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Book Review: The hope that comes from ‘Growing Pains’
You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.
Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”
From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.
Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.
This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:
“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”
The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.
This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.
Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”
In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”
One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.
Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).
You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.
Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”
From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.
Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.
This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:
“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”
The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.
This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.
Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”
In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”
One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.
Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).
You might be surprised by child psychiatrist’s Mike Shooter’s response revealed in his book, “Growing Pains: Making Sense of Childhood: A Psychiatrist’s Story”(London: Hodder & Stoughton, 2018). Rather than hospitalizing this patient, as was done many times before, he makes a bold decision to listen to the group members, who help the patient develop a plan that ultimately leads to greater resiliency.
Dr. Shooter shares many stories about the power of therapy to heal, often visiting patients at their homes to better understand the dynamics of their distress. Stories themselves heal: “It is the job of the therapist to encourage them to reveal their story, to listen to it, and to help them find a better outcome.”
From these stories, we learn about Dr. Shooter’s passion and commitment to his relationship with the child – listening, fostering autonomy, recognizing the power of family systems, working with a multidisciplinary team, and using his own experiences with depression to better help his patients.
Dr. Shooter closes the distance between himself and readers by sharing his own story – his difficult relationship with his strict father, his own uncertainty about his future profession, the deep depression that could have derailed his family life and career, and the treatment that got him back on track.
This book is an excellent read for psychiatrists and other mental health professionals, whether they work with children or adults. It is especially valuable to psychiatrists like me who work with college students – transitional-age youth at the border between childhood and adulthood. Dr. Shooter beautifully describes the societal ills that have contributed to a global rise in child and adolescent mental health problems:
“We live in an ever-more competitive world. To the normal pressures of growing up are added the educational demands to pass more and more exams, a gloominess about the future, and a loss of faith in political processes to put it right; private catastrophes at home and global catastrophes beamed in from all over the world; and a media that’s in love with how to be popular, how to look attractive, and how to be a success.”
The general public would also find this book an interesting glimpse into the world of child psychiatry. The public as well as politicians would benefit from knowing the value child psychiatry can provide at a time when services are underfunded in many countries, including the United States.
This book uses the words of children to highlight the challenges young people face – from bereavement to bullying to abuse. He writes about children on the “margins of margins.” As I read the book, Dr. Shooter reminded me of psychiatrist and author Robert Coles, who taught my favorite college class and wrote about children in crisis from the Appalachians to Africa.
Not surprisingly, Dr. Shooter describes spending time with Dr. Coles at a conference on bereavement. He adheres to the advice Dr. Coles offered, which was to “Listen to what the children say, not what the adults say about them. ... Follow what your gut tells you, not your head.”
In addition to listening to the patient and your gut, Dr. Shooter describes offering hope as another essential element to treatment. He describes giving hope to children of parents who die by suicide, as these children often fear they will meet their parents’ fate. “And they need to know, too, that suicide is not inevitable. … Help is ready and available to stop the children and young people ever getting to that state.”
One element of treatment Dr. Shooter minimally addresses is psychopharmacology, and mostly in a negative way. While he acknowledges that some children genuinely do have attention-deficit/hyperactivity disorder or depression, he feels they are overdiagnosed and thus overtreated with medication. I would have liked to hear more about the times he prescribed medication and how it was integrated into comprehensive care that included therapy and lifestyle changes. I would not want parents reading this book to feel badly if they have supported having their child take medication for a mental health disorder.
Dr. Shooter does make the important point that therapy is often left on the sidelines in current medical systems. Therapy can benefit people of all ages as we face our own “growing pains.” He highlights the “opportunity for growth” that challenges provide, and indeed gives us a great sense of hope in our lives and our work as psychiatrists.
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of “The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students” (Lanham, Md.: Rowman & Littlefield of Lanham, 2018).
Ending hazing as a rite of manhood on college campuses
Is hazing a necessary rite of passage in Greek life, or a terrible tradition that needs to end once and for all?
There can be no justification for hazing, especially after the recent tragic deaths of fraternity pledges at Florida State University, Texas State University, and Louisiana State University. The horror of hazing has been brought home by the refiling of charges against several Penn State fraternity members in the torturous death last February of Timothy Piazza, which was recorded on videotape. In response to recent deaths and injuries, some colleges have suspended Greek life activities on campus. Unfortunately, hazing deaths are not new to college campuses but have a been a problem for several years, with 40 deaths in the last decade. The majority of these deaths involved the forced consumption of large amounts of alcohol, but some have involved beatings and other forms of abuse.
What exactly is hazing? According to the organization StopHazing (stophazing.org), it is “any activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers them regardless of a person’s willingness to participate.” Activities may involve alcohol consumption, humiliation, sleep deprivation, physical abuse, and sexual abuse. Hazing is not just a problem of fraternities; half of college students joining clubs, teams, and other organizations experience hazing. In fact, half of young adults have been hazed by the time they graduate from high school.
Given its inherent dangers, we have to wonder, why does hazing continue? The National Public Radio show 1A offered one answer to this troubling question on its Nov. 15 show, “How to Stop Hazing.” Two panel members, a filmmaker and a professor, discussed their own hazing experiences in college fraternities that included being forced to drink too much alcohol, eating noxious products, and being subjected to violence. One of the panel members talked about hazing other people. Both men admitted that the hazing process made them feel closer to their fraternity brothers: They formed lifelong bonds and also became stronger in facing adversity. In many ways, hazing was a masculine rite of passage. Neither panel member condoned the behaviors they were subjected to or participated in, and in fact suggested that college men should find new ways to bond and have a sense of belonging.
Even though the panelists were not promoting hazing, I was struck by their almost fond recollection of these experiences. I, in contrast, have no fond memory of an incident that I would consider medical hazing. During my internship when working on an internal medicine unit, I was ordered back to work after 2 days at home with the flu, although I was still febrile and coughing up a storm. That week, I was punished with an extra night of on-call duty. This incident did not leave me embracing the camaraderie and hardiness of my medical colleagues. It left me more determined than ever to treat peers and trainees with care and compassion, and never to abuse my power.
In our own practices as psychiatrists, we can play a role in helping our young adult male patients avoid hazing experiences, which have the potential to lead to depression, anxiety, posttraumatic stress disorder, and suicidal behaviors. We can work with our male patients to develop a sense of belonging and an understanding of who they are as men, without putting their lives or others’ lives at risk. In my work as a college counseling center psychiatrist for over 2 decades, I have often addressed the issues of masculinity, friendship, and peer pressure with my male patients. For those of you who work with young adult men, particularly in the college population, here are some tips:
1. Talk with your male patients about healthy versus harmful relationships. No relationship should involve the intentional infliction of physical or emotional pain. Men will acknowledge that a man hitting a girlfriend is abusive. They need to understand that male fraternity brothers hitting each other or forcing someone to drink a large volume of alcohol is equally abusive. Encourage your patients to know their limits and set boundaries if they are asked to do something dangerous to themselves or others.
2. Role play with your patients how to say no to their peers. I did that with a patient who was drinking too much in general with his fraternity brothers. He was afraid they would reject him if he drank less. He was pleasantly surprised when they did not pressure him to drink more, but instead encouraged him to do what is healthy for him.
3. Encourage your patients to have strong social connections on campus. Well-run fraternities can provide these friendship without inflicting pain. Intramural sports, singing groups, bands, and volunteer organizations all provide great ways to connect and also have a sense of accomplishment. Social connections improve grades, physical health, and emotional health.
4. Encourage your male patients to accept who they are, without embracing one stereotype of what it means to be a man. Social media often promotes unattainable physical images, and some male patients will take supplements or even steroids to build up muscle mass. Promote a healthy lifestyle without extremes in exercise and diet. Explore with your patient what it means to be a man in the 21st century, at a time when typical gender roles are being challenged.
5. Listen for cues about your patients’ relationship with their fathers, which have a large impact on how they view masculinity. Many of the male patients I see discuss how they are trying to be more in touch with and expressive about their feelings, after watching their fathers hold in their emotions or use alcohol to numb emotional pain. Some patients have been able to model and encourage a greater openness with their fathers, while others have been met with silence. As a patient is creating his own life story, his father’s history is always in the background.
Should all fraternities be shut down to end the hazing problem? I don’t believe this is the answer. Each campus has a different fraternity culture, and fraternities on many campuses can be a positive force. I have heard young men describe how fraternities encouraged them academically, discouraged excessive drinking, and promoted ethical behavior. But given that abuses have been prevalent on certain campuses, it is incumbent upon universities to enforce safe behaviors. Fraternity brothers who hurt others should be prosecuted, not protected.
The hazing on campuses needs to stop, and we as psychiatrists should talk about this important issue with our patients and sometimes their parents. We can educate our patients about this insidious form of physical and emotional abuse; we can encourage them not to be bystanders when this happens; and we can promote a culture of respect on our campuses.
Hazing is not just a campus but a national cultural problem, as we are finding from the avalanche of news reports about sexual harassment and assault in the political and entertainment worlds. Victims are exposed to abuses and then deterred from reporting them as a condition of staying in and advancing in the professions they love. Hazing is an abuse of power that we as psychiatrists must continue to fight. We should teach our young adult men the mantra that is now being used by some fraternities, “Real men don’t haze.”
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students, which will be published by Rowman & Littlefield of Lanham, Md., in January 2018.
Is hazing a necessary rite of passage in Greek life, or a terrible tradition that needs to end once and for all?
