Dear community,
Here’s a conversation with the wonderful Dr Jessi Gold — on workplace mental health, how to achieve a prevention focus over doling out interventions, and reflections on her own mental health journey — including recently uncovering and shedding self-stigma she didn’t realize she carried.
💫 Spread the light with Dr Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify
Because stigma festers in the dark and scatters in the light
More about Dr Gold:
Jessi Gold, MD, is the first Chief Wellness Officer for the University of Tennessee System and serves as an Associate Professor of Psychiatry at the University of Tennessee Health Science Center. (This conversation was recorded before she started these roles.) Dr Gold is an internationally recognized speaker, media advocate, author, and mental health consultant with a special focus on college students, healthcare workers, and the entertainment industry. She lives openly with depression.
Dr Gold has been spreading the light for decades with her critical work, and I’m thrilled to be sharing her wisdom about optimizing well-being with all of you.
Trigger warning: In this interview, we talk about systemic challenges inherent to working within the US medical system and their mental health consequences, mental illness self-disclosures, and living with depression.
Above, you’ll find the audio recording of the podcast episode and below, a transcript. The written version of the conversation has been lightly edited for clarity and length. If you’d prefer to watch this conversation, please click here. Here’s a brief video clip:
Catch our mini-series on clinician well-being:
Psychiatrist Dr Ahmed Hankir’s journey with melancholia and elation in medicine
Psychiatry resident Dr Jake Goodman’s journey with depression and anxiety in medicine
Nephrology fellow Dr Justin Bullock’s journey with suicidality and depression in medicine
Understand the key issues — Deep dive: Clinician well-being
Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.
If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here.
If you’re a US-based clinician or health student dealing with “any issue, not just a crisis” — reach out to the Physicians Support Line, free of cost and confidentially: 888-409-0141 (M-F, 8 am to 12 am ET).
Wishing you light,
Dr Devika Bhushan
DB: As you’re looking back at the last 10 or 15 years, there are factors that are worsening physician well-being — like you've found there's been an astronomical increase in the number of messages that patients are sending their mental health providers. And on the other hand, there's all of this increased awareness, stigma reduction that's going on where people are coming out and sharing their [mental illness] stories, coming into community, and feeling normalized and supported. Peer support networks are growing. On balance, as you're looking at this whole landscape, are things getting better or worse?
JG: I wouldn't say worse. I'd say the same, if not better.
And I think awareness is always the first thing. In all big things requiring cultural change, people need to know it's a problem, right? And awareness comes in lots of ways. The pandemic helped a lot with this because doctors were on TV crying and couldn't fight what they were showing. And everybody understood why that would be hard for doctors. And then people like me could say, ‘Oh, hey, this isn't new — right?’
But you had this picture of a person trying to do their best and not being able to — in the system — that everybody could see. And so many people were struggling across the hospital system with different things in different ways that it was sort of just a universal: This is what's going on right now. We are all not great, right?
We're not talking about it as much as we should. We're not getting help as much as we should, but we know this is a problem and we can't hide it much anymore.
Places across the country then put more money into it. If they had the money, they started to try to figure out ways that they could better support this.
A lot of that is on the intervention, not the prevention side.
So a lot of: How do we get you access to care? Not: How do we prevent you needing access to care in the first place?
A lot of stopping the bleed — and I think that continues to be the focus. Given a choice, they're going to do an intervention because they don't want the bad outcome, but they're missing all of the steps that prevent the bad outcome.
I also think that places that put money into it will very easily not put money into it in the long term. So it's hard for me to say, are we having a temporary awareness — like, good moment — in this? And if you asked me in a year, would I go everywhere stopped caring? It's possible because it's definitely less exciting and sexy to them right now than it was two years ago, or one year ago even.
Which is concerning because again, this stuff existed before. This stuff is only getting worse. And there are new problems all the time, right? So like, just because we are not burnt out by not having PPE [personal protective equipment] does not mean that we're not burnt out by anything. And that is a misconception that I think administrators or sort of the ethos of this conversation has — which is, the pandemic did this and made it worse.
And maybe when that goes away, we'll be able to say, ‘Eh…’ And we'll go back to not really investing in this thing. And I think that's a big problem — the longevity of this conversation and then the investment in the prevention, not intervention side.
And then you and I both know that talking about things doesn't mean people actually are doing something about it.
