What a full circle moment! In October, I had the opportunity to travel to Chiba (just outside Tokyo), Japan, for the International Society for Bipolar Disorders’ annual conference, whe…

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I want to open with one of my favorite stories from this season of life — a testament to how quickly our 4-year-old, Rumi, is growing, and simultaneously a love poem to his teacher — a…

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In honor of Mental Health Awareness Month, I’m so pleased to feature the groundbreaking and deeply compassionate way my friend, Dr. Nzinga Harrison, approaches treatment for substance use disorders — which are still among the most stigmatized health conditions to exist.

💫 Spread the light with Dr. Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify

Because stigma festers in the dark and scatters in the light

About Dr. Nzinga Harrison:

Nzinga Harrison, MD, is a board-certified physician with specialties in psychiatry and addiction medicine. She is also the Chief Medical Officer and cofounder of Eleanor Health, an innovative mental health and addiction treatment company. Dr. Harrison holds an adjunct faculty appointment at the Morehouse School of Medicine and sits on the Practice Management and Regulatory Affairs Committee for the American Society of Addiction Medicine. She has written a brilliant book called Un-Addiction that walks through 6 mind-changing conversations about addiction and recovery that could save a life.

My top takeaways from this conversation and Dr. Harrison's book:

• Contrary to popular belief, 75% of people with substance use disorder do recover. And one-year relapse rates for high blood pressure and asthma are the same or higher than that for addiction.

• Upholding abstinence-only as the goal path for recovery from substance use disorder is dangerous. Instead, most people with substance use disorder recover to controlled use — and it's paramount for people to set their own recovery goals.

• Up to 60% of the risk for substance use disorder is inherited.

• "Drug use is a choice. Substance use disorder is an illness."

• "...the more we can get away from this tough love, disconnection, shameful, stigmatizing approach that we've been trained in — the more we can get to compassionate boundaries for psychological, emotional, and physical safety — the faster we can get to recovery."

Trigger warning: In this episode, we talk about substance use disorders, adverse childhood experiences and mental illness.

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Above, you’ll find the audio and video recording of the podcast episode and on the Substack app/website, you’ll find a transcript. If you’d prefer to watch this conversation on YouTube, please click here.

Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.

If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here.

Wishing you light,

Dr. Devika Bhushan

Dr. Nzinga Harrison's groundbreaking approach to substance use disorder treatment

DB: In the book Un-Addiction, you talk about being a medical student taking care of patients awaiting liver transplants, only to learn that people with alcohol use disorders have to be in remission for at least 3 years to be eligible, while patients with other diseases are not held to the same standard. “The lives of people who use alcohol and drugs don’t matter to the health care system,” you write. Talk about this moment and anything else that led you to focusing your career on addiction recovery.

NH: Yeah, I think that really is the moment.

I went to medical school with the intention to be a pediatric surgeon. And you know, you have to rotate through all of the different specialties. And so I went to my six weeks’ psychiatry rotation, dismayed that I even had to do it because I was like, I could be doing surgery right now.

What I really found was even before the system doesn't care about the lives of people who use alcohol and drugs, was: the system really was built in a way that was legitimately harming and killing people that had mental health conditions. I was raised an activist and that really tapped my activism bone.

I just went home feeling so heavy every day because we did all of the liver transplant pre-transplant psychiatry evaluations, and it just became shockingly, amazingly clear that if your liver disease was from anything other than substance use disorder, it was easy to just say, psychiatrically clear — going on the list. No problem.

But when a person had a substance use disorder, whether in remission for years or not, it was like we were legitimately having to put on our hardest-core advocacy skills with other physicians to prove, it felt like, why this person deserved to live.

And that just really bothered me deep in my soul. This was 24 years ago. A very small kernel of people believed and understood substance use disorder as an illness. Instead, it was seen as a moral failing: You make bad decisions. We can't trust you to take care of this liver — this idea that people don't recover from substance use disorders. [But 75% of people with addiction do recover. And one-year relapse rates for high blood pressure and asthma are the same or higher than that for addiction.]

I just legitimately came away feeling like the system doesn't care if these people die or not.

As community members come to us at Eleanor Health, they carry all of that stigma internalized, right? Like, they believe they're bad people. They believe they don't have willpower. They don't trust in their own intuition. They don't understand their ability to make decisions and their right to make decisions about their own behaviors and their health.

And so I tell this story in the book about the St. Kitts monkeys.

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So much is happening, and it’s hard to track it all. This week — National Public Health Week — is especially ironic, given recent federal decimation of public health programs, workforc…

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Today, in recognition of National Eating Disorders Awareness Week, I want to share my friend Shannon Kopp’s experiences living in recovery with eating disorders (bulimia and restrictiv…

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It’s been a rough few weeks… from the wildfires in LA to dispiriting setbacks in our nation’s public health and equity protections, many with global ramifications.

(For any of you read…

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Earlier this year, I published a piece in Slate about the hidden costs of breastfeeding that I’d like to share with you here — along with messages from readers.

When I was expecting my…

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This season of life is full, and it’s been a little bit since I sat down to write to you all.

This past weekend, after a few tries at bat, we finally struck the right balance between e…

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Today is the day when two years ago, I first shared my own mental health journey publicly, while I was serving as California’s acting Surgeon General. I wrote about it in my friend Emi…

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In honor of National Minority Mental Health Awareness Month, I’m so pleased to feature the thoughtful perspectives of my friend and colleague, Pooja Mehta.

💫 Spread the light with Dr. Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify

Because stigma festers in the dark and scatters in the light

About Pooja Mehta:

Pooja Mehta serves with me on the National Board of Directors at the National Alliance on Mental Illness (NAMI). She’s been a powerful mental health advocate since she was 19 and lives with anxiety with auditory hallucinations, depression, and lost her brother Raj to suicide in 2020.

Hear from her on:

- How she centers being a South Asian woman in her advocacy

- What current suicide prevention efforts miss

- An annual tradition in honor of her brother, Raj, to foster kindness and connectedness

- How to craft a lived experience message to drive policy change

Trigger warning: In this episode, we talk about death by suicide, suicidal ideation, anxiety, auditory hallucinations, and depression.

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Above, you’ll find the audio and video recording of the podcast episode and on the Substack app/website, you’ll find a transcript. If you’d prefer to watch this conversation on YouTube, please click here.

Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.

If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here.

Wishing you light,

Dr. Devika Bhushan

 “I am the child of immigrants — many of us are — and we grew up hearing how our parents, our peers, our contemporaries left everything they knew to start a life in an entirely foreign country with the intention of making life better for themselves, with the intention of making life better for their children.

And I would say that taking care of your mental health is not only a part of that, it is fundamental to that.” —Pooja Mehta

 PM: There's so many rooms that I walk into where I'm the only person who looks like me. There are so many places that I go to and I give talks and I give presentations and I'm the only name that they're stumbling on.

And even in South Asian spaces, I'm the only one who is speaking about my mental illness — sometimes to the chagrin of the people in the room: ‘Oh no, this isn't something that we deal with. You just need to do more yoga.’

And so one of the things that I really try to be intentional about is whenever I'm talking about mental health, I'm wearing something — there's part of my physical appearance — that is South Asian or South Asian-inspired. It's jewelry; it's wearing a kurti, sometimes wearing a bindi — like really tuning into that part of me in a way that can't be overlooked.

And then also in South Asian spaces, being very intentional about, ‘No, I want to have this conversation and I want to talk to you as a South Asian person. I want to talk to you as an Aunty or Uncle about this topic.’

And I want to do it from a place of compassion, from a place of understanding, in a way that invites you into the conversation rather than calling you out for not already being a part of it.

DB: We are, for better, for worse, pallbearers of our diaspora, of the immigrant community in the US. And there's a way in which people want for that to be this shiny, sort of ideal version of what a person can be. And there still is a deep level of shame around experiences of illness, and specifically mental illness, that are hidden. And I love how much intentionality you put into bringing even a visual piece of your South Asian identity into spaces and rooms where you're the only person who looks like you having conversations openly about what it takes to have a world where everybody has the resources, the access, the opportunity to have optimal mental health.

It’s been a little bit since we last connected! These past few weeks have been a flurry: winding down our time as a nomadic family to put down roots in Berkeley, California; starting a…

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We have a special episode of Spread the light with Dr. Devika B for you this month — with the wonderful — who offers many important nuggets about how to foster healthy masculinity and emotional fluency from a young age to optimize both educational and health outcomes. #MillionMaskMovement

💫 Spread the light with Dr. Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify

Because stigma festers in the dark and scatters in the light

About Ashanti Branch:

Ashanti Branch has over 20 years of experience in building healthy relationships in schools — he’s a pioneer in reforming education, youth mental health, and traditional masculinity. Ashanti is the Founder and Executive Director of the Ever Forward Club,* a non-profit organization that takes students who are disengaged and dropping out to 100% graduation rates, 90% college enrollment, and 0% incarceration, using tools like the Taking Off the Mask workshop. Ashanti has received the US Surgeon General’s Medallion for his work (2023; the highest honor a civilian can receive from the Surgeon General).

*Ever Forward Club just celebrated their 20th year and here are some photos of a 5K my son and I did (using a wagon) to raise funds for them.

Trigger warning: In this episode, we talk about systemic challenges inherent to working within the US public education system and youth mental health issues.

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Above, you’ll find the audio and video recording of the podcast episode and below, a transcript. The written version of the conversation has been lightly edited for clarity and length. If you’d prefer to watch this conversation on YouTube, please click here.

Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.

If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here.

Wishing you light,

Dr. Devika Bhushan

DB: Can you give us a picture of who you are and how you came to this work?

AB: So I was raised by a single mother, in Oakland, California. My Dad died three months before I was born. My grandfather — my Dad's father — died a week before my father died. So leading up to my birth, I lost both my grandfather and my father.

And my Mom, in her grieving and her worry and her 22-year-old college student self, she just began to stress and grieve and I picked up all of those chemicals of feelings.

I was a boy growing up in Oakland, California, and I felt everything in a society where men are not supposed to feel, and if you do feel, you better just not show it.

And I'm like, 'Wait a minute, you don't feel this sadness, fear, worry? You don't feel this stress, doubt? What's up with people around me not feeling this stuff, not feeling the hardship of friendships breaking apart?’ You're supposed to just get over it really quick.

And I felt so many things that I was often told, 'Suck it up; man up; boys don't cry; be a man, man…' And it wasn't always happening from adults. It was a lot of time happening from peers. That was the sauce that kind of created this boy growing up.

So elementary school, [I] got in a lot of trouble. Middle school, was following some of the same trouble — got bullied. High school, I finally got my act together.

A teacher in middle school really helped change my life… from my educational focus.

And then [I] went to college, graduated as an engineer, started making good money.

And then teaching called me. And I was like, 'Nope, you got the wrong house. You got the wrong civil servant. Because this guy wants to be rich and teachers can't be rich, as far as I know.' (My Mom was a teacher. So I knew that.)

There was no way that that was going to happen. So I ran from that job to make more money. So I was driving, say, an hour and a half each way. That's just on a regular day, just to fight and get away from this calling on my soul that you should be doing this teaching job.

