This is the second part of our series with NPR about mental health and generation gaps.
When Giselle applied to medical school she decided to be completely open about her experience with mental health: depression, anxiety and a suicide attempt when she was 16 years old.
She’s not alone—roughly 300 physicians in America commit suicide every year, and a higher percentage of doctors are depressed than the average person. But the intensity and prestige of the medical field doesn’t always lend itself to an open conversation about these issues.
The stakes are high for Giselle. Her mental health makes some people—from her school to future patients—uneasy. And sometimes her anxiety is so bad she can’t take her medical school exams. But as you’ll find out in the episode, these are not challenges that Giselle is about to shy away from. She says her challenges will make her a better doctor, and hopefully encourage other physicians find the help they need, too.
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MARY HARRIS: I’m Mary Harris, this is Only Human. Ok, here’s a confession. I work on a show about health but I can think of about five different ways that I’ve avoided telling most people I work with when I’m going to see my therapist. I tell them I’m going to a breakfast meeting or a doctor’s appointment or an interview. Mostly, I just don’t say anything and I don’t think I’m alone in this. Unless you’re Woody Allen, dealing with your mental health can seem basically just unprofessional. But today, Amanda Aronczyk has the story of a woman named Giselle who’s taking the opposite approach. She’s a medical student. Before that she’d worked as a doula where she’d seen how some doctors just weren’t very empathetic. So from the start, beginning with her medical school application, she’s attempted this radical openness when it comes to her mental health. Physicians don’t really do this. She’s convinced it’s going to make her a better doctor. Just a heads up, there’s some swearing in this episode. Amanda takes it from here.
AMANDA ARONCZYK: Giselle was not sure what she wanted to put in her application. You know she, of course, wanted to talk about why she wanted to be a doctor but she also wanted to be honest and she wanted to talk about her years of depression.
GISELLE: A lot of people were like you don't say that at all. Especially some older doctors are like you do not say that. You talk about all your achievements, do not mention that you have any kind of weakness. Especially not a mental health one. And that is the uh, the wisdom out there.
AA: But she did it anyway. Her depression, her anxiety, her suicide attempt, all in.
G: Which was, yeah, it was ‘ballsy’ according to my (laughs) advisor and I needed to ‘know my audience.’ (laughs) And so um, but I put it anyway.
AA: Giselle is actually quite a bit smaller than her voice, she’s just 4’10. She’s got long, dark wavy hair. And on the day we met, she was wearing a t-shirt that said Be the Doctor Your Mom Wanted You to Marry.
G: This here is our clinical assessment (untelligible - 2:08). Ok.
AA: Now she’s a second year student at the University of Wisconsin School of Medicine and Public Health. She picked this school because it didn’t seem as cutthroat as some of the other places she’d heard about. They offer free, unlimited counseling and they accepted her, even with that totally candid application.
AA: Ok, so what are we about to walk into?
G: So this is our kind of clinic assessment area where we have our practice patients come so there’s…
AA: Giselle first started to notice that she was having trouble when she was a kid. It started not long after she moved from the coast of Colombia to Chicago. Her parents had just split up, she was going through really severe culture shock.
G: I remember having those first really intense, um, suicidal thoughts when I was like 10, I was a child. So for me, like, being a little gloomy had always been a part of me.
AA: How come you don’t seem gloomy at all? Is it...
GISELLE: Oh I get that a lot (laughs). Um, which does trip some people up actually, because they're like, well you can't really be depressed, I’m like, really am (laughs).
AA: Things started getting much worse when she became a teenager. She had really bad mood swings. She was totally defiant. She would scream and yell at her mother. And when she was 16, she tried to kill herself.
AA: How did you try?
G: Uh, pills. Yeah, lots of pills.
AA: After that suicide attempt, she started going to therapy and a couple years later she started taking SSRIs. So an antidepressant.
G: I never imagined that I could sleep really well and not feel exhausted all the time.
AA: It worked?
G: Oh, it worked extremely well. I was like poster child for SSRIs. So I was like, my life is awesome!
Dr. CHRISTOPHER HILDEBRAND: Giselle is amazingly, um, transparent
AA: This is Dr. Christopher Hildebrand, he is Giselle’s assigned mentor. And Dr. Hildebrand said Giselle showed up in his office and instead of saying, ‘look at all these amazing things I’ve done.’ Instead she said, ‘This is how I’m struggling.’
