by Sara Solovitch
Winter 2007, Volume 3, Number 1
One morning when she was 27, Suzanne Vogel-Scibilia,
MD, went to work, a young, up-and coming
resident psychiatrist at a major Pittsburgh hospital and left, hours
later, as a person with bipolar disorder.
The diagnosis-her own and later confirmed-took place
as she was routinely questioning a distraught patient who after
spraying her neighbor vvith a hose, had been brought into the
emergency room by police.
How much sleep had the
woman been getting, Dr. Vogel-Scibilia asked. "Not much," she
answered. "Maybe a couple hours a night."
And I'm thinking, me too.
How about food? Was she eating?
"Oh, I had some dinner last
night," the woman responded. "I wasn't very hungry."
And I'm thinking,
that's interesting. Same as me.
Was she under stress?
"Sure," the woman said. "But you know what's really annoying me?
They're talking about me on the PA system."
And at that moment, I
could hear the PA system and they're not talking about her.
They're talking about me. And I'm not hearing a damn word
this woman is saying. I'm just thinking. 'What diagnosis does this
woman have? Bipolar?' Oh my god! Suzanne, you've got biPolar
Dr. Vogel-Scibilia was
convinced that her diagnosis-which she now traces back to age 15,
the first time she attempted suicide-would mark the end of her
The medical profession
doesn't look kindly on mental illness within its ranks. Michael
Myers, MD, clinical professor of psychiatry at the
University of British Columbia, Vancouver, British Columbia. and
former president of the Canadian Psychiatric Association, argues
that the stigma attached to mental illness is greater in medicine
than anywhere else. Worst of all, he says, are psychiatrists who
suffer from "internalized stigma."
'Just because we've trained
in psychiatry doesn't mean we've purged ourselves of out-dated and
discriminatory attitudes," says Dr. Myers.
"I've looked after
psychiatrists who feel dreadful-some actually say they feel
fraudulent-that they are taking care of depressed people when they
themselves are on antidepressants. I say, 'Hold on a minute, I'm
sure there's an endocrinologist out there who has diabetes.'"
Research shows that doctors
in general are at greater risk of depression, mood disorders, and
suicide than other professionals. "Psychiatrists commit suicide at
rates about twice" the rate of other physicians, according to a 1980
study by the American Psychiatric Association, which found that "the
occurrence of suicide by psychiatrists is quite constant
year-to-year, indicating a relatively stable oversupply of depressed
"It's an oversimplification
to say it's all due to the stress and strain of practicing
medicine," cautions Dr. Myers, a specialist in physician mental
health. "It's more to do with who we are: Many of us in medicine are
wounded healers.We're interested in practicing medicine precisely
because we come from families with problems."
Higher rates of family
dysfunction, parental alcoholism, sexual and physical abuse,
parental death, and psychiatric hospitalization were reported among
female psychotherapists than in other women professionals in a 1993
study in the journal Professional Psychology, confirming
the image of wounded healers.
Continues Dr. Myers:
"Coupled with that, there are certain personality traits among
people who become doctors. 'We're perfectionistic; you have to be if
you want to practice proper medicine. And people who are that way
are hard on themselves."
Yet the stigma of mental
health continues to create what he and others haye called "a
conspiracy of silence" among doctors-psychiatrists in
By her last year of
college, Beth Baxter, MD, "knew" there was "something wrong" with
her brain; during the previous four years. the top student and class
president had routinely slept only four hours a night. She would
enter the cafeteria only during off-hours, eating peanut butter
sandwiches day after day, just to avoid running into her classmates.
She fought suicidal urges and had already made several half-hearted
In her second year of
medical school at Vanderbilt University, she became convinced that
the songs being played on the radio were carrying messages to her.
Her grades began to slip for the first time, so she took a break and
visited her grandparents' cattle ranch in Texas. While there, she
went missing. She left on an imagined meeting with friends and
followed some "messages" on the radio. Found wandering a day later,
she was picked up by police on the side of a highway.
So began Dr. Baxter's first
hospitalization when she was diagnosed as having bipolar disorder.
She managed to return and graduate from medical school, hiring a
tutor to talk through all of her class notes.
She was accepted into an
internship in internal medicine in Memphis, Tennessee. "They
accepted me before they knew I had bipolar disorder," she recalls.
"The dean of students told them I'd had counseling, but it wasn't
fully explained, and they were kind of angry when they found out." A
year later when she transferred to Rochester, New York, she changed
special ties. "Because," she says, "I knew how much good a
psychiatrist could do and I wanted to do that for somebody
After her residency, her
symptoms worsened: she became increasingly depressed and suicidal;
she tried to slash her neck and had to return to her hometown of
Nashville, Tennessee, where she was hospitalized for a year and the
doctors told her parents that the most she could expect was to work
on an assembly line. And the diagnosis had now changed to
schizophrenic affective disorder.