So that can be at a policy level, but that can also be on an individual level, right? So, like, just because it might be easier to say you get therapy doesn't mean people are getting therapy. And I see that a lot — like people still come pretty sick, which means they still hid it for a while, even if when they finally come, they feel better finally coming, there's still a lot of cultural problems in help-seeking to begin with.
And so, just because some of us are talking about it more, and maybe even world culture-wise, mental health is being talked about more, doesn't mean that all of a sudden, medicine's totally fine with it.
I'd love to say that, right? But just because we talk about it more doesn't mean that it results in people getting help earlier or getting help at all. And I think that people don't realize that. I think people think college kids are super in tune with their emotions and all get care when they need it. And that's not true.
They hide care just as much as everyone else. They still have really high rates of pretty serious stuff coming up that maybe didn't have to come up, but they put it off because they were doing well in school. Right? And so we have a misconception that talking about it is the only thing we have to do.
And, as somebody who talks about it because I can, I talk about it with the hope that it helps to normalize it. But then maybe we can take the next step from that and use that to make people change, or change the way systems think about this stuff.
DB: Yeah. So tell me more about that. What are the three things that systemically need to change?
JG: Time. So I don't know what that looks like, but you can't go to appointments — like going to see a therapist is a weekly thing. So either that means you're providing people who can see healthcare workers in the evenings and on weekends and everybody in your system is doing that, which was a lot of work for you, but the right thing to do.
Or that means people can't get care because you're not supporting them in it. It's hard.
There's no redundancy, right? So time is really redundancy, which is like, how are we making sure that if I'm not there for an hour, patients are okay? Or if I take a sick day, because I should take a sick day, the whole system doesn't implode.
We need better support around redundancy, to make sure that people can step away and it's okay — it's not a disaster. And they can take care of themselves if they need to and they don't feel like the bar to do so is like a hundred.
That's just not fair. And that's why we get a lot of this intervention stuff and not prevention stuff. So time slash redundancy.
Most people would say EMR [the electronic medical record]. I think there are good things and bad things about an EMR. I think other people dictating what matters in medical care is more of the problem than an EMR.
So the reason that note-taking is problematic is the notes are not for us. The notes are for insurance companies and legal purposes. And the little tiny bit at the end, about what's going on, is for us and signing out to the person who's covered, right? Most of the note is not about us. And it takes a long time to do the things that other people need us to do. The same with prior auths. The same with — I'm constantly doing, like, return to work, time off work forms — they're the same forms all the time. They don't understand mental health. I'm constantly writing them; it's a lot of work — it's not really something an MA [medical assistant] can do super easily, like a nurse maybe, but not an MA. It's a lot of work.
And so as much as people are gonna pinpoint the systems problems of an EMR, I actually think it's the system of medicine being not about medicine, being about all these other parties, like what insurance wants you to do, what legally you need to do, what your hospital system needs you to do, like productivity-wise, right?
These outside factors that aren't about the patient. You can't do your job well, and you can't find the meaning that you need because you have to spend hours doing all this other stuff because you have to.
So I say the system of medicine and the external factors controlling medicine — we need to get a handle on that or somebody else needs to be playing that role.
And then, you know, from my side, it's being able to culturally ask for help. So that means licensing [that don’t penalize having or seeking help for mental health conditions]. That means peer support in a way that feels safe.
That means seeing your supervisors also ask for help and knowing it's okay.
The time thing comes into there, too: being allowed to go do the things you need to do for you without being told you're weak, or you can't cut it.
You gave me three and I feel like it's 1) time, redundancy; 2) these external factors ruining the system of medicine, like productivity or insurance companies, and legal systems; and then 3) how we treat each other. And that's where I spend a lot of time because the other ones feel very big and outside of my control.
Like redundancy, right? That means you need more residency slots and people should be matching when they want to be doctors. That's not me. I can't change residency slots. There are things I can advocate for publicly. There are things I can do within my own system that are more system-wide. Those things take time.
The things I feel like I can control are how we talk to each other and how we support each other and how we validate each other's experiences and normalize that in a way that feels not just okay, but goes that extra step and makes it fine to do whatever you need to do for you without feeling wimpy or like you can't cut it or you don't belong.
I spend the vast majority of my energy on that because I feel like you can see results. Like if I make one of my patients feel safer talking about feelings and that person is in an admin role, they make all of the people under them feel safer, right?