There can be no justification for hazing, especially after the recent tragic deaths of fraternity pledges at Florida State University, Texas State University, and Louisiana State University. The horror of hazing has been brought home by the refiling of charges against several Penn State fraternity members in the torturous death last February of Timothy Piazza, which was recorded on videotape. In response to recent deaths and injuries, some colleges have suspended Greek life activities on campus. Unfortunately, hazing deaths are not new to college campuses but have a been a problem for several years, with 40 deaths in the last decade. The majority of these deaths involved the forced consumption of large amounts of alcohol, but some have involved beatings and other forms of abuse.
What exactly is hazing? According to the organization StopHazing (stophazing.org), it is “any activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers them regardless of a person’s willingness to participate.” Activities may involve alcohol consumption, humiliation, sleep deprivation, physical abuse, and sexual abuse. Hazing is not just a problem of fraternities; half of college students joining clubs, teams, and other organizations experience hazing. In fact, half of young adults have been hazed by the time they graduate from high school.
Given its inherent dangers, we have to wonder, why does hazing continue? The National Public Radio show 1A offered one answer to this troubling question on its Nov. 15 show, “How to Stop Hazing.” Two panel members, a filmmaker and a professor, discussed their own hazing experiences in college fraternities that included being forced to drink too much alcohol, eating noxious products, and being subjected to violence. One of the panel members talked about hazing other people. Both men admitted that the hazing process made them feel closer to their fraternity brothers: They formed lifelong bonds and also became stronger in facing adversity. In many ways, hazing was a masculine rite of passage. Neither panel member condoned the behaviors they were subjected to or participated in, and in fact suggested that college men should find new ways to bond and have a sense of belonging.
Even though the panelists were not promoting hazing, I was struck by their almost fond recollection of these experiences. I, in contrast, have no fond memory of an incident that I would consider medical hazing. During my internship when working on an internal medicine unit, I was ordered back to work after 2 days at home with the flu, although I was still febrile and coughing up a storm. That week, I was punished with an extra night of on-call duty. This incident did not leave me embracing the camaraderie and hardiness of my medical colleagues. It left me more determined than ever to treat peers and trainees with care and compassion, and never to abuse my power.
In our own practices as psychiatrists, we can play a role in helping our young adult male patients avoid hazing experiences, which have the potential to lead to depression, anxiety, posttraumatic stress disorder, and suicidal behaviors. We can work with our male patients to develop a sense of belonging and an understanding of who they are as men, without putting their lives or others’ lives at risk. In my work as a college counseling center psychiatrist for over 2 decades, I have often addressed the issues of masculinity, friendship, and peer pressure with my male patients. For those of you who work with young adult men, particularly in the college population, here are some tips:
1. Talk with your male patients about healthy versus harmful relationships. No relationship should involve the intentional infliction of physical or emotional pain. Men will acknowledge that a man hitting a girlfriend is abusive. They need to understand that male fraternity brothers hitting each other or forcing someone to drink a large volume of alcohol is equally abusive. Encourage your patients to know their limits and set boundaries if they are asked to do something dangerous to themselves or others.
2. Role play with your patients how to say no to their peers. I did that with a patient who was drinking too much in general with his fraternity brothers. He was afraid they would reject him if he drank less. He was pleasantly surprised when they did not pressure him to drink more, but instead encouraged him to do what is healthy for him.
3. Encourage your patients to have strong social connections on campus. Well-run fraternities can provide these friendship without inflicting pain. Intramural sports, singing groups, bands, and volunteer organizations all provide great ways to connect and also have a sense of accomplishment. Social connections improve grades, physical health, and emotional health.
4. Encourage your male patients to accept who they are, without embracing one stereotype of what it means to be a man. Social media often promotes unattainable physical images, and some male patients will take supplements or even steroids to build up muscle mass. Promote a healthy lifestyle without extremes in exercise and diet. Explore with your patient what it means to be a man in the 21st century, at a time when typical gender roles are being challenged.
5. Listen for cues about your patients’ relationship with their fathers, which have a large impact on how they view masculinity. Many of the male patients I see discuss how they are trying to be more in touch with and expressive about their feelings, after watching their fathers hold in their emotions or use alcohol to numb emotional pain. Some patients have been able to model and encourage a greater openness with their fathers, while others have been met with silence. As a patient is creating his own life story, his father’s history is always in the background.
Should all fraternities be shut down to end the hazing problem? I don’t believe this is the answer. Each campus has a different fraternity culture, and fraternities on many campuses can be a positive force. I have heard young men describe how fraternities encouraged them academically, discouraged excessive drinking, and promoted ethical behavior. But given that abuses have been prevalent on certain campuses, it is incumbent upon universities to enforce safe behaviors. Fraternity brothers who hurt others should be prosecuted, not protected.
The hazing on campuses needs to stop, and we as psychiatrists should talk about this important issue with our patients and sometimes their parents. We can educate our patients about this insidious form of physical and emotional abuse; we can encourage them not to be bystanders when this happens; and we can promote a culture of respect on our campuses.
Hazing is not just a campus but a national cultural problem, as we are finding from the avalanche of news reports about sexual harassment and assault in the political and entertainment worlds. Victims are exposed to abuses and then deterred from reporting them as a condition of staying in and advancing in the professions they love. Hazing is an abuse of power that we as psychiatrists must continue to fight. We should teach our young adult men the mantra that is now being used by some fraternities, “Real men don’t haze.”
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students, which will be published by Rowman & Littlefield of Lanham, Md., in January 2018.
Is hazing a necessary rite of passage in Greek life, or a terrible tradition that needs to end once and for all?
There can be no justification for hazing, especially after the recent tragic deaths of fraternity pledges at Florida State University, Texas State University, and Louisiana State University. The horror of hazing has been brought home by the refiling of charges against several Penn State fraternity members in the torturous death last February of Timothy Piazza, which was recorded on videotape. In response to recent deaths and injuries, some colleges have suspended Greek life activities on campus. Unfortunately, hazing deaths are not new to college campuses but have a been a problem for several years, with 40 deaths in the last decade. The majority of these deaths involved the forced consumption of large amounts of alcohol, but some have involved beatings and other forms of abuse.
What exactly is hazing? According to the organization StopHazing (stophazing.org), it is “any activity expected of someone joining or participating in a group that humiliates, degrades, abuses, or endangers them regardless of a person’s willingness to participate.” Activities may involve alcohol consumption, humiliation, sleep deprivation, physical abuse, and sexual abuse. Hazing is not just a problem of fraternities; half of college students joining clubs, teams, and other organizations experience hazing. In fact, half of young adults have been hazed by the time they graduate from high school.
Given its inherent dangers, we have to wonder, why does hazing continue? The National Public Radio show 1A offered one answer to this troubling question on its Nov. 15 show, “How to Stop Hazing.” Two panel members, a filmmaker and a professor, discussed their own hazing experiences in college fraternities that included being forced to drink too much alcohol, eating noxious products, and being subjected to violence. One of the panel members talked about hazing other people. Both men admitted that the hazing process made them feel closer to their fraternity brothers: They formed lifelong bonds and also became stronger in facing adversity. In many ways, hazing was a masculine rite of passage. Neither panel member condoned the behaviors they were subjected to or participated in, and in fact suggested that college men should find new ways to bond and have a sense of belonging.
Even though the panelists were not promoting hazing, I was struck by their almost fond recollection of these experiences. I, in contrast, have no fond memory of an incident that I would consider medical hazing. During my internship when working on an internal medicine unit, I was ordered back to work after 2 days at home with the flu, although I was still febrile and coughing up a storm. That week, I was punished with an extra night of on-call duty. This incident did not leave me embracing the camaraderie and hardiness of my medical colleagues. It left me more determined than ever to treat peers and trainees with care and compassion, and never to abuse my power.
In our own practices as psychiatrists, we can play a role in helping our young adult male patients avoid hazing experiences, which have the potential to lead to depression, anxiety, posttraumatic stress disorder, and suicidal behaviors. We can work with our male patients to develop a sense of belonging and an understanding of who they are as men, without putting their lives or others’ lives at risk. In my work as a college counseling center psychiatrist for over 2 decades, I have often addressed the issues of masculinity, friendship, and peer pressure with my male patients. For those of you who work with young adult men, particularly in the college population, here are some tips:
1. Talk with your male patients about healthy versus harmful relationships. No relationship should involve the intentional infliction of physical or emotional pain. Men will acknowledge that a man hitting a girlfriend is abusive. They need to understand that male fraternity brothers hitting each other or forcing someone to drink a large volume of alcohol is equally abusive. Encourage your patients to know their limits and set boundaries if they are asked to do something dangerous to themselves or others.
2. Role play with your patients how to say no to their peers. I did that with a patient who was drinking too much in general with his fraternity brothers. He was afraid they would reject him if he drank less. He was pleasantly surprised when they did not pressure him to drink more, but instead encouraged him to do what is healthy for him.
3. Encourage your patients to have strong social connections on campus. Well-run fraternities can provide these friendship without inflicting pain. Intramural sports, singing groups, bands, and volunteer organizations all provide great ways to connect and also have a sense of accomplishment. Social connections improve grades, physical health, and emotional health.
4. Encourage your male patients to accept who they are, without embracing one stereotype of what it means to be a man. Social media often promotes unattainable physical images, and some male patients will take supplements or even steroids to build up muscle mass. Promote a healthy lifestyle without extremes in exercise and diet. Explore with your patient what it means to be a man in the 21st century, at a time when typical gender roles are being challenged.
