“Doctor, I just want to say that I chose you to be my physician because you have an impressive educational background.” I hear this statement often from new patients coming in to establish care with me, and while I smile and say thank you in response, internally I shudder and cringe. It is not Stanford nor Johns Hopkins that has made me a good physician. Rather, I am convinced that the “training experience” that has best equipped me with the skills to be an effective physician is one that you will never find in my CV. My secret weapon is something considered by most to be unspeakable. It is a mental illness. It is my bipolar disorder. I truly believe that without it, I would be half the physician (and person) that I am today.
For 7 years, I have been hiding in a closet — a Texas-sized closet with the expanse of a master bedroom, and I have dozens of loved ones hiding in here with me. Today, I’m coming out of the closet, and I’m dragging some of my closet-mates out with me. For my uncle with OCD, for my ex-husband’s father with schizophrenia, for my friend with postpartum depression, and many others — enough is enough, we have committed no crime and we should feel no shame. Allah has not tested us with these illnesses to punish us. Rather, Allah tests those whom He loves the most, for in that test is a blessing (Tweet this).
It was during my 3rd year psychiatry clerkship when I realized that the long, painful period of low mood that I experienced the year before was actually clinical depression, and that I might have been tested with depression because of my attitude towards it – it was a perfectly designed test. I was overcome by the memory of being in my first year psychiatry small group discussion just 2 years before, and having been asked by my professor, “Noor*, what do you think about depression and its causes?” Like many others raised in a traditional, conservative Muslim environment, I answered what I had been taught: that depression is a sign of weak faith, and those of strong faith are not afflicted. Unfortunately, it was not until I myself was afflicted with depression that I came to realize that this is a fallacy like no other.
Needless to say, my approach to patients with mental illness was forever altered after I experienced it myself. While at times I struggle with my illness and ask, “Why me?,” it is my experiences in dealing with patients in the clinic who suffer from mental illness that always reassures me why it is me. My bipolar is a test, a very difficult one at times, but it is also an asset. Without it, I would not be able to empathize the way I do with my patients (Tweet this). It is my encounters with such patients that make the struggle worthwhile. It took me 5 years from the time I was diagnosed to feel comfortable sharing my illness with a troubled patient. I had no plans to share my illness, as I had learned (as do all patients with mental illness) that it is a mar on your reputation and you should try to hide it at all costs. The first patient I shared it with, Judy, had been struggling with bipolar for decades, and when I saw how anxious she was about discussing her bipolar, I could not refrain from blurting out, “I have bipolar, too.” I could see the look of relief in her face and whole body when I told her. “Thanks so much for sharing that. It makes a huge difference when your doctor truly understands.”
The next patient I shared my diagnosis with was Kellie, a 21 year old who had a strong family history of depression and suicide. She looked fearful of being judged but began to share with me her recurrent depression and the suicidal thoughts that were plaguing her. She was terrified of the suicidal thoughts because her father committed suicide and she did not want to follow in his footsteps. “You must think I’m a freak,” she said. “Well, if you’re a freak, then I’m an even bigger freak,” I responded. She looked puzzled. I continued, “I don’t normally share this with my patients, but I will share this with you: I have bipolar disorder. I have not just depression, but also mania. I’ve struggled with suicidal thoughts myself. Are you ok with an even bigger freak being your doctor?” For the first time in the encounter, she laughed and smiled. We discussed medication management and psychotherapy, and she left with some hope and a plan.
Most recently I saw Patrick, a 56 year old man who had been a very high-functioning and successful businessman until a month before he saw me. He came into my office accompanied by his wife. Tearfully, he described how symptoms of severe anxiety were incapacitating him. “Doc, I hate being like this. This is not me.” Then, looking over at his wife and bursting into tears he finished, “and I am tired of my family having to suffer because of me.” As much as I wanted to comfort him, I had to turn away for my own sake, to quell the flood of tears that came to my own eyes. His statement immediately reminded me of my ex-husband’s oft-repeated words to me, and I could hear his haunting voice again: “Do you know how much pain and suffering you cause everyone when you’re sick?”
The worst part of having a mental illness is not your own suffering, but knowing that you are the cause of your loved one’s suffering. My advice to those who have a loved one with a mental illness is always: seek to understand, and avoid blame (Tweet this). Just as it would be heartless to tell your family member undergoing chemotherapy for cancer treatment, “Do you know how much we all have to suffer when you get chemo? You vomit everywhere and we have to clean up after you.” It is actually quite similar to tell a family member suffering from a mental illness the same sort of statement. People with mental illness do not choose to be ill; the illness is chosen for them. So instead of blaming them, encourage them to take charge of their illness and be responsible for their own care, which may include taking medications, participating in psychotherapy, and adopting a healthier lifestyle with regards to diet, exercise, and sleep habits (Tweet this). Just as your ill loved-one has to bear the burden of taking good care of himself, you also have a responsibility to bear as well. You must try to support them by understanding what their illness is, which is a two-part process: 1) how does the illness manifest in symptoms (which is the easy part), and 2) how does the person with the illness feel (which is the hard part, and the most critical part).
A dear friend recently asked me during a deep conversation about my bipolar, “You don’t love yourself, do you?” “No,” I replied, bursting into tears. “You need to work on that,” my friend said. My divorce launched me on the beginning of a journey towards learning to love myself again. It will be a long journey, but this “coming out” process has brought me one step closer. I write not only for myself, but also for the others with me in the “Texas-sized closet.” I dream of a better world, a world in which the stigma of mental illness does not hinder those suffering from it from seeking help. If we can normalize mental illness to be like any other medical illness, then patients and their loved ones will be better able to access support when they need it, rather than suffering in silence (Tweet this). As a wise person once said, “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.”
Noor Shams* is a primary care physician practicing in California. She received her B.S. from Stanford University and her M.D. from Johns Hopkins University School of Medicine. She is passionate about raising awareness of mental health issues in the Muslim community and beyond.
*This is a fictional name; pen name used to protect privacy.