The Doctor and His Quiet Depression

Reblogged from the New England Medical Journal; article By Michael S. Weinstein, M.D., M.B.E.

• • •

One might have predicted my fall. I have had depression and dysthymia since my teen years. When I was a third-year resident with increasing operative independence, a couple of surgical complications threw me into a funk. I convinced myself that I shouldn’t be a surgeon. I wasn’t good enough, technically or cognitively. I didn’t have the fortitude. I was a fake.

“Enduring is not thriving.”

I didn’t know what to do with these feelings. I didn’t believe anyone around me had similar thoughts. I didn’t know how to talk to my coresidents or faculty about medical mistakes and the accompanying self-flagellation. I don’t remember anyone talking about such issues back then.

Outside observers might have perceived me as “having it all”: a surgeon with leadership promise, with an amazing wife and two great kids, who’s paid more than I ever expected to earn.

But enduring is not thriving. I had heard of burnout but didn’t really comprehend it. And though I had mental illness, I still saw it as a weakness, a personal fault. I remember early in my career hearing of a colleague who took a leave of absence for a “nervous breakdown.” I joked about it, said he was weak. Now it was my turn.

You would not be reading this today were it not for the love of my wife, my children, my mother and sister, and so many others, including the guards and doctors who “locked me up” against my will. They kept me from crossing into the abyss.

My work lost meaning; I was just going through the motions. I thought everything I tried to accomplish was a failure. I had trouble relating to patients and felt the urge to avoid encounters altogether. I cared less and less about anything I was doing. I didn’t know it then, but I had long experienced classic signs of burnout: emotional exhaustion, depersonalization, and low perceived personal achievement. But the burnout had been waxing and waning for 22 years; now I was in the worst episode of major depression of my life.

You would not be reading this today were it not for the love of my wife, my children, my mother and sister, and so many others, including the guards and doctors who “locked me up” against my will. They kept me from crossing into the abyss.

Photos by Masa Israel Journey and Adrian Clark


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