On Deciding to Disclose
By JB
This week, I had a very hard decision to make. Faced with a meeting about my less-than-stellar academic performance, I had two choices. One, I could continue keeping my bipolar disorder a secret, continue pretending like I have no extra-ordinary challenges to medical school. Two, I could tell the truth I’ve been aching to tell all along. I’m bipolar. I’m treated. It presents unique challenges to my medical school education, and I am still figuring out all the intricate twists and turns of what it means to be a functioning bipolar person, a functioning bipolar medical student.
I’m only 10 months in, here. I am still figuring out who to tell, how to tell them, when to tell them. When is that magical moment? I told Joe in the line at Subway, I told Thomas while we were floating in kayaks on a river. I told Sahar while we were eating lunch; I told my lab group during one of our first lab meetings. All of these times, I felt, were the right times. These were people who needed–or deserved–to know. These were people I would feel fake around if I didn’t tell.
For all the grief it causes me in deciding, actually telling someone I am bipolar is truly a freeing event. Being bipolar is part of every moment of every day. It is inextricably tied up in my being. There is no point where I am not bipolar. I am medicated, which means I don’t act bipolar, but there is always the chance that my medicine will slip and become less effective, that I will need people in my life who know so that we can catch it early. So we can catch it before anything bad happens. So we can catch it before I ruin my life.
So I decided yes, which is something out of the norm. All materials I’ve read on the subject–and there are not many–by bipolar medical students reveal that they did not disclose. Above that, they refuse to disclose. They say it is the worst thing they could possibly do. Unfortunately, these medical students worry that the doctors who surround them, who decide about residencies, will discriminate against them. And I’m sure the concern is valid, which is a sad state in itself. How can we tell our patients that it is possible to be a whole functioning human being if we don’t believe it ourselves?
The truth is, I want to disclose my mental illness to everyone at my school. I want them to probe and pick my brain, to learn from my mistakes. This is something that my friends who know do sometimes. They get this look on their face, and it inevitably leads to a question. “Why did you seek treatment?”
“What was the worst part of being bipolar?” We talk about the symptoms and signs; we talk about what they should do if they suspect that something wrong is happening, which ranges from the practical [“Get me to a therapist.”] to the absurd [I’ll just run across the horseshoe and tackle you.”] We talk, which is good for me. It’s good for our friendships. It’s good for their future patients. It’s just good.
So, facing the dean of the graduate school, the director of my program, the words tumbled out like an avalanche. “In March, I was diagnosed with bipolar disorder. I am treated, and I have made a lot of lifestyle changes in the last year. The first semester of medical school was a difficult transition for me, because in college, I did a lot of manic studying. I’m still trying to figure out how normal people study.” He was very supportive and inquired about treatment. I assured him that I take my medication, but told him I was currently without a therapist or psychiatrist because of some insurance
problems. He was, thankfully, understanding, and referred me to the school psychologist. I have already made an appointment.
I hope that I–and my generation of doctors–can change minds, opinions, and attitudes about mental illness, especially as it pertains to medical school. People with mental illnesses can perform well in medical school, and they can [and deserve] to be doctors. Although I would gladly trade my mental illness for a clear bill of health, I can do good with it. I can advocate for other mentally ill people, and I will share a true empathetic bond with my patients. It is well-noted that doctors make poor patients, but I hope the opposite is true well. I hope that patients make good doctors.
So I disclosed. So I will continue to disclose, to trusted colleagues and administrators, to anyone who will hear and listen, to anyone who is interested and can offer support. I will continue to disclose, because I owe it to myself. I owe it to future generations of medical students, who I hope will have an easier time of disclosing. And I owe it to all of the patients of all the future doctors I know now, the ones who may have an easier diagnosis because of me.
Originally posted here.
February 9th, 2008 at 10:51 pm
bravo. I’m proud of you.
February 10th, 2008 at 2:09 pm
As an M1 married to a man with bipolar disorder, your post was especially interesting to me. Even more interesting was that he was diagnosed one month before you were, so he’s in a very similar stage of treatment. He’s still working on his management, too.
More power to you. I wish my husband felt freer to disclose, but at this point, he doesn’t. I respect his privacy, but this general cultural attitude about mental illness we have is ridiculous and must be changed.
February 10th, 2008 at 3:20 pm
I’m happy to hear another mentally ill person decide to disclose. I made the same decision, though I’m not a medical student, in any appropriate conversation where it is relevant for a person to know that I am mentally ill I tell them. If I meet someone who might become a friend, I tell them. I decided to never keep it in the dark because the only way the stigma against mental illness will lift is if we all talk about it, a lot.
