…despite the obvious vital importance of feelings to the human condition, little can be found on the subject in modern and medical psychology textbooks. We are being held back by a structure that is ill-suited to our needs. What is needed is the energy and vision to support the emerging paradigm…It is clear that, as doctors, we need your help. – Dr. Robin Kelly, The Human Hologram
What Happened to the Doctors?
Something is drastically wrong with medical education as it currently stands, and the effects flow into the professional arena. For decades medical students have been notorious for having abnormally high rates of illness, both physical and mental compared with the rest of the population. Depression is one problem that is well known. Dr Robert Mendelsohn stated in Confessions of a Medical Heretic (1979) that he saw a higher rate of illness in first year medical students than any other subgroup. At the time his book was published, medical students’ suicide rates in the US were reportedly second only to American Indian children who were sent away from their reservations to attend high school.
The sheer physical separation of many college/university students from their families and friends leaves them much more vulnerable to the adverse influence of teachers with agendas, toxic peer influence, and of course the pharmaceutical industry which controls medical education.
Problems in medicine are not restricted to medical students, however.
If today we doubt the value of the modern medical ethos and the effectiveness of current mainstream medical practice, we have decades of context backing us up and no shortage of statistics. Even as early as 1979, when Mendelsohn was eviscerating the medical profession for its brutality, incompetence, dishonesty, etc., the health status of the professional medical community (in the US) in itself was reason enough to doubt its methods. 1 in 20 physicians were deemed psychiatrically disturbed, more than 30,000 were alcoholics, and around 1% were narcotics addicts. A thirty year study concluded by finding that almost half of doctors were either divorced or unhappily married, over a third used drugs such as amphetamines, barbiturates, or others, and a third had suffered emotional problems severe enough to warrant a minimum of ten trips to a psychiatrist. Suicide rates for doctors were double the average for white Americans. For female physicians, the rate was four times higher than normal for women over age 25.[iii]
Is this what “healers” look like?
Mendelsohn attributed most of this disaster to the cutthroat moral and psychological climate of medicine, its power politics, bribery, and corruption. He believed that by the time students got to pre-medical training, they had already learned the cheating, vying for position, and competitive practices needed for medical school.
He further pointed out that the admissions tests “virtually guarantee” that the students who do make it through will be bad doctors, funneling through personalities that are autocratically leaning, and unable and unwilling to communicate with people, having the drive to succeed but not the integrity or will to rebel when they should.[iv]
Judging by the real-world results, it is clear that medical schools are geared to churn out automata-like drug and surgery pushers with few scruples, little nous, truant empathy, and no originality, who are willing to sell their humanity out to the Church of Modern Medicine. When you factor in that in 1979 the half-life of medical information/education was regarded as being a mere four years, you have the recipe for an autocratic and severely outdated profession (and industry) that is eminently resistant to important new information, truth, and, perhaps above all, change.
Student Stress and the Erosion of Empathy in Medicine
There has been some recent research done into the impact of medical training on undergraduates. The results are not flattering. In White Coat, Mood Indigo, an investigative piece by fourth year medical student Julie Rosenthal and her co-author Dr Susan Okie, we find that medical students are more prone to “depression” than their peers, with around 25% reportedly having it. Psychiatrist Laurie Raymond believes that students’ coping strategies and health worsen as they linger through medical school. They are overworked, stressed, socially isolated, and sleep deprived.[v]
Angela Nuzzarello, a psychiatrist and dean of students at Northwestern University’s Feinberg School of Medicine in Chicago comments that “all medical students aren’t sleeping.” “They are overwhelmed, they are working hard, and they aren’t having fun socially…Of course they are fatigued.”[vi] Is this how to create healers?
In a study by M. Hojat et al. called The Devil is in the Third Year: A Longitudinal Study of Erosion of Empathy in Medical School the question of empathy was investigated. The results:
…consistently showed no substantial change in empathy between orientation (year 0) and the end of year 2. However, a considerable decline in mean empathy scores occurred in the third year of medical school. No significant trend toward improvement in empathy scores was observed in the fourth year. The decline in mean empathy score from year 0 to the end of year 3 is greater than one-half standard deviation unit (0.54), which is considered substantial and practically important.
Conclusions: It is ironic that the erosion of empathy occurs during a time when the curriculum is shifting toward patient-care activities; this is when empathy is most essential.[vii] (emphasis added)
To repeat: right when medical students really need a good handle on empathy and “bedside manner,” they are reaching a point of stress and burnout that has significantly eroded their empathic capacities.
The coldness of many doctors and nurses has reached legendary proportions. The 1980s sitcom The Golden Girls (1985-1992) featured a memorable scene in which the character Dorothy rebukes her dismissive ex-physician for not taking her seriously and making her feel like a fool for thinking she was sick. Seeking answers, Dorothy was eventually diagnosed with CFS, re-assuring her that she was not in fact neurotic or delusional, and did have something going on physically. Subsequently she happens upon her ex-doctor in a restaurant and interrupts his dinner to deliver an impassioned and scathing monologue, stating acerbically at one point: “I don’t know where you doctors lose your humanity but you lose it.”
We can tell Dorothy now that we know doctors effectively have their compassion schooled out of them – if they even have much to begin with. Whatever embers remain into their professional years are effectively neutralized by legal restrictions and the code of practice which prevents doctors from being allowed to advocate the most humane, cutting-edge, intelligent, and effective remedies.
The highly stressed, highly competitive—and socially alienating—environment of medical education explains a lot regarding the erosion of empathy. It is simply hard to even want to feel and see things from another person’s point of view when you are stressed. The more stressed you are, the more diminished that basic capacity is. But there are other indicators that show up prior to that third year decrease in empathy.
A recent survey of first- and second-year medical students at the University of California found that about one quarter were depressed. Laurie Raymond, a psychiatrist at Harvard Medical School said that students “see themselves going into a very narrow tunnel. A lot of the depression we see halfway through the [first] year — it’s a reaction to having constricted themselves down to studying these subjects in a very intense way. It’s pretty unidimensional [unbalanced].”[viii] (emphasis added)
There is a powerful cluster of stressors affecting medical students: lack of sleep, chronic stress, living from test to test, academic pressure, encounters with death may trigger previous loss/grief, intense peer competition, no time to nurture the self and recuperate, isolation during residency, student debt, working with constantly changing teams of residents and physicians, intensive time commitment, worry about finding time to start a family, and so on.
According to Nanette Gartrell associate clinical professor of psychiatry at UCSF, the most intense period of distress occurs “during the third and fourth years, when students rotate through the hospitals and clinics.”[ix]The unspoken attitude or code for the students is that since they are the “healers” they should deal with it and just be able to cope. Talking about depression has been taboo for decades—a culture that is only now slowly changing.
There is also the disillusionment that can result from discovering that practicing medicine isn’t quite what one expected it to be. One of the students Rosenthal interviewed found herself thinking: “Man, this life isn’t exactly what I imagined it would be, and now I’m stuck and have all these debts. I don’t like what I’m seeing in the hospital; that’s not how I want to practice medicine.”[x] Given that Big Pharma has long had the reigns of the medical system, it is not surprising that students should experience a jarring clash between idealized expectations and the grim reality of everyday allopathic medicine in practice.