It feels more doable. And I think just like with any big issue — so racism, sexism — these big things that are inherent to how medicine was built: they feel big and daunting and frustrating.
And a lot of times I give talks on it, people just get mad at me because like, 'What are you gonna tell us? Do yoga again?'
And I try to frame it very much like, 'I'm not telling you to do yoga, but I'm telling you if If you don't want to quit, you have to figure out what yoga is for you.' Because I'm not trying to tell you yoga solves the fact that insurance companies and productivity requirements are controlling medicine, but I am trying to tell you that, if you'd like to still be in medicine, you have to figure out how to deal with it because that's not going away tomorrow.
In fact, it might get worse. And so: do I think that a lot of people may choose to actually leave medicine? Yes, I do.
And I think that's something medicine needs to reckon with.
And medicine as a system needs to fight for these things to make sure people stop leaving. But I do think you have to go, 'Okay, this is what medicine looks like. I'm not lying to you. I get it. I see it. I see all the brokenness. I want to fix it, but also I can't fix some of these things and tomorrow, they're not going to be fixed. So how do we help you survive today?' And that's what I do.
DB: Yeah, that's really thoughtful. And also to have identified where your lane is and where you feel the most efficacy in terms of driving progress. And it makes a lot of sense that it's in helping people feel safe, driving culture change, making a difference in how we speak to ourselves and to each other around some of this stuff. It's hard work. And I really want to thank you for having done it for as long as you have and continuing to do it. It's awesome.
JG: I did my thesis when I was in my Master's program on pre-med as a culture.
So I've always really been interested in how did we get here and why? And is there a way that we could do better for each other, even if we're stuck in this thing? Because all of us have ecosystems and family structures and cultural structures, and we grow up with all of these microcosms of problems that just make things worse.
But can this be better, even as bad as it is, for each other? Can we do better? And some of that, too, is honestly saying if this is wrong for you, don't do it. And if this feels bad, don't do it. Get out of it. There are other things you can do.
And we didn't talk about that — it's a secret that people go into other fields with an MD or end up not liking it. Or questioning it is part of cultural change and we should question it because it is not great. And you know, I remember when I was in college, it was like probably right when managed care was taking over more and all these people were like, ‘Don't be a doctor. It's run by insurance companies.’
And I was like, 'Who are these people telling me this?' Like, ‘I don't know you — what do you know, right?’ But I kind of wish they sat with me and explained it more and didn't let me just tell them, 'No, this is what I want to do — I'm gonna like it.'
You need to go into this a bit more with your eyes open, and not in this super idealized, you're not supposed to question it way, because that's unhealthy. And then you don't end up questioning it until you're like us, and you’ve done this for a really long time and then you're like, 'Wait a second, what am I doing? I gotta find the way that this fits me better so that I'm doing what I feel good about.'
And [for] a lot of people that comes in residency — like you did a specialty for a month and [based on that], you're supposed to figure out what you're gonna do for the rest of your life. You know, a lot of people want to drop out of residency and switch, but it's just not normalized.
And so we need to do this better, right? Like, take the time you need. Ask the questions you want to ask. It's a really long life. This takes a really long time. But it takes longer if you're miserable.
And so I think part of how we change that culture of help-seeking and support is also: turns out, not everyone likes this, or you might hate it sometimes. You have to find the ways to like it. Like, I hate it sometimes, too. But I like X, so I can still hate it, and like it, right?
I feel like people turn to people like you and me, and they're like, 'Fix it. This is bad. I hate this. Fix this.’ And, oh lord, how I wish I could, right?
Like, I wish I could wave a magic wand and medicine was better, but I don't even know exactly what that looks like, starting from scratch. But what I do know is, I don't want everyone to quit, but I want the people who want to quit to quit. And I want the people who don't want to quit to figure out how to make this right for them.
And that needs to be the conversation. It's sacrilegious to say medicine is broken and most people hate it. It just feels like we need to be more honest about that stuff.
So I get it. You think I'm giving you a lecture on well-being because I think I'm fixing the problem? I'm giving you a lecture on well-being because we all need lectures on well-being because we don't know how to take care of ourselves. Because no one taught us, right?
So, I've put my energy into that bucket because I can't help but be authentically honest about it. And so if I have to be the realistic person who also happens to know mental health coping techniques, I'm happy to do that.
DB: Yeah, it's huge. And so thinking about these three buckets, what is the prevention focus rather than the intervention focus? And how does that play out? What does that look like?