I thought if I would drove further and made more money, it would make the feeling that you're doing the wrong job go away. And it actually made it worse. And so I said, 'Well, look — the Peace Corps — they go two years and they go back to their real life… I'll do that.'

So I was going to go teach for two years and then come back. And that was 20 plus years ago.

I guess it doesn't always happen the way you envision it. But I'm thankful. There were some hard times in that journey — like, my salary dropped 66%. I'm a math teacher. So I did the math. Probably shouldn't have, but I did.

And to imagine like when students would like mild off and say something like, 'Oh, you only here for this check!' And I could, with proof, go over to my desk because I still have the check stubs from engineering that I would look at once in a while, and I would show them: here's my teacher check stub, and here's my engineering check stub.

Now that's a little petty. Sometimes, for those mildy kids, you know, sometimes they just need to have proof. And sometimes it was because I was like, ‘How dare you think I'm here for the money they pay us here for this work?’

And I think sadly, they don't pay teachers a salary where you feel happy or proud about sometimes. I mean, maybe after you teach for 20 plus, 30 years, you move up this little scale and you finally have made it to some kind of salary, but it's nowhere measuring compared to professions that pay because those professions are seen as more important.

I want people to know that we can't expect that schools are going to continue — are going to work and get better — if we continue to pay teachers just enough to keep them from quitting.

And it was painful and it was sad at times, but I look back and I'm like, 'Okay, that was part of my journey.'

DB: That was definitely an important part of your journey. And it's so striking because we don't pay teachers enough to sustain the best talent, right? And it's exactly what you just alluded to: People say, 'Okay, I'm going to put in my service time. It's going to be two years. It's going to be five or 10 years.’

But nobody says, ‘I would love to be in this for my life because it's a way that I can support myself, support a family, support people that come next after me.’ And it is such a shame that we lose the best and the brightest in so many ways out of this profession where we really need you — you're going to be shaping our most impressionable young people — at such a critical time in their lives. And you're going to be spending day in and day out with them so many hours in a day — more than their parents, more than grandparents — more than anybody else. And to not value that is just despicable.

AB: And people who don't know, don't know, right? So you have to help educate people. Some people think that as a teacher, you get paid for summers.

You don't get paid for the summer. You get paid for the time you teaching. And if you're not careful, if you don't stretch your check out… if you don't do summer school, if you don't work in the summer, there is no money and that's two months.

And then on top of that, you don't get another check till after you've worked a month. So it's like you got to stretch three months out over the summer if you don't work.

So I think just as there's a lot of misunderstandings, and there's a lot of lack of empathy and understanding.

Like the fact that schools are so jacked up, teachers get a lot of the blame. They don't often blame the people making six figures in the offices wearing the suits who walk around the schools with film crews around them taking pictures of kneeling next to a kid saying ‘hi,’ right? Those people — they're not so worried, right?

And they are the ones who negotiate on behalf of the teachers in the classroom.

On top of that, schools look like they did a hundred years ago [and] we are surprised why most of them aren't working. I mean, what other industry do we know of that looks like it did a hundred years ago?

There's a teacher in the front of the room, there's students in rows, the teacher tells them some information. Two weeks later, the students tell the information back to the teacher, and then I grade you based on how well you memorized the stuff I told you over the last two weeks. And then we repeat the cycle over and over again.

And if you're bad at that process, then you must be a bad student. What? What other industry are we looking at that is still operating like it did 100 years ago?

And we wonder why it's not working. We should not be surprised. It's evident that it's not working. It's working exactly as good as it should, based on the times we were in.

Same thing with the battle over AI technology. There are people getting ahead in this AI race, and there are people getting further behind. There's plenty of schools saying, ‘You can't use it; you can't touch it; don't worry about it.’ And what's happening? The people who are learning it are going to be the next billionaires, trillionaires.

Why? Because they're figuring out what's possible.

We oftentimes just keep recycling these patterns, right? That’s how long it took some schools to finally get computers. When they finally got computers, their new technology was already out, right? They finally got these big boxes on every desk, right?

DB: Oh, I remember the big boxes. Definitely. It's so true. If schools aren't evolving and they're not keeping pace with what's happening externally — and really helping students thrive in the ways that suit them, right? Rote memorization as a model works for some kids, and it leaves a lot of other kids out and behind.

And we have to find ways to recruit, retain, inspire more of the kids. And so speaking of effective changes, can you tell us about the Million Mask movement? Where did that idea come from?

AB: So as a first-year teacher, when I started the Ever Forward Club, I wasn't trying to start a nonprofit.

I was trying to help some young men pass algebra. Fast forward 15 years, we get a feature in this documentary called The Mask You Live In. It came out in 2015.

In that documentary, when they asked to come film, I was at my alma mater, Fremont High School in Oakland. I was working with some young men.

I said, 'Well, you should probably go to our other club at this other school — those students, they're youth leaders — they're leading the clubs. I've been there for two years. The young men I'm right here with, they're not really taking over the leadership.’

And they're like, 'No, we want to see where you're at.' I said, 'Okay, well, just know you're not going to see young men opening up, deeply connecting. I'm battling just to get them to listen to each other sometimes, you know?'

They can't talk about their feelings without creating a fight… It's [out of] fear. If you believe that to let people see your true feelings is dangerous, then you're going to fight against that danger. And since I'm the person bringing this experience to them, they will fight against me.

So I said, 'What if they don't have to talk about it? What if they can just write it?' And so the first activity, I actually printed out masks.

I said, 'Write words on the front and write words on the back: the front of the things you let people see — the back of things you don't usually let people see, that are harder to let people see.'

And then we threw the papers at each other. We mixed them all up. And that's how the activity first began.

I'm still waiting to see what's going to happen because I don't know if it's going to work. I don't know if they wrote real stuff on it. Cause I had never tried this activity before.

And what ends up happening is they open these pieces of paper up and they start reading them. And man, that room dropped in. I mean, it dropped in, like I had never been able to drop them in.

And as you start reading them off, you were hearing similar words: fear, anger, worry.

That powerful deep connection of like, 'Oh, wow. It's somebody else in here is going through this. How is that possible?'

Everyone is always, on the outside, so cool. We don't realize that so many things are happening.

In the early days, I was just collecting the mask at the end of workshops. It felt like I couldn't throw [them] away. Like, I got one right here.

And so this one, the front of the mask: happy, smart, smart, outgoing, and caring.

And I'm gonna show you the back. You probably saw some of the back bleeding through the front — for a good reason. Cause look at the back. Oh my gosh, just so much anger, nothing else. Eighteen times.

I still get goosebumps when I think about it. How many of our young men are walking around smart, happy, cool, outgoing, and yet behind, they're carrying all this stuff that they don't let anybody see?

And it's coming out somewhere. It has no choice. Like, there's only so much you can store. All that stress and worry and anger before it either takes out your organs, it takes out your health, it takes out people you care about because it's energy in motion. That's what we tell our young men: Emotions are energy in motion.

Most of our young men — they turn everything into anger. They turn sadness into anger, they turn fear into anger, they turn doubt into anger, they turn embarrassment into anger.

Because the anger in our community is accepted.

It's safe. It's almost respected. You get angry enough — no one's going to mess with you. You get angry enough — no one's going to say nothing bad about you. You can command enough [respect with] people being worried, some fear of you.

I've been there.

What we try and help them see is that, man, there's so much [more].

So this was where it started, these pieces of paper. And then: the long story short, a teacher from some school called me and said, 'Hey, your activity is not safe.'

They were like, 'Well, the thing you did in the documentary.' And I was like, 'I didn't teach anybody how to do that. What do you mean? Are you telling me you did that activity with your students?' I've been working with these young men for months and we were in that room for an hour plus; you saw a five-minute clip and you tried to do it with students?

Thank goodness that teacher blamed me out loud, but how many teachers are blaming me in silence? And so I talked to some of my mentors and we decided we're going to have to give it away — figure out how to teach people how to do it the right way.

And so long story short, it became what is currently called the Million Mask Movement. We have a goal of engaging a million people around the world in this self-reflective tool.

And now it's a four by six card. It's that words on the front, words on the back of the mask. And it's been amazing. It is amazing wherever community I'm in. I was just in New York this past week doing some workshops with some high school students and some middle school students, and just watching them find ways to find those words and sometimes not even have a word.

One young man said, 'I don't know myself well enough yet to know what I don't show.'

DB: That's really insightful.

AB: Yeah, so powerful. He had a really soft voice, and part of me was like, 'I should tell him to yell,' and I didn't do it. He — his voice — has been blocked. But it was my first time meeting him. So I didn't want to push too hard. So I just told him, 'I see you brother. I just want to let you know, I see you. I had a hard time hearing you, but I see you and I hope that you can let yourself be heard more.'

And he heard it. He didn't say anything really back, but he heard what I said. And that's all I could do is just plant a seed. That you were seen today, right?

And how many people don't ever — either they don't believe it or they don't ever hear it — [know] they're seen? And I think that's so important.

DB: That is really powerful. And as you were thinking about how to operationalize the Million Mask Movement, what elements needed to be in place for it to feel like a safe experience for people? What does it entail from beginning to end besides the front and back of that mask?

AB: When we created the first activities that we gave out, we started telling teachers, 'Hey, there's a free tool. Sign up for this.' We had over 600 teachers sign up around the country to do the activity.

Once it leaves you, people are going to translate it to mean what they want it to mean. As a former teacher, I've made lots of curriculum. I've helped people create curriculum. This is what I think I'm somewhat good at: is helping create experiences.

So we try to be as thorough as we could. One of my mentors was like, ‘Ashanti, you got to decide: do you want to make an impact or do you want to make money?’

And I was like, 'Can I have both, please?' He's like, 'Well, yeah, but if you know that this activity got to get out, you can't put a money barrier because you know how schools are; they have no money, really. They barely are operating in themselves.' And so we want to make an impact.

So I first, ask this question: how much time do you have? Really trying to make it so teachers would use it the most healthy way and not make it unsafe, right?

It's supposed to be anonymous for a reason. It's anonymous because we want students to be able to have their paper out there and no one knows it's them. But even if you tell somebody is anonymous, they may not still believe it. So they may still be hesitant about what they would write on the paper.

And so we gave them the steps: Ask your class what they understand about the concept of wearing an emotional mask.

And so it was really giving teachers a step-by-step guide to how to make that space. And if you're a teacher who is afraid of doing your own work, it's going to be hard. Because if you haven't yet [been] willing to look at your own mask, and I'm just telling you to do this as an activity, I'm trying to make it a grade for you.

You're trying to build connection. So it can't be connected to a grade. So I'm going to trust that you're going to give your best.

I don't care about what you draw — whatever you feel comfortable drawing. I don't want people to get into their head that, 'Oh, I have to have a perfect drawing,' or 'I can't draw like these people.'

And it becomes a trying to get people to say, 'Oh, this is me. This is me as best as I can demonstrate on this piece of paper. This is me.'

We've learned a lot over the years of how we grow the movement. In 2019, we got a grant from LinkedIn, a Compassion Award. It gave us enough money to build the first prototype of the website.

We put it online so the teachers didn't have to worry about mailing anything back to us. But a lot of teachers wanted the tactile. They wanted the touch of the hand.

