I joke that I chose psychiatry because I wanted to be a doctor but am bad at science and dislike touching people.
In truth, nothing is more compelling to me than the chance to relieve the suffering of a tortured mind.
Psychiatry, however, has always been the stepchild of medicine, and psychiatrists the oddball cousins. In medicine’s hierarchy, where surgeons believe a chance to cut is a chance to cure and cardiology is king, we’re accustomed to being misunderstood.
Nowhere is the gulf between psychiatry and the rest of medicine starker than in the COVID-19 response. As hospitals redeploy physicians outside their specialties to meet patient surges, few efforts have included psychiatrists.
One reason is that psychiatrists have not experienced the decreased patient volumes plaguing other areas of medicine. It’s possible to postpone a knee replacement, but a psychotic break heeds no calendar.
Our business is booming. As a recent American Psychiatric Association poll revealed, many Americans worry about themselves or a loved one getting coronavirus; one-third reported the virus negatively affecting their mental health.
Excluding psychiatrists from the COVID-19 response, however, reflects something beyond our practices remaining full. Admittedly, we are unaccustomed to providing hands-on medical care. My anesthesiologist partner observed: “If you were faced with a malfunctioning vent, you would probably try to encourage it to want to fix itself.”
While psychiatrists have less to offer patients struggling to breathe, we have a critical role to play in supporting COVID-19’s other victims: our physician peers. And the characteristics differentiating us from our colleagues are precisely those required to navigate moral complexity and manage the feelings of helplessness and distress that are as much symptoms of coronavirus as fever and cough.
Pre-pandemic, half of physicians experienced burnout, a syndrome associated with anxiety, substance misuse and depression. Yet doctors are reluctant to seek mental health treatment, citing concerns about stigma, confidentiality, lack of time and fear of discrimination in licensing.
As the pandemic drags on, uncertainty, loss of control, and worries about personal safety and infecting loved ones contribute to unprecedented levels of physician distress. A study from Wuhan, China, found that 70% of health care workers directly involved in the coronavirus response reported depression, anxiety and insomnia.
Doctors already take their own lives at staggering rates: male physicians 40% higher and female physicians 130% higher than the general public. In April, Lorna Breen, an emergency medicine physician treating COVID patients in Manhattan, took her life. Her family created a foundation to foster “a world where seeking mental health services is universally viewed as a sign of strength for health care professionals.”
Such a shift in physician attitudes can’t come soon enough. Perfectionism, combining high standards and self-criticism is endemic in medicine. Stoicism is encouraged. Doctors are comfortable being in charge, but they don’t do self-compassion. Nothing in medical training prepares physicians to ration ventilators.
Psychiatrists, however, are accustomed to scarcity. While 1 in 5 Americans experiences mental illness, two-thirds receive no mental health services. We have minimal objective data, limited lab tests and few procedures. Our main tools are Kleenex, a prescription pad and tincture of time. Psychiatrists learn early to abandon rescue fantasies and understand that even the best among us will lose patients to suicide.
Most importantly, psychiatrists acknowledge emotions. Uncomfortable feelings are the currency of our trade, providing essential data about our patients’ limitations as well as our own. During residency training I was taught to pay attention to my feelings and to never worry alone.
So here I am, sharing my fears.
I worry that my colleagues caring for coronavirus patients will become its next victims, casualties of their unwavering sense of duty, a broken health care system and incoherent national leadership.
I worry that our surviving physicians will suffer complex trauma. First, in their powerlessness to save patients. Second, by experiencing this as personal failure instead of the result of scarce resources and a disorganized pandemic response.
Most of all, I worry that the doctors currently lauded as heroes will be neglected once the crisis is over, left to manage their post-traumatic stress disorders and depression the same way our military veterans do — alone and frequently ashamed.
So here is my plea to my physician colleagues: During this pandemic, we psychiatrists have more to offer than comic relief.
We are here. We see you.
We never worry alone. Neither should you.
Elizabeth M. LaRusso is medical director, Department of Psychiatry, Abbott Northwestern Hospital.
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