The Medical-Military Mindset
Denying depression and suicide ideation
Posted Feb 06, 2017
About a month ago, I composed an hour’s length workshop for students and staff at a major children’s hospital on how to prevent stress and burnout for those in the helping professions. The emphasis was on how everyday language patterns can lead to excessive stress, and the coming to terms with unresolved anger, which increases the risk of subtle (and not so subtle) self-destructive behaviors.
More recently, I noticed an article in the Journal of the American Medical Association that cited 27 percent of medical students suffered from depression and 11 percent had suicidal thoughts. I immediately emailed the education director of a leading medical college, citing these figures and proposing she entertain the possibility of my brief preventative workshop. She replied with a terse, “Unsubscribe.”
The following week, I came across an article in the Washington Post that a survey of 2,000 U.S. physicians found roughly half believed they had met the criteria for a mental health disorder in the past but had not sought treatment. They not only worried about being stigmatized, but worse, having dire consequences upon their license to practice medicine.
Given such professional risks, it’s understandable why so many doctors who need treatment are terrified about getting mental health care. One physician, interviewed for this new study reported, “all of my fears were realized when I did report it. I was placed in a very strict and punitive [program] that didn’t allow me to take meds written by my doctor for anxiety and insomnia. I am now not practicing at all because of this.”
Actually, medical school should be a good time not just for undergoing preventative measures, but treating mental health concerns. Any physician knows that untreated symptoms can only exacerbate the problem over time. A 2011 study found that more than 60 percent of surgeons who had experienced suicidal thoughts were reluctant to get help because of licensing concerns. When they do commit suicide, it’s usually hushed up. (As many as 400 doctors kill themselves every year in this country.)
The military mindset is similar to that of the medical, with reporting symptoms stigmatized and promotional rank dead-ended. (An estimated 270 active military personnel commit suicide every year.) Only slightly more than half of those discharged for symptoms of PTSD or major depression seek treatment, and of those, 25 percent quickly drop out largely due to the failure of two VA favored psychotherapies—Cognitive Processing Therapy (CPT) and Prolonged Exposure therapy (PE).
A 2015 meta-study by the New York School of Medicine found the pooled success rates (mitigating symptoms, while still retaining a significant PTSD diagnosis) was only 49 percent for CPT and 70 percent for PE. The major danger with PE is that it can amplify the trauma, worsening the trauma, and intensify self-destructive behaviors.
Researchers at Duke found 68 percent of children under age 16 had exposure to at least one traumatic event, while under age seven it was usually unreported. As a consequence, many of us are vulnerable to latent mental issues, including not just suppressed traumatic stress, but pent up rage that can lead to crippling anxieties, dysfunctional depression, and self-defeating behaviors. This rage, of course, also is at the heart of our hatred toward others, externalizing the unremitting pressure from within.
If, it is the lack of preventive workshops that uncover both the language patterns that lead to self-inflicted powerlessness and the latent mental issues that lead to self-defeating behaviors within the medical-military mindset--then medical schools, medical boards, and the military top-brass should be held accountable.
This blog was co-published with PsychResilience.com