness would be if there were negative repercussions to a med student disclosing her mental illness despite there being no issues with her performance. When there are issues with performance, they should be addressed just like they are with any student. If standard protocol is to kick students out who routinely fail exams, then that should hold true for all students, even those who may have legitimate “reasons” for failing. The goal of med school is to prepare skillful and responsible doctors, right? If they’re not learning or retaining the material they shouldn’t be blindly passed through the system regardless if it’s because they have a mental illness or because they just don’t study.
Think of the consequences. You wouldn’t want someone with an active substance abuse problem performing surgery just the same as you wouldn’t want an actively suicidal person counseling depressed individuals. I am all for people with mental illness following their dreams and not letting their issues hold them back in life. I also think there is a time and place for accommodations to be made. It may take someone extra time to finish school because they’re getting intensive treatment for their condition, and in many fields, this is not a problem. Likewise, some career fields may allow more room for error than something like medicine, so setting the bar lower for certain students may make more sense.
As much as I often struggled in school and other areas of life due to mental illness, I never wanted anyone to give me special treatment or expect any less from me. When I first decided to major in psychology as a college freshman, my ultimate goal was to become a therapist who treats eating disorders (so original, I know). However, I soon realized this was not a good option for me. There are some people who can make this work and end up being better therapists because of their experiences. Others end up being really bad therapists because they either can’t handle working with the ED population without falling back into it themselves, or they unintentionally trigger their clients by displaying signs of their own struggles that they may not even be aware of. As much as I wanted to believe I could be that first type of therapist, I had to be honest with myself. I know firsthand how perceptive and easily affected clients are when it comes to their therapists. Even being where I am now, I still wouldn’t completely trust myself to work with ED clients without unintentionally triggering them in some way. I also wouldn’t completely trust myself to work with that population without being triggered or negatively impacted by my clients. I am so glad I realized this early on, and that I wasn’t too proud to admit it. All my non-existent clients from my alternate future thank me for this too, I’m sure.
I mentioned this because I think so often we want to believe that anyone is capable of anything– that we have to support everyone in their chosen life path because “anyone can do anything they set their mind to.” That’s kind of crap though, isn’t it? Someone with a serious mental illness may not be cut out for medical school, and admitting this shouldn’t automatically be seen as discrimination. No one is saying that person can’t be successful in any number of other career paths, they’re just saying that maybe, just maybe, medicine isn’t the ideal path, for the person’s own sake and the sake of their nonexistent future patients. I can think of several therapists who I wish had been told this at some point– “Hey ______, we get that you really want to help people and you have the best of intentions, but maybe this isn’t the ideal career for you?”
I also wanted to touch on the subject of disclosing mental illness in a professional environment, whether that be in school, work, etc. As I said before I think in general people should feel more comfortable speaking up about their struggles. That said, this should be done with much thought and consideration into all the possible outcomes. Opening up about my eating disorder to people at work was not a decision I made on a whim. I waited until I had been there for nearly two years and was pretty sure no one was going to hold it against me or treat me differently as a result. I also made sure I was in a place where I could confidently say that my eating disorder in no way negatively affects my work or my ability to do my job. This is just my opinion, but I think it’s always best not to state these things upfront before people have gotten a chance to know you. When I was applying to grad schools, I was advised not to talk about my past in my applications, because that’s the first thing they’d associate me with and it may very well work against me. Just the same, I didn’t walk into work on my first day and announce, “Hey guys, I’m kind of crazy!” I waited until I had established myself as reliable, competent, and hardworking employee and until I was confident they were a safe audience.
At the end of the day, the main thing a school or employer should be concerned with is whether or not you can succeed in the program, or the job. If you can– awesome! The fact that you spent more time in the psych ward with your psych ward buddies than with your school-aged peers should be irrelevant. If you can’t succeed at the job, well, you should be treated just like the lazy slacker down the hall who can’t succeed at the job. It just isn’t for you, at least not at this time. Is this harsh? I don’t know, but I’m putting it out there.
Finally, I want to make it clear that I know very little about the woman in the article I linked to, other than what she revealed in the article. She may very well be “cut out for” a career in medicine and my suggesting she may not be was merely to illustrate a point in the larger context of things. Her story was just a jumping off point for this blog. 😉