JG: It has a much bigger focus on peer and supervisor support.
So I see faculty. I see college kids. I see med students. No matter what, everybody's stressed. Because the faculty don't know how to support the people that are struggling. But the people that are struggling only have access to the faculty, right?
So we need to do a better job globally supporting people in identifying signs and symptoms, in understanding early signs of distress, and knowing what kind of stuff you can support people with. Like turning in a paper late. We're talking like, not rocket science. Do they need a quick little intervention just to get them through the week?
Peer support in a way that feels good, like, turning to other people that are not professionals, even with real trainings, like Mental Health First Aid kind of stuff.
I don't think everybody needs to go see me. I don't want everybody to see me. We're doing something wrong if everybody sees me.
Am I a good peer supporter? Yes, but does every peer supporter need to be a mental health professional? No, right?
So I think that we need to be in a place where friends and colleagues and supervisors feel safe talking about this stuff, looking out for this stuff, noticing behavioral changes, and having earlier conversations with people and having things you can be pointed to at that point.
So we're talking: That's where mindfulness comes in. That's where deep breathing and coping skills come in. That's where exercise comes in. That's where sleep hygiene comes in.
These things that people groan at me for — they're groaning at me because they haven't slept in four weeks, not because they haven't slept in a few days, right?
And so if we're better able to say, 'My warning signs are X, If I notice my warning signs, I need to do something then instead of like 10 weeks later.' That's important. A supportive supervisor also isn't only pointing out things that are bad; [they are] also trying to make sure people feel they're getting gratitude in some capacity.
That people have the ability to say, 'I need that meeting to start 10 minutes later so I get a 10 minute break because I lose my mind otherwise.' Flexibility is super important. ‘I need to work from home on Mondays.’ Whatever that looks like, right? A supportive supervisor understands that there is not a one-size-fits-all model to this.
And there shouldn't be. And so we have to be able to say, 'Okay, why do you need to work at home on Monday? Is it because you're being lazy? Probably not. Is there something else that you need to do? Okay, let's understand how I can support you through that.' And also, you still do work, because you do work and you're paid to work, right?
You have to be able to form these workplaces that work and fit the person — more than the workplace is just the workplace and everybody has to fit it, right? And that requires an awareness across the board [about] how to deal with this stuff.
Like, for me, my early signs and symptoms are not I'm sleeping every day after work, and I'm isolating, and I'm ordering takeout, right?
My early signs and symptoms are, if you send me one more email, I will take my computer and throw it across the room. That's how mad an email makes me. That is not a normal reaction to an email. Doesn't matter who it's from, doesn't matter what it says — that is not a normal reaction to an email. I am aware of that.
But do I blow past that sometimes to the only paying attention when I'm sleeping every day after work? Absolutely.
And so prevention is: the individual level — noticing your own stuff; the colleague level and the friend level — being able to talk about it and notice it and talk about this with each other and suggest ways that it has worked for you, when that feels right and doesn't feel like you’re advice-giving and not listening, and the supervisor support level — feeling safe being a supervisor of people who can struggle.
Which means you have some knowledge about it, being able to talk when you need to, but also being aware that you can help with flexibility, support, praise, etcetera, where needed, by being a better, mindfully mental health-aware supervisor.
DB: It's this deep knowledge of what works for you. And also this deep awareness of when somebody else in your ecosystem is not acting like themselves. Something is slightly amiss and just being curious and digging a little bit deeper, rather than just being like, 'Oh, this person is not trying or this person is not showing up to work the way that they should be.'
But it requires for you as a supervisor, as a peer, as a colleague, to also be in a good enough place to have that bandwidth and capacity to be mindful and intentional and curious rather than 'This is getting in my way. I wish I could rely on this person to do the things that I, you know, need them to do for me.'
And it really requires all of us to be super committed to our own well-being first and foremost, so that we can create that safe ecosystem then for each other, as well.
JG: Yeah, and we could say, 'I do X, I'm committed to my well-being,' right?
Or they say they can do work — they're fine, right? It's usually not true.
You know, I am a psychiatrist who is a burnout expert and I was burned out and didn't know I was burnt out, right? Just because you spend all day in the topic doesn't mean you apply it well to yourself.
And in fact, you probably resist it because you think you know.