Then 2020 came and it was like, 'Oh boy, they have to do it this way because everyone is remote learning. That's when the website took off. And it was so helpful during that time that teachers could use it with their students — figure out what was going on with their students in a really safe, anonymous way and really begin having healthy conversations with students about those masks.

DB: It's so interesting to hear about all of the different elements that went into this journey. What is the youngest you think that a kid might be able to experience this and really understand and use it?

AB: We know in elementary school, around fifth grade, is probably a good age.

We've done workshops with fourth graders. They get it, too.

If they're too young, they're not yet used to being metacognitive. They're not used to thinking about their thinking.

So when you ask them, 'What is it you don't show?' the younger they are, [they say]: 'I don't let people see my socks. I don't let people see my feet. I don't let people see my underwear.’ They're very literal.

DB: They may also not be in that place of intentionally shielding parts of themselves. So my almost three-year-old, right? There is no level of artifice. What he's feeling is what he's going to be displaying and whatever it is, is fully there in the present moment.

And at some point we lose that. We begin to build up these walls — like you’re saying, it's somewhere in that elementary school zone. It's very interesting to hear about these examples of socks, feet, underwear. That's very cute.

AB: And imagine that the age is also depends on what type of school they're in.

Is it a school that's very caring and nurturing, or is it a school where there's a lot of like, 'I have to put on an edge,' because it's not safe to be too nice and too kind? And you start learning that early. I was at an elementary school, they were doing a documentary screening for parents of a second grader.

At the end, a second grade parent, she says, you know, 'I have a question about just how do I help my son? I don't want him to be treated badly. Like I don't want him to become a bully. And I also don't want him to be a victim, right? So how do I help him learn?’

She's a second grade parent. So those are boys about seven.

He was having lunch with his best friend. They're just sharing lunch. And some bigger boy said, 'Oh, you two are gay.' And this second grader didn't even know what that meant.

So he came home that day, asks his mom, 'Mom, what is gay?' And she's like, 'Huh? What's going on here? What are you talking about?' And he told her the story, what happened. And she felt this pressure — how do I let him continue having a best friend where they're so kind and caring with each other, and then worry about what the bigger boys or the playground are going to say and do? Because he doesn't fit the mold of what these other boys [expect]... and who told this bigger boy that that is not okay? Where did he get that language from? He's beginning to box those boys into a system that he has been told that is not okay.

And imagine how often that happens. Something happens with other kids on the playground: 'Oh, wait, I can't sit close to my friend. I can't. I don't want the other boys to treat me like this.'

There's a Belgian film called Close. It was nominated for a Oscar. And it was about these two boys. They left middle school, best friends, — they pretty much spent the whole summer together. They go to high school. And now the pressure to fit into the high school. And one of the friends joined the ice hockey team. One of them didn't.

And man, it just began that pressure of them separating from each other, that friendship that was so close, then it had to get ripped apart.

And for some, it's so hard to accept it and to understand it. ‘How did I just lose my best friend? Did I change? Did they change?’

How do we help young people have those feelings that they handle them in a delicate way — [that] they don't try and ignore them? And I think parents, teachers, adults in our lives, have a responsibility to really channel back. ‘What was it like to be 12 and to lose a friend?’

But if you've erased your childhood memories, you tell him, 'Just get over it,' like it was that easy. And I think that's what sometimes gets missed.

DB: Yeah, how huge those moments are the first time it's ever happened and it means everything because it's your sense of self and your identity. So how many to the way of 1 million are we so far?

AB: We're at over 80,000. The original campaign came out as the 100,000 Masks challenge. So we were like, 'Okay, we're going to get there fast.' So we started getting close and we rebranded it as the Million Mask Movement. So it's almost like we took the goalposts and moved it 10 times further away.

I started with a group of young men at Fremont High School in Oakland, California, making these masks. Something told me to hold on to them. It didn't start with this big strategy. It was like, 'I can't throw these away.' Like this one, this wrinkled one, this is from 2004. I think this is 10 years old.

I didn't start this as a researcher. I started this as a practitioner working with young people. And so we're gonna put out our first research paper. It's the tale of two schools. We're looking at this private school and this public school: sophomore boys and how their masks showed up, how they looked. And, people would think that public school and private school — they're so different.

Like, these kids have all these resources and these kids have no resources. And you may think that their masks look different, but there's amazing similarities between just what they don't talk about; what they do. We're super excited to put that out.

DB: One question that I think always comes up around all of this is: what if you learn anonymously that somebody is struggling with thoughts of suicide, or somebody is really struggling with aggression that might burst out in some real way in the real world? How do you help with that?

AB: You know, normally we don't know until we get back to the office with all the cards. If, when we do an activity in a workshop and we, you know, bring some volunteers up and they read off some cards randomly, those students get to read what words they want to read. If I got a card that says something really harsh on it, I may not feel comfortable reading, so I may read one of the easier words. So we don't know when we do a live workshop. It has happened a couple of times.

Because it's anonymous, we first see how students are going to respond to it. Like, did a student notice that word that showed up? Because I don't want to bring undue, unnecessary attention to it, but I'm listening to all the words that are read out.

And so, let's say someone does mention thoughts of suicide. Once the students read off cards, we say, 'What did you hear? What did you notice? What are you feeling?'

And either someone would bring it up or someone won't bring it up. And I'll say, 'Well, maybe someone noticed that there was a word there that was pretty hard to hear. Did anybody hear that word?' And people will raise their hand.

They heard it, but no one pointed out. And I say, 'you know, we don't know who that card belongs to. We made this anonymous for a reason.'

And what I think happens in that moment — a couple of things happened. They saw that the reaction wasn't like, people laughed. I don't know who wrote it because it's anonymous for that reason, and it gives the room and the freedom for me as a practitioner, but also for the school to say, now that you are aware that this is here, it is important that you begin to do some kind of learning, some kind of poster campaign, some kind of experiential opportunities for students to come to safe places.

Because guess what? If I don't think people can handle it, maybe the only time I've ever been able to write it was when I got to write it anonymous and throw that piece of paper away. Now I've wrote it.

Thank goodness they mixed them up with all the other cards, because the students are seeing us collect them all. They're like, 'Okay, it's out of my hands.' And they're wondering what's gonna happen next. And so, if we do come back to the office and we do start seeing some of those words, and we just type the words out — we send an email to the teacher or the school and say, 'Hey, we just want to let you know some of these things came up. And we want to support you to do the next steps.'

Sometimes I find schools are action-oriented to do it. And some are not. The tricky part is, I get really frustrated when they're not, when they're not taking it serious to take next steps to do something.

It's easy to be like, 'If it's anonymous, then I don't know who it belongs to. So there, I can't do anything.' That's a easy out if you were looking for an excuse. If you don't want to really do something, any excuse will do. ‘We're not going to go ask every student, no, you don't have to do all that.’

How about you make sure that students know, here's where you go if you need some support. Where are the posts around campus that tell students who are struggling? So who they can call, who they can go to, what room in the school they can go to anonymously and what are the ways that they can get the support without you having to figure out who it is?

Now, when we were in the virtual world, we had a student who changed their name on the computer. It was Zoom time. Changed their name — wrote a really heartfelt statement about what they were thinking about doing, and then changed their name back. So by the time the message got to the box and people noticed it, that person had changed their name back already.

It was wild. It was in middle school. It happened so fast, and I was like, 'Okay. All right. Everyone take a breath.' Everyone's taking a breath because somebody in the comment was like, 'Why would somebody write that?' We didn't know if it was somebody being a jokester or somebody just need[ing] to see how the room was going to respond.

Some kids said, 'Hey, you're not alone.' And we had another meeting with the school, and we actually found out the student actually told one of his teachers that it was him.

And so I think what happens is sometimes people are wondering who can they tell these things that they're battling with and wonder how not to make it worse. I mean, I think people want to have those deep relationships, those deep connections. But if you don't trust that people can handle it, then we keep it to ourself.

If you live in a home where secrets are the norm: 'Don't talk about what happens in this house.' [How] do I talk about the stuff that I'm going through if I can't talk about it? Therefore, I get good at just performing what I need to perform so that everyone is good around me.

Maybe I'm taking care of my parents. Maybe I'm looking out for their needs so much that I don't think they have time to deal with my needs. And so therefore I operate like that. And I think those are the ways that so often, we miss the opportunity.

Because me growing up, I was the oldest. Always working, helping take care of my siblings. So a lot of stuff that I was dealing with, I didn't talk to my Mom about it. I just kept it to myself. Not that I didn't think she loved me. I believe she did, but I was like, 'She ain't got time. She ain't got energy. She got to take care of the littlest ones.’

And so I'm always trying to look out for others. And so therefore, some of those needs went unmet. Not because I don't think somebody could have helped, but because I had made the decision, or I felt the need to make the decision for the adults in my life.

DB: And what you're doing here is you're really making space for people to have their needs, their emotional needs, at least be heard and feel like there is a space for that. And that's a big, big thing.

AB: It's been beautiful. What I hear from students when they do a reflection is that I didn't realize that so many people here were going through the same thing. 'I'm so glad to know that I'm not alone.'

I wish I knew who that these cards belong to so I could go and talk to them and, you know, listen to them. The depth of how students understand this has been so beautiful. And I think just this awareness that we sometimes get judged from what we see on the outside, right?

People judge us from what they see. But there's so much more to me than you can see. That's one of the taglines of the movement, right?

DB: Yeah, there's so much more to me than you can see! So with that in mind, what is a mental health myth out there that you want to settle the score on?

AB: Beautiful question. Well, I was just talking about how my community handles it, that to have worries and thoughts that people can't name doesn't make anything wrong with you. That as humans, we feel.

And if your feelings have been twisted around because you have been having to not fully be able to feel them, you may not be able to explain them.

So when I ask you, 'What's going on with you?' And I'm like, 'I don't know. I can't explain it,' it doesn't mean nothing's going on with me. It means, I don't have the words. And I think sometimes think people think that if something's going on with you, you should be able to explain it. And I think we have to take a break and take a moment of just quiet and calm and say, 'Actually, I don't know what I'm feeling.'

And when we rush people to try and come up with a description of the feeling that is hard to name, it's not fair to make a person who never got a chance to talk about how they feel, to now want to come up with it right away and then blame them for not being able to do it.

I think the myth is that because you're feeling odd or you're feeling some type of way, that you should be able to explain it clearly to somebody who asked you how you're feeling. I think we have a society that has told us not to show a lot of feelings.

And so we need to give each other time and say, 'Okay, well, you know, like, I'm not a therapist in that way, but I am a person who listens.' And so when somebody is coming to me, a young person and they're like, 'Man, I don't know how to say it.' I'm like, 'Oh, take a breath. Let's just slow it down. Don't be in a hurry to tell me what it is.'

And I'll just name off some emotions for them to think about. ‘Like, are you sad? Are you worried? Are you afraid?’ And a lot of people have very limited emotional knowledge, or at least, how many emotions can they list? And if you're going to list five emotions, then it's going to be really hard to explain.

'I'm not angry. I'm not feeling... no, I'm not angry. I'm not sad.' Then you're like, what word is in there? There's a word out there for it.

