DEPRESSION-
How My Depression Revealed My New North Star.
A Personal Perspective: Failing to identify my own severe depression.
Reviewed by Lybi Ma

It was a humbling experience, but one I feel is important to share: Although I am a 20-year veteran of psychiatry and the chair of a major department in the field, for months I failed to identify my own severe depression and resisted getting treatment, causing myself pain and harm.

How could this happen? Well, doctors are clearly not immune from the proverbial saying that the shoemaker goes barefoot. But I have concluded that there is more: our society must shut down the stigmatization of mental illness.

I feel I'm called to tell my story, in hopes of helping others muster the strength and courage to seek the help they need. So here it is.

A few years ago, I became the chair of Behavioral Medicine and Psychiatry at West Virginia University’s Rockefeller Neuroscience Institute. We have over 200 employees, a psychiatric hospital, and a residency training program. I was new at this, and nobody put me through a ”chair school” to learn it. But it’s not uncommon that people who demonstrate some degree of confidence, trustworthiness, and perhaps competence receive authority. So far, so good.

I began to experience insecurity about the new job. I compared myself to others – the “compare and despair” phenomenon. That leads to what’s known as imposter syndrome – the feeling that any day somebody might realize you’re the wrong person, just pretending to be what others wanted you to be. I think this is more common than often realized, and it affects people in different ways. Some can become horrible bosses. I became more vulnerable.

Then Covid hit in March of 2020, and we didn’t know what this would do. Would we harm patients by bringing them in? Would staff be harmed by coming into work? Would we bring this virus back to our families? There was so much fear and uncertainty, and as the department head, I felt responsible for people's lives.

I threw myself into my job, working 12-hour days, while my community support shut down. My church had been an especially important community for me, for connection and spirituality. Looking back, being cut off from it was a big hit against my wholeness, and even who I was as a human being.

When I talk about this now with other doctors, we realize that we can be horrible about recognizing illness in ourselves. I did recognize that I was stressed, waking up in the middle of the night with panic attacks, but felt it was just stress from job anxiety. For all my training, despite all the teaching I’d done, I couldn’t recognize that I was in a state of clinical depression.

I think what saved me was some caring friends and colleagues who began to note that I wasn’t looking so good and to tell me that I don’t seem like myself. I reached out to my mentor, who is a psychiatrist at the University of Hawaii, and he walked me through some questions:

Are you losing weight? Yeah, I’ve lost about 15 pounds in the last two months.

Are you sleeping? I sleep about two hours a night.

Are you enjoying anything anymore? No, I can't stand anything and don't enjoy the things that I used to. I feel like every day is drudgery and that it’s a chore to get out of bed.

Are you feeling like you don’t want to live anymore? Yeah, I think about suicide every day, and I wish I were dead.

And then he said it: “Jim, you're depressed.”

I imagine readers will ask themselves how it can be that experts cannot diagnose themselves. My explanation is that like everyone else we put up defense mechanisms to just get through the day. All people have strong egos and we don't want to admit that we are weak – that something powerful could interfere with who we are. We are slaves to a mystique that we are masters of our domain. In short, emotions are stronger than intellect at times.

Even after I acknowledged I was in a depression, it took me weeks to finally get treatment for it, because of pride. I thought should be able to handle this myself. And while I had prescribed thousands of antidepressants over the years, I was unwilling to take one myself or to see a therapist.

Finally, I broke down and agreed to treatment directed by my mentor. He started meeting with me weekly to check in. I started exercising, which I had not done in a long time. I started an antidepressant. I saw a counselor who helped me understand what was happening within my body and my brain.

It was all stuff I knew, but I needed to hear it from another professional – where I could be the patient as opposed to the educator. It is akin to a medical doctor who comes in for a physical – you need to leave your own stethoscope at the door.

Over about a month I began to feel more energetic. I started feeling better, standing up straight, regaining weight, sleeping better, and thinking less about dying. The whole ordeal lasted about five months. It could have been shorter.

My experience is probably typical. What can we do better?
I think part of the issue is that our culture enforces competition and if we show signs of weakness and vulnerability that puts us at a disadvantage versus others in what is seen as a zero-sum game. As a society at large, we can do better in that area. This is not good for society, or individual wellness.

We could also use a renewed emphasis on human connection. The fact that I had friends who cared about me enough to warn me was invaluable. I knew they had my back and could go into a position of safety, to confront what I didn't want to confront.

We need to better educate the public that depression is something that certainly can be managed, and it can go away. Even chronic mental illnesses like schizophrenia may not go away but we have the tools to help people thrive. For all of us, the three hardest words to say are “I need help.” That’s especially so with mental illness. We need to arrive at the point where it's as natural and supported to reach out to get help for your mental illness as it is for your hypertension, diabetes, or cancer.

Mainly, though, we need to genuinely fight the stigmatization of mental illness and of everybody who suffers from it. No one is spared from such issues – including those in powerful positions, like CEOs or principals or judges, or politicians. As it is, there will be barriers that will keep them from getting help. The stigma of mental illness should not be one of those barriers.

In my case, part of my fear had been whether my career would suffer. In West Virginia, as in many states, the medical license renewal form asks whether you’ve been treated for a mental illness. I wanted to be ethical, so I wrote yes – but really, why is that question there? It's discriminatory against people who suffer from mental illness. Better, as some states do, to ask whether the doctor is undergoing anything that would impair the ability to practice medicine.

I'm sorry I went through this. I never want to go through it again. But in a way, I’m grateful that I did. It has given me a new dimension of understanding what people go through when they're in the depths of despair. Once you get out of it you've got space to reflect on the bigger picture. But when you're in the middle of it, it's just darkness.

I want people to know that there’s no reason to wallow in that darkness and that they need not be alone. That is the North Star for me now.