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Student and Resident Letters to the Editor: Well-Being of Learners

The Shadow of Shame

Krishnan, Aparna

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doi: 10.1097/ACM.0000000000001754
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To the Editor:

Thus far in 2016, at least four medical students have committed suicide. Depression and suicide are a crisis within our community: 28% of medical students experience depression, and almost 10% report suicidal ideation during medical school.1,2 Following bouts of depression, suicidal ideation, and suicide attempts, shame plagues many medical students. Yet, we seldom utter the word. The culture of medicine promotes a model of the ideal physician that deemphasizes the admission of personal vulnerabilities. Students experiencing depression and suicidal ideation regard mental illness as a weakness and themselves as unworthy of respect.1 Ironically, we are regarded as future healers in our communities, yet many of us are consumed by a consciousness that we are even unworthy of human connection.

Efforts addressing medical student mental health, including surveys of burnout levels, confidential counseling services, pass–fail grading systems, and student wellness groups, are under way. However, talking about suicide within our communities is a critical first step without which we cannot have psychologically safe learning spaces. We shirk this difficult task and treat suicide as a taboo. Fear that open discussion will tarnish the intellectual, righteous, and self-reliant image of the medical profession perpetuates the shame shrouding these issues. One direct repercussion is the undertreatment of medical student depression and suicidal ideation.3

We need open-forum discussions about depression and suicide that include personal testimonials from students and physicians. We need to share our experiences—in person, in writing, and, when we feel comfortable, over social media. Collectively, we must accept our human vulnerability and thereby foster connection, which is necessary to build resilience, vanquish isolation, and dispel shame.4 This connection comprises the bond of grief: our shared lament for those already lost to suicide.

No longer can we characterize this issue by citing statistics, or fool ourselves that only “other” medical institutions experience student suicide. Silence and secrecy about suicide foster shame. They place a chokehold on our community. Openness is our liberation.

Let us speak.

Aparna Krishnan
Fourth-year medical student, Johns Hopkins University School of Medicine, Baltimore, Maryland; [email protected]


1. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Educ. 2016;50:456468.
2. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA. 2010;304:11811190.
3. Dyrbye LN, Eacker A, Durning SJ, et al. The impact of stigma and personal experiences on the help-seeking behaviors of medical students with burnout. Acad Med. 2015;90:961969.
4. Saadat H, Lin SL, Kain ZN. The role of “wellness” in medical education. Int Anesthesiol Clin. 2010;48:131138.
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