And so I think that's one of the myths is that we should be able to explain always at the drop of a dime when someone is asking us when we're feeling something.

And I think the other side of that is we need to be giving more emotional education to young people. They should be able to list 15, 20, 30 emotions. Now is that a vocabulary lesson or is it a human lesson? Well, sometimes people think, 'Well, if it doesn't fit in the curriculum, then we can't do it.'

Well, that's part of the problem. That's why the curriculum ain't working. Cause you got kids walking around feeling all these things they can't talk about.

And you're wondering how you're going to make it an assignment, right? And so I think our schools continue to sometimes perpetuate these things.

DB: You're essentially saying the most important thing that young people need to understand and learn is really a set of deeply layered skills. Like you have to name the emotion. You have to have enough vocabulary and enough ability and practice to do that with yourself.

And then building on top of that, what do you need from another person to help you feel differently in that moment? Emotional fluency, or just emotional awareness, right? Around yourself and other people. And then what makes things better for you or worse?

AB: That's right — absolutely; it's huge.

DB: One final question, which is: What do you hope to see for us for our future?

AB: You know, I'm a big feeler. So my hope is that we find more ways to love. I just think we — our communities, our world — is lacking so much love.

And I think maybe that we're not lacking the love; we're just showing so much of hate, you know what I'm saying? I think the love is in there. I think we've let hate take over the voices of the loudest speakers. And it is devastating our youth in ways that we are gonna keep finding out later.

And we wonder why our communities are ravaged by young people who don't seem to care. But I think the young people are going to help us figure it out. I hope that our communities will continue taking care of our schools. I hope we will make it a priority — talking about our feelings in healthy and safe ways.

I hope for our world that people take that journey from the head to the heart. The longest distance most people travel is the 18 inches between their head and their heart. But most people get stuck in their heads. And so we invite people to just take that journey down to our heart.

And I think if we stay up in here, we can find all the things wrong with other people out there. We can keep pointing fingers, but when we come into our hearts, we're like, 'Man, what is that person dealing with? What are they going through?'

And so I just hope we can find more love. I think we need it.

This was my first time on live network TV, though I’ve done pre-recorded (and hence editable) spots and I was honestly surprised by how quickly the time went, and how much fun I was having by the end…. though I was definitely sweating at the beginning! I also realized I had more to say than the time allowed, and I’m capturing some of my longer form thoughts for you here.

The interview was about new survey data from the Girl Scouts of the USA showing that nearly 70% of girls 5-13 years (N=1000) feel lonely and have low self-esteem — worsening as they get older — with very real health impacts.

When asked how parents can know that their kids are lonely, I pointed out that younger children may not be able to directly verbalize a new concern or stressor, and that instead, changes in health or behavior might serve as clues to dig deeper. For instance:

Is a chronic health condition like asthma or eczema flaring?

Are there any changes in sleep, mood, appetite, and behavior?

Connection is the antidote to loneliness — first and foremost with oneself — absolutely required before we can meaningfully connect with others.

This is especially hard today. Young people are often developing from the outside in — cultivating that outer image, such as on social media, instead of tapping into and building who they really are inside.

5 things a caregiver can do to bolster kids’ sense of self-worth and connectedness:

I would love to hear your additions and thoughts.

✅ Cultivate kids’ inner values, interests, and connections

Compliment a young person’s core attributes, rather than their looks. Replace “that’s such a nice dress” or “I love your smile” with something intrinsic you admire about them — like “I loved how you kind you were to Billy today.” Take their lead on joint activities that they choose: Spend time together in nature, cultivate a hobby like art or dance, and enable them to connect with others who share their interests.

✅ Create a family culture of anti-perfectionism

Embrace and even celebrate failure and mistakes — as necessary for growth.

✅ Let kids struggle!

Give kids space to figure things out for themselves (while still being available for support), especially when they’re trying something new, from tying their shoelaces on their own to addressing schoolyard drama. This builds self-efficacy and builds to mastery. Importantly, it gives them the message that you believe they can do new, hard things — and succeed. Watch them rise to that expectation.

✅ Invest in tech-free zones

These are essential for meaningful in-person connection, such as a daily walk or family dinner — where any topic can be broached (see below). Also keep cell phones out of reach for deep work/study time — even having them out, on silent, steals attention and other cognitive resources. Norwegian middle schools that banned cell phones had higher grades and nearly 60% lower need for specialty care, including for mental health, in girls, and 40-50% less bullying for both boys and girls.

✅ Have an open door policy

Encourage kids to talk to you about anything that concerns them — online or offline. Emphasize that nothing is off limits, and you will love them no matter what.

Wishing you light,

Dr. Devika Bhushan

Today is Earth Day, but of course, we call this planet home every single day of the year. On this day, let’s each make a plan to incrementally reform our collective actions towards a l…

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This month, in honor of the inaugural Health Workforce Well-Being Day on March 18th, commemorating the day the President first signed the Lorna Breen Act into law in 2022, I’m thrilled to feature conversations with three brilliant national leaders who are transforming health worker well-being.

💫 Spread the light with Dr. Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify

Because stigma festers in the dark and scatters in the light

More about our speakers:

Corey Feist, JD, MBA, CEO and co-founder of the Dr. Lorna Breen Heroes’ Foundation, founded in 2020 to address the systemic drivers of health worker ill health and honoring Dr. Lorna Breen, a frontline emergency room doctor and Corey’s sister-in-law, who died by suicide. The work of the Foundation was recognized by the US Surgeon General’s Medallion Award in 2023 and I’m proud to serve as an Ambassador.

Mona Masood, DO, the psychiatrist who founded the Physician Support Line, staffed by volunteer psychiatrists to extend free, 1-1, anonymous support to physicians and medical students, starting in 2020.

Janae Sharp, CEO and founder of the Sharp Index in 2018, with a vision to make health care “the healthiest place to work,” and to prevent physician suicides like that of her ex-husband, Dr. John Madsen.

Trigger warning: In this episode, we talk about systemic challenges inherent to working within the US medical system and their mental health consequences, including burnout and death by suicide.

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Above, you’ll find the audio recording of the podcast episode and below, a transcript. The written conversation has been lightly edited for clarity and length. If you’d prefer to watch this conversation, please click here. Here’s a brief video clip:

Catch other parts of our mini-series on health worker well-being:

• Chief Wellness Officer Dr. Jessi Gold on optimizing health worker well-being

• Psychiatrist Dr. Ahmed Hankir’s journey with melancholia and elation in medicine

• Psychiatry resident Dr. Jake Goodman’s journey with depression and anxiety in medicine

• Nephrology fellow Dr. Justin Bullock’s journey with suicidality and depression in medicine

• Emergency resident Dr. Ade Osinubi’s journey with hopelessness in medicine

• Understand the key issues — Deep dive: Clinician well-being

Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.

If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here. If you’re a US-based clinician or health student dealing with “any issue, not just a crisis” — reach out to the Physicians Support Line, free of cost and confidentially: 888-409-0141 (M-F, 8 am to 12 am ET).

Wishing you light,

Dr. Devika Bhushan

DB: First up, we’ll hear from Corey Feist. I’m moved and inspired by the work you're leading, and I wanted to have a chance to get your perspectives and vision on record.

CF: Thank you for that — thrilled to have a conversation.

I also just make a note: thank you for being vulnerable and sharing your own mental health challenges. Because I think it is critically important that clinicians at all levels openly talk about these issues.

What we've learned over the years is: When you speak of the unspeakable, it gives permission to others to speak about it, too.

It's easy as putting a signature block on the bottom of their email that says, 'in therapy since...' or 'medicated for XYZ since...' — little things like that all chip away at this stigma.

DB: I love how you put that: Speaking of the unspeakable to make it an easier and more normalized experience for others. Corey, I'm curious if you could give us a sense of how you came to this work.

CF: You know, I spent my whole career in health care, first as an attorney, and then as the CEO of the University of Virginia Physicians Group. I moved from being on the hospital side as a lawyer to then a policy person and then an operations leader.

So that my professional upbringing and my entire career has been in healthcare, really looking out for the impact of the increasing demands, around EMR and other administrative burdens, on the time of clinicians. And I saw over the last 20 years: this incredible work shift and burden shift across the clinicians whom I represented.

And then, in the spring of 2020, we made national news when my sister-in-law, Dr. Lorna Breen, died by suicide. Lorna was an emergency medicine leader and a practicing clinician in New York City, and had a singular mental health episode following a really horrible bout with COVID and then returning to the workplace too early. And [she] was so burdened by stigma, both the perceived stigma of her peers and her colleagues, as well as the structural stigma, which she believed was around penalties for obtaining mental health care. That this incredibly bright, vivacious 49-year-old getting her MBA, taking the world by storm, living her dream, amazing human decided to take her own life... And the response by the workforce to her death, the publicity around her death — publicity we never asked for. We found Lorna's story on the front page of a couple of New York City newspapers 12 hours after she died.

And we were so incredibly just overwhelmed with loss and grief. And then in this moment of clarity, my wife, Jennifer, and I decided that we really needed to share the story of this amazing, amazing human.

And we never would have imagined the response by the healthcare workforce to that story. With my professional career and Jennifer, also as an attorney — we suspected that there were issues that Lorna was speaking about that were real. But we never in a million years would have expected the feedback that we received. To this day, every single day I hear from someone new that I didn't know who says, ‘This either happened to me or this is happening to me — and we need a better day.’

We've done quite a bit of work in a three-year period of time to make an immediate and long-term impact on the professional well-being and mental health of our healthcare workforce. I think we're in some ways just getting started on this work and just really honored and privileged to be in this space now, carrying on Lorna's legacy.

But really, this is for all the health care workers out there who need help. So they can take care of patients and just do their job.

DB: I'm so sorry for your loss and I just want to thank you for doing this in Lorna's name and legacy and really helping so many do better and be better. It's huge. Looking back, what are you proudest of having accomplished at the Foundation?

CF: The first thing I'm most proud of is that in that moment of clarity, we decided to act and speak out. It was a real testament to the human condition, particularly during COVID, when hundreds of people — thousands, really — offered help. And we took that help.

One of the humans that reached out was United States Senator Tim Kaine. He had read her story. And that conversation led to the first ever federal law looking out for the well-being of the healthcare workforce, called the Dr. Lorna Breen Healthcare Provider Protection Act, signed by President Biden on March 18th, 2022. That was quite a moment of pride.

As you know, as someone who's been in policy for a long time, it takes a long time to create new law, particularly at a federal level. We did this in 18 months. And we really view that law change as the first few steps of a whole body of law that's really looking out for the professional well-being and mental health of health workers.

Sticking with the policy angle for a second, we identified that there were at least six structural barriers or penalties to obtaining mental health care that apply to licensed health workers that apply in almost every state and almost every hospital they work in. And one of the most proud things we were able to do was we were able to develop a national badge recognition program and audit medical licensing across the country and begin to audit nursing and hospital credentialing applications.

For medical licensing, we've gone from 17 states that were compliant with our recommendations, which are basically consistency with the Americans with Disabilities Act for their questions on mental health — we've gone from 17 states when we started to now the majority of states.