H: She allowed me into her life right away.
AA: For you, does the talking about the mental health stuff make you uncomfortable?
H: Oh, I think initially I was a little.… oh no, no, I mean it was a different spin. I mean students don't come in early and kind of spill everything.
AA: Giselle assumed that if she was upfront with the administration, they would be understanding. Now both sides, Giselle and the school, are very invested in her doing well. But in the first year, you either pass or you fail. And if you fall on the wrong side, there are consequences. Within weeks of starting school, Giselle was in trouble fast. It went wrong in a few different ways, some predictable and some not.
G: It was rough, like the adjustment was rough. I was really struggling.
AA: What was so rough?
G: So, so, I’m kinda here and I’m by myself. And I have, like I feel alone and I feel overwhelmed by school. So it was really difficult and it just got worse and worse.
AA: She was alone, she didn’t have her supportive friends, her family, her regular therapist. And Giselle’s the only Latina in a class of about 175 students. She wasn’t use to being noticed for that. There was this one time she says.
G: I was in the hospital and I hadn’t put on a white coat.
AA: She’s still wearing her regular clothes, she walked into this woman’s room.
G: I came in.
AA: And instead of greeting Giselle as a young doctor in training…
G: She said, ‘Somebody has already taken out the garbage.’
AA: Giselle realized the patient’s mistake.
G: She had mistaken me for the cleaning lady. And I’m like, ‘No, I’m a medical student with Doctor so and so that had already come in.’ And then she was just like, ‘Oh.’
AA: In Madison, at the school, this issue of race came up all the time.
G: Like I can’t forget my race kind of a thing. This is the first time I’ve been made very aware of my race in my life.
AA: There was also the stress of the exams.
G: Hi Amanda, this is Giselle. So I’ve never recorded a voice memo…
AA: I asked Giselle to record herself, on her phone, every day during exams.
G: It’s about 5:40 in the morning.
AA: So this is a typical exam week compressed.
G: What is different about this week? We switched to paper ware in my house. There’s no time for washing dishes so it’s just a lot of paper plates and cups and spoons everywhere. I did have a cup of coffee this morning and a 5-hour energy… 50 mg of black tea and so that will last….Almost 500mg of caffeine so… that doesn’t help. (Sigh) I’m so tired (sigh). So yeah, this is, this is exam week.
AA: In those first few miserable weeks of school, Giselle was too depressed to study for her genetics exam so she failed it. And then, in her second semester, she had a panic attack during her anatomy exam.
G: I remember finishing all the questions, I remember being able to answer everything but it was all in this terrible daze where I felt I was kinda floating, um, and my heart was just about to fall out of my chest.
AA: Did you have the thought, maybe I’m not cut out for Med School?
G: Oh, of course. I think everyone has that thought. Absolutely.
AA: But it doesn’t obsess you?
G: No, no, it doesn’t obsess me.
AA: The school let her retake those tests and she did really well. So from her point of view, she is cut out for this. She just needs a little more time and support. She sees those awful tests as symptoms of her mental health but it isn’t clear if her school sees it the same way. More on that after this break.
MH: Last week on the show we heard a young woman named Rose confess to her mother for the first time that she’s been depressed. Her story hit close to home for some of you.
PUMA: My pen name is Puma and I’m from San Diego. I had Rose’s experience 30 years ago.
MH: Puma says talking to her parents about her depression was especially hard because they’d faced serious trauma in their own lives.
P: So my father, being in the Japanese internment camps in Arizona, and my mother having historical trauma, being Native American, they hadn’t dealt with their own trauma. So they were not available for me and it took me until my adulthood and, yes I became a therapist like Rose, to understand those things.
MH: She remembers one particular conversation with her mom on a long flight.
P: So I told her my whole story of my depression in childhood and adolescence and young adulthood and how I had to get therapy. And I told her everything that I went through. She looked at me like a deer in headlights and said absolutely nothing. She couldn’t validate my reality, she couldn’t say I’m sorry, she couldn’t say I didn’t know or I had no idea you were going through that. She said nothing. I also came to understand that my parents were not capable of validating my reality because they had so much trouble understanding their own.