5. Listen for cues about your patients’ relationship with their fathers, which have a large impact on how they view masculinity. Many of the male patients I see discuss how they are trying to be more in touch with and expressive about their feelings, after watching their fathers hold in their emotions or use alcohol to numb emotional pain. Some patients have been able to model and encourage a greater openness with their fathers, while others have been met with silence. As a patient is creating his own life story, his father’s history is always in the background.
Should all fraternities be shut down to end the hazing problem? I don’t believe this is the answer. Each campus has a different fraternity culture, and fraternities on many campuses can be a positive force. I have heard young men describe how fraternities encouraged them academically, discouraged excessive drinking, and promoted ethical behavior. But given that abuses have been prevalent on certain campuses, it is incumbent upon universities to enforce safe behaviors. Fraternity brothers who hurt others should be prosecuted, not protected.
The hazing on campuses needs to stop, and we as psychiatrists should talk about this important issue with our patients and sometimes their parents. We can educate our patients about this insidious form of physical and emotional abuse; we can encourage them not to be bystanders when this happens; and we can promote a culture of respect on our campuses.
Hazing is not just a campus but a national cultural problem, as we are finding from the avalanche of news reports about sexual harassment and assault in the political and entertainment worlds. Victims are exposed to abuses and then deterred from reporting them as a condition of staying in and advancing in the professions they love. Hazing is an abuse of power that we as psychiatrists must continue to fight. We should teach our young adult men the mantra that is now being used by some fraternities, “Real men don’t haze.”
Dr. Morris is an associate professor of psychiatry and associate program director for student health psychiatry at the University of Florida, Gainesville. She is the author of The Campus Cure: A Parent’s Guide to Mental Health and Wellness for College Students, which will be published by Rowman & Littlefield of Lanham, Md., in January 2018.
Stemming the rising tide of suicide
What is causing the alarming increase in suicides in the United States, and what can psychiatrists do to help?
The Centers for Disease Control and Prevention recently reported that the suicide rate in 2014 was 13/100,000, a 24% increase from the 1999 rate of 10.5/100,000. Every age group from 10 to 74 had an increase in suicides; people over age 75 had a decrease. The suicide rate increased by 1% yearly from 1999 through 2006 and then by 2% per year from 2006 through 2014.
It’s hard to find a single explanation for the increased suicide rates, since so many events have rocked our country since 1999. You could talk about 9/11 and the wars that followed, you could mention the Great Recession of 2007-2009 and its anemic recovery, and you could note the growing disparity between the rich and the poor as placing immeasurable stress on this country.
The economy and war do not explain the most startling statistic: The suicide rate for girls aged 10-14 tripled from 1999 to 2014. I can only speculate on the cause of this rise, but I believe social media play a role. Facebook was launched in 2004, and there are now dozens of social media sites that adolescent girls use, despite age restrictions. The bullying and sexual harassment that have always been part of the adolescent years now can be amplified when a message or post goes viral. Cyberbullying has been linked to some high-profile adolescent suicides. While researching this topic, I learned about a book, “American Girls: Social Media and the Secret Lives of Teenagers” (New York: Knopf, 2016) by Nancy Jo Sales, which highlights the harm of unmonitored social media use on girls’ psyches.
While women had a larger increase than men in suicide rates, men’s rates continue to exceed women’s rates. The ratio of male to female suicides was 3.6 in 2014, a decrease from a rate of 4.5 in 1999. Possible explanations for men’s continued higher suicide rates include their decreased likelihood of seeking help for mental health issues and increased likelihood of using more lethal means (firearms) in suicide attempts.
Most psychiatrists may not be surprised to learn that suicide rates have steadily risen from 1999 to 2014. In my own work as a university counseling center psychiatrist, I see a student population with increased rates of anxiety, depression, and suicidal thoughts and behaviors. Suicide is now the second-leading cause of death for people aged 15-24.
Whenever I hear about a suicide, I lament that the individual either did not seek treatment or lost faith in the treatment they were in. Tragically, it is estimated that 2 out of 3 of people who killed themselves suffered from depression, and the majority of them were not receiving treatment. If they only knew what we have seen as psychiatrists – amazing recoveries in people who had nearly given up hope.
How do we engage people who are depressed and suicidal into believing they can get help and feel good again?
We have to start young, by educating parents about the warning signs of depression and suicide in their children. For the last few years, I have written parenting articles, given talks, and done radio shows on mental health. Psychiatrists can teach parents through writing and speaking in their local communities. Parents should be encouraged to monitor their child’s social media use. Parents should urge both girls and boys to talk openly about their feelings and not be afraid to ask for help.
We have to encourage people of all ages to recognize and get early treatment for mental health problems. We need to get the word out that there is strength in seeking help. We have to fight the stigma that continues to accompany mental health treatment.
We also need to loudly support more funding for mental health. Too many of my patients who need intensive levels of treatment for psychosis, severe depression, or borderline personality disorder lack access to care; some have no insurance or insurance with limited coverage. Write your congressman, senator, or local representative to support bills that increase mental health coverage. Promote groups like NAMI, National Alliance on Mental Illness, and the Depression and Bipolar Support Alliance that provide support and advocacy.
Over the next few months, there may be explanations for the increased suicide rates and a public health approach to this problem. There is one fact we know: Many people with mental health issues are not getting treatment. Now more than ever, psychiatrists need to go beyond the walls of their office to educate the public about the benefits of treatment, and to advocate for greater access to care.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
What is causing the alarming increase in suicides in the United States, and what can psychiatrists do to help?
The Centers for Disease Control and Prevention recently reported that the suicide rate in 2014 was 13/100,000, a 24% increase from the 1999 rate of 10.5/100,000. Every age group from 10 to 74 had an increase in suicides; people over age 75 had a decrease. The suicide rate increased by 1% yearly from 1999 through 2006 and then by 2% per year from 2006 through 2014.
It’s hard to find a single explanation for the increased suicide rates, since so many events have rocked our country since 1999. You could talk about 9/11 and the wars that followed, you could mention the Great Recession of 2007-2009 and its anemic recovery, and you could note the growing disparity between the rich and the poor as placing immeasurable stress on this country.
The economy and war do not explain the most startling statistic: The suicide rate for girls aged 10-14 tripled from 1999 to 2014. I can only speculate on the cause of this rise, but I believe social media play a role. Facebook was launched in 2004, and there are now dozens of social media sites that adolescent girls use, despite age restrictions. The bullying and sexual harassment that have always been part of the adolescent years now can be amplified when a message or post goes viral. Cyberbullying has been linked to some high-profile adolescent suicides. While researching this topic, I learned about a book, “American Girls: Social Media and the Secret Lives of Teenagers” (New York: Knopf, 2016) by Nancy Jo Sales, which highlights the harm of unmonitored social media use on girls’ psyches.
While women had a larger increase than men in suicide rates, men’s rates continue to exceed women’s rates. The ratio of male to female suicides was 3.6 in 2014, a decrease from a rate of 4.5 in 1999. Possible explanations for men’s continued higher suicide rates include their decreased likelihood of seeking help for mental health issues and increased likelihood of using more lethal means (firearms) in suicide attempts.
Most psychiatrists may not be surprised to learn that suicide rates have steadily risen from 1999 to 2014. In my own work as a university counseling center psychiatrist, I see a student population with increased rates of anxiety, depression, and suicidal thoughts and behaviors. Suicide is now the second-leading cause of death for people aged 15-24.
Whenever I hear about a suicide, I lament that the individual either did not seek treatment or lost faith in the treatment they were in. Tragically, it is estimated that 2 out of 3 of people who killed themselves suffered from depression, and the majority of them were not receiving treatment. If they only knew what we have seen as psychiatrists – amazing recoveries in people who had nearly given up hope.
How do we engage people who are depressed and suicidal into believing they can get help and feel good again?
We have to start young, by educating parents about the warning signs of depression and suicide in their children. For the last few years, I have written parenting articles, given talks, and done radio shows on mental health. Psychiatrists can teach parents through writing and speaking in their local communities. Parents should be encouraged to monitor their child’s social media use. Parents should urge both girls and boys to talk openly about their feelings and not be afraid to ask for help.
We have to encourage people of all ages to recognize and get early treatment for mental health problems. We need to get the word out that there is strength in seeking help. We have to fight the stigma that continues to accompany mental health treatment.
We also need to loudly support more funding for mental health. Too many of my patients who need intensive levels of treatment for psychosis, severe depression, or borderline personality disorder lack access to care; some have no insurance or insurance with limited coverage. Write your congressman, senator, or local representative to support bills that increase mental health coverage. Promote groups like NAMI, National Alliance on Mental Illness, and the Depression and Bipolar Support Alliance that provide support and advocacy.
Over the next few months, there may be explanations for the increased suicide rates and a public health approach to this problem. There is one fact we know: Many people with mental health issues are not getting treatment. Now more than ever, psychiatrists need to go beyond the walls of their office to educate the public about the benefits of treatment, and to advocate for greater access to care.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
What is causing the alarming increase in suicides in the United States, and what can psychiatrists do to help?
The Centers for Disease Control and Prevention recently reported that the suicide rate in 2014 was 13/100,000, a 24% increase from the 1999 rate of 10.5/100,000. Every age group from 10 to 74 had an increase in suicides; people over age 75 had a decrease. The suicide rate increased by 1% yearly from 1999 through 2006 and then by 2% per year from 2006 through 2014.
It’s hard to find a single explanation for the increased suicide rates, since so many events have rocked our country since 1999. You could talk about 9/11 and the wars that followed, you could mention the Great Recession of 2007-2009 and its anemic recovery, and you could note the growing disparity between the rich and the poor as placing immeasurable stress on this country.