That is progress. That is an impact that will be enduring for a very long time and will benefit thousands and thousands. Same on credentialing: we have now moved the vast majority of hospitals into credentialing in Virginia, my home state. We just heard earlier today from a very large health system that has over a hundred hospitals across this country that is going to use our recommendations.

So removing barriers and penalties to mental health access is absolutely one of our biggest feathers in our cap.

The other is that we've come together and brought together operationally all these different arms of health care. So right after we talk today, I'm going to be talking with the American Nursing Association and I have them in a campaign that we call All In: Well-being First for Healthcare. We brought together over a dozen of the largest national associations — who don't always get along, by the way — to lock arms around the well-being of the workforce. Collectively, they represent over a million health care workers.

We're scaling now a program called All In: Caring for Caregivers, which is the starter kit for hospitals and health systems. We have every single hospital in Virginia participating.

And then I would be remiss if I didn't point to the awareness work that we've been able to continue to drum up: speaking about this topic publicly, multiple appearances on morning shows, 60 Minutes, tons of publications.

In all of that, it's the stories that we get from healthcare professionals who reach out or stand up — like Dr. Christopher Veal did at the American Society of Family Medicine Physicians, in Missouri earlier in the year. He stood up in front of all of his colleagues and he pointed at me and said, ‘Dr. Lorna Breen Heroes’ Foundation is the reason I spoke up about my mental health challenges and they've helped to save my life.’

And it's those kind of things — getting an email or a message through social media from someone who attended one of my talks who said, ‘Your words saved my life’ —that is what I'm actually most proud of, after all of it, that those people are here today because of the work.

DB: That's amazing. As you said, an 18-month span of time leading up to really momentous federal legislation.

I remember when I applied for a medical license in the state of California, it was much before your regulations had come into play and it was a very onerous application for somebody with a mental health condition — it required several hours of additional labor, cost, time. It was a nightmare.

And now I look at the questions on the exact same application, and they are so much better — so much more humane, so much more equitable. And it is literally thanks to the Dr. Lorna Breen Heroes’ Foundation that that change has occurred now at such scale. It's truly remarkable.

CF: Thank you for saying that. And it's incredibly important now that physicians and other licensed healthcare workers know the rules. Every time I go to speak with groups of nursing students or medical students, and I ask them about obtaining mental health care, the vast majority, if not all of the room, says, 'We can't get help if we need it because there will be repercussions.'

And so now what we know is the enduring part of this work, once we make the change is to ensure that the workforce knows what the rules are. Physicians and other licensed healthcare workers deserve to know what the rules are. There should be no repercussions for getting mental health treatment.

Within the last year, the American Hospital Association published their suicide prevention guide, identifying three key drivers of suicide.

The issue that we're talking about here is the number one key driver of suicide identified by the American Hospital Association. And that's a call to action to wake up — we lose 400 doctors a year to suicide in this country — at twice the rate of the general population.

You look at the rates of suicide and mental health by physicians in the United States compared to other countries, and they're the worst off. I think a lot of this has to do with the drivers around billing, compensation, and how the workforce is required to document everything it does while running as fast as possible on a hamster wheel, trying to push a boulder up the hill that keeps pushing them back down. How's that a mix of metaphors between a Sisyphus and a hamster wheel?

DB:  Why is it that you think we still have the 24 to 28 hour shift in medical training, as well as in the physician workforce?

CF: I think there are a lot of things around the practice of medicine — which have been hidden and in plain sight for the general public — and have just been the way that we've always done it. Your example's a perfect one.

I'll contrast it with a flight crew. Everyone knows that if your flight is disrupted because your crew has been working too long, that's a safety issue.

I don't think the general public knows how long doctors and nurses have been working at any one time. You know, nothing magical happens when you graduate from residency where they count your hours at 80 hours a week to becoming an attending physician. Nothing magical happens in terms of your ability to sustain a prolonged amount of time without hurting somebody.

That’s the tragedy. In the airline industry, they did that for safety reasons for the passengers. If there was a real hard look at this — and there has been a hard look, particularly when it comes to nursing shifts — that after a certain period of time, the increase in medical errors rises. But it hasn't really been published very much.

I think back to when I was much younger, there was a Dateline episode on wrong site surgery. And that wrong site surgery was because a resident had been up for hours and hours and hours. And that led to a lawsuit. And it also led to limits on hours.

I think part of this is the general public doesn't know. The economics are not in favor of this. I remember the hue and cry across healthcare when we had to cap residency hours at 80 hours a week. Because it was going to require you to backfill those clinical hours with a higher paid person, a nurse practitioner or an attending physician.

So a lot of this is antiquated thinking. The rest of the world has moved on and has evolved in a much more employee- or workforce-friendly manner. Healthcare is one of the few that are lagging far, far behind.

At a basic level, healthcare workers need to know what their rights are. They need to know, if I go get therapy, ‘Am I going to have a consequence or not?’ And the answer should always be no. They also should know, ‘Do I have to work all these shifts?’

I was just on a panel at the Aspen Ideas Festival and there was a physician who runs a nursing recruiting firm. They put together employers and employees. And she talked about how important it was for hospitals to provide flexible shifts, because that's what nurses are asking for. But she was looking in her database and only a handful of hospitals were actually listening. The employees are speaking — and the employers need to adjust their operations, so that the workforce can thrive.

DB:  Next, let's hear from Dr. Mona Masood, the psychiatrist who in 2020 founded the free Physician Support Line, staffed by volunteer psychiatrists to support physicians and medical students in a one-on-one and anonymous way. Mona, how did you come to this work?

MM: So I am an outpatient psychiatrist in the greater Philadelphia area and that has been my primary role for a number of years until March of 2020, the beginning of COVID as we know it in America. And at that point, many physicians — we found ourselves at the front lines of this kind of unprecedented pandemic. We're all trying to collaborate and share information from our various backgrounds and specialties on how to navigate all of this.

And in those discussions — tens of thousands of physicians all over the world on social media — I, as a psychiatrist was trying to do what I do, which is read between the lines of what people were posting… And yes, people are talking about diagnoses and imaging and treatment and all of that.

But there was a deafening silence in all of this: How are they feeling about this? How are they coping with all this? Where is the human in all of this?

I see the physician, but where's the human?

And this was a big red flag for a psychiatrist: They weren't talking about how they were feeling.

Physicians have a habit of intellectualizing: 'Give us facts, give us data, give us research.' We can really hide behind those things. But feelings — feelings are hard.

I remember one particular post from an ICU doctor in New York, 'Hey, does anybody know of a good lawyer? I want to write my will.'

Why would he be asking that, in this context? It's because he was thinking about his mortality — as all of us were, right?

And so I wrote my own post right after that one because it wouldn't leave me alone.

I wrote my own post, calling all psychiatrists, 'Who's with me?' — about starting a hotline for doctors navigating this pandemic.

And the response was quite incredible: 500 psychiatrists signed up within the span of a week. And then the support line started about a week later.

In that post, what I realized is we have to give permission to first talk about it.

DB: So this was to help people be human in this new moment, born of you feeling like physicians in particular were not acknowledging those pieces of their own needs. Was this on Twitter? I'm just curious. Was that the platform?

MM: No, it was actually on Facebook. I think there was a COVID-19 physician group: at the time, about 70,000 were on that group. Physicians from all across the globe.

DB: And how many physicians have come through? What have been some of the patterns you’ve seen?

MM: This is an anonymous support line. And we don't report to anyone in that regard in order to preserve the sanctity of the space.

But there are certain things that we log in order to make sure that we are meeting the needs of our callers: the subjects that people call about and also numbers.

We are tens of thousands of calls in — 4 years running.

With the start of the pandemic, people were calling in with imminent anxiety about what this could mean. Could they pass this on to their families? We were getting calls from people who were front-liners — ICU doctors, pulmonologists, infectious disease physicians.

I remember, because how can you forget? ‘I'm in the supply closet in my ICU. And I just need a moment to get a grip because I know I have to go back out there. I know that the patients need me, but I need to get a grip.’

And so sometimes, it was just holding space.

Sometimes, all you would hear on the other line is breathing. Sometimes all you would hear from the other person was, 'Are you there?' Just needing that reassurance that someone gets it and almost permission to even have any of these feelings.

We have debrief sessions between volunteers on a weekly basis.

And I remember that we were all surprised to find that most of these calls would start off with an apology.

The caller would be like, 'I'm so sorry for wasting your time,' when this is a deliberate line for this exact purpose. They would be like, 'I'm so sorry for calling. I know that there's people who could use this more than me. And if you need to go, I understand.'

These kinds of things are more telling than even what they would talk about. Physicians… we really, really do struggle with validating our own mental health.

MM: It went from the acuity of this whole time and survival mode — then callers would change the subjects to things that had nothing to do with COVID. Because we were physicians and struggling with our mental health prior to COVID, which we know, but wouldn't acknowledge it.

Then conversations would shift to family, like: 'Am I a good Mom? Am I a good Dad? Am I a good spouse?'

It would shift to political issues, because of course, we're affected by that, as well.

I remember when the whole tragedy with George Floyd happened, Black physicians were calling about how it felt to be a Black physician and how they felt triggered by all of this, and all the inequities that bleed into health care.

So what we realized from these conversations were that — behind the white coat, the stethoscope — doctors were still people who had the same thoughts and struggles as everybody else.

And that shared humanity piece became what we would give back to them in these conversations. Like, ‘That is something that you should be thinking about or caring about,’ or ‘You're not weird for having these thoughts or caring about things outside of medicine.’

DB: I'm curious about the volunteer psychiatry workforce. How many people are there? What do they do to support each other through this and to enable them to do it financially?

Great questions — and questions I had when I even put out that impulsive post.

I went in going, ‘Okay, a support line that makes sense — but what else makes sense?Anonymity. One person can't do this all on their own. We have to have volunteers.’

That part actually came pretty easily. People were really into that idea and were thinking about it themselves.

From there, we hired a lawyer, pro bono, who walked us through the policies and procedures and making sure that we were within our licensing, that we weren't acting as a physician, but more as a peer. We were not going to do continuity of care. And we're not going to prescribe medications.

Why it needed to be psychiatrists is that we were going to be able to apply various therapeutic modalities we were trained in, without needing additional training — it was already inherent in the field. So that's why we could start so quickly.

So we could standardize who you're talking to: These had to be actively licensed psychiatrists in the United States. We worked with a company who was going to vet that for us.

How we financially support this line is through a grant by the National Suicide Prevention Lifeline. Their owner and operator is Vibrant Emotional Health — they run the 988 number, and various support lines. They reached out to us at the very beginning when they started seeing us in various news platforms and said, ‘We want to support this.’

And we came back at them saying that it's incredibly important for the integrity of the line that it be run by physicians — because we have an issue with healthcare being run by people who are not in healthcare — so that would cause mistrust amongst our callers. We wanted to remain in control of the line.

And then within the group itself, we would have weekly educational seminars — again, pro bono — like the American Cross First Aid in Mental Health; experts on moral injury in health care; people from specific specialties talking about what’s unique about that specialty that causes burnout.

Weekly, we all meet together and we decompress: ‘What was hard for you this week; did you feel helpless? Or did you feel like you actually made a breakthrough?’ Sharing of knowledge and strategies — and also, we became friends [through this].