MH: We are so grateful you all shared your stories with us, we know it’s not easy. Keep sharing if you can. You can find us on Facebook at Only Human podcast.
MH: This is Only Human, I’m Mary Harris. Too often students who struggle with their mental health in college or in med school they just disappear. They stop going to classes, they don’t ask for help.
AA: Giselle is completely the opposite. School’s got this open door policy and Giselle just keeps walking through it. She figures she’s met with the dean at least eight times. So when her depression interferes with her studies she’s like, ‘Guys, I told you about my mental health. Why do I keep getting in trouble when something goes wrong?’
AA: Did that work?
G: OK, there you are yeah.
AA: There you are, ok.
AA: Two weeks ago I called Giselle because she was going before committee. Now this is a meeting that med students dred.
AA: How, how’s it going?
G: It’s going. I really just kinda want tomorrow to be over with.
AA: The next day she was seeing the committee and this is for students who are not keeping up and they can suspend you or worse, they can kick you out from school. Giselle had just gotten a lousy grade and lost her scholarship.
G: Like yesterday really sucked and it kinda is what it is and it took me a little bit to, to kinda realize the magnitude of the fact that I was gonna lose my scholarship.
G: So it’s suddenly like this one thing overshadows all of the last two years of work. So it’s, it’s, yeah, it’s really hard to like not be angry and bitter about that.
AA: Now the point of med school is to graduate students who will become competent doctors, failing an exam is a really big deal. Here’s Assistant Dean for Students, Dr. Gewn McIntonsh.
DR. GWEN MCINTOSH: When we see that a student isn’t following our standard academic path or meeting our performance metrics, then we need to have and develop a different plan.
AA: Part of why Giselle is so freaked out is because she’s been to this rodeo before, twice, and the last time it did not go well. She told me about it when we met in person. She said she walked into the room and this is what she saw.
G: A chair with a box of tissues and then a room full of people that are standing around in like a semicircle, with you in the center.
AA: A box of tissues.
G: A box of tissues. That was not subtle.
AA: The head of the committee questioned Giselle.
G: Asking me if he really thought I was kind of cut out for this, if I had a handle on my issues. He kept referring to them as like issues. It was like just a jamming session on me.
AA: And remember she had retaken the tests and had done well. So she walked out thinking, why are they being so hard on me.
G: I walked away from that and I was just so furious like I felt so hurt. Because I like work so hard I mean like look I did just great on these these tests and now you've like honestly made me feel like, I said, I’m not really cut out for this. Sniff.
AA: I mean a lot of the mentality is suck it up?
G: Yes, that is the mentality is suck it up. And I think to a certain extent that has to be the mentality because, you know, biochemistry’s not gonna get any easier. The material’s not gonna get any easier. The exams are what they are like and that I completely agree with that. No one’s here to kinda hold your hand and like you do have to suck it up.
AA: If your appendix bursts it’s obvious why you missed the test but what if you’re feeling too anxious for the tests? Or too depressed? Giselle felt like she’d been honest about her problems and that she should be treated like she was sick not broken. She was pissed.
G: I think that the mentality that they would have liked me to walk away from that would’ve been like go suck it up, cry, think about what you’ve done and then, you know, keep studying. And, and I could’ve done that and a lot of people do that when they walk out of committee but I felt, I felt kind of indignant.
AA: At this point she did something that you may or may not understand, probably depending on your age, she posted in detail about what happened on Facebook.
G: And it says, dealing with academic administration is an awful part of med school. It’s a medieval-like process of judgment and punishment to ask for help or find yourself struggling with all the exams.
AA: She was pretty harsh.
G: I refuse to accept the overt insinuations that I’m less-than deserving of this career because of anxiety or exam scores. Or let the bullying and questioning whether I should remain in medical school quote change my thoughts on the value of the doctor I’m going to be or what I can bring to the health care field. I got into several schools and taking the classes…
AA: Now I know what you’re thinking or at least I know what I was thinking, no Giselle. But for her this was cathartic. Her friends wrote all these encouraging posts like you can do it Giselle and focus on yourself. And someone wrote, you are just getting better at kicking ass in all the best ways that help people heal.
STILLWELL: You know the disclosures you make may affect how you are perceived.
AA: This is Chris Stillwell and he runs student services at the school. And while he and Dr. McIntosh would not talk about Giselle, we did talk about Facebook.
