Should Doctors Voice Their Own Mental Illness Publicly?
Another Sensible Medicine debate
This debate stems from a long running conversation between Vinay and Adam. The conversation was provoked by tweets in which doctors shared their mental health struggles. We have seen tweets about anxiety disorders, suicide attempts, and psychiatric drug dosing. What underlies the conversation is a simple question: Should Doctors Voice Their Own Mental Illness?
Here Adam takes the “No” side of the debate while Vinay takes the “Yes” side. We note that we debate for enjoyment, and may not necessarily agree with the positions we were assigned to defend.
Finally, we are trying something new. Vote before and after reading the arguments and the winner will be the person who CHANGES the most opinions
Adam goes first:
Doctors should NOT voice their own mental illnesses publicly.
Someday, people will treat medical and mental illness the same way. We will see no difference between hypertension and depression. Patients will be as comfortable receiving a prescription for sertraline as they are for chlorthalidone. Employers will not hesitate to hire an applicant they discover has been hospitalized for 2 weeks with community acquired pneumonia or after a suicide attempt. Patients will be as comfortable visiting a doctor who walks with a cane as one who discusses her lithium dosage on twitter.
Unfortunately, we are not there yet.
I admire doctors who are open about their mental health struggles. I tend to assume that they do so because they are comfortable with their illness, accustomed to sharing online, and – maybe -- working to make the world more accepting of mental health struggles.
I am just not sure it is a good idea.
I know that many people, unfairly and wrongly, see mental health issues as completely distinct from physical struggles. I think many patients would be uncomfortable finding out that their doctor is being treated for anxiety, depression, OCD, or ADHD. As doctors, our primary responsibility is to make our patients, as many of them as possible, feel comfortable seeing us. I don’t think sharing our mental struggles helps with this.
I also fear the impact on the careers of younger doctors – those that share this information tend to be overwhelming (much) younger than me. If faced with two equally qualified applicants, it is unlikely that future employers would choose the one who publicizes their mental health struggles. Maybe this is not how the world should be, but it is how the world is.
None of this is to say that doctors should hide their mental health issues. Doctors need to be upfront about issues with their doctors and some well-chosen friends and colleagues. I am convinced this will make for a healthier workplace. It will also, probably, make things safer for patients. When doctors have a temporary physical disability, it is usually clear to everyone. If a surgeon arrives with both wrists in casts after a weekend fall off of a bicycle, having made the senseless decision that she remains well enough to operate, her colleagues will call her on it. If an internist continues to work through a severe depression, unable to concentrate, perhaps without the insight to know there is something wrong (anosognosia), the problem may be missed by his colleagues.
Our atavistic and counterproductive view of mental health needs to change. Maybe the way to instigate change is for doctors to share their ills on Twitter/X/TikTok/Threads. I don’t think so.
And now Vinay:
Doctors should (publicly) voice their own mental illnesses.
I recently saw this on X:
I didn’t ‘Lol’.
I have been assigned the position of arguing: doctors should be open about their mental health, and you may expect me to argue: the more doctors admit that we are people too— subject to the same anxiety, depression, and even suicidality— we normalize these health concerns, permitting patients to be open and seek care.
Unfortunately, I can’t say this because there is no evidence to support it. I offer a different argument.
Patients have a hard time picking a doc. Recently a friend saw a doc at *big name university* and said, “she must be good b/c she works there.” This time, I did lol.
Nothing could be further from the truth. US News and World Report hospital rankings don’t tell you who is a good doctor. Word of mouth has no empirical validation. Yelp reviews are a disaster. The bitter reality is patients choose doctors at random— it is only chance when they click. So…
Doctors should be more open about their mental health because that allows patients to seek care if they want a doctor open about mental health.
On social media, doctors can reveal an appetite to analyze research (like Sensible Medicine writers), broadcast their mental health struggles, or even dance, supposedly a form of education.
(Editor’s Note: I would have mentioned in the dancing video that we have little idea how much benefit comes from treatment before vs. after, and these trials are designed by Pharma to maximize profit and not answer that vital question. This has been called contribution of component. We have ongoing research on the topic).
If you think you will click with a cancer doctor who dances to NSYNC, if you prefer a doc who open about mental health, or if you want a doc who critically appraises data— you know where to go.
If you see Oliver Sacks, you know he may betray your confidence and write about you. That’s better than not knowing. What doctors voluntarily admit online has to be better than picking at random.
I have never and will never make public details of my personal life, but I have written volumes about health policy and trials. If I felt seeing a PCP was useful (I’m not sure), I want a doc like me. If I need a pediatrician, I want one who doesn’t recommend a COVID booster for a toddler who had COVID— for e.g— so I appreciate if they tweeted about it, as I know who to avoid.
There are many people, growing larger by the day, who actually do want a doctor open about their mental health. So doctors, be vocal, tell your patients what you think they should know about you. I believe it will lead to a better fit between doctor and patient. It certainly can’t be any worse than the status quo.
Now after reading, vote again.
Photo by Bhong Bahala
From a psychiatrist’s viewpoint:
Transference happens in every relationship. In psychotherapy it is used therapeutically to promote change.
So, what is it? It is a series of assumptions about the other person based on prior experience with others, particularly the experiences with one’s parents or other authority figures.
There are negative transferences which generally means the patient doesn’t stick around for the full course of treatment.
If you let a patient know much about your conditions or worse, you confess to certain facts about your personal life, it may unburden you but it will burden them. They will make adjustments to what they tell you based on their experience with that other person(s) and what they now think they know about you.
The “House of God” rule # 4 applies here: “The patient is the one with the disease.”
They will find your feet of clay, anyway, without you showing your feet.
Positive transferences include trust, and if the majority of the patient’s experiences were with trustworthy authoritarian figures, then that trust will automatically be transferred to you. If those figures didn’t lie a lot, then they’ll generally believe you are telling the truth. They’ll even forgive you a lie or a misrepresentation if your other behavior is trustworthy.
If you introduce more reality than they can glean from your office, your clothes and your car, it can cause more difficulties.
They will automatically adjust their behavior to suit whatever it is that they believe about you.
If you want to assure a pt. about the efficacy of, say, an antidepressant, it’s better to say, “Studies have shown. . . “ or “Several patients of mine have reacted well to . . . “ than to say, “This antidepressant really works! It helped my depression!”
Also, no matter how well that antidepressant worked for you, other people can respond differently with different side effect profiles.
I voted undecided on both. I am an old school patient AND therapist - and I go by one rule and one rule only when it comes to self-disclosure.
If self disclosure truly helps a patient, self disclose. If it’s helping YOU, then keep your mouth shut, take care of your patient, and go see your therapist.