[If] I'm managing the line, I'm seeing missed calls come through because it's busy — I'll contact a volunteer and be like, 'Hello, friend — are you available to take a missed call right now?’

We have a census of 800 psychiatrists. We practice what we preach in terms of our own mental health and our boundaries. This is completely voluntary. We have signups on a weekly basis; we also have backup lists — if it's busy, they're able to sign on and take calls. On any given week, sometimes a [given] person will take 1 or 2 hours out of the week.

DB: And is this now your full-time work, or are you still doing other work?

MM: Oh, no, not at all. This is completely still volunteer. Even for me — I don't get anything out of it. I'm still a full-time outpatient psychiatrist. That's still my primary income.

We joke amongst the admin, that we were building a plane while we're flying it, essentially. We launched one week, but it's still in the process of becoming a nonprofit entity.

DB: Okay, so based on what you’ve seen in the last 3 and a half years, what is your sense of physician well-being: is it getting worse, staying the same, or improving?

MM: I do think it's getting less stigmatized. I will say there has been more acceptance of mental health as being a valid pursuit, a valid part of your health.

I am also seeing more advocacy among systems, which is what we actually needed. With any of these major movements, — BLM, women's rights, any rights — it's not just the individuals that protest, it's also the systemic reform that needs to happen.

And for physicians, we have a lot of systemic barriers to mental health [support]-seeking. There are states where their medical licensing applications definitely violate the Americans with Disabilities Act: they ask for treatment, previous medications, all this kind of stuff. So we've been working with the Dr. Lorna Breen Heroes’ Foundation on language of licensing applications to de-stigmatize that on systemic levels.

A lot of my work — and what I was just doing right before our talk today — is I was talking to a medical school on mental health and systemic reforms. We have to change the culture of how we encourage each other about our mental health.

DB: Our third conversation today is with Ms Janae Sharp, CEO of the Sharp Index. To start, do you mind giving us a glimpse into how you came into this work?

JS: I feel like it just happened somehow — by life experience and by my decision to make a difference.

As background, I got married when I was 23. I don't know why we have to start there, but we do. And my husband [John Madsen] got his MPH; he went to medical school at Geisinger. We had three children.

During medical school, he had essentially a mental health breakdown, which he never really recovered from and he died by suicide; didn't finish his residency. And I went on, you know, to take care of our three kids.

I got a job doing stuff for patient reminders and went down the road to health IT and started writing about it. But I remained passionate about mental health. And I was going to speak at a conference and someone was like, 'Well, are you going to really make a difference here?' And I didn't have the complete answer.

But I knew that we needed more conversation about mental health. And I knew that largely, medicine didn't take mental health seriously. So I started Sharp Index to broadly to advance the mission to reduce suicide amongst physicians and healthcare workers, and improve clinician mental health.

I feel like we've been really lucky. We have so many amazing volunteers, especially data science experts, who are able to look at what technology can do and what would make a difference. We also have physician volunteers, and now we're subscribing to this great idea that health care should be the healthiest place to work.

If we really believe that health matters, and that the whole person matters, I think healthcare can be part of healing — even healing some of our larger societal problems that are reflected in care.

So, we work on lots of different stuff: we work on helping people individually and helping with narratives, whether that be talking to press or events, or helping communities.

We work with individuals who have lost someone, or physicians and healthcare systems who are struggling. I'm very proud of the work we've done for people who are in crisis or who have lost someone. Some of the stuff is long-term, like we have scholarships, we have aid — but when someone comes to you in crisis and trusts you or says, 'I lost this physician last week or maybe even several years ago, and I don't quite understand why I'm still feeling so connected to it,' that's very important.

I'm also proud that the way people talk about physicians is more human. It's less like us versus them. It's more this recognition that we've all been through a lot in the past few years and that we need to take care of everyone, including the people who will take care of us — or they'll leave.

But mostly I'm proud of the people who have come back and said, ‘You know, 'we could have ended up like John.’

Some people were there for me when that happened, but not the same way. There weren't a lot of people there saying, 'This is how you're going to feel and this is normal and this is one way to make it better.'

So I'm intensely proud of that.

DB: That's huge. Knowing everything you know in this space, what are your top tips for how to be there with somebody as they're recovering from a suicide loss? What should a community member or friend do or not do in that moment?

JS: Oh, that's a great question. I have a few top tips.

One is to know where you start and they end. When you're trying to be there for someone, it's really important to recognize that what they're going through is separate from you. And you might have big feelings: you might also be going through that loss. And you can be there for people and decide these are the things I can do to help, without trying to take on the whole weight of their pain.

I also think it's very important for people to realize that we don't really have a lot of education about grief, about death. It's culturally not something that we're very comfortable with. We don't sit there and grieve together in big groups. We have this culture of silence.

Learn about both how other cultures deal with this, but also decide what you want it to be yourself.

Grief is something you can learn about. And it's actually something that is more predictable than you would think and more normal — and also that we're not raised with.

When you're talking to someone about death, but you don't have any of the words to talk about what that feels like and you've never really seen it, it's a lot harder.

And I think my third tip is that you can carry people some of the way — you don't have to carry people all of the way.

And there will be times when you can do what you can do, and there will be times when you need to take the responsibility with your mental health to be healed and to be well. The entire process of our lives, I think, is that give and take. Recognizing how we can interact with other people, and when is the time that we need to heal, and when is the time that we need to help.

DB: You mentioned learning about how other cultures cope with grief. I'm wondering if there's one or two in particular that you think are better at it than we are.

MM: I think a study just got released about how people in Japan, when they're older, they live healthier, happier lives. And they have a greater acceptance of loss. So they particularly have a great reputation for being good at this. And also connecting young people with old people, connecting people with people who are struggling with mental health. They do better.

DB: I'm thinking more about that striking first tip — about knowing where you end and where that other person begins. I'm curious if you could say more about that.

MM: I learned it from having a family member with serious, ongoing chronic mental illness, where it wasn't really expected that that would go away.

And I think that profoundly changed the way that I approach everything with mental health. Like what if instead of saying, 'Oh, you're in crisis now, I'm going to fix you and let you go,' you said, 'This might just be how this person's brain works. And I need to decide what I can and can't do to still meet my obligations.'

Some people just need one-time help, but usually, we need healing that's more long-term.

And we also need to drastically alter our expectations for what other people will be doing:

We talked to a healthcare system who had a physician death a few months ago and the well-being team had had done a lot to help people and they still lost someone. And one of the hardest things that I heard was they just said, 'I just want to make sure this will never happen again.’ And that's something you hear a lot in suicide loss, especially with health care workers. And this is a Chief Well-being Officer. I wish I could have told them: 'You can't guarantee that. So what does your work look like when you can't guarantee it?’

For me, it means you still keep going. For some people, they shut down.

That's a larger philosophical idea about mental health where I think it's an expected disease, that we are fully capable of taking care of each other. [And] one person can't take care of all of one other person's needs or all of everybody's needs, but as a whole, we can.

DB: What have you found to be the most effective ways of supporting someone in crisis?

JS: A lot of the people who come to us in crisis are physicians. On several occasions, we've had a physician through our network just show up, sit with and talk to them. Showing up in person matters. We've also tried to do online support where people can meet with peers.

I've also found that there are two types of crisis. There's the acute crisis where they've kind of reached their breaking point and everything's spilling over. And then there's the crisis that's more prolonged that doesn't look the same, [but] largely is the same. So for those people, we found that going over truths without expecting a lot is important.

Usually when someone's in crisis, the thing they need most is someone to be there. Sometimes it's someone to go do their dishes — something very practical. Someone who will actively show up and not say, 'What can I do for you?' but will say, 'Look, we're going to go on a walk; we're going to go to lunch,' and take over and kind of carry that person for a while.

If you come bring someone a meal after a death, a lot of times, we're doing all we can, but they might still have a hard time two months later, if they're normal people.

DB: As you're looking at the field, what are the big bright spots — the places to feel optimistic or feel good about our progress?

JC: For me, the brightest spots are the individuals who keep sharing their stories. Chase Anderson shared his story — like, what is this actually like?

In addition, there are more people involved in policy and making it safe from a workforce perspective. I do like the Lorna Breen stuff — what they're doing with credentialing.

There are some things that we need to do that are not as popular.

Wendy Dean asked me the other day: ‘Is the cost of doing business [just] physician lives or patient lives?'

Sometimes the bright spot is that people are just leaving. People are saying no. Because you have to have people come together — striking. You have to have that for change. And that's not the most popular thing for people who are working with hospitals.

As a survivor, I'm like, 'All these people together, they can take power, and they can decide care is going to look different.'

And for me, that's a bright spot.

Because people have been pushed to do too much work for long enough.

The switch to daylight savings time (DST) was just observed in the US this past weekend — and many of us are feeling its effects. Before we dive into why and what we can do about it, a…

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Here’s a conversation with the wonderful Dr. Jessi Gold — on workplace mental health, how to achieve a prevention focus over doling out interventions, and reflections on her own mental health journey — including recently uncovering and shedding self-stigma she didn’t realize she carried.

💫 Spread the light with Dr. Devika B. Conversations that dispel stigma and stereotypes and instead, spread hope and light — also on YouTube, Apple, Spotify

Because stigma festers in the dark and scatters in the light

More about Dr. Gold:

Jessi Gold, MD, is the first Chief Wellness Officer for the University of Tennessee System and serves as an Associate Professor of Psychiatry at the University of Tennessee Health Science Center. (This conversation was recorded before she started these roles.) Dr. Gold is an internationally recognized speaker, media advocate, author, and mental health consultant with a special focus on college students, healthcare workers, and the entertainment industry. She lives openly with depression.

Dr. Gold has been spreading the light for decades with her critical work, and I’m thrilled to be sharing her wisdom about optimizing well-being with all of you.

Trigger warning: In this interview, we talk about systemic challenges inherent to working within the US medical system and their mental health consequences, mental illness self-disclosures, and living with depression.

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Above, you’ll find the audio recording of the podcast episode and below, a transcript. The written version of the conversation has been lightly edited for clarity and length. If you’d prefer to watch this conversation, please click here. Here’s a brief video clip:

Catch our mini-series on clinician well-being:

• Psychiatrist Dr. Ahmed Hankir’s journey with melancholia and elation in medicine

• Psychiatry resident Dr. Jake Goodman’s journey with depression and anxiety in medicine

• Nephrology fellow Dr. Justin Bullock’s journey with suicidality and depression in medicine

• Understand the key issues — Deep dive: Clinician well-being

Click here to catch up on other Spread the light columns, in addition to other posts organized by column type, going back to our newsletter’s launch in January 2023.

If you or a loved one needs help for a mental health crisis, don’t hesitate to call or text 988 — or reach them online here. Find other resources here, search for a US treatment facility here, and find a US-based therapist here.

If you’re a US-based clinician or health student dealing with “any issue, not just a crisis” — reach out to the Physicians Support Line, free of cost and confidentiality : 888-409-0141 (M-F, 8 am to 12 am ET).

