Becoming an Ironman for Myself and My PatientsThe sliver of light coming under the door of the windowless office seemed unbearably bright and offensive. I turned away from it and closed my eyes. There is a flat spot on the back of my head that, if angled just right, would lie on the textbook I was using as a pillow. In a few moments, I would be asleep again. I was supposed to be out seeing patients, but it was all I could do to show up at work and hide in my office. My supervisor was a gentle woman who would come check on me a couple of times a day. She would crack the door and ask, “Dr. Franklin, why don’t you come out and see one of the new patients?”
“I can’t. I just can’t... I’m no good to anyone.”
Drifting in and out of consciousness in that dark room seemed far superior to being up and about, feeling the pain that seemed to emanate from my chest and flow throughout my body. It was as if my blood had been replaced by some impossibly dense material that could barely flow, making every step I took an effort. If I didn’t lie on that floor and feel my body supported all the way from that flat part of my skull to the small of my back, to the backs of my ankles, it felt like I might fall through to the center of the earth, through the dirt, rock, and then to the molten core where I would be incinerated. I wondered if that might be better than living like this.
Fearing Stigma but Seeking Help
I was a psychiatric intern at the time, and I was depressed. But I couldn’t bring myself to seek treatment. I suffered like that for months until I saw a colleague in consultation, where I described suffering the symptoms of attention deficit disorder, but suggested that a third-line medication for that diagnosis, also used for depression, might help me. I needed so much more than that medication, but my depression, my own inhibitions, and stigma kept me from getting the help I needed. Difficulty concentrating seemed a safer problem to admit to than depression. I was worried that I wouldn’t be taken seriously as a psychiatrist if it became known that I, too, was a patient.
I continued to suffer off and on for years, finally getting into real treatment for the first time after my training was over. A combination of psychotherapy and medications led to the relief of stabilization. Ultimately, psychoanalysis, a more intensive therapy experience, helped me to fundamentally change how I thought about myself and the world, which led to not just relief, but a transformation of how my mind worked. Eventually, I was able to stop taking medicines. The way I had felt only years before seemed so far away. I felt a part of the human race.
Until now, I have kept quiet about my experience. A continued fear of stigma has kept me quiet. I felt that if I was known as a psychiatric patient, even a so-called “cured” one, I would be labeled or disgraced or stereotyped. I thought it might hold back my career.
But the only way to combat stigma is to speak out. This is not easy, but I am inspired by those that have travelled before me on this road and by my current patients. I can’t go on urging them to be courageous, to face down the stigma they were feeling, without doing all I can to fight stigma myself. Only by shining the light of truth on people’s lived experience of mental illness will stigma finally become a thing of the past.
Why a Triathlon?
After my psychoanalysis was over, I took up triathlons. Exercise has not only helped my mood, but I found that endurance sports are a powerful metaphor for what living with a mental illness can be like. In some ways, training for and finishing races makes me feel that I have mastery over that part of me that suffered so much.
In triathlons, like in depression, you have to go on putting one foot in front of another for as long as it takes. It will be painful. Your best-laid plans will go awry. Small mistakes early in the race can turn into big problems before the end of the day. The finish line will seem an impossibly long way away. There are moments of despair, but also moments of triumph. There is beauty around the next corner that can give you hope, if you only look up long enough to take it in. But preparing for and finishing the race is much more about your mind than your body.
On July 24th, I will be racing the 140.6 miles of the Ironman Lake Placid triathlon to fight stigma, to show people that are suffering that treatment works, and to raise money for the Sheppard Pratt Patient Care Fund so that no one has to go without the treatment they need. 100 percent of the monies donated to this fund are spent on patient care. Maybe someone we help get treated will become the next courageous voice in the fight against stigma. Please give generously, whatever that means for you in your life. Thank you for your support.
Dr. Thomas Franklin is the medical director of The Retreat at Sheppard Pratt. He is a clinical assistant professor of psychiatry at the University of Maryland School of Medicine and a candidate at the Washington Center for Psychoanalysis. He is Board Certified in Addiction Medicine and Psychiatry, and has extensive experience in psychotherapy, psychopharmacology, and addictions and co-occurring disorders. Dr. Franklin previously served as medical director of Ruxton House, The Retreat’s transitional living program, before assuming the role of medical director of The Retreat in 2014.
I commend Dr. Franklin for a courageous and useful blog on an incredibly important topic. Whenever someone speaks authentically about themselves and their personal experiencee with depression, it helps people who have the same challenge of seeking treatment but fearing the effect of possible stigma associated with mental illness. Thank you, Dr. Franklin for writing this blog. Your patients are fortunate to have you for their psychiatrist. I trained at Sheppard Pratt in the mid1980's and remember it with fondness. Glad to see that the high quality remains.
Peter Hartmann, MD, DFAPA
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