S: And your patients will, rightly or wrongly, make a judgement about your fitness to be a physician, to be a medical student based on that. You’re being critiqued...
AA: You’re being evaluated.
M: Your patients will be evaluating you and your fitness as a health care provider based on information and that information will include whatever you put forth publicly in social media.
AA: Of course patients look online when they’re trying to find a doctor. You have to be cautious but her post had an unusual upside because what happened was other students in the med school emailed Giselle about their own struggles with mental health.
G:All of a sudden my inbox is full of these people that I’ve been kind of hiding. And, and I kind of just stumbled upon this role of being like the person that speaks on behalf of the, the anxious and depressed, you know.
AA: This is one of the reasons why Giselle wants to become a doctor. She wants to be the kind of person who people will turn to when they need help or empathy.
AA: Do you think that she ever uses her sort of mental health struggles as an excuse for not getting work done?
H: No. No.
AA: This is D. Hildebrand again, Giselle’s mentor.
H: We’re human after all. Um and being human is what makes a doctor good. Um but there’s also the fact that being human means you’re not always going to be on your A-game. And knowing what your A-game is and knowing when you’re on it and knowing when you’re not quite there is a very important part of being a physician.
AA: He also said that there were already a few doctors that had seen Giselle working with patients and that she was great. She was empathetic, she was a good listener and she would call things as she saw ‘em.
H: We need Giselles in medicine. We need people who are unafraid to have the insight to talk about, not only their own struggles in life, but how did that relates to others.
AA: So earlier I told you Giselle was going up in front of committee again for the third time and this time is was at her request, she just wanted to change the timing of some of her classes in the next year. But because she’d gotten that lousy grade and because it had gone so badly last time, she didn’t know what to expect.
G: Here I am.
AA: How’s it going?
G: Good. Good, it’s nice to be done with that.
AA: When I called her she said committee had gone pretty well. Her scholarship was still gone, they don’t really have a say in that kinda thing, but the tone had changed.
G: Yeah it actually went, it actually went just fine.
AA: On that’s so good. What was it like when you walked in?
G: They were, they were all smiling.
AA: Was the box of tissues sitting out?
G: It was, there was still a box of tissues and now they added a few bottles of water.
AA: Oh that’s nice. You can, you can cry and hydrate.
G: And hydrate yourself. But it’s still the same kind of setup. It wasn’t like last time when I felt I was being very much attacked.
AA: One of the things that came up like when I was listening back to all the tape was the lingering question which is like, Giselle, are you sure you are up for this? Are you sure you’re up for med school?
G: Oh yeah, I am, I’m very excited. It’s actually a really good way of closing my year because now I kinda feel like I was heard. Um not heard, but I think um, I don’t want to say I was respected because I do feel respected but uh, just like they were talking to me not at me kind of a thing. And that was, I, that was really helpful to me.
AA: Do you think that you’ll always be this open about your mental health?
G: Um, I think so. I, I really think, um, there’s no way I would get through it if I just kept this to myself, um, it would be awful. I find that the more open I am, the better I can listen to other people too and I think people tend to respond to my honesty with their own honesty. I find that really, I find that really humbling. Um, I had a (unitelligble - 19:44) patient tell me once, we’re learning how to do social histories and I remember he was talking about having lost his job and we’re talking about stresses and, you know, we’re just kind of keeping this conversation. Eventually at the end he said, I never had anyone, I never had any doctor listen to me like that. And at the end he actually thought he might go to therapy for, for feeling depressed about his job. He was like, I never thought about therapy either. And this was, it was such a really validating moment for me. So, I, the long answer to this is yes, I think I will always be honest about my mental health.
AA: Giselle that was great. Um, I was like oh my god Giselle that’s the end of the story, you did it (laughs).
AA: So, so,
AA: Here’s my last question for you. Um so Giselle, uh, what do you think, are you going to make it through med school and be a doctor?
G: I sure probably think so.
MH: Giselle just finished up her second year and she just got married a couple weeks ago so congratulations are in order. She is planning to go into family medicine when, not if, she finishes her degree. This was the second part of our series about mental health in collaboration with our friends at NPR. If you haven’t already subscribed to this podcast, so you can hear all the stories, find us on iTunes or at OnlyHuman.org