"You Are Broken and You Have a Superpower"
My recent appearance on the Carlat Psychiatry Podcast
I was thrilled to join Chris Aiken, M.D., on the Carlat Report Podcast. For non-professional readers, the Carlat Report has been evaluating data to “keep psychiatry honest” since the 90s. The recent episode, in which I participated, is called “(Wounded Healers) Guide to the DSM. (link to the episode). This episode pools the stories of 15 mental health professionals and is part of a larger series. Dr. Aiken is an excellent interviewer…and made one difficult choice that I both understand and am now prompted to write about. He decided to not identify anyone in the episode by name.
Welcome to The Frontier Psychiatrists. It’s a newsletter. It’s written by the non-anonymous Owen Scott Muir, M.D. I'm excited to be part of the Carlat Report, but this is not my first podcast rodeo related to self-disclosure. When I was a Child Psychiatry fellow, I received a grant as a part of the Rudin Master Scholar’s Program in Ethics and Humanities at NYU. It was to support a project, which at the time was called “Self-Disclosure.” I will share a few thoughts on that today.
The following episodes were created in my time as a Rudin Scholar:
The Once Suicidal Psychiatrist
The State Psychiatric Nurse…Who Was Once A Patient
Living As Your Authentic Self Is a Life Saving Gift
Several other episodes were subsequently completed, from interviews done in that era, including:
A Psychiatrist Copes With Depression After Miscarriage
On Self-Disclosure As A Public Health Intervention
The thesis for my series of interviews and subsequent podcasts was that there is a tremendous amount of stigma around psychiatric illness. It is worse in health professionals. This stigma leads to death, at remarkable rates, up to 400% higher than the general population. This means that being a physician is more risky than having an alcohol use disorder, when it comes to death by suicide. One of the ways to increase survival, I have long argued, it to increase help-seeking behavior among physicians (and other health professionals). At the same time, making sure the help we provide—when help seeking connects with actual help—is effective. We have more effective treatments every day.
Literally today—the 30th of April, 2024—the commercial launch of one of the most effective treatments for depresison ever …happened (SAINT neuromodulation by Magnus Medical). That is a treatment that works for suicidal depression.1.2
Our field also has Spravato, Auvelity, Nutritional Ketosis, Lavender, psychotherapy, and myriad options available to help physicians heal that are effective, as well as treatments with long track records of safety and robust data, as reviewed—regularly— in the Carlat Report!
Physicans are often reluctant to seek help. There can be negative impacts on the careers of those who have a psychiatric illnesses, and there can be even worse impacts once that diagnosis is weaponized against those physicians. I should know, it has happened to me. At the same time, as much as I’d love “for no one to take a swing at me for my psychiatric illness,” I’d prefer to risk that, if it means fewer of my colleagues live in terror of anyone finding out about their condition, such that they don’t seek help. I chose to interview colleagues using their names. I made that choice because I believe there is…
NOTHING TO BE ASHAMED OF.
The problem of phsycians being shamed, and being attacked for their disabilities—as protected by the ADA, among other statutes—doesn’t change when we agree, tacitly, that the stigma is winning, and we need to hide.
We only need to hide if there are very few of us who life our heads up. If too many of us are out and about, publicly speaking about our experience, together, it becomes less plausible to punish any individual for the temerity to live our lives with dignity.
Sparticus and his supporters got the hang of this. Qua the Carlat Report’s decision to not use the names of any of the participants, I will remind readers that the Romans still crucified Sparticus and his colleagues. It’s a risky strategy to stand up and be identified. Chris, and Carlat, didn't want to be responsible for damage to the careers of their participants—they were not wrong. The goal of their series wasn’t to challenge the status quo regarding stigma—it was to help inform all our our clincal practice with insights from those with personal knowledge.
Challenging stigma to reduce physician suicide was the goal of my series. And thus, I, along with my interviewees, made a different decision about our identity—to disclose.
Just like the same drug can have different formulations for use in different conditions—Zyban for smoking cessation is different bupropoion dosing than wellbutrin XL for depression—so too can podcasts be formulated differently to accomplish different ends. The risks and benefits of self-disclsoure are crucial to weigh, and in the context of creating broad educational material, I support my colleagues in taking a thoughtful approach to the risks of the material they chose to share from people like myself with lived experience.
I believe challenging stigma still needs to happen. Just not all the time, and in every forum. We can, and should, exercise discretion. Take a listen to the Carlat Report Podcast, and consider subscribing. They do remarkable work, and I’m thrilled to support it.
I came out because I believe Silence = Death3, as we learned from our gay colleagues before. It’s a personal choice, however, and even then, it is not a mandate to scream your truth at every available second.
Li, B., Zhao, N., Tang, N., Friston, K. J., Zhai, W., Wu, D., ... & Wang, H. (2024). Targeting suicidal ideation in major depressive disorder with MRI-navigated Stanford accelerated intelligent neuromodulation therapy. Translational psychiatry, 14(1), 21.
I would argue it should be first line for physician depression. We need to get well and back to work, caring for everyone else too, as it’s a source of meaning for us. This treatment is available at Acacia Clinics, MUSC, University of Arkansas for Medical Sciences, Kaizen Brain Center. It’s also available at Fermata, my clinic, as part of a research study.
Gamson, J. (1989). Silence, death, and the invisible enemy: AIDS activism and social movement “newness”. Social problems, 36(4), 351-367.