As I sat quietly on the bed staring at the wallpaper that was made to look like a forest, I tried to slow the racing thoughts in my head that had landed me in the psychiatric emergency department. Normally, I find great solace in the serenity that the woods offer and find myself comforted in the quiet whisper of the wind in the leaves above my head. But these wallpaper trees offered no solace or any semblance of peace. In fact, they made me want to get as far away from them as possible. As far away from the picture of the trees, the peeping eyes through the open blinds, and the two overhead cameras that were watching my every move.
I sat with perfect posture on the bed to show whoever was watching on the other end of the feeds that I was perfectly OK and did not warrant being locked in this cage. Were the images of me hanging from my closet exploding into the forefront of my mind, interrupting any attempt to put together more than one coherent thought? Yes. But, if I sat quietly and calmly, my doctors would definitely see that I was OK. After a couple of hours, at the behest of my personal therapist, I was given Ativan to induce sleep, so my mind could rest. As the medication took effect, I allowed myself to lie flat on the mattress, with one eye trained on the door keeping watch, and my thoughts finally began to slow enough to allow sleep to come.
I was diagnosed with post-traumatic stress disorder (PTSD) approximately two and a half years ago, during my second year of surgical residency, in the wake of the murder of my older brother, Zamoura. Immediately following his death, I flew home to be with my family and attempted to process the sudden loss of someone so important to me. While home, I began the process of packing away the memories and the emotions into a neat little box that I would bury deep down inside me. It was surprisingly easy. I had been silently battling anxiety and depression for nearly two decades at this point, so breaking down my grief into little boxes and compartmentalizing the complexity of this loss had honestly begun the moment I found out he was gone.
Growing up Black in America, there are certain lessons I learned from a very young age — and I’ve tried to use these to hide my mental health struggles. One of the most important was emotional modulation and compartmentalization. This is taught when walking through grocery stores with our parents about what is and is not acceptable behavior. Temper tantrums as toddlers were never to be had in public. Causing a scene was basically a sin. In school, Black children learn to mute anger and frustration, as not to make their classmates and teachers uncomfortable or fearful of a violent outburst. In interactions with law enforcement, we learned not only to be deferent but also stoic. We know any emotion we may be feeling at the time may trigger a reaction that could be perceived as hostile. Walking through life with brown skin is already an unavoidable obstacle. Admitting to those around me I was also anxious and depressed seemed like an unnecessary burden. I could not afford to be considered “weak” or “less than” by my peers — especially in the medical field. So, I used the skills I had been honing since I was a toddler to mask my depression and anxiety.
Outlets such as exercise and music, as well as healthy lifestyle modifications, can play an important role in symptom management. However, they are often not enough on their own. I’d beg anyone reading this to think of all the people who have died by suicide who ate healthy, exercised regularly, didn’t use drugs, and on the outside “seemed fine.” Society’s ostracization of mental health and false equivalency of weakness leads to the loss of too many lives each year, many of them young and full of potential. Many of them physicians, like myself. The stigma attached to mental health often stops people from seeking help and being able to benefit from therapy. Negative views of pharmacotherapy that further perpetuate the stigma of “weakness” also serve as a significant barrier for people seeking or undergoing treatment. The desire to not “mask my symptoms” and the belief I was “strong enough to manage on my own” significantly contributed to my hesitation to start medications to help with my symptoms.
Once residency started, the outlets I’d always relied on — sports and music — to help me decompress my mind disappeared. As the stressors grew larger and more frequent, the more necessary it became for me to seek help. I bounced in and out of therapy in college and medical school. I could never quite find someone to confide in but still found places to unload just enough to keep going. Throughout medical training, navigating my mental health became progressively more difficult. After the death of Zamoura, I found that I could only “manage” for so long before my mind and body gave out. While the death of a sibling on its own can trigger a depressive episode, the years of silently suffering finally took its toll. How could I care for patients when I wasn’t caring for myself?
I think back on my mental health journey as we begin to navigate life post-COVID, and I worry about the long-lasting mental health repercussions. Isolation and uncertainty during the pandemic have resulted in a dramatic rise in anxiety and depression. Healthcare workers and essential workers were forced to work in tense and, at times, life-threatening conditions. Millions of Americans found themselves without work and unable to make ends meet. Many are still struggling to find their way back to normal life. The delayed grief, burnout, and added stress to millions of peoples’ lives will only make the need for accessible and adequate mental health treatment options more necessary in a field that is wholly underfunded and severely strained. As we shift to post-COVID norms, we must also shift our ideology from stigma to compassion and understanding. Our lives depend on it.
Imani McElroy, MD, MPH, is a general surgery resident at Massachusetts General Hospital.