The economy and war do not explain the most startling statistic: The suicide rate for girls aged 10-14 tripled from 1999 to 2014. I can only speculate on the cause of this rise, but I believe social media play a role. Facebook was launched in 2004, and there are now dozens of social media sites that adolescent girls use, despite age restrictions. The bullying and sexual harassment that have always been part of the adolescent years now can be amplified when a message or post goes viral. Cyberbullying has been linked to some high-profile adolescent suicides. While researching this topic, I learned about a book, “American Girls: Social Media and the Secret Lives of Teenagers” (New York: Knopf, 2016) by Nancy Jo Sales, which highlights the harm of unmonitored social media use on girls’ psyches.
While women had a larger increase than men in suicide rates, men’s rates continue to exceed women’s rates. The ratio of male to female suicides was 3.6 in 2014, a decrease from a rate of 4.5 in 1999. Possible explanations for men’s continued higher suicide rates include their decreased likelihood of seeking help for mental health issues and increased likelihood of using more lethal means (firearms) in suicide attempts.
Most psychiatrists may not be surprised to learn that suicide rates have steadily risen from 1999 to 2014. In my own work as a university counseling center psychiatrist, I see a student population with increased rates of anxiety, depression, and suicidal thoughts and behaviors. Suicide is now the second-leading cause of death for people aged 15-24.
Whenever I hear about a suicide, I lament that the individual either did not seek treatment or lost faith in the treatment they were in. Tragically, it is estimated that 2 out of 3 of people who killed themselves suffered from depression, and the majority of them were not receiving treatment. If they only knew what we have seen as psychiatrists – amazing recoveries in people who had nearly given up hope.
How do we engage people who are depressed and suicidal into believing they can get help and feel good again?
We have to start young, by educating parents about the warning signs of depression and suicide in their children. For the last few years, I have written parenting articles, given talks, and done radio shows on mental health. Psychiatrists can teach parents through writing and speaking in their local communities. Parents should be encouraged to monitor their child’s social media use. Parents should urge both girls and boys to talk openly about their feelings and not be afraid to ask for help.
We have to encourage people of all ages to recognize and get early treatment for mental health problems. We need to get the word out that there is strength in seeking help. We have to fight the stigma that continues to accompany mental health treatment.
We also need to loudly support more funding for mental health. Too many of my patients who need intensive levels of treatment for psychosis, severe depression, or borderline personality disorder lack access to care; some have no insurance or insurance with limited coverage. Write your congressman, senator, or local representative to support bills that increase mental health coverage. Promote groups like NAMI, National Alliance on Mental Illness, and the Depression and Bipolar Support Alliance that provide support and advocacy.
Over the next few months, there may be explanations for the increased suicide rates and a public health approach to this problem. There is one fact we know: Many people with mental health issues are not getting treatment. Now more than ever, psychiatrists need to go beyond the walls of their office to educate the public about the benefits of treatment, and to advocate for greater access to care.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Sexual assault on college campuses: The psychiatrist’s role in recovery
More than 23% of female undergraduates have experienced “sexual assault and sexual misconduct due to physical force, threats of physical force, or incapacitation since they enrolled at their university” according to the 2015 Campus Climate Survey on Sexual Assault and Sexual Misconduct conducted by the American Association of Universities.
Those of us who work as college mental health psychiatrists know firsthand that these sobering statistics are a reality. Sexual assault continues to be an all-too-common problem for university students.
I usually see a sexual assault survivor 3-6 months to a year after the event. She might be experiencing symptoms of depression, anxiety, or posttraumatic stress disorder, and her grades might have declined. She thought that she could handle the event by not talking about it and forgetting about it.
You as a psychiatrist might be the first one she reveals this trauma to. You have an important role in helping her through the journey of recovery.
Your first task should be to establish that she is safe. Does she live near the perpetrator? Does she see him? Is she afraid for her safety?
If the perpetrator is a student, sexual assault survivors usually live in fear of running into him on campus either in class or in housing. A small college, where students might spend all 4 years in campus dorms, poses special challenges for survivors.
The best person who can help the patient establish safety is a victim advocate. Many colleges or local police have a victim advocate, a person a student can talk to without necessarily reporting a crime. This person is an expert at helping students establish boundaries to protect themselves and will work with university officials to make this happen.
In addition to safety, the psychiatrist should address medical issues. Encourage your patient to get a physical exam with testing for sexually transmitted diseases. If the assault is recent, she has the option of getting a forensic exam and can decide later if she will report the assault. Our campus as well as the local emergency room have designated providers who will do a forensic exam.
The decision about pressing charges is a very difficult one for survivors, as rates of prosecution and conviction are low. In fact, few women even report assaults to police or campus officials. According to the Campus Climate Survey, the rate of reporting ranged from 5% to 28%.
I asked Annie Carper, a victim advocate at the University of Florida, Gainesville, about the best way to respond if a patient asks for advice about reporting. She notes that “since control has been taken away from the survivor, you need to give her a range of control to decide what happens next. … Be honest about the process of reporting both at the campus and community level.”
Victim advocates are the best people to provide information about reporting and will work with patients during the process.
Along with addressing safety and medical issues, you will perform a psychiatric evaluation and prescribe medications if needed. Encourage your patient to join a support group for survivors of sexual assault or see an individual therapist. Promote self-care through physical exercise, healthful eating, and avoidance of drugs and alcohol. Assure her that she will feel better with time.
A psychiatrist’s role goes beyond treating survivors of sexual assault. We also should educate our patients, particularly freshmen, with the goal of preventing sexual assault. Freshmen women are the most likely victims of sexual assault, according to the Campus Climate Survey and earlier studies.
Sexual assault can happen to any woman, and it is never her fault. Some helpful, empowering safety tips for female patients follow:
• Take a campus self-defense class.
• Get a good group of friends who will look out for you when you go out.
• Avoid binge drinking and drug use.
• Be aware that 80% of sexual assaults are committed by someone the victim knows, so be cautious as you meet new people on campus and ask trusted friends for feedback.
Many campuses are striving to reduce sexual assault on campus, and I hope there comes a day when this epidemic ends. In the meantime, you as a psychiatrist can help a survivor through the journey of recovery and alter the trajectory of her life for the better.
I would like to acknowledge the helpful feedback and expertise provided by Annie Carper, victim advocate, and Debbie Weiss, a counselor, both at the University of Florida, in writing this article.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
More than 23% of female undergraduates have experienced “sexual assault and sexual misconduct due to physical force, threats of physical force, or incapacitation since they enrolled at their university” according to the 2015 Campus Climate Survey on Sexual Assault and Sexual Misconduct conducted by the American Association of Universities.
Those of us who work as college mental health psychiatrists know firsthand that these sobering statistics are a reality. Sexual assault continues to be an all-too-common problem for university students.
I usually see a sexual assault survivor 3-6 months to a year after the event. She might be experiencing symptoms of depression, anxiety, or posttraumatic stress disorder, and her grades might have declined. She thought that she could handle the event by not talking about it and forgetting about it.
You as a psychiatrist might be the first one she reveals this trauma to. You have an important role in helping her through the journey of recovery.
Your first task should be to establish that she is safe. Does she live near the perpetrator? Does she see him? Is she afraid for her safety?
If the perpetrator is a student, sexual assault survivors usually live in fear of running into him on campus either in class or in housing. A small college, where students might spend all 4 years in campus dorms, poses special challenges for survivors.
The best person who can help the patient establish safety is a victim advocate. Many colleges or local police have a victim advocate, a person a student can talk to without necessarily reporting a crime. This person is an expert at helping students establish boundaries to protect themselves and will work with university officials to make this happen.
In addition to safety, the psychiatrist should address medical issues. Encourage your patient to get a physical exam with testing for sexually transmitted diseases. If the assault is recent, she has the option of getting a forensic exam and can decide later if she will report the assault. Our campus as well as the local emergency room have designated providers who will do a forensic exam.
The decision about pressing charges is a very difficult one for survivors, as rates of prosecution and conviction are low. In fact, few women even report assaults to police or campus officials. According to the Campus Climate Survey, the rate of reporting ranged from 5% to 28%.
I asked Annie Carper, a victim advocate at the University of Florida, Gainesville, about the best way to respond if a patient asks for advice about reporting. She notes that “since control has been taken away from the survivor, you need to give her a range of control to decide what happens next. … Be honest about the process of reporting both at the campus and community level.”
Victim advocates are the best people to provide information about reporting and will work with patients during the process.
Along with addressing safety and medical issues, you will perform a psychiatric evaluation and prescribe medications if needed. Encourage your patient to join a support group for survivors of sexual assault or see an individual therapist. Promote self-care through physical exercise, healthful eating, and avoidance of drugs and alcohol. Assure her that she will feel better with time.
A psychiatrist’s role goes beyond treating survivors of sexual assault. We also should educate our patients, particularly freshmen, with the goal of preventing sexual assault. Freshmen women are the most likely victims of sexual assault, according to the Campus Climate Survey and earlier studies.
Sexual assault can happen to any woman, and it is never her fault. Some helpful, empowering safety tips for female patients follow:
• Take a campus self-defense class.
• Get a good group of friends who will look out for you when you go out.
• Avoid binge drinking and drug use.
• Be aware that 80% of sexual assaults are committed by someone the victim knows, so be cautious as you meet new people on campus and ask trusted friends for feedback.
