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Early into my military career and as an oral and maxillofacial surgery resident, I started to acknowledge the fact that, during periods of sleep deprivation that were initially inherent to my military training hours and then surgery call requirements, I found myself thinking dark thoughts that I had never experienced before.
I scheduled an appointment with a psychiatrist and was diagnosed with depression. Scratch that. I was diagnosed with "high-functioning depression."
"High-functioning depression?" It seems like an oxymoron, but I didn't question it. I wasn't ready to question it. My brain didn't let me question it. To admit that I was anything other than "high functioning" felt like a threat to my dental, medical, and military careers, reputation, identity, and ego. At the depths of depression, I even censored myself in my mental health appointments, concerned to reveal that I was anything other than "high functioning."
However, it has become increasingly apparent that not talking about hard things means that we are risking our lives, often due to the tremendous psych-ache that develops from the pressure and energy that it takes to preserve our careers and image of perfection, while sacrificing basic needs such as sleep, nutrition, exercise, and community. So, here I go. Talking about hard things in hopes that sharing my experience will help others and provide encouragement to share their voice as well, even if "sharing your voice" means privately in a mental health appointment.
Reflecting on my experience, sleep deprivation was a main factor that led to my mental health decline. While waiting for an operating room to become available, I still recall a night when I asked my upper-level resident if everyone shared the same dark thoughts (signs of severe depression) I had while on call. It was my first subtle cry for help, admitting that there was a problem. It was scary. My mind did not feel like my own.
Up until that point, I was embarrassed to admit I was struggling. I knew no one loved being on call, so I tried not to complain. I was embarrassed that I was exhausted from sleep deprivation. I was embarrassed for craving the basic needs of a normal functioning human: sleep.
Additionally, my judgment was compromised when in the depths of depression and exhaustion. I thought I had to continue on the career trajectory that I had committed to on paper or end my life. I could not see another option, and my brain was hyper-focused on the risks of letting people know I was not OK. Then, one day, I had a plan to end the pain, and at that moment, I thought: This is no longer about saving my career. This is about saving my life.
At that moment, I finally surrendered. I called my military program manager and said, "I think I need to take a medical leave."
He replied with compassion and understanding. "When?" he asked.
"Days or months ago, but I'll settle for now," I replied.
The next day, I was on medical leave. I risked my career to save my life. Saying it like that, it should have been a clear decision. However, the truth is that -- at the moment -- it was anything but clear to me.
When we are put into high-pressure positions to look and act perfect with fear that a misstep may end our career or taint our reputations, the depression may cloud our judgment and ability to see what really matters most in life: our lives.
The outcome? I saved my life by risking my career. Though I did end up getting medically discharged from the military, the discharge means I can speak without fear of losing the career I was so desperately trying to save. It means that I can initiate the hard discussions in hopes that talking about it will help others to see and get help when their world is dark and their options feel limited. If you're there and you need to hear it.
Nothing in your career is more important than your life. Nothing. I'll say that as many times as it takes to make it true for you.
"High-functioning depression" meant that I minimized what I was experiencing secondary to depression and functioned highly until I could barely function at all. "High-functioning depression" often means you function. Until you don't.
Ultimately, I reconstructed my career to recover, starting with permitting myself to pivot, as discussed in
I have spent years in silence about my career decisions, nervous that my inability to take call and inability to thrive while sleep-deprived could be seen as weaknesses. Being afraid to admit I was advocating for my mental health and my life. That's a problem. I am experiencing fear for advocating for the health and safety of myself and others for concern that I may sound weak. That's a big problem.
Silence is not the answer. Avoiding talking about it is not the answer. I cannot avoid call hard enough for prolonged sleep deprivation to be less of a problem for others. So, let's keep talking.
Physicians need sleep. The system needs to change. Many are not OK. I was one of them.
We need to normalize talking about the hard things and creating environments that promote psychological safety and the ability to truly ask for help, not censor our struggles in mental health appointments to save face.
And if you need to hear it: It's OK to crave basic needs and advocate for them. You're a human, not a robot; we need to create a system made for humans, not robots.
If you are having dark thoughts, please seek help. While the best time may have been days or months ago, the next best time is now.
Jillian Rigert, MD, DMD, is an oral medicine specialist and radiation oncology research fellow.
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