With the end of National Suicide Awareness Week and the constant Instagram and Facebook reminders to check on your “strong” friends, I thought I’d touch on depression a bit today.
I recently had a brief conversation with another physician mom about the feeling of being “alone”. Not lonely, but A-L-O-N-E. It is a very real, very intense feeling especially when you are in the midst of a mental battle. That battle can be depression, anxiety, a full-on nervous breakdown, heartbreak, and even burnout. It doesn’t matter how many times people tell you that you are not alone, it’s essentially impossible to believe. You can reason with yourself a hundred times and find example after example that proves you are not alone, but you are incredulous. In the midst of this conversation, she said something really profound, “There is a difference between being intellectually alone and being emotionally alone.” All I could think was “Yes! [So much yes!]” I think about this statement a lot. On my hard days, when I’m doubting my own recovery–I’m reminded how alone it feels. When I see others struggling, or when others are honest about their own hard times, I can see that they are intellectually reaching out–intellectually not alone, but where are they emotionally?
What do we mean by “emotionally alone” but not “intellectually alone”? Simply put: it’s a vast, deep feeling of being alone, but at the same time, knowing we aren’t alone. For instance, just a few months ago I was burned out and depressed. I didn’t want to show up to work, I was short with nurses, I was cynical, I had lost my sense of purpose in medicine, and yet, I wasn’t convinced that anyone understood. It wasn’t just my husband that didn’t get it, or my best friend who isn’t a physician, or the male doctors that I work with, there was NO ONE that could possibly feel like they very seriously wanted to up and quit their job tomorrow. I had started researching burnout (I didn’t need to research depression, I had been there and done that), and I was finding all sorts of life coaches that were making entire careers of helping people like me. There was plenty of evidence that I wasn’t alone. There were burned out moms, burned out physicians, burned out nurses, burned out lawyers, burned out everyone. There were depressed moms, depressed physicians, depressed nurses, depressed lawyers, depressed everyone. But I was still alone. You could not have convinced me otherwise. I’m still not certain that you can convince me, now, that I was not alone in that deep, dark place. I wasn’t physically alone, even though I was often trying to be. I had plenty of support from my husband, my parents, my husband’s family, and my friends. I had a calendar so full of events with friends and family that I needed a vacation just to get away from it all and find some personal rest. I was not intellectually alone. I was certainly not physically alone. But emotionally, I was very much alone.
As a physician, I think this sense of being alone is magnified. The mom I mentioned above, she’s a perinatal psychiatrist. She’s damn good at it, and possibly because she knows how terrible postpartum depression is, firsthand. Yet, even she will tell you, she doesn’t feel like she is supposed to know firsthand. How can she possibly have fallen ill to the very thing that she treats every day? With the remaining stigma around mental health and people not giving mental health the respect it needs, this can be even more troubling. While it might be ironic, I am sure there is no short list of physicians that have succumbed to the very things they treat–colorectal surgeons dying of colon cancer, neurologists dying of stroke, cardiologists dying of heart disease, trauma surgeons dying in motor vehicle collisions. This must happen every day. We are simply not immune even to the things we know the most about. But can you imagine, as a psychiatrist, having to endure the mental and emotional pain that your patients endure? Knowing every way to prevent it, every way to identify it, and every way to treat it, yet having to enlist someone else’s help. Yes, I’m sure said person also knows other psychiatrists, psychologists, and counselors. But I can promise you, she still felt alone. She spends days on end trying to convince others that they aren’t alone–reading through massive amounts of studies about people just like her. Intellectually she is not alone. Emotionally, she was very much alone.
I haven’t once used a synonym of alone in this article. The other words just don’t get there. Thesaurus.com lists the synonyms as: “solo” “unaccompanied” “unattended” “abandoned” “companionless” “deserted” “desolate” “detached” “forsaken” “solitary” “isolated” “lonely” “lonesome” “sole” “unaided” “unassisted” “unattached”. None of these quite describe this abyss that some of your “strong” friends may be feeling right now. They may be smiling, surrounded by friends and family, getting support from others, and yet still feeling alone. I don’t know that there is a remedy for this one part of depression other than finding the road to recovery and finding some amount of comfort in actually being alone. Perhaps finding comfort in the synonyms–solo, unaccompanied, solitary–allows you to take ownership of your own emotional recovery. Meanwhile, knowing we are not “unaccompanied”, “unattended”, “abandoned”, “deserted”, “forsaken”, “unaided”, or “unassisted”. Someone is out there trying to attend to your every need and assist you on your way to finding yourself again. And maybe, that “intellectual togetherness” is the same thing as that very dim light at the end of the emotional tunnel. Maybe it’s the thing that allows us to see ourselves through. Maybe knowing we aren’t alone eventually washes over us until we feel we aren’t alone. Almost like the old adage of “fake it until you make it”. Maybe knowing is just superficial feeling–until you make it.
If you know someone who is suffering, please reach out. Truly, check on your strong friends. Check up on yourself too. If you would have someone check your heart, your labs, your back pain, then check your mental health too.
If you want more help with burnout and depression, feel to free to contact me as well. I’d be happy to lend a hand. Follow me on Instagram (@doctorenough) to see my own journey out of burnout/depression.