Many campuses are striving to reduce sexual assault on campus, and I hope there comes a day when this epidemic ends. In the meantime, you as a psychiatrist can help a survivor through the journey of recovery and alter the trajectory of her life for the better.
I would like to acknowledge the helpful feedback and expertise provided by Annie Carper, victim advocate, and Debbie Weiss, a counselor, both at the University of Florida, in writing this article.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
More than 23% of female undergraduates have experienced “sexual assault and sexual misconduct due to physical force, threats of physical force, or incapacitation since they enrolled at their university” according to the 2015 Campus Climate Survey on Sexual Assault and Sexual Misconduct conducted by the American Association of Universities.
Those of us who work as college mental health psychiatrists know firsthand that these sobering statistics are a reality. Sexual assault continues to be an all-too-common problem for university students.
I usually see a sexual assault survivor 3-6 months to a year after the event. She might be experiencing symptoms of depression, anxiety, or posttraumatic stress disorder, and her grades might have declined. She thought that she could handle the event by not talking about it and forgetting about it.
You as a psychiatrist might be the first one she reveals this trauma to. You have an important role in helping her through the journey of recovery.
Your first task should be to establish that she is safe. Does she live near the perpetrator? Does she see him? Is she afraid for her safety?
If the perpetrator is a student, sexual assault survivors usually live in fear of running into him on campus either in class or in housing. A small college, where students might spend all 4 years in campus dorms, poses special challenges for survivors.
The best person who can help the patient establish safety is a victim advocate. Many colleges or local police have a victim advocate, a person a student can talk to without necessarily reporting a crime. This person is an expert at helping students establish boundaries to protect themselves and will work with university officials to make this happen.
In addition to safety, the psychiatrist should address medical issues. Encourage your patient to get a physical exam with testing for sexually transmitted diseases. If the assault is recent, she has the option of getting a forensic exam and can decide later if she will report the assault. Our campus as well as the local emergency room have designated providers who will do a forensic exam.
The decision about pressing charges is a very difficult one for survivors, as rates of prosecution and conviction are low. In fact, few women even report assaults to police or campus officials. According to the Campus Climate Survey, the rate of reporting ranged from 5% to 28%.
I asked Annie Carper, a victim advocate at the University of Florida, Gainesville, about the best way to respond if a patient asks for advice about reporting. She notes that “since control has been taken away from the survivor, you need to give her a range of control to decide what happens next. … Be honest about the process of reporting both at the campus and community level.”
Victim advocates are the best people to provide information about reporting and will work with patients during the process.
Along with addressing safety and medical issues, you will perform a psychiatric evaluation and prescribe medications if needed. Encourage your patient to join a support group for survivors of sexual assault or see an individual therapist. Promote self-care through physical exercise, healthful eating, and avoidance of drugs and alcohol. Assure her that she will feel better with time.
A psychiatrist’s role goes beyond treating survivors of sexual assault. We also should educate our patients, particularly freshmen, with the goal of preventing sexual assault. Freshmen women are the most likely victims of sexual assault, according to the Campus Climate Survey and earlier studies.
Sexual assault can happen to any woman, and it is never her fault. Some helpful, empowering safety tips for female patients follow:
• Take a campus self-defense class.
• Get a good group of friends who will look out for you when you go out.
• Avoid binge drinking and drug use.
• Be aware that 80% of sexual assaults are committed by someone the victim knows, so be cautious as you meet new people on campus and ask trusted friends for feedback.
Many campuses are striving to reduce sexual assault on campus, and I hope there comes a day when this epidemic ends. In the meantime, you as a psychiatrist can help a survivor through the journey of recovery and alter the trajectory of her life for the better.
I would like to acknowledge the helpful feedback and expertise provided by Annie Carper, victim advocate, and Debbie Weiss, a counselor, both at the University of Florida, in writing this article.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Strategies for medical students who face harassment during training
Recently, a friend asked me for advice regarding how to help her daughter, a medical student who was distressed after being showered with invectives by a doctor during one of her first clinical rotations.
Unfortunately, 50% of medical students report being subjected to some kind of verbal or physical abuse during training. A recent study of university surgeons showed harassment continued long after medical school and was a contributing factor to suicidal ideation (BMC Psychol. 2014;2:53). I experienced persistent verbal abuse during my own training many years ago. So I told my story to my friend in the hope it would help her daughter as she moves through the challenges of medical training.
I’ll call my abuser “Dr. Evil.” At the beginning of clinical rotations during my third year of medical school, I first met Dr. E on rounds early on a Monday morning. I noticed the resident and intern were shifting restlessly until Dr. E showed up; at that point they stood stock still. It reminded me of small animals encountering a bear and freezing in fear, knowing that one wrong move could make them a festive meal. Dr. E seemed harmless enough. What was there to be afraid of?
The second day of rotation, Dr. E, the intern, the resident, and I were in the hallway outside a patient’s room when Dr. E asked me to present a history of the patient. He proceeded to interrupt every other word that came out of my mouth. He had a voice that was smooth and full and mellifluous as he berated me; the experience was simply terrifying.
Nevertheless, I completed the presentation. When I was done, he told me it was the worst presentation he had ever heard. A string of invectives followed, but I stopped hearing them at a certain point as can happen with traumatic events. Now clearly, there are worse traumas in life than being berated by an arrogant doctor, but in my fledgling medical student mind, I had failed.
Worse yet, tears started to run down my face. I was humiliated, sniffling as doctors and nurses walked by seemingly unfazed as they had probably seen it all before.
On rounds that day, I continued bleary eyed, in a daze. During the next 2 weeks, the episodes of verbal abuse continued. I could do nothing right. Dr. E did not like the way I presented patients, wrote chart notes, answered questions, looked at him, or breathed.
This was not my first clinical rotation. My previous rotation had been a great experience, but now I was trapped in a circle of hell for the next 2 weeks.
I needed to find resilience. I was not Dr. E’s only emotional punching bag. I witnessed him harassing other students and staff, even taking on established physicians. I realized that Dr. E attacked anyone who showed vulnerability or doubt. I dusted off my thespian skills and put on a stony mask of confidence. I showed no emotion. I vowed never again to cry if he verbally attacked me.
The rotation ended and I thought I had escaped Dr. E’s abuses. I was wrong. Dr. E refused to pass me, and I had to come back every few weeks to present write-ups of patients on other rotations. Much later, in my third year of school, Dr. E allowed me to pass his rotation, with a low C. I complained to the dean of students. I got the usual response: “Move on. Deal with it.”
Today, as a psychiatrist in a university counseling center, I often provide care to graduate and medical students who deal with difficult advisers or professors. I share with them the lessons I learned from my experience. And I told my friend to share this message with her daughter: She is intelligent. She will survive. If she has to work with this doctor again, she should develop an emotional shield. If he often attacks her verbally or ever lays a hand on her, she needs to report him to the dean of students office. She will find that wherever she works, there may be one person who abuses power, and she will need to learn how to deal with that individual. If the situation begins to get under her skin, she may want to speak with a therapist.
My hope is that my friend’s daughter will find a profession that she loves, and that she will one day look back at this encounter as a distant memory and reminder of how far she has come. She will marvel at how she was able to move forward and keep her humanity. Should she find herself in the position of a mentor or teacher, she will treat her students with respect and end the cycle of harassment that is far too prevalent in medical settings.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Recently, a friend asked me for advice regarding how to help her daughter, a medical student who was distressed after being showered with invectives by a doctor during one of her first clinical rotations.
Unfortunately, 50% of medical students report being subjected to some kind of verbal or physical abuse during training. A recent study of university surgeons showed harassment continued long after medical school and was a contributing factor to suicidal ideation (BMC Psychol. 2014;2:53). I experienced persistent verbal abuse during my own training many years ago. So I told my story to my friend in the hope it would help her daughter as she moves through the challenges of medical training.
I’ll call my abuser “Dr. Evil.” At the beginning of clinical rotations during my third year of medical school, I first met Dr. E on rounds early on a Monday morning. I noticed the resident and intern were shifting restlessly until Dr. E showed up; at that point they stood stock still. It reminded me of small animals encountering a bear and freezing in fear, knowing that one wrong move could make them a festive meal. Dr. E seemed harmless enough. What was there to be afraid of?
The second day of rotation, Dr. E, the intern, the resident, and I were in the hallway outside a patient’s room when Dr. E asked me to present a history of the patient. He proceeded to interrupt every other word that came out of my mouth. He had a voice that was smooth and full and mellifluous as he berated me; the experience was simply terrifying.
Nevertheless, I completed the presentation. When I was done, he told me it was the worst presentation he had ever heard. A string of invectives followed, but I stopped hearing them at a certain point as can happen with traumatic events. Now clearly, there are worse traumas in life than being berated by an arrogant doctor, but in my fledgling medical student mind, I had failed.
Worse yet, tears started to run down my face. I was humiliated, sniffling as doctors and nurses walked by seemingly unfazed as they had probably seen it all before.
On rounds that day, I continued bleary eyed, in a daze. During the next 2 weeks, the episodes of verbal abuse continued. I could do nothing right. Dr. E did not like the way I presented patients, wrote chart notes, answered questions, looked at him, or breathed.
This was not my first clinical rotation. My previous rotation had been a great experience, but now I was trapped in a circle of hell for the next 2 weeks.
I needed to find resilience. I was not Dr. E’s only emotional punching bag. I witnessed him harassing other students and staff, even taking on established physicians. I realized that Dr. E attacked anyone who showed vulnerability or doubt. I dusted off my thespian skills and put on a stony mask of confidence. I showed no emotion. I vowed never again to cry if he verbally attacked me.