Having said that, I do respect that for some people it’s much safer and more comfortable to choose not to disclose.
February 10th, 2008 at 6:08 pm
This gladdens me to no end. I have been wanting to try out medical school, but afraid that bipolar disorder, which I am still trying to get under wraps, will prevent me from doing well, and achieving what I hoped to accomplish. Which is simply, to aid others in their struggle for mental health. I think I had convinced myself that I couldn’t do well. I am glad you are succeeding. And thank you for your post.
February 10th, 2008 at 6:51 pm
Brave, brave woman! Congratulations, and best wishes that it continues to be a supportive environment.
February 11th, 2008 at 12:01 am
This is wonderful. Our mental illness does not define us in whole, but only in part. Nor does cancer define a person. Nor does diabetes nor AIDs nor any other chronic illness. Treatable illnesses are situations through which we ebb and flow and move. This is simply our life, not our curse. Not our hindrance. Not our insurmountable obstacle … unless we hide and keep it under wraps, untreated, unrecognized and misunderstood.
February 11th, 2008 at 1:00 am
This is amazing – on both your end and the standpoint of the dean!
For some reason, people seem to think that mental illness, treated or no, = incompetence and that is just ignorance, given folks like this list’s.
February 11th, 2008 at 1:32 am
I wish you could be my doctor right now.
Being brave will help you help your patients be brave.
February 11th, 2008 at 4:59 am
Kudos to your bravery! :)
February 12th, 2008 at 5:08 pm
I struggle a lot with who to disclose to. I feel like it’s “coming out,” and there’s just so many people I feel I can’t trust to understand what it really means. A lot of times, when I do tell my truth, I say, “I am depressed and take medication for it.” It’s half the truth, since I am bipolar and get depression, but I want to shout from the rooftops that I’m bipolar.
My reasons aren’t honorable though. I’m medicated, but can’t seem to get it under control. So what I really want to shout from the rooftops is, “I’m bipolar! Give me a break already!”
I’m happy you’re finding your way in the world with bipolar disorder. You inspire me to *try* to be more honest and open.
Just an aside. I told a physician I trust that I’m bipolar, and he told me, “You’ve got to face every day and ask yourself, ‘how can I make this the best possible day for me?'” I about fell off the exam table. On a bad day, I think we can all identify with how impossible that feels. OK, what feels like the best possible day to me is laying on the couch eating a bag of baked Cheetos! I think he meant well, but I was insulted that he went on to imply that it was my choice how I felt. It may be my choice some of the time, but not all of the time.
Anyway, good post.
February 17th, 2008 at 6:08 pm
I thought of you when I read this article in the NY Times (http://well.blogs.nytimes.com/2008/02/08/when-doctors-become-patients/). It’s an interview with psychiatrist Dr. Robert Klitzman about his new book “When Doctors Become Patients”. I was immediately sucked in by the interview and the excerpts I read on Amazon.
Good post. You made a brave choice to disclose. I respect you for it.
May 18th, 2008 at 12:58 am
So cool! I was home this weekend and my mom said, you should become a doctor (I’m a librarian at the moment) and I said, with bipolar? No thanks! I have tons of friends who are almost doctors (I fell in with some med students a few years ago and admire their tenacity in living crazy schedules.)
Go, you! And disclosing is hard to do, and selective, but important. It’s our own “coming out of the mental health closet.” I can’t imagine how Kay Redfield Jamison kept it under for so long.
But at the same time, I don’t tell folks right away–being bipolar doesn’t define who I am, it’s a quality, like red hair, only red hair isn’t something that makes you more susceptible to colds because of minor mood swings, isn’t something that sometimes makes you depressed and you don’t know why, sometimes makes you ack! I need an appointment!
Hope you find a good therapist. They are worth their weight in gold.
September 18th, 2008 at 2:08 am
Hello there from another bipolar medical student.
You are very brave in disclosing.
I have disclosed for the same reasons-because I don’t want to hide or be ashamed or fake, and I want people to ask me about it, and I want people to know that bipolar people can be successful and good colleagues.
As you get to your clerkship years, I would advise you strongly to disclose less. You will probably notice that there are less times when it feels “right” to disclose.
Residency directors finding out us a real fear and shouldn’t be mnimized. Even if they know you have needed time off for some generic illness they could still be prejudiced against you. I think I would only disclose to a residency program after I had been accepted.
I haven’t disclosed to anyone in third or fourth year, which I just started. I have had episodes of illness during third year which required documented time off from my psychiatrist. The letters have to go to so many people that I felt pretty naked and vulnerable that so many people knew. Some of those faculty treat me differently now.
I’m glad you had a good experience disclosing to faculty but please be wary-many will not understand.