Content warning: This story includes descriptions of suicidal thoughts and behavior.
I was 42 when I decided to go to med school to become a doctor. I’d been a high school and middle school science teacher and a little burned out, but I also felt there was a lot more I could do for adolescents with significant emotional struggles. So I decided to become a psychiatrist, figuring the stress associated with med school would not feel unfamiliar.
I’d soon learn that the pace and expectations of actually being a doctor resulted in a far more intense form of burnout than I had ever experienced before. Still, I think my relative seniority, compared to others who were just starting med school, at least gave me some insight.
I remember sitting with a young attending physician who was a leader in undergraduate medical education at the University of New Mexico School of Medicine where I had just started two months prior. Knowing my background, she asked me, “What do you think we need to do to keep from turning all of you really excited first-year medical students into burned out second- and third-year medical students?”
My response was quick and simple: “Stop hazing us.”
Hers was equally swift: “But we don’t do that.”
“So there’s your problem,” I retorted. Denial.
Studying medicine can involve 30-hour shifts and 80-hour work weeks. Once you get into residency, it does not get any better. In many ways, it gets worse. Second-year residents report a burnout rate of about 47%, which is 10 percentage points higher than first-year interns, probably due to heightened responsibility and expectations. According to several studies, at least half of medical students admit to being burned out and as many as one in 10 will even admit to thoughts of suicide or engage in self-harm.
For me, medical training lasted nine years. Since then, I’ve largely focused my practice on young people, though I’ve carved out another sub-specialty: stressed out doctors. I’ve also learned a lot from my own struggles with burnout.
Wondering if I was better off dead
Burnout is a very complex and sometimes fatal condition that generally involves exceedingly high expectations coupled with a grueling amount of work and a fairly constant sense that you are not doing enough. It has been called “moral injury,” because it comes from expecting someone to be superhuman and then berating them when they fail to do the impossible.
Faced with moral injury in med school, being significantly older was a real life-saver for me. I had already developed healthy boundaries and did not take the unrealistic expectations of training all that seriously. I learned to actually enjoy the learning process, rather than feeling the need to get through the training and start my “actual life.”
However, when burnout did hit me, it hit me hard.
After several years as a private psychiatrist, one of my long-term, especially ill patients accused me of unprofessional behaviors to the medical board. Although, this is not actually that unusual in my specialty, it was nonetheless, quite a blow to me. I had experienced acute burnout during the nadir of my teaching career, but never — as I did now — to where I thought I might be better off dead, and truly questioned the work I was doing.
Although the accusations were completely dismissed, the ordeal left me meeting full criteria for major depression. As the assistant medical director of the resolve crisis center here in Pittsburgh from 2017 to 2019, I had seen more than my share of medical colleagues come through its doors, expressing similar thoughts and feelings of abject hopelessness. Until I was on the receiving end of a false accusation, I never truly understood how dark these feelings can actually be.
My therapeutic vehicle
I didn’t think to seek help until a good friend and colleague suggested it. That’s despite the fact that I’m a psychiatrist who has made it a personal mission to reduce the stigma of my profession and tell anyone who will listen that mental health and physical health are really the same thing. I took my colleague’s advice readily, and found the combination of therapy and Prozac to be the light that pulled me out of this dark tunnel.
More important than the prescription was something my therapist reminded me of something that I have been doggedly preaching to my patients for years: The absolute necessity to have a life outside of one’s profession. Don’t get me wrong: I love being a psychiatrist. But at that time it was all I could focus on, and what I was feeling was incompetence, frustration and anger about my chosen career path.
I have more hobbies than I can count, including photography, videography, education, storytelling and even fabrication. Yet, during my darkest hours, it never really occurred to me to reconnect or focus on some of these unrelated pleasures.
Partly at the suggestion of my therapist, partly at the insistence of my wife, I threw myself back into an old idea I had: Converting my Nissan pickup truck into an off-road overland vehicle with which I could explore the world.
Slideshow: Psychiatrist Vint Blackburn shows customized features he developed for the truck and camper he is constructing in his Millvale workshop, Sept. 18. Blackburn is retrofitting the vehicle with built-ins for tools and battery power, water for showering and different sources of power to prepare for a trip across the world. (Photo by Stephanie Strasburg/Pittsburgh’s Public Source)
Previous to medical school, I visited more than 40 countries. But since medical school, I had only gotten out of the country a handful of times, because I always had too much to do and too many responsibilities to my patients. However, I was reminded of another thing I am constantly telling my patients: “You’re no good to anybody else if you aren’t good to yourself.”
Getting back into a completely different mindset — the one that I have when I am welding, constructing, making something — was a crucial ingredient that pulled me out of that putrid fog and replenished my emotional reserve. Sometimes I worry that I spend too much time on this project and then remind myself of just how much better I now feel working with my patients and simply existing.
Faced with junk science
In the current political environment, where doctors are being sidelined by conspiracy theories and junk science and our patients are facing potentially devastating cuts to mental and physical health care service, it is easy to become overwhelmed and despondent. I have watched plenty of my colleagues go through this over the last year.
But when I am working on my vehicle, whether it is making carbon fiber sheets, putting together an electrical system or even just trying to overcome a complex problem, I feel content. Part of the reason is the ability to be in control of something. When I’m creating art, working on the truck or developing an idea for a video, I’m in control. It may not turn out great, but the buck still stops with me.
In our professional lives, this is often far from the case. Our patients may or may not choose to adhere to our advice. The system for which we work more often does not support us in our goals to help our patients. Burnout and depression are exemplified by this lack of control, as well as feelings of helplessness and hopelessness. At the root of suicidal thinking is the feeling of being trapped.
But having things that we can control gives us back a sense of identity and mastery. For me, it was only when I was reminded of many ways in which I was not trapped, where I did have efficacy, that I saw myself getting better.
Thinking back on that sense I had of being hazed in med school, it is clear to me how those just starting off in life could feel trapped, without agency and desperate. After all, I only got through it because I was too old to let it get to me.
When a sense of losing control did catch up to me — as it does to so many of my colleagues — the effect was just as profound. Thank God I was willing to seek help, and that therapy led me to focus on other things in my life that I could control, outside of medicine.
Vint Blackburn is board certified in child and adult psychiatry and is in private practice through Blackburn Psychiatry as well as working at Family Pathways in Butler. He has published and spoken on personality disorders nationally and can be reached at vint@blackburnpsych.com.
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