The rotation ended and I thought I had escaped Dr. E’s abuses. I was wrong. Dr. E refused to pass me, and I had to come back every few weeks to present write-ups of patients on other rotations. Much later, in my third year of school, Dr. E allowed me to pass his rotation, with a low C. I complained to the dean of students. I got the usual response: “Move on. Deal with it.”
Today, as a psychiatrist in a university counseling center, I often provide care to graduate and medical students who deal with difficult advisers or professors. I share with them the lessons I learned from my experience. And I told my friend to share this message with her daughter: She is intelligent. She will survive. If she has to work with this doctor again, she should develop an emotional shield. If he often attacks her verbally or ever lays a hand on her, she needs to report him to the dean of students office. She will find that wherever she works, there may be one person who abuses power, and she will need to learn how to deal with that individual. If the situation begins to get under her skin, she may want to speak with a therapist.
My hope is that my friend’s daughter will find a profession that she loves, and that she will one day look back at this encounter as a distant memory and reminder of how far she has come. She will marvel at how she was able to move forward and keep her humanity. Should she find herself in the position of a mentor or teacher, she will treat her students with respect and end the cycle of harassment that is far too prevalent in medical settings.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Recently, a friend asked me for advice regarding how to help her daughter, a medical student who was distressed after being showered with invectives by a doctor during one of her first clinical rotations.
Unfortunately, 50% of medical students report being subjected to some kind of verbal or physical abuse during training. A recent study of university surgeons showed harassment continued long after medical school and was a contributing factor to suicidal ideation (BMC Psychol. 2014;2:53). I experienced persistent verbal abuse during my own training many years ago. So I told my story to my friend in the hope it would help her daughter as she moves through the challenges of medical training.
I’ll call my abuser “Dr. Evil.” At the beginning of clinical rotations during my third year of medical school, I first met Dr. E on rounds early on a Monday morning. I noticed the resident and intern were shifting restlessly until Dr. E showed up; at that point they stood stock still. It reminded me of small animals encountering a bear and freezing in fear, knowing that one wrong move could make them a festive meal. Dr. E seemed harmless enough. What was there to be afraid of?
The second day of rotation, Dr. E, the intern, the resident, and I were in the hallway outside a patient’s room when Dr. E asked me to present a history of the patient. He proceeded to interrupt every other word that came out of my mouth. He had a voice that was smooth and full and mellifluous as he berated me; the experience was simply terrifying.
Nevertheless, I completed the presentation. When I was done, he told me it was the worst presentation he had ever heard. A string of invectives followed, but I stopped hearing them at a certain point as can happen with traumatic events. Now clearly, there are worse traumas in life than being berated by an arrogant doctor, but in my fledgling medical student mind, I had failed.
Worse yet, tears started to run down my face. I was humiliated, sniffling as doctors and nurses walked by seemingly unfazed as they had probably seen it all before.
On rounds that day, I continued bleary eyed, in a daze. During the next 2 weeks, the episodes of verbal abuse continued. I could do nothing right. Dr. E did not like the way I presented patients, wrote chart notes, answered questions, looked at him, or breathed.
This was not my first clinical rotation. My previous rotation had been a great experience, but now I was trapped in a circle of hell for the next 2 weeks.
I needed to find resilience. I was not Dr. E’s only emotional punching bag. I witnessed him harassing other students and staff, even taking on established physicians. I realized that Dr. E attacked anyone who showed vulnerability or doubt. I dusted off my thespian skills and put on a stony mask of confidence. I showed no emotion. I vowed never again to cry if he verbally attacked me.
The rotation ended and I thought I had escaped Dr. E’s abuses. I was wrong. Dr. E refused to pass me, and I had to come back every few weeks to present write-ups of patients on other rotations. Much later, in my third year of school, Dr. E allowed me to pass his rotation, with a low C. I complained to the dean of students. I got the usual response: “Move on. Deal with it.”
Today, as a psychiatrist in a university counseling center, I often provide care to graduate and medical students who deal with difficult advisers or professors. I share with them the lessons I learned from my experience. And I told my friend to share this message with her daughter: She is intelligent. She will survive. If she has to work with this doctor again, she should develop an emotional shield. If he often attacks her verbally or ever lays a hand on her, she needs to report him to the dean of students office. She will find that wherever she works, there may be one person who abuses power, and she will need to learn how to deal with that individual. If the situation begins to get under her skin, she may want to speak with a therapist.
My hope is that my friend’s daughter will find a profession that she loves, and that she will one day look back at this encounter as a distant memory and reminder of how far she has come. She will marvel at how she was able to move forward and keep her humanity. Should she find herself in the position of a mentor or teacher, she will treat her students with respect and end the cycle of harassment that is far too prevalent in medical settings.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Commentary: The value of the doctor-patient relationship
My computer flashes a message that Lisa checked in, so I go to the waiting area of the college counseling center where I work. At first I do not see her, but then I notice a short, thin woman sitting in the corner, her head bowed with long, wavy blond hair covering her face.
Lisa came in for an appointment at the beginning of the semester and then missed the next appointment. After a few e-mails and phone calls on my part, I get her in for a follow-up visit. I do not always pursue a patient, but I am worried about Lisa. She was hospitalized a few months earlier after becoming paranoid and hitting her mother.
We walk into my office, and she sits and looks at me, pushing her hair from her face so I can see her blue eyes. She starts by telling me: “I ran out of medication, but I know I need to restart it.” I ask her to tell me how she knows.
“Since I stopped taking medication, my friends are getting annoyed with me for talking too much and keeping them awake when I call late at night. My professor spoke with me after class and told me I was being disruptive with all my questions. I think I am too revved up, and it is getting hard to concentrate on my school work.”
I feel a deep sense of relief that Lisa has insight into how her behavior affects others and that medication can help her. This is a major step for her, and I am hopeful that she will continue treatment that helps her achieve her goals. I praise Lisa for listening to feedback from others.
Lisa’s insight has been limited in the past. Her first hospitalization was 1 year ago, her second 2 months ago, both for psychotic episodes following escalating marijuana use. She had been a regular cannabis smoker since coming to college. Did the marijuana cause psychosis, or did she increase use to self-medicate psychosis? This will be debated until the end of time, but I don’t believe marijuana benefits her. She has been in college for 7 years.
I started to see Lisa after her first hospitalization. I was relieved that she subsequently stopped using marijuana and took an antipsychotic. Her mind cleared, and she successfully completed the semester. After 4 months of treatment, she told me she was going to taper her medication and would not need to see me anymore. I was sad, but not surprised, when she returned to my care after the second hospitalization.
Lisa still doubts she has bipolar disorder, a diagnosis she was given in the hospital. Whatever her diagnosis is, I ask her to consider using antipsychotic medication as a tool, along with therapy, friendship, exercise, and healthy eating, to accomplish her goal, graduating from college, which she will do at the end of the semester.
With Lisa, I see more trust with each visit. I also see a rocky road ahead for her, as she still uses marijuana, although not on a daily basis. I have tried to convince her of the benefits of abstinence, without success. I believe the antipsychotic is helping her, so I prescribe it. I schedule a follow-up appointment.
Sitting with patients like Lisa, believing you are slowly making steps toward wellness, is deeply rewarding. My job in a college counseling center allows me to spend 30-45 minutes in follow-up with my patients and meet as often as I need to. Lisa would be lucky in the public health sector to see someone every 3 months for 15 minutes.
I truly feel we as college mental health psychiatrists are often in the role of in loco parentis, and we make a difference. The doctor-patient relationship is the key element in our treatment, enabling patients to trust our recommendations, whether it is for medication, therapy, or exercise. Sometimes, with patients like Lisa, the trust has to be built up over time.
The importance of the doctor-patient relationship has not changed in the last 21 years since I completed my training. Sometimes, it is a battle to maintain this relationship, as I spend an increasing amount of time bent over my computer typing and tapping information into the electronic medical record. My notes have gone from short stories to novellas, as I fill in information to meet insurance, risk management, and psychiatry board requirements. I fear I will soon have a closer relationship with my computer than with my patients. Sometimes I feel like the astronaut in “2001: A Space Odyssey,” and Hal the computer has taken over my life.
Patients like Lisa literally bring me down to earth and help me remember why I became a psychiatrist. As I puzzle over how to strengthen the doctor-patient bond, I try to plant the seeds that will allow Lisa to forego marijuana and other drugs for good. I encourage her to connect with others in her shoes by going to a support group, acknowledging my own deficits in knowing her experience but my desire to understand it as best I can. The connections I form with patients, especially the more challenging ones like Lisa, cannot be measured, and don’t have a reimbursement code, but they are priceless.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
My computer flashes a message that Lisa checked in, so I go to the waiting area of the college counseling center where I work. At first I do not see her, but then I notice a short, thin woman sitting in the corner, her head bowed with long, wavy blond hair covering her face.
Lisa came in for an appointment at the beginning of the semester and then missed the next appointment. After a few e-mails and phone calls on my part, I get her in for a follow-up visit. I do not always pursue a patient, but I am worried about Lisa. She was hospitalized a few months earlier after becoming paranoid and hitting her mother.
We walk into my office, and she sits and looks at me, pushing her hair from her face so I can see her blue eyes. She starts by telling me: “I ran out of medication, but I know I need to restart it.” I ask her to tell me how she knows.
