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Managing Bipolar Disorder in Medical School

Two days before interviewing at the medical school I now attend, I couldn’t get out of bed. At the nadir of my eighth major depressive episode in eight years, I seriously considered whether I could make the trip. Thankfully, I did. And thankfully, six days after that interview I met the psychiatrist who would finally piece together my long and steadily worsening psychiatric history.

I sat in his office, quiet and dulled compared to my spring and summer self, and began recounting my story – the weightiness of my current depression, the semester in college marked by a mere two to four hours of sleep a night (“insomnia” according to my doctor then), and the clockwork nature of my mood changes each year. Within ten minutes, he stopped me mid-sentence and said, almost casually, “You know, you show a lot of signs of bipolar disorder.”

At that point, I was poised to start medical school in five months. I initially underestimated the amount of work it would take to manage the disease, but it quickly became apparent that starting school so soon was not a viable option. I chose to defer. The following year and a half proved the most difficult of my life. I had to come to terms with the fact that I had something incurable, something that could at best be managed, but most likely only with lifelong medications I did not want to take. When I felt better, I doubted the diagnosis – did I really need all these drugs or to be so strict with my self-care and routine? It seemed that whenever such doubts crept in, the disease leveled up. My mood changes became more pronounced. The next winter brought an even more vicious depression. New medications, dose changes, a hospitalization, and a leave of absence from work marked the time as August grew closer.

It’s clear that my school deferral and leave of absence were crucial to my gaining stability. The processes of obtaining them, however, were anything but conducive to mental health. My search for information on deferrals for mental health reasons yielded dead ends or vague warnings to “be careful” in my language. It was suggested my psychiatrist write a “more general” diagnosis on my leave of absence paperwork, and I was told that many doctors paid out of pocket for mental health care so as to not leave an insurance record. Luckily, the clinicians I worked with and those caring for me made it clear they thought such warnings were overstated. I finally began asking questions.

Though I was exhausted and far from well, I began digging and repeatedly discovered that no one could explain why I had to be particularly secretive about a psychiatric condition. One day I worked my way through calls to a chain of hospital employees until I reached the woman who processed and filed leave of absence paperwork. It was kept in a locked cabinet in a locked office and could only be accessed by court order. Although I know stigma is still alive and well, I began to suspect that the fear of consequences for seeking psychiatric help among medical professionals is grossly exaggerated and exacerbated by what appears to be a giant game of telephone.

The day I wrote the letter requesting a deferral at my medical school, I read an article on SDN describing how half of medical students considering suicide do not seek mental health treatment. Half. I wrote a letter detailing exactly why I was requesting a one-year deferral and sent it in that day.
From that day forward I’ve honestly experienced only positive consequences from being open about having bipolar disorder. I may be unusually lucky. There may be unknown consequences I’ll experience as a result of my transparency. But there are known consequences to secrecy and shame. Treatable disorders go untreated. Bright and capable people don’t pursue their dreams. And, tragically, sometimes stigma kills.
Within weeks of submitting my deferral request, I was asked to set up a phone call with one of the medical school deans. Though I had no reason to suspect problems, I was nervous. The call ultimately left me in tears. I was commended for my openness and bravery, and told I would make a great physician. I couldn’t have hoped for a better response, and I was emboldened to continue being open.

My difficulties in the years prior to medical school trained me to be cautious. I knew not to underestimate the disease and, in part thanks to my ability to disclose my illness, I knew I wanted people around me to help if I was unwell. I set up care with a psychiatrist and met with the disability office before fall term to put accommodations in place should I need them. My classmates know that I’m bipolar and many have asked what they can do if they notice I seem depressed or hypomanic. The open dialogue I have with my psychiatrist, the administration, and my classmates has eliminated the anxiety that a mood episode during school would be disastrous.

Medical school has turned out to be surprisingly stabilizing. Structure, interacting with others all day, and plenty to occupy my mind seems to keep my brain in check. There have been hiccups – the sudden screeching of the brakes whenever a long weekend or vacation follows an exam can spark the beginnings of a mood episode. Over Thanksgiving I spent two full days making image occlusion histology flashcards on Anki. The fact that I found it genuinely thrilling should have been a red flag. However, a good relationship with my psychiatrist allows me to catch these hiccups early and correct for them.

Just as medical school has helped me manage bipolar disorder, being bipolar has in many ways prepared me for medical school. I’ve developed enormous perspective. I began school not only with newfound coping skills, but unshakeable confidence that I can overcome any challenges I face. The habits I’ve adopted to manage the disorder are also conducive to success in school. I practice good sleep hygiene, eat a healthy diet, limit caffeine, avoid alcohol, exercise, and manage my stress.

If you are passionate about medicine, pursue it. Take care of health issues as much as is possible before starting. But know that even with a chronic, often unpredictable illness like bipolar disorder, you can succeed with trusted clinicians caring for you and supports in place. Never, never let stigma, real or perceived, stop you from getting the care you need. Reach out to others – they may surprise you. And most importantly, don’t give up.

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