Most cardiologists view themselves as strong, hardened clinicians with a broad knowledge-base, alongside (sometimes very) specialist expertise. As clinicians we are seen to embody the quintessential type A stereotype, impervious to most emotional traumas, managing and coping with frequent, both sudden and slow, demises and challenging, complex and often time-pressured, scenarios.
I am no stranger to the demands of a profession that requires precision, composure, and resilience. Yet, behind the façade of clinical and academic competence, lies a reality that many of us, including myself, are reluctant to confront: the personal and professional toll that psychiatric illness can take on physicians.
Stigma
Despite rigorous training, doctors are not immune to the same mental health struggles that affect those we treat, much as we might like to pretend otherwise. And when these struggles arise, the stigma within our own profession makes addressing them, or even acknowledging them, far more challenging than it should be.
I first experienced psychological distress after completing MRCP, though I did not understand what was happening and confided in no one. I now appreciate I was experiencing flashbacks of childhood abuse, and, though I sought help from a therapist, it was short-lived. Being a doctor provided an integral structure to who I was, and a positive vision of what my life comprised; I was not ready to jeopardise that by unleashing inner turmoil. Work provided a haven to hide from the potential horrors lying beneath my conscious reach, and it was the priority for me – I didn’t go back to therapy and ploughed headlong into higher training instead, re-burying my past.
I managed my symptoms quietly, compartmentalising them as best I could, pushing through the insomnia, the anxiety, the nightmares. I believed that admitting to any form of psychological frailty would undermine my credibility and, specifically, the sense of self being a doctor provided. It became harder to block things out, so I started to calorie restrict to help reinforce it. As with my career, I was successful at this; however, it soon became difficult to hide. I finally sought help and stuck with it.
The rigours of medical training allowed me to escape my past and develop a perception of who I was that did not include what happened to me many years prior. I needed to be strong to sustain this; psychological weakness was not to be tolerated, and the career and speciality that I chose presented the environment that supported and enhanced this belief. It made the therapy process agonisingly slow for my therapist, and for years I kept the fact I was seeing him entirely secret – even from close friends. I was terrified and felt like an utter failure the first time he strongly encouraged me to see a psychiatrist. After many challenging therapeutic years, I finally told my GP what happened to me as a child.
I achieved and maintain a high-level consultant appointment, but have only very recently been a little more open with colleagues about my mental health issues. Decades after my first symptoms, I received a diagnosis of complex post-traumatic stress disorder (PTSD) and have finally acquiesced to psychiatric medication.
Attitude change
The need to hide within my training for psychological respite shaped my life and who I am as a doctor. It took me an incredibly long time to accept help and support from those in a position to do so. Environments that foster an intolerance to physician vulnerability will not allow for the development of self-compassion and safety – this must be learned separately and is no easy task. Psychiatric illness is not a failure of willpower or a reflection of one’s competence, though this has taken me a long time to understand and accept. It is a condition that demands the same compassion, understanding, and treatment we afford our patients.
Sadly, since being a little more open at work, it has been my experience that the challenges I have faced are perceived as a limitation, despite holding a successful and high-functioning role. I have felt questioned in my ability to handle responsibility and stress, largely overlooking my achievements and the value of lived experience in promoting empathy and resilience. I believe overcoming mental health challenges can be a source of strength and leadership, not a barrier.
As I continue my personal and professional journey, I have come to realise that strength is not defined by the ability to suppress vulnerability, but by the courage to confront it. My experiences have deepened my empathy for both my patients and my colleagues; every one of us is human, subject to the same struggles that we often treat in others. We need to foster environments where mental health is openly discussed, where colleagues are encouraged to seek help without fear of judgment, and where our experiences with adversity are seen as sources of wisdom, rather than weakness. Ultimately, I believe that creating space for vulnerability will allow us to become better doctors – and better people.
Conflicts of interest
None declared.
Funding
None.
Editors’ note
The editors confirm that this article has been submitted by a consultant psychiatrist on behalf of the anonymised author, who will act as its guarantor.