And so I think it's important that people realize for someone like me, it's still hard. I struggle doing what my therapist tells me to try because I don't have time, just like you don't have time. And I think it's silly, just like you think it's silly. Or I'm not gonna like it. I have the exact same reactions in my head because turns out I'm human, right?
I think it's important that people realize that it's not easy for anybody.
It's not easy — it's a big change for all of us, because we didn't learn it as kids. We learned to prioritize work. We figure if we're doing school and work fine, we must be fine, and that's just the way that it is. And we can do school and work blindfolded, most of us. It's usually the last thing to go.
The rest of your life can look like a big, big disaster, and you can still be getting As, and you could still be getting high marks at work from supervisors, because we know how to turn it on and play the part and be the good little student. But the rest of your life could be a complete disaster.
And it's important that when we talk about well-being, we're not just talking about: Are you doing your work and are you showing up at school? And that's a big cultural change. I never did that; I still don't do that. Like if I can go to work, I'll go to work, right? And maybe that's not right.
Maybe we have to reframe that. Where we actually might need the break from work because everything else is also a mess or we need the time to figure it out. I just think it's important that we realize a lot of stuff is ingrained in us from a young age, compounded by gender, culture, ethnicity, workplace, whatever, right?
But even somebody who literally, this is my job is to help people do this stuff — struggles. And I think that that just means everybody struggles, right? Because if it's not easy for me, who's it easy for?
And so I just think people shouldn't beat themselves up about this stuff, either.
And say, I'm bad at coping, or I'm bad at taking care of myself, or I don't have time for that. I don't have time for it, either. But it makes me better when I do take the time, you know, and I mess up sometimes and I fall off and don't do everything I'm supposed to do. And it's a growth and learning process. There'll be bad times and good times.
We have to support each other through all of that and realize, we're humans in the workplace, not machines.
DB: Thank you for that transparency, because it is really hard to stay whole, healthy, even when it is a focus in our day-to-day work. What are your top strategies?
JG: Number one, therapy. I go every week, unless, you know, I'm out of town and it doesn't work, but I go every week. I think people hear that and they say, 'Oh, she must have problems that she really needs to deal with.'
And yes, sometimes I do, but I see it as like a thing that makes me better at my job. And I don't view it as, like, 'I have a problem, I need an intervention, and that's the intervention.' I view it as, this whole thing is just making me better, and sometimes I might have something acutely wrong, and sometimes I don't. And that's okay. It all makes me better.
Number two, what I do for coping super varies. Sometimes I journal. That can be hard for me because I do a lot of writing and so I have to like fight the urge to make it into a piece. And so I journal in a book and I try, but it can sometimes like be an issue.
I don't like mindfulness. I've tried it 100 times. I hate it. I'm more likely to calm down reading a book or listening to a podcast or watching a stupid television show. I can't just do stupid TV though because my therapist says that's not an active coping skill. So, I try to be good about that, kind of balancing what I'm doing.
Sleep is big for me. I can get off sleep patterns because I feel productive at night or I'm having trouble sleeping and then I want to take a nap and whatever. It just throws me off and that has a big impact on my mental health and so I pay more attention to that when I can. If I get off, I try to get back on a cycle that's better.
I have a really good like supportive network of friends and family and stuff. Maybe I lucked out: some of those people are also therapists, but it's not like our relationship is like that. You know, I like distractions; I like plans. I like knowing that if work is really hard, I'm going to go on a trip in three weeks and that's okay.
That matters to me — having things to look forward to. So I plan things that way because I can get through anything for a short amount of time if I have something to look forward to.
And then finally, and last, but not least, I've been on meds since college. I haven't changed them. I don't see a psychiatrist; actually never saw a psychiatrist. I've been on the same med for like 15 years, but I mean, I think it helps. I tried to go down once and it wasn't a great idea. And I think that it probably makes it so like when I have a harder time, I bounce back quicker.
I think that it helps my baseline. It's probably not something that's like actively making a huge change every day. If you look at the studies of long-term use of antidepressants at a certain point, quality of life improvement stops, but it doesn't get worse. And I feel it's sustaining my quality of life and if I chose to get off of it or try to get off of it again, I'm sure I could, but I just don't want to.
DB: Thank you for that. You've written about how it took you kind of that extra layer of conviction and strength to even to share the fact that you're on antidepressant, right?
And how that was a different layer of self-stigma that you had to unravel for yourself than even saying, you know, that you had a mental health condition. So can you talk a little bit about anything that may have surprised you post-disclosure, what that journey was like, in general?