“Since I stopped taking medication, my friends are getting annoyed with me for talking too much and keeping them awake when I call late at night. My professor spoke with me after class and told me I was being disruptive with all my questions. I think I am too revved up, and it is getting hard to concentrate on my school work.”
I feel a deep sense of relief that Lisa has insight into how her behavior affects others and that medication can help her. This is a major step for her, and I am hopeful that she will continue treatment that helps her achieve her goals. I praise Lisa for listening to feedback from others.
Lisa’s insight has been limited in the past. Her first hospitalization was 1 year ago, her second 2 months ago, both for psychotic episodes following escalating marijuana use. She had been a regular cannabis smoker since coming to college. Did the marijuana cause psychosis, or did she increase use to self-medicate psychosis? This will be debated until the end of time, but I don’t believe marijuana benefits her. She has been in college for 7 years.
I started to see Lisa after her first hospitalization. I was relieved that she subsequently stopped using marijuana and took an antipsychotic. Her mind cleared, and she successfully completed the semester. After 4 months of treatment, she told me she was going to taper her medication and would not need to see me anymore. I was sad, but not surprised, when she returned to my care after the second hospitalization.
Lisa still doubts she has bipolar disorder, a diagnosis she was given in the hospital. Whatever her diagnosis is, I ask her to consider using antipsychotic medication as a tool, along with therapy, friendship, exercise, and healthy eating, to accomplish her goal, graduating from college, which she will do at the end of the semester.
With Lisa, I see more trust with each visit. I also see a rocky road ahead for her, as she still uses marijuana, although not on a daily basis. I have tried to convince her of the benefits of abstinence, without success. I believe the antipsychotic is helping her, so I prescribe it. I schedule a follow-up appointment.
Sitting with patients like Lisa, believing you are slowly making steps toward wellness, is deeply rewarding. My job in a college counseling center allows me to spend 30-45 minutes in follow-up with my patients and meet as often as I need to. Lisa would be lucky in the public health sector to see someone every 3 months for 15 minutes.
I truly feel we as college mental health psychiatrists are often in the role of in loco parentis, and we make a difference. The doctor-patient relationship is the key element in our treatment, enabling patients to trust our recommendations, whether it is for medication, therapy, or exercise. Sometimes, with patients like Lisa, the trust has to be built up over time.
The importance of the doctor-patient relationship has not changed in the last 21 years since I completed my training. Sometimes, it is a battle to maintain this relationship, as I spend an increasing amount of time bent over my computer typing and tapping information into the electronic medical record. My notes have gone from short stories to novellas, as I fill in information to meet insurance, risk management, and psychiatry board requirements. I fear I will soon have a closer relationship with my computer than with my patients. Sometimes I feel like the astronaut in “2001: A Space Odyssey,” and Hal the computer has taken over my life.
Patients like Lisa literally bring me down to earth and help me remember why I became a psychiatrist. As I puzzle over how to strengthen the doctor-patient bond, I try to plant the seeds that will allow Lisa to forego marijuana and other drugs for good. I encourage her to connect with others in her shoes by going to a support group, acknowledging my own deficits in knowing her experience but my desire to understand it as best I can. The connections I form with patients, especially the more challenging ones like Lisa, cannot be measured, and don’t have a reimbursement code, but they are priceless.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
My computer flashes a message that Lisa checked in, so I go to the waiting area of the college counseling center where I work. At first I do not see her, but then I notice a short, thin woman sitting in the corner, her head bowed with long, wavy blond hair covering her face.
Lisa came in for an appointment at the beginning of the semester and then missed the next appointment. After a few e-mails and phone calls on my part, I get her in for a follow-up visit. I do not always pursue a patient, but I am worried about Lisa. She was hospitalized a few months earlier after becoming paranoid and hitting her mother.
We walk into my office, and she sits and looks at me, pushing her hair from her face so I can see her blue eyes. She starts by telling me: “I ran out of medication, but I know I need to restart it.” I ask her to tell me how she knows.
“Since I stopped taking medication, my friends are getting annoyed with me for talking too much and keeping them awake when I call late at night. My professor spoke with me after class and told me I was being disruptive with all my questions. I think I am too revved up, and it is getting hard to concentrate on my school work.”
I feel a deep sense of relief that Lisa has insight into how her behavior affects others and that medication can help her. This is a major step for her, and I am hopeful that she will continue treatment that helps her achieve her goals. I praise Lisa for listening to feedback from others.
Lisa’s insight has been limited in the past. Her first hospitalization was 1 year ago, her second 2 months ago, both for psychotic episodes following escalating marijuana use. She had been a regular cannabis smoker since coming to college. Did the marijuana cause psychosis, or did she increase use to self-medicate psychosis? This will be debated until the end of time, but I don’t believe marijuana benefits her. She has been in college for 7 years.
I started to see Lisa after her first hospitalization. I was relieved that she subsequently stopped using marijuana and took an antipsychotic. Her mind cleared, and she successfully completed the semester. After 4 months of treatment, she told me she was going to taper her medication and would not need to see me anymore. I was sad, but not surprised, when she returned to my care after the second hospitalization.
Lisa still doubts she has bipolar disorder, a diagnosis she was given in the hospital. Whatever her diagnosis is, I ask her to consider using antipsychotic medication as a tool, along with therapy, friendship, exercise, and healthy eating, to accomplish her goal, graduating from college, which she will do at the end of the semester.
With Lisa, I see more trust with each visit. I also see a rocky road ahead for her, as she still uses marijuana, although not on a daily basis. I have tried to convince her of the benefits of abstinence, without success. I believe the antipsychotic is helping her, so I prescribe it. I schedule a follow-up appointment.
Sitting with patients like Lisa, believing you are slowly making steps toward wellness, is deeply rewarding. My job in a college counseling center allows me to spend 30-45 minutes in follow-up with my patients and meet as often as I need to. Lisa would be lucky in the public health sector to see someone every 3 months for 15 minutes.
I truly feel we as college mental health psychiatrists are often in the role of in loco parentis, and we make a difference. The doctor-patient relationship is the key element in our treatment, enabling patients to trust our recommendations, whether it is for medication, therapy, or exercise. Sometimes, with patients like Lisa, the trust has to be built up over time.
The importance of the doctor-patient relationship has not changed in the last 21 years since I completed my training. Sometimes, it is a battle to maintain this relationship, as I spend an increasing amount of time bent over my computer typing and tapping information into the electronic medical record. My notes have gone from short stories to novellas, as I fill in information to meet insurance, risk management, and psychiatry board requirements. I fear I will soon have a closer relationship with my computer than with my patients. Sometimes I feel like the astronaut in “2001: A Space Odyssey,” and Hal the computer has taken over my life.
Patients like Lisa literally bring me down to earth and help me remember why I became a psychiatrist. As I puzzle over how to strengthen the doctor-patient bond, I try to plant the seeds that will allow Lisa to forego marijuana and other drugs for good. I encourage her to connect with others in her shoes by going to a support group, acknowledging my own deficits in knowing her experience but my desire to understand it as best I can. The connections I form with patients, especially the more challenging ones like Lisa, cannot be measured, and don’t have a reimbursement code, but they are priceless.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
Advice for interns still resonates
The sage, bearded, middle-aged doctor stood at the lectern in the auditorium in front of the young, eager, restless interns who were ready to begin their first day of training post medical school. Had smartphones existed at the time, we would have held ours high, recording the speech that would launch us into our careers.
"I have only one bit of advice: Drink lots of water."
That’s it? No words of encouragement like, Go out there and save lives? Study hard? Don’t kill anyone?
Sometimes the simplest advice is the best advice.
Being an intern is like running a marathon. You don’t have time to eat. You don’t have time to sleep. You’re tired all the time. And you feel like you’re stuck at Heartbreak Hill – will this nightmare ever end? So my advice to interns is the same – drink lots of water, and you will make it to the finish line. Take care of yourself, because you won’t be able to help others if your basic needs are not met. And when you are pushed to the limit, sometimes you have to step back and laugh at life’s absurdities.
The hospital where I spent endless days and nights had a beautiful exterior, its white neo-Gothic structure towering over the East River in Manhattan. The inside was another story – it was downright rundown. This was 25 years ago, and I imagine it has gone through a major renovation since that time.
The patients’ rooms had air conditioning units, but the hallways and nurses stations were like furnaces. I thought I was in Dante’s Inferno. My internship began in July, so I drank lots of water. A bit of advice: Never get sick in July when the interns are starting.
I didn’t kill anyone those 2 months on the internal medicine unit, and I was relieved to go to another hospital nearby to work on the neurology unit. At least there was central air conditioning. But the nicer environment did not make up for a toxic atmosphere. The female nurses seemed to have an allergy to the female interns, because when we approached to ask for help they would run to the open arms of the male interns.
Worse yet, a well-known neurologist yelled at me loud and long, following me down the hallway, waving his arms, his comb-over coming undone. He was the doctor in charge on the unit, and I had respectfully brought up the idea of a change in treatment plan, a less medically aggressive and more palliative approach for a suffering patient with end-stage cancer. This doctor carried on as if I were some kind of serial killer instead of a caring doctor.
The unit was so depressing that I would read "Anna Karenina" to cheer myself up.
The next 6 months of training were heavenly in comparison because I was working on medical-psychiatric units in a freestanding psychiatric hospital in Westchester County, N.Y. This hospital would provide my 3-year psychiatry residency training after internship. Frederick Law Olmsted, the architect of Central Park, had designed the hospital’s grounds, which had rolling hills with walking trails lined by beautiful oak, maple, and sycamore trees.
