What we call the beginning is often the end. And to make an end is to make a beginning. The end is where we start from-TS Eliot
I was reminded of this quote recently when, at my request, our medical university, for the first time in its 150 year history, instituted a ‘mental health screening’ for all newly inducted medical students. The teaching and care of mental health and mental illness in our medical colleges and universities has always been abysmal with the result that not only are we graduating doctors with little or no awareness of mental illness, we are also leaving many fragile vulnerable medical students at the mercy of a system that offers them little sympathy and no help.
Just in the last few months, in addition to treating dozens of medical students for the usual symptoms of anxiety related to exams, depression and other stress related illnesses, we have also been forced to deal with medical students in the throes of acute mental illness. A medical student from our own institution who came to my attention after he caused a ruckus in class and assaulted another student; another whose doctor brother brought him to me in tears reporting that he had been severely mentally ill for at least 2 years, a student of another college who had to drop out of classes because he became acutely ill from the pressure of his studies – the list goes on and on.
At the root of this problem is a fundamental paradox: doctors are usually pretty good at taking care of other people and terrible at taking care of themselves. This, by the way, is a global phenomenon. When it comes to mental health, the situation is far worse. Awareness about mental illness and the resources, including trained manpower, to deal with it is minuscule. This is especially true in our medical colleges and universities where most medical teachers and administrators denigrate or outright deny mental health issues and severely stigmatize medical students who suffer from any symptoms related to mental illness. The result is a multi-‘generational’ cycle of neglect and abuse: medical professors who trivialize and deny mental illness, not just in patients but their own students as well and then pass on this contemptible attitude to the people who work with them.
What is supremely ironic is that the same medical teachers and professors prescribe antidepressants and anti-anxiety medicines liberally in their private clinics for symptoms related to the heart, lungs, stomach and what not. In addition, few if any of them ever refer people they are treating for anxiety or depression related physical symptoms to a properly qualified psychiatrist.
Regardless, the idea for a mental health screening came to me when one of our medical students became severely mentally ill and required hospitalization (he later made a complete recovery). During a committee meeting to discuss his condition, I pointed out the obvious: Our University is the top merit medical institution in the Punjab. Just recently we admitted 305 medical students to our first year class with the last admitted having an overall grade of over 94%! All newly inducted medical students are required to have a ‘Medical’ as a part of their admission process.
This includes a basic medical exam to rule out major medical problems and an eye exam to check for vision. Why did we not have a basic mental health screening as part of our admission process? Granted that a brief mental health screening at the time of admission would not predict the risk of problems later in the college but it would, at a minimum, allow us to ‘flag’ those students we deemed most ‘at-risk’ and would also introduce the students to the concept of mental health so they would ask for help if they needed it.
At this year’s medical student induction, we talked briefly to all 305 incoming medical students, introduced ourselves and asked them one or two basic questions about their reactions to stress in the past, their ways of coping with it and whether they had any history of ever being diagnosed or treated. As expected, most students did not have any such history but we did get a few interesting responses that we flagged: a student told us that she had been treated for ‘stress headaches’ before exams. Another said he sometimes got depressed because he was losing his hair and was on medicines for hair loss. Yet another told us that she had a history of ‘anorexia’ and often lost a significant amount of weight before exams.
None of this is to say that these students will later develop mental health difficulties but considering the pressure of studies and exams, especially in the first two years of medical college, combined with the stress, in some students, of living away from home for the first time, we should at the very least be on the lookout for any problems and offer them help before they get sick.
And this does not even begin to address the other problem that these brilliant young people will soon face: teachers who have been trained in Pakistan to believe that ‘teaching’ means either regurgitating what’s written in books or humiliating and insulting students who are bright and inquisitive and want to ask questions. One would think that medical college would be different from school and that there would actually be an attempt by teachers to groom and mentor these intensely intelligent, idealistic young people into confident, freethinking adults but in fact, the opposite is often the case. Colleges and universities in our countries are often graveyards of free minds where they are taught to conform, obey and cease thinking freely. This process, in itself, generates tremendous mental stress and frustration. But more on that next time.