Wishing you light,

Dr. Devika Bhushan

DB: As you’re looking back at the last 10 or 15 years, there are factors that are worsening physician well-being — like you've found there's been an astronomical increase in the number of messages that patients are sending their mental health providers. And on the other hand, there's all of this increased awareness, stigma reduction that's going on where people are coming out and sharing their [mental illness] stories, coming into community, and feeling normalized and supported. Peer support networks are growing. On balance, as you're looking at this whole landscape, are things getting better or worse?

JG: I wouldn't say worse. I'd say the same, if not better.

And I think awareness is always the first thing. In all big things requiring cultural change, people need to know it's a problem, right? And awareness comes in lots of ways. The pandemic helped a lot with this because doctors were on TV crying and couldn't fight what they were showing. And everybody understood why that would be hard for doctors. And then people like me could say, ‘Oh, hey, this isn't new — right?’

But you had this picture of a person trying to do their best and not being able to — in the system — that everybody could see. And so many people were struggling across the hospital system with different things in different ways that it was sort of just a universal: This is what's going on right now. We are all not great, right?

We're not talking about it as much as we should. We're not getting help as much as we should, but we know this is a problem and we can't hide it much anymore.

Places across the country then put more money into it. If they had the money, they started to try to figure out ways that they could better support this.

A lot of that is on the intervention, not the prevention side.

So a lot of: How do we get you access to care? Not: How do we prevent you needing access to care in the first place?

A lot of stopping the bleed — and I think that continues to be the focus. Given a choice, they're going to do an intervention because they don't want the bad outcome, but they're missing all of the steps that prevent the bad outcome.

I also think that places that put money into it will very easily not put money into it in the long term. So it's hard for me to say, are we having a temporary awareness — like, good moment — in this? And if you asked me in a year, would I go everywhere stopped caring? It's possible because it's definitely less exciting and sexy to them right now than it was two years ago, or one year ago even.

Which is concerning because again, this stuff existed before. This stuff is only getting worse. And there are new problems all the time, right? So like, just because we are not burnt out by not having PPE [personal protective equipment] does not mean that we're not burnt out by anything. And that is a misconception that I think administrators or sort of the ethos of this conversation has — which is, the pandemic did this and made it worse.

And maybe when that goes away, we'll be able to say, ‘Eh…’ And we'll go back to not really investing in this thing. And I think that's a big problem — the longevity of this conversation and then the investment in the prevention, not intervention side.

And then you and I both know that talking about things doesn't mean people actually are doing something about it.

So that can be at a policy level, but that can also be on an individual level, right? So, like, just because it might be easier to say you get therapy doesn't mean people are getting therapy. And I see that a lot — like people still come pretty sick, which means they still hid it for a while, even if when they finally come, they feel better finally coming, there's still a lot of cultural problems in help-seeking to begin with.

And so, just because some of us are talking about it more, and maybe even world culture-wise, mental health is being talked about more, doesn't mean that all of a sudden, medicine's totally fine with it.

I'd love to say that, right? But just because we talk about it more doesn't mean that it results in people getting help earlier or getting help at all. And I think that people don't realize that. I think people think college kids are super in tune with their emotions and all get care when they need it. And that's not true.

They hide care just as much as everyone else. They still have really high rates of pretty serious stuff coming up that maybe didn't have to come up, but they put it off because they were doing well in school. Right? And so we have a misconception that talking about it is the only thing we have to do.

And, as somebody who talks about it because I can, I talk about it with the hope that it helps to normalize it. But then maybe we can take the next step from that and use that to make people change, or change the way systems think about this stuff.

DB: Yeah. So tell me more about that. What are the three things that systemically need to change?

JG: Time. So I don't know what that looks like, but you can't go to appointments — like going to see a therapist is a weekly thing. So either that means you're providing people who can see healthcare workers in the evenings and on weekends and everybody in your system is doing that, which was a lot of work for you, but the right thing to do.

Or that means people can't get care because you're not supporting them in it. It's hard.

There's no redundancy, right? So time is really redundancy, which is like, how are we making sure that if I'm not there for an hour, patients are okay? Or if I take a sick day, because I should take a sick day, the whole system doesn't implode.

We need better support around redundancy, to make sure that people can step away and it's okay — it's not a disaster. And they can take care of themselves if they need to and they don't feel like the bar to do so is like a hundred.

That's just not fair. And that's why we get a lot of this intervention stuff and not prevention stuff. So time slash redundancy.

Most people would say EMR [the electronic medical record]. I think there are good things and bad things about an EMR. I think other people dictating what matters in medical care is more of the problem than an EMR.

So the reason that note-taking is problematic is the notes are not for us. The notes are for insurance companies and legal purposes. And the little tiny bit at the end, about what's going on, is for us and signing out to the person who's covered, right? Most of the note is not about us. And it takes a long time to do the things that other people need us to do. The same with prior auths. The same with — I'm constantly doing, like, return to work, time off work forms — they're the same forms all the time. They don't understand mental health. I'm constantly writing them; it's a lot of work — it's not really something an MA [medical assistant] can do super easily, like a nurse maybe, but not an MA. It's a lot of work.

And so as much as people are gonna pinpoint the systems problems of an EMR, I actually think it's the system of medicine being not about medicine, being about all these other parties, like what insurance wants you to do, what legally you need to do, what your hospital system needs you to do, like productivity-wise, right?

These outside factors that aren't about the patient. You can't do your job well, and you can't find the meaning that you need because you have to spend hours doing all this other stuff because you have to.

So I say the system of medicine and the external factors controlling medicine — we need to get a handle on that or somebody else needs to be playing that role.

And then, you know, from my side, it's being able to culturally ask for help. So that means licensing [that don’t penalize having or seeking help for mental health conditions]. That means peer support in a way that feels safe.

That means seeing your supervisors also ask for help and knowing it's okay.

The time thing comes into there, too: being allowed to go do the things you need to do for you without being told you're weak, or you can't cut it.

You gave me three and I feel like it's 1) time, redundancy; 2) these external factors ruining the system of medicine, like productivity or insurance companies, and legal systems; and then 3) how we treat each other. And that's where I spend a lot of time because the other ones feel very big and outside of my control.

Like redundancy, right? That means you need more residency slots and people should be matching when they want to be doctors. That's not me. I can't change residency slots. There are things I can advocate for publicly. There are things I can do within my own system that are more system-wide. Those things take time.

The things I feel like I can control are how we talk to each other and how we support each other and how we validate each other's experiences and normalize that in a way that feels not just okay, but goes that extra step and makes it fine to do whatever you need to do for you without feeling wimpy or like you can't cut it or you don't belong.

I spend the vast majority of my energy on that because I feel like you can see results. Like if I make one of my patients feel safer talking about feelings and that person is in an admin role, they make all of the people under them feel safer, right?

It feels more doable. And I think just like with any big issue — so racism, sexism — these big things that are inherent to how medicine was built: they feel big and daunting and frustrating.

And a lot of times I give talks on it, people just get mad at me because like, 'What are you gonna tell us? Do yoga again?'

And I try to frame it very much like, 'I'm not telling you to do yoga, but I'm telling you if If you don't want to quit, you have to figure out what yoga is for you.' Because I'm not trying to tell you yoga solves the fact that insurance companies and productivity requirements are controlling medicine, but I am trying to tell you that, if you'd like to still be in medicine, you have to figure out how to deal with it because that's not going away tomorrow.

In fact, it might get worse. And so: do I think that a lot of people may choose to actually leave medicine? Yes, I do.

And I think that's something medicine needs to reckon with.

And medicine as a system needs to fight for these things to make sure people stop leaving. But I do think you have to go, 'Okay, this is what medicine looks like. I'm not lying to you. I get it. I see it. I see all the brokenness. I want to fix it, but also I can't fix some of these things and tomorrow, they're not going to be fixed. So how do we help you survive today?' And that's what I do.

DB: Yeah, that's really thoughtful. And also to have identified where your lane is and where you feel the most efficacy in terms of driving progress. And it makes a lot of sense that it's in helping people feel safe, driving culture change, making a difference in how we speak to ourselves and to each other around some of this stuff. It's hard work. And I really want to thank you for having done it for as long as you have and continuing to do it. It's awesome.

JG: I did my thesis when I was in my Master's program on pre-med as a culture.

So I've always really been interested in how did we get here and why? And is there a way that we could do better for each other, even if we're stuck in this thing? Because all of us have ecosystems and family structures and cultural structures, and we grow up with all of these microcosms of problems that just make things worse.

But can this be better, even as bad as it is, for each other? Can we do better? And some of that, too, is honestly saying if this is wrong for you, don't do it. And if this feels bad, don't do it. Get out of it. There are other things you can do.

And we didn't talk about that — it's a secret that people go into other fields with an MD or end up not liking it. Or questioning it is part of cultural change and we should question it because it is not great. And you know, I remember when I was in college, it was like probably right when managed care was taking over more and all these people were like, ‘Don't be a doctor. It's run by insurance companies.’

And I was like, 'Who are these people telling me this?' Like, ‘I don't know you — what do you know, right?’ But I kind of wish they sat with me and explained it more and didn't let me just tell them, 'No, this is what I want to do — I'm gonna like it.'

You need to go into this a bit more with your eyes open, and not in this super idealized, you're not supposed to question it way, because that's unhealthy. And then you don't end up questioning it until you're like us, and you’ve done this for a really long time and then you're like, 'Wait a second, what am I doing? I gotta find the way that this fits me better so that I'm doing what I feel good about.'

And [for] a lot of people that comes in residency — like you did a specialty for a month and [based on that], you're supposed to figure out what you're gonna do for the rest of your life. You know, a lot of people want to drop out of residency and switch, but it's just not normalized.

And so we need to do this better, right? Like, take the time you need. Ask the questions you want to ask. It's a really long life. This takes a really long time. But it takes longer if you're miserable.

And so I think part of how we change that culture of help-seeking and support is also: turns out, not everyone likes this, or you might hate it sometimes. You have to find the ways to like it. Like, I hate it sometimes, too. But I like X, so I can still hate it, and like it, right?

I feel like people turn to people like you and me, and they're like, 'Fix it. This is bad. I hate this. Fix this.’ And, oh lord, how I wish I could, right?

Like, I wish I could wave a magic wand and medicine was better, but I don't even know exactly what that looks like, starting from scratch. But what I do know is, I don't want everyone to quit, but I want the people who want to quit to quit. And I want the people who don't want to quit to figure out how to make this right for them.

And that needs to be the conversation. It's sacrilegious to say medicine is broken and most people hate it. It just feels like we need to be more honest about that stuff.

So I get it. You think I'm giving you a lecture on well-being because I think I'm fixing the problem? I'm giving you a lecture on well-being because we all need lectures on well-being because we don't know how to take care of ourselves. Because no one taught us, right?

So, I've put my energy into that bucket because I can't help but be authentically honest about it. And so if I have to be the realistic person who also happens to know mental health coping techniques, I'm happy to do that.

DB: Yeah, it's huge. And so thinking about these three buckets, what is the prevention focus rather than the intervention focus? And how does that play out? What does that look like?

JG: It has a much bigger focus on peer and supervisor support.

