I made it 28 years before my first depression. It was a good run.
Darkness descended spring semester of my third year of medical school, the hardest year by my count.
Timing-wise, it was paradoxical. I had just aced our first board exam (Step 1)—scoring in the 90th percentile—meaning I had a chance at landing a residency coast to coast. My grades were beaming, recording more honors designations than not. During the fall, I’d even appeared on the Dr. Oz show discussing teen mental health based on my work in HealthCorps. I was “on my way”.
None of that held sway internally, where a divergent narrative took shape: I was losing who I was.
If second year’s pursuit of that board score emptied my tank (I gave it everything I had), third year slashed my tires. That much time in the hospital kicked my ass. I clocked over 60 hours/week, beginning at 6AM, then studied when I got home. This was the stake required to become a physician. Any reserve I had remaining for mountain biking (or any other “work-life balance”) was pulverized. The effect was insidious but devastating. It also limited how much I could process the recent death of my best friend from childhood, which hung over me unprocessed.
By spring of third year, I examined my features in the mirror thoroughly to be sure it was me. I tried and cared deeply about my patients. I learned everything I could about surgery, internal medicine, pediatrics, all the specialties. What was absent in authentic passion for medicine I donated in passion for people. Yet, I couldn’t outrun the obvious; I was doing something I didn’t want, motivated by fear, while losing who I was. I hated myself for putting myself there. By February, I was depressed, hopeless, and truly angry for the first time in my life. This dejection forced a realization: I have to change.
In becoming a doctor, I chose to forego what I wanted and figured I’d be fine (not a sustainable ethos but my experiences led me to believe it was possible). In time, I came to understand why I made that choice and learned to compassionately forgive myself. That process would take years to flower and then and there, I just needed to stop digging.
And I stopped, slowly. I took more ownership of the residency application process, choosing the field of psychiatry on my own counsel, and boldly went after residency programs near surf (the adventure I really wanted). My happiness was only my responsibility. I had to go build it.
Without that period of darkness, I’m not sure the lesson would’ve landed.
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Did I guess right in what would make me happy next? Was surfing my salvation? Nope, to evaluate that errant ethos required a second depressive episode in California.
The story was similar. Long work hours during intern year, doing something I didn’t want, blah blah blah. SIGECAPS was back. The difference was the setting: I was now where I figured would make me happy (and surfing)… and I wasn’t happy, huh.
This time, I’d run out of pipedreams, no residency mirages off on the horizon. Just me and a plan built upon a failed assumption: I can do something I don’t want to do and be happy. I had no idea how to fix it, thus I was forced into another choice: keep pretending you know what you’re doing and repeat the cycle or go get help. By second year of residency, I was in therapy. I had to surrender my all-knowing omnipotence. Which, after four more years of repeated lessons and micro-progress, got me here.
The pearl of the second depression was more foundational: I am not omnipotent and have limitations. That surrender (another depression lesson) has made all the difference. It’s empowered me to be who I am, instead of everything. Matthew McConaughey describes it well in Greenlights:
The great man is not all to each,
He is each to all.
Don’t think I’m recommending depression or advocating that all depressions are the deserved manifestation of misguided (usually well-intentioned) living. Trauma happens. Loss happens. Genetics play a role. Environment has a hand.
For me they were insightful departures that I desperately needed. How can I say different? They were the “All is lost” moments described by Steven Pressfield, where one must give something up to transcend. The renunciation process has been critical to move on. House Rules.
In those depressions, I would’ve hated the message put forth here; responsibility wasn’t a sought after virtue. But here and now, I am beyond grateful for those periods and the lasting impact they’ve had on my life.
The darkness was needed.
(P.S. If you’re going through something and need support, the National Suicide Hotline (dial 988) is a fantastic outreach program for resources. Asking for help has been huge part of my journey. This is not healthcare advice. This site is not intended to provide medical advice, diagnosis or treatment. The information, services and other content provided on and through this Site, including information that may be provided on the Site are provided for informational purposes only. Please consult with your physician or other healthcare professional regarding any medical or health-related diagnosis or treatment options.)
In fairness, I think it’s not possible to make it through med school and residency without having some symptoms of depression, if not an outright episode.
Pretty rare these days unfortunately
If anything it’s easier now than it was. I trained under the resident duty hour restrictions 1.0, but I knew residents just a few years ahead of me that had done internship with no work hour restrictions. Those were the bad old days. One neurosurgery resident I knew had done Q2 overnight call for weeks on end, showing up at the hospital for work at 5:00 am and finally leaving at about 7:00 pm — the next day! Then he was back to start another 38 hour shift at 5:00 am the next morning.
That is staggering. The horror stories are hard to fathom!
Having survived more than 1 “introspective disorder”, I find playing in the mud to be quite therapeutic, as is the weight and measurement of your personal darkness. It is only when we can find our way in the dark that we pull back the veil and let in the light (I said that and you can quote me if you wish).
I will quote this liberally!