JG: I mean, I'm a big — you don't owe your story to anyone. Your story is your story. Whatever part of your story you want to tell is your part to tell whoever you want to tell it to.
Like certainly publicly, we do not need everyone to do what you and I do.
Some of us need to do it because that's how you kind of change it from the top. But everybody does not need to tell your whole mental health history and there's a privacy aspect of it.
And people think they know everything about me, but they don't. Like, nobody knows actually why I'm in therapy and why I started in college. And nobody knows all my details because that's my business. And if I ever choose to talk about it, I'll have felt like that was the right time, but I have felt like there are parts of my stuff that is mine and not theirs.
And I very openly talked about seeing a therapist and finding a therapist beneficial for a really long time and definitely on social. And there was this time in 2020 where all these people were tweeting like, ‘I am a this and I, you know, I take this’ and I said, ‘I'm a… I go to therapy’ and I felt like my tweet was good.
“I first noticed that I selectively left out my medication history early in the pandemic, when a bunch of healthcare workers, professions that traditionally do not talk about mental health at all, shared on social media about their mental health treatment — I participated on Twitter, but only shared about my therapy. I read their responses and thought they were brave and vulnerable, and that mine didn't really say enough.
It wasn't a lie, but it wasn't the whole truth….
…Knowledge and awareness do not make you immune to stigma.”
—I'm a Psychiatrist and Even I Kept My Mental Health Meds a Secret, Dr Jessi Gold
Then I started like reading everybody else's and I was like, 'Why does everyone keep mentioning meds?' I'm like, 'Why didn't I say that? Like, what part of me is preventing that from coming out?' Because, again, like I told you, same med, no changes — I'm as boring as it comes when it comes to that stuff. I never even saw a psychiatrist because my first med worked, right?
Like, I'm boring. And I spend all day telling people mental health meds are normal. ‘They're the same as blood pressure meds. Why would you be ashamed to do it?’ And I believe that. I don't think I'm blowing smoke. I actually think that's a core value.
But there's something about applying core values to yourself that sometimes get warped in there. And I was like, 'I need to sit on that' and spent a while talking to my therapist about it, trying to understand what that was about — and really figured out that I had some deep view that for me, meds meant I was sicker — meds meant maybe people would view that as I'm a worse doctor or something.
You can tell when you try to sell meds to people how much easier it is to sell therapy, most of the time. (Some doctors just don't like talking about themselves and would love a pill to fix them. So doctors are this kind of weird population.) But for the most part, culturally, we've accepted therapy as almost a well-being sort of wellness technique and meds are not there yet. And I know that, but I didn't really feel like it was true for me.
And when I figured that out, I was like, 'Uh, oh, I need to work on that.'
'I need to tell people and the reason I need to tell people is not because I owe it to them, but because I owe it to them for them to know it is this hard to talk about it.'
And sort of like I said about the burnout stuff, I don't think that my story is Earth-shattering. I don't even think people should praise me for telling it because it's so boring. But I do think that it is important for people to realize that I can spend all day telling you to take meds, and you're exactly like me, and I can believe it, and I will not apply that to myself, because of all this stuff, right?
Which means, all the stuff going on in my head is the same stuff going on in your head. And that's worth a conversation because that part is a part we need to change. And I think that, you know, writing about that helped some people understand that disconnect in a way that was helpful.
I didn't just go like, 'I took meds, I'm great, la la la.' I was like, 'Here's how come I never told you this.' And I think that's important as a conversation.
I think there are lots of these areas that we need to do better. Like, I think you talking about bipolar is one of them, too, right? We spend a lot of time on anxiety and depression. We don't spend a lot of time with people who — poorly titled — [have] sort of serious mental illness, right? We need to talk more about all the spectrum of stories so we understand: there is not a good mental illness and a bad mental illness.
There's just everybody's struggle on a spectrum and we need to be okay with all of it.
So like that same way that we need to talk about all of it, we need to talk about why we don't talk about some of it or why it's hard for us to talk about some of it. And that's what I wanted to do. I think people responded pretty well to it.
I think the hardest thing with me in storytelling is wanting to be authentic, while also knowing I want to hold stuff back.
I don't know that I think it's courageous. I think it's sad that it's courageous. Like I get why it is; I understand why people say that to me or thank me for telling it. But I also think, I am so boring.