"I was a pretty sorry
sight," she recalls. ''I'd lost 70 pounds and I had a movement
disorder - jerky hands and feet."
By this time, however, her
parents had become active in the local chapter of NAMI (National
Alliance on Mental Illness). When the local NAMI officers learned
that a doctor was hospitalized in Nashville, they approached her
with a request: would she write an educational training program for
people who have mental illnesses? Baxter completed the project while
she was still on suicide watch.
Little by little she began
to come back. "A psychiatrist there had a lot of hope in me," she
says, "and that hope was really important."
Dr. Baxter is still on
medication; the last time she was hospitalized was in 2000, when a
prescription change failed to work. But today, she runs a large
private practice in Nashville, where - just as in medical school,
when she hired a tutor she now retains an older and more
experienced psychiatrist "to help me talk through my cases and
review how they're going."
She talks about her
experiences openly, addressing NAMI workshops around the country,
speaking at physician conferences, and often sharing her story with
patients - "to show that you can recover from serious problems in
She is famous around town
for giving away little clay turtles from Guatemala: she sees turtles
as a symbol of perseverance and determination, and has hundreds of
clay, plastic, and ceramic turtles throughout her house.
Openness, for Dr. Baxter,
was hardly a matter of choice: her medical history made disclosure
an all too obvious decision. "But I still think it's good when
people know," she says. "Then, when I got sick and bad things
happened, they were more compassionate."
Dealing with BP in
Mental Health Awareness
Week in Canada features an annual campaign called the Four Faces of
Mental Health. It's a way of putting a human face on conditions,
such as bipolar disorder, schizophrenia, and depression. For the
first time last year, one of the four faces was a doctor.
"I had to convince myself
to do it," concedes Michael Pare, MD, a Toronto, Ontario, general
practice psychotherapist. ''I'm always telling my depressed patients
that they don't have to feel ashamed: They're not bad; they're not
crazy; they're not weak. But doctors - while we're taught to say
that - are not actually following through and admitting it. If it
[mental illness] isn't our fault, then why is it so bad to stand up
and be counted?"
After a "very, very
difficult childhood," Dr. Pare sunk into a major depression in his
mid 20s. "Literally, every day was like a terror, like being alive
was the worst possible thing," he says. "It's impossible for me to
remember the feeling, but I do remember my knowledge of it. Like
when I opened my eyes in the morning, it was like, 'Oh no, I'm still
He swallowed a lot of pills
one day and fell into a coma for a week, recovering only after
undergoing a lumbar puncture, or spinal tap.
A few years ago, Dr. Pare
was invited to address a large group of psychiatrists on the subject
of depression. It was a professional talk, but at the end, he
impulsively made mention of his own experience.
"I said, 'Interestingly
enough, I've suffered from major depression.' And there was no
reaction. No one came up to me after the talk. I thought I was
dropping a bomb, but not one person acknowledged it. And these were
psychiatrists who work with depression every day."
Despite his own candor, Dr.
Pare typically counsels young doctors against disclosing any history
of mental illness at the beginning of their careers. Most young
doctors don't need to be told. Consider the case of M., a
24-year-old California woman diagnosed as having bipolar disorder
dming her second year of medical school in Lebanon. She is so
fearful of one day being denied a medical license that she refuses
to see a psychiatrist now that she is back in the U.S.
Instead, she orders her
medications online. They cost $400 a month and they're generic, but
they have one overriding advantage: they arrive unmarked from India
"1' d go to any lengths to
have my medication," she says. "If I go to a psychiatrist here, my
whole future is ruined everything I worked for. There are
always questions on the residency or licensing applications - do you
have a medical condition? That's why it's so important to keep it to
That fear is widespread. A
2001 survey of Michigan psychiatrists found that half of them would
rather self-treat than risk having a history of mental illness on
their health insurance record.
And with good reason,
according to psychiatrists who point to the widely publicized case
of Steven Miles, MD, whose own bipolar disclosure turned into a
In 1994, Dr. Miles, a
well-respected gerontologist and professor of biomedical ethics at
the University of Minnesota Medical School, had sought help for
depression from a psychiatrist who diagnosed bipolar disorder II.
After a few weeks on medication - and with no interruption in his
teaching or clinical work - Miles began to recover.
But several months later,
on filling out the annual renewal form for his state medical
license, he answered the questionnaire affirmatively when asked if
he had ever been diagnosed with or treated for manic depression,
schizophrenia, compulsive gambling, or other psychiatric
Though he had never been
the subject of a patient's complaint, and though his name appeared
regularly on lists of the state's "Top 100 doctors," the Minnesota
Board of Medical Practice began an investigation, demanding a letter
from his psychiatrist and full access to the records of his
Dr. Miles refused, and for
the next four years he fought the board, arguing that its policy was
overly invasive and served to deter physicians from seeking help for
mental health disorders. After a protracted standoff and threats of
legal action, the licensing board eventually changed its policy.