The geriatric psychiatric unit was interesting and tough – we treated many patients with Parkinson’s disease and dementia. One time, in a meeting with a supervising psychiatrist in her office, I cried because the patients reminded me of my grandparents, who had dementia. The psychiatrist glared at me after this demonstration of countertransference with a response that could only be called disgust and hate. I turned off the tears and my emotions as well. And I drank a lot of water.
I spent my last 2 months back in Manhattan doing internal medicine. By then the interns and residents were complete burnouts and were especially foul tempered. One of the interns kicked his foot through a glass door after being tormented by a resident. We had had enough.
Despite drinking water, I was worn down and developed a 103° fever. I did not come into work for a day or two. This was unacceptable. The resident thought I was faking the fever, and I had to get a doctor’s note to document my illness.
I remember the last day of internship. It was one of the best days of my life. Water became my friend again. On my way to the basement of the hospital to turn in my beeper – the ugly black box that was attached to my pants and went off at all hours day and night – I made a stop at the ladies room. I pulled down my pants and the beeper fell into the toilet. The beeper sizzled and then was silent. I swear it was an accident, but I did laugh out loud.
I fished out the beeper and attempted to dry it off with a paper towel, but it kept dripping water. I think I killed it.
I brought the beeper to a clerk, and she gave me a nasty look like it was not the first time this had happened. Then I walked out of the hospital on a beautiful summer day and strolled down the lovely avenue on my way to a celebratory dinner with my husband, who had finished his internship as well. And I drank lots of water.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
The sage, bearded, middle-aged doctor stood at the lectern in the auditorium in front of the young, eager, restless interns who were ready to begin their first day of training post medical school. Had smartphones existed at the time, we would have held ours high, recording the speech that would launch us into our careers.
"I have only one bit of advice: Drink lots of water."
That’s it? No words of encouragement like, Go out there and save lives? Study hard? Don’t kill anyone?
Sometimes the simplest advice is the best advice.
Being an intern is like running a marathon. You don’t have time to eat. You don’t have time to sleep. You’re tired all the time. And you feel like you’re stuck at Heartbreak Hill – will this nightmare ever end? So my advice to interns is the same – drink lots of water, and you will make it to the finish line. Take care of yourself, because you won’t be able to help others if your basic needs are not met. And when you are pushed to the limit, sometimes you have to step back and laugh at life’s absurdities.
The hospital where I spent endless days and nights had a beautiful exterior, its white neo-Gothic structure towering over the East River in Manhattan. The inside was another story – it was downright rundown. This was 25 years ago, and I imagine it has gone through a major renovation since that time.
The patients’ rooms had air conditioning units, but the hallways and nurses stations were like furnaces. I thought I was in Dante’s Inferno. My internship began in July, so I drank lots of water. A bit of advice: Never get sick in July when the interns are starting.
I didn’t kill anyone those 2 months on the internal medicine unit, and I was relieved to go to another hospital nearby to work on the neurology unit. At least there was central air conditioning. But the nicer environment did not make up for a toxic atmosphere. The female nurses seemed to have an allergy to the female interns, because when we approached to ask for help they would run to the open arms of the male interns.
Worse yet, a well-known neurologist yelled at me loud and long, following me down the hallway, waving his arms, his comb-over coming undone. He was the doctor in charge on the unit, and I had respectfully brought up the idea of a change in treatment plan, a less medically aggressive and more palliative approach for a suffering patient with end-stage cancer. This doctor carried on as if I were some kind of serial killer instead of a caring doctor.
The unit was so depressing that I would read "Anna Karenina" to cheer myself up.
The next 6 months of training were heavenly in comparison because I was working on medical-psychiatric units in a freestanding psychiatric hospital in Westchester County, N.Y. This hospital would provide my 3-year psychiatry residency training after internship. Frederick Law Olmsted, the architect of Central Park, had designed the hospital’s grounds, which had rolling hills with walking trails lined by beautiful oak, maple, and sycamore trees.
The geriatric psychiatric unit was interesting and tough – we treated many patients with Parkinson’s disease and dementia. One time, in a meeting with a supervising psychiatrist in her office, I cried because the patients reminded me of my grandparents, who had dementia. The psychiatrist glared at me after this demonstration of countertransference with a response that could only be called disgust and hate. I turned off the tears and my emotions as well. And I drank a lot of water.
I spent my last 2 months back in Manhattan doing internal medicine. By then the interns and residents were complete burnouts and were especially foul tempered. One of the interns kicked his foot through a glass door after being tormented by a resident. We had had enough.
Despite drinking water, I was worn down and developed a 103° fever. I did not come into work for a day or two. This was unacceptable. The resident thought I was faking the fever, and I had to get a doctor’s note to document my illness.
I remember the last day of internship. It was one of the best days of my life. Water became my friend again. On my way to the basement of the hospital to turn in my beeper – the ugly black box that was attached to my pants and went off at all hours day and night – I made a stop at the ladies room. I pulled down my pants and the beeper fell into the toilet. The beeper sizzled and then was silent. I swear it was an accident, but I did laugh out loud.
I fished out the beeper and attempted to dry it off with a paper towel, but it kept dripping water. I think I killed it.
I brought the beeper to a clerk, and she gave me a nasty look like it was not the first time this had happened. Then I walked out of the hospital on a beautiful summer day and strolled down the lovely avenue on my way to a celebratory dinner with my husband, who had finished his internship as well. And I drank lots of water.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
The sage, bearded, middle-aged doctor stood at the lectern in the auditorium in front of the young, eager, restless interns who were ready to begin their first day of training post medical school. Had smartphones existed at the time, we would have held ours high, recording the speech that would launch us into our careers.
"I have only one bit of advice: Drink lots of water."
That’s it? No words of encouragement like, Go out there and save lives? Study hard? Don’t kill anyone?
Sometimes the simplest advice is the best advice.
Being an intern is like running a marathon. You don’t have time to eat. You don’t have time to sleep. You’re tired all the time. And you feel like you’re stuck at Heartbreak Hill – will this nightmare ever end? So my advice to interns is the same – drink lots of water, and you will make it to the finish line. Take care of yourself, because you won’t be able to help others if your basic needs are not met. And when you are pushed to the limit, sometimes you have to step back and laugh at life’s absurdities.
The hospital where I spent endless days and nights had a beautiful exterior, its white neo-Gothic structure towering over the East River in Manhattan. The inside was another story – it was downright rundown. This was 25 years ago, and I imagine it has gone through a major renovation since that time.
The patients’ rooms had air conditioning units, but the hallways and nurses stations were like furnaces. I thought I was in Dante’s Inferno. My internship began in July, so I drank lots of water. A bit of advice: Never get sick in July when the interns are starting.
I didn’t kill anyone those 2 months on the internal medicine unit, and I was relieved to go to another hospital nearby to work on the neurology unit. At least there was central air conditioning. But the nicer environment did not make up for a toxic atmosphere. The female nurses seemed to have an allergy to the female interns, because when we approached to ask for help they would run to the open arms of the male interns.
Worse yet, a well-known neurologist yelled at me loud and long, following me down the hallway, waving his arms, his comb-over coming undone. He was the doctor in charge on the unit, and I had respectfully brought up the idea of a change in treatment plan, a less medically aggressive and more palliative approach for a suffering patient with end-stage cancer. This doctor carried on as if I were some kind of serial killer instead of a caring doctor.
The unit was so depressing that I would read "Anna Karenina" to cheer myself up.
The next 6 months of training were heavenly in comparison because I was working on medical-psychiatric units in a freestanding psychiatric hospital in Westchester County, N.Y. This hospital would provide my 3-year psychiatry residency training after internship. Frederick Law Olmsted, the architect of Central Park, had designed the hospital’s grounds, which had rolling hills with walking trails lined by beautiful oak, maple, and sycamore trees.
The geriatric psychiatric unit was interesting and tough – we treated many patients with Parkinson’s disease and dementia. One time, in a meeting with a supervising psychiatrist in her office, I cried because the patients reminded me of my grandparents, who had dementia. The psychiatrist glared at me after this demonstration of countertransference with a response that could only be called disgust and hate. I turned off the tears and my emotions as well. And I drank a lot of water.
I spent my last 2 months back in Manhattan doing internal medicine. By then the interns and residents were complete burnouts and were especially foul tempered. One of the interns kicked his foot through a glass door after being tormented by a resident. We had had enough.
Despite drinking water, I was worn down and developed a 103° fever. I did not come into work for a day or two. This was unacceptable. The resident thought I was faking the fever, and I had to get a doctor’s note to document my illness.
I remember the last day of internship. It was one of the best days of my life. Water became my friend again. On my way to the basement of the hospital to turn in my beeper – the ugly black box that was attached to my pants and went off at all hours day and night – I made a stop at the ladies room. I pulled down my pants and the beeper fell into the toilet. The beeper sizzled and then was silent. I swear it was an accident, but I did laugh out loud.
I fished out the beeper and attempted to dry it off with a paper towel, but it kept dripping water. I think I killed it.
I brought the beeper to a clerk, and she gave me a nasty look like it was not the first time this had happened. Then I walked out of the hospital on a beautiful summer day and strolled down the lovely avenue on my way to a celebratory dinner with my husband, who had finished his internship as well. And I drank lots of water.
Dr. Morris is a psychiatrist at the University of Florida Counseling and Wellness Center in Gainesville and has provided clinical care to University of Florida students for the last 20 years. Her areas of specialty include depression, eating disorders, and anxiety disorders.