Like, look at Chase [Anderson, MD, MS], right? He’s a good friend of mine, and Chase talks about having chronic suicidality. Like, the most thing that happened to me recently is I've been really burnt out. I'm still on meds, I go to therapy. I'm a pretty boring mental health story.
And yet, because none of us talk about it, it's still Earth-shattering that I do, right?
I appreciate that my story can resonate with people because it's so boring, probably, because also, if we only heard extreme stories or more severe stories, we would be confused about what I mostly see in my clinic, which is me, right?
But I'm aware my story is boring, and I think in its boringness, I can have conversations about how much further we have to go, and how typical things are hard for us.
It makes me sad that being on an antidepressant since college and having stable depression is... saying that out loud as a physician is huge.
It makes me sad that my story isn't boring to everyone because everybody's already said it.
DB: It's still profound to speak it out loud in your position — to be a doctor and say these truths about yourself. It's funny that [Twitter[ chain that you're talking about, I'm thinking back to it. I think it was 2020, right? And I similarly wasn't fully out or hadn't revealed my diagnosis yet, and I remember putting out like, 'I'm on therapy and I've used meds and that's helped my mental health.' But then the kind of the next layer of truth came later, right?
And so it is always fascinating for those of us who do decide to talk about things publicly, like what we hold back at what points in our life and then when we feel ready to give more details and what parts — it's one of those things you think so hard about, right?
Like what will the implications of — you know, this detail, or that story — be for the people in my life, the people who might come in the next generation? It's complicated.
JG: Yeah. I mean, I think some people don't think enough about it, right? I think some people just tell everything and then they regret it, not because of the backlash or something, but it's really hard to tell your story and then keep telling your story.
And I'm sure you've gotten like lots of people who tell you in return. It's like a domino thing. Sometimes you can handle that and sometimes you can't, and that's important to know that you're gonna get that.
And I think the layer part of it is important because it gives you control.
Some of it's subconscious, right? Like, I didn't actually mean to not say, I never intentionally in my head was like, I'm not gonna tell people I'm on an antidepressant. But then when I realized I didn't and everyone else felt fine about it, I was like, 'Oh, right… let's look at this.'
I think it's important to do things on your timeline if you do them. And it is just as fair if you only told me you were on meds or you had depression or whatever, and you didn't say you had bipolar depression 'cause you didn't want to. Right?
DB: Totally.
JG: And I think we all need to be more of the masters of our own story and know that you're allowed to have that control.
Because so much of it feels out of control. Like if something happens at work. You lose control, right? You have to tell somebody; it might not be what you wanted to do. You might have to step out of work and you might have to tell them, right?
Or if you're about to have something happen at work and you need to get off of work — same thing. You're going to tell somebody. And that is out of your control in a way.
Similar: Britney Spears shaving her head. Out of her control at some point to tell us something was wrong because everyone saw her shave her head.
That is not a fun way to have to tell your story.
That is a story that is out of your control, that is based on your behavior, that is people judging you based on whatever you did, as opposed to you being in a place where you processed it, felt good about it, told what you wanted to tell, knew what the repercussions were, all of that stuff.
And so given a choice — not all of us have it — but given a choice, the other one is better. And we should view storytelling that way. It isn't easy, it shouldn't be expected, and it should be seen as something that you're doing because you choose to, and in a way that you feel safe. When you feel safe, how you feel safe, what you feel safe telling.
And I hope people know that, and don't see us as: 'Look, they told all their stuff, I should, too.' If that's how you feel, cool. But I would just caution that impulse, and be like, 'What does it mean?' And think about it: ‘Am I ready to handle other people telling me their stuff? Do I want people to know everything, or should I test out the waters and see what it's like?'
You know, actually thoughtfully do it, instead of just feeling like, 'Oh, other people did it, I should do it. Or, there's a trend on social where everybody's doing it, I'm gonna do it. It's Physician Suicide Awareness Day, I'm gonna do it.'
I just want people to own that. And not just feel like the Internet expects it, or in order for us to have cultural change, we all need to do it. Because we don't, actually.
I think we would change culture if people just said medicine was hard. Right, if people were honest about the fact that most people don't like their jobs in medicine — lots has to change.
You don't have to tell me you're depressed, or you're bipolar, or you're on meds, or whatever. We can feel more safe talking to each other if we know that somebody can be a little vulnerable, just a little.
Dr Jessi Gold on optimizing well-being