Today, many state licensing
boards have adopted similar changes, but there is no consistent
state-to-state policy. Nor is there any specific system for
physician health care in the U.S.; the only health programs aimed at
doctors are those restricted to drug and alcohol treatment.
In Canada, a physician
wellness program has been set up in every province; its directors
have joined to create a federal network, Canadian Physician Health
Network, to share information and strategies. Under this system, a
doctor who has bipolar disorder, for example, can be assisted and
will be monitored at least three to five years, after which - if he
or she is deemed stable - the monitoring is decreased or even
Here's how it works for
one Toronto doctor, a 41-year-old resident psychiatrist who last
year was diagnosed as having bipolar disorder. A, as he asked to be
identified, was someone who didn't "do" just residency. He
simultaneously created a banking project for residents, invested
$8,000 of his own money into a biotech company, organized a
charitable organization for autism, conducted research into
schizophrenia, and juggled a series of home renovation projects.
"I always have to
self-monitor to slow down," he explains ruefully, "because the rest
of the world doesn't operate as fast as my world does."
Then last year, everything
crashed. "A secretary made a note saying I was speaking too fast,
had taken time off from work, and that I'd asked for a referral to a
psychiatrist. And suddenly, there's this note going around saying I
have bipolar disorder - and no one had even diagnosed me at the
After a letter was sent off
to the Ontario College of Physicians and Surgeons, the
self-regulating body for the province's medical profession, A's
first instinct was to fight.
"I don't want to be labeled
just because I'm outside the box," he says. "No way in hell was I
going to have a label like that. I didn't want someone labeling my
enthusiasm - even though I realized some of my experiences were
His psychiatrist reassured
him, however, that he was not alone, that other physicians had
similar problems, and that the system's checks and balances would
allow him to continue in his career.
"I thought that was a bunch
of hogwash," A says. "All my faculties are based on my judgment and
if that's taken away from me how can I practice when people's lives
are dependent on my judgment?"
That insight doesn't always
mitigate the irritating presence of the system's checks and
balances. To A they feel like an albatross, like he's being
"I have to inform my
program director that I have an illness," says A, checking off the
list. And everything I say to my psychiatrist becomes open to the
College of Physicians and Surgeons. They want me to see a mood
disorder specialist. I have a case manager to keep an eye on me and
make sure I'm functioning on all cylinders.
"I also have the people who
'supervise' me at work," A continues. "So all these eyes are on me.
It feels like I'm being policed even though I'm not being
The choice is no longer
his. His behavior had become so erratic that he could no longer deny
his problems by working harder and plugging in the answers that he
knew would get him off the hook with his fellow psychiatrists.
"With our specialized
training we may be able to rationalize or deny our symptoms," says
Mamta Gautam, MD, an Ottawa, Ontario, psychiatrist who restricts her
practice to physicians.
"And, a doctor's ability to
function at work is often the very last thing to go. In fact, you
see that most people don't have any idea that a colleague is
struggling, because if anything they're more productive than before.
When, really, it's just a mechanism - to keep working and stay with
what's known rather than stop and reflect."
Coping and Reaching
Long before Dr.
Vogel-Scibilia examined the patient who had bipolar and saw herself
reflected back, she had figured out ways of adapting to her seasonal
mood swings. Anticipating depression in winter, she scheduled her
most challenging coursework for the fall.
'I'd do the research, pick
the cards, and do the bibliography," she says, "so if I had to write
the paper I'd just have to write the text out. I would try to
compensate for things, study stuff in advance."
Now a practicing clinical
psychiatrist in Beaver, Pennsylvania, she operates an independent
mental health clinic and serves as clinical assistant professor at
Western Psychiatric Institute, the same hospital where she did her
residency and diagnosed herself.
Today, she is president of
NAMI at the national level and a consultant for psychopharmacology
projects at the National Institute of Mental Health and is a grant
reviewer for the federal government.
But at least once a week,
she gets a call from a young medical student or resident doctor -
usually, she says, it's a psychiatric resident secretly struggling
v.rith mental illness. Some of them offer to fly or drive long
distances for a consultation.
"I have this theory," she
says. "If you were a patient before you were a doctor you don't have
so much trouble being in a patient role. But if you've been the
doctor first and then you get sick, you have a hell of a hard time
being a patient.
"You could do a study
[about physicians having mental illnesses], but there'd be no
sample, because nobody would agree to be interviewed. Actually I
could just poll my friends. The trouble is it wouldn't be a random
sample. It would be the friends of Suzanne."
Sara Solovitch also
wrote "People Like Me, " which appeared in the Summer issue of bp