So I see faculty. I see college kids. I see med students. No matter what, everybody's stressed. Because the faculty don't know how to support the people that are struggling. But the people that are struggling only have access to the faculty, right?

So we need to do a better job globally supporting people in identifying signs and symptoms, in understanding early signs of distress, and knowing what kind of stuff you can support people with. Like turning in a paper late. We're talking like, not rocket science. Do they need a quick little intervention just to get them through the week?

Peer support in a way that feels good, like, turning to other people that are not professionals, even with real trainings, like Mental Health First Aid kind of stuff.

I don't think everybody needs to go see me. I don't want everybody to see me. We're doing something wrong if everybody sees me.

Am I a good peer supporter? Yes, but does every peer supporter need to be a mental health professional? No, right?

So I think that we need to be in a place where friends and colleagues and supervisors feel safe talking about this stuff, looking out for this stuff, noticing behavioral changes, and having earlier conversations with people and having things you can be pointed to at that point.

So we're talking: That's where mindfulness comes in. That's where deep breathing and coping skills come in. That's where exercise comes in. That's where sleep hygiene comes in.

These things that people groan at me for — they're groaning at me because they haven't slept in four weeks, not because they haven't slept in a few days, right?

And so if we're better able to say, 'My warning signs are X, If I notice my warning signs, I need to do something then instead of like 10 weeks later.' That's important. A supportive supervisor also isn't only pointing out things that are bad; [they are] also trying to make sure people feel they're getting gratitude in some capacity.

That people have the ability to say, 'I need that meeting to start 10 minutes later so I get a 10 minute break because I lose my mind otherwise.' Flexibility is super important. ‘I need to work from home on Mondays.’ Whatever that looks like, right? A supportive supervisor understands that there is not a one-size-fits-all model to this.

And there shouldn't be. And so we have to be able to say, 'Okay, why do you need to work at home on Monday? Is it because you're being lazy? Probably not. Is there something else that you need to do? Okay, let's understand how I can support you through that.' And also, you still do work, because you do work and you're paid to work, right?

You have to be able to form these workplaces that work and fit the person — more than the workplace is just the workplace and everybody has to fit it, right? And that requires an awareness across the board [about] how to deal with this stuff.

Like, for me, my early signs and symptoms are not I'm sleeping every day after work, and I'm isolating, and I'm ordering takeout, right?

My early signs and symptoms are, if you send me one more email, I will take my computer and throw it across the room. That's how mad an email makes me. That is not a normal reaction to an email. Doesn't matter who it's from, doesn't matter what it says — that is not a normal reaction to an email. I am aware of that.

But do I blow past that sometimes to the only paying attention when I'm sleeping every day after work? Absolutely.

And so prevention is: the individual level — noticing your own stuff; the colleague level and the friend level — being able to talk about it and notice it and talk about this with each other and suggest ways that it has worked for you, when that feels right and doesn't feel like you’re advice-giving and not listening, and the supervisor support level — feeling safe being a supervisor of people who can struggle.

Which means you have some knowledge about it, being able to talk when you need to, but also being aware that you can help with flexibility, support, praise, etcetera, where needed, by being a better, mindfully mental health-aware supervisor.

DB:  It's this deep knowledge of what works for you. And also this deep awareness of when somebody else in your ecosystem is not acting like themselves. Something is slightly amiss and just being curious and digging a little bit deeper, rather than just being like, 'Oh, this person is not trying or this person is not showing up to work the way that they should be.'

But it requires for you as a supervisor, as a peer, as a colleague, to also be in a good enough place to have that bandwidth and capacity to be mindful and intentional and curious rather than 'This is getting in my way. I wish I could rely on this person to do the things that I, you know, need them to do for me.'

And it really requires all of us to be super committed to our own well-being first and foremost, so that we can create that safe ecosystem then for each other, as well.

JG: Yeah, and we could say, 'I do X, I'm committed to my well-being,' right?

Or they say they can do work — they're fine, right? It's usually not true.

You know, I am a psychiatrist who is a burnout expert and I was burned out and didn't know I was burnt out, right? Just because you spend all day in the topic doesn't mean you apply it well to yourself.

And in fact, you probably resist it because you think you know.

And so I think it's important that people realize for someone like me, it's still hard. I struggle doing what my therapist tells me to try because I don't have time, just like you don't have time. And I think it's silly, just like you think it's silly. Or I'm not gonna like it. I have the exact same reactions in my head because turns out I'm human, right?

I think it's important that people realize that it's not easy for anybody.

It's not easy — it's a big change for all of us, because we didn't learn it as kids. We learned to prioritize work. We figure if we're doing school and work fine, we must be fine, and that's just the way that it is. And we can do school and work blindfolded, most of us. It's usually the last thing to go.

The rest of your life can look like a big, big disaster, and you can still be getting As, and you could still be getting high marks at work from supervisors, because we know how to turn it on and play the part and be the good little student. But the rest of your life could be a complete disaster.

And it's important that when we talk about well-being, we're not just talking about: Are you doing your work and are you showing up at school? And that's a big cultural change. I never did that; I still don't do that. Like if I can go to work, I'll go to work, right? And maybe that's not right.

Maybe we have to reframe that. Where we actually might need the break from work because everything else is also a mess or we need the time to figure it out. I just think it's important that we realize a lot of stuff is ingrained in us from a young age, compounded by gender, culture, ethnicity, workplace, whatever, right?

But even somebody who literally, this is my job is to help people do this stuff — struggles. And I think that that just means everybody struggles, right? Because if it's not easy for me, who's it easy for?

And so I just think people shouldn't beat themselves up about this stuff, either.

And say, I'm bad at coping, or I'm bad at taking care of myself, or I don't have time for that. I don't have time for it, either. But it makes me better when I do take the time, you know, and I mess up sometimes and I fall off and don't do everything I'm supposed to do. And it's a growth and learning process. There'll be bad times and good times.

We have to support each other through all of that and realize, we're humans in the workplace, not machines.

DB: Thank you for that transparency, because it is really hard to stay whole, healthy, even when it is a focus in our day-to-day work. What are your top strategies?

JG: Number one, therapy. I go every week, unless, you know, I'm out of town and it doesn't work, but I go every week. I think people hear that and they say, 'Oh, she must have problems that she really needs to deal with.'

And yes, sometimes I do, but I see it as like a thing that makes me better at my job. And I don't view it as, like, 'I have a problem, I need an intervention, and that's the intervention.' I view it as, this whole thing is just making me better, and sometimes I might have something acutely wrong, and sometimes I don't. And that's okay. It all makes me better.

Number two, what I do for coping super varies. Sometimes I journal. That can be hard for me because I do a lot of writing and so I have to like fight the urge to make it into a piece. And so I journal in a book and I try, but it can sometimes like be an issue.

I don't like mindfulness. I've tried it 100 times. I hate it. I'm more likely to calm down reading a book or listening to a podcast or watching a stupid television show. I can't just do stupid TV though because my therapist says that's not an active coping skill. So, I try to be good about that, kind of balancing what I'm doing.

Sleep is big for me. I can get off sleep patterns because I feel productive at night or I'm having trouble sleeping and then I want to take a nap and whatever. It just throws me off and that has a big impact on my mental health and so I pay more attention to that when I can. If I get off, I try to get back on a cycle that's better.

I have a really good like supportive network of friends and family and stuff. Maybe I lucked out: some of those people are also therapists, but it's not like our relationship is like that. You know, I like distractions; I like plans. I like knowing that if work is really hard, I'm going to go on a trip in three weeks and that's okay.

That matters to me — having things to look forward to. So I plan things that way because I can get through anything for a short amount of time if I have something to look forward to.

And then finally, and last, but not least, I've been on meds since college. I haven't changed them. I don't see a psychiatrist; actually never saw a psychiatrist. I've been on the same med for like 15 years, but I mean, I think it helps. I tried to go down once and it wasn't a great idea. And I think that it probably makes it so like when I have a harder time, I bounce back quicker.

I think that it helps my baseline. It's probably not something that's like actively making a huge change every day. If you look at the studies of long-term use of antidepressants at a certain point, quality of life improvement stops, but it doesn't get worse. And I feel it's sustaining my quality of life and if I chose to get off of it or try to get off of it again, I'm sure I could, but I just don't want to.

DB: Thank you for that. You've written about how it took you kind of that extra layer of conviction and strength to even to share the fact that you're on antidepressant, right?

And how that was a different layer of self-stigma that you had to unravel for yourself than even saying, you know, that you had a mental health condition. So can you talk a little bit about anything that may have surprised you post-disclosure, what that journey was like, in general?

JG: I mean, I'm a big — you don't owe your story to anyone. Your story is your story. Whatever part of your story you want to tell is your part to tell whoever you want to tell it to.

Like certainly publicly, we do not need everyone to do what you and I do.

Some of us need to do it because that's how you kind of change it from the top. But everybody does not need to tell your whole mental health history and there's a privacy aspect of it.

And people think they know everything about me, but they don't. Like, nobody knows actually why I'm in therapy and why I started in college. And nobody knows all my details because that's my business. And if I ever choose to talk about it, I'll have felt like that was the right time, but I have felt like there are parts of my stuff that is mine and not theirs.

And I very openly talked about seeing a therapist and finding a therapist beneficial for a really long time and definitely on social. And there was this time in 2020 where all these people were tweeting like, ‘I am a this and I, you know, I take this’ and I said, ‘I'm a… I go to therapy’ and I felt like my tweet was good.

Then I started like reading everybody else's and I was like, 'Why does everyone keep mentioning meds?' I'm like, 'Why didn't I say that? Like, what part of me is preventing that from coming out?' Because, again, like I told you, same med, no changes — I'm as boring as it comes when it comes to that stuff. I never even saw a psychiatrist because my first med worked, right?

Like, I'm boring. And I spend all day telling people mental health meds are normal. ‘They're the same as blood pressure meds. Why would you be ashamed to do it?’ And I believe that. I don't think I'm blowing smoke. I actually think that's a core value.

But there's something about applying core values to yourself that sometimes get warped in there. And I was like, 'I need to sit on that' and spent a while talking to my therapist about it, trying to understand what that was about — and really figured out that I had some deep view that for me, meds meant I was sicker — meds meant maybe people would view that as I'm a worse doctor or something.

You can tell when you try to sell meds to people how much easier it is to sell therapy, most of the time. (Some doctors just don't like talking about themselves and would love a pill to fix them. So doctors are this kind of weird population.) But for the most part, culturally, we've accepted therapy as almost a well-being sort of wellness technique and meds are not there yet. And I know that, but I didn't really feel like it was true for me.

And when I figured that out, I was like, 'Uh, oh, I need to work on that.'

'I need to tell people and the reason I need to tell people is not because I owe it to them, but because I owe it to them for them to know it is this hard to talk about it.'

And sort of like I said about the burnout stuff, I don't think that my story is Earth-shattering. I don't even think people should praise me for telling it because it's so boring. But I do think that it is important for people to realize that I can spend all day telling you to take meds, and you're exactly like me, and I can believe it, and I will not apply that to myself, because of all this stuff, right?

Which means, all the stuff going on in my head is the same stuff going on in your head. And that's worth a conversation because that part is a part we need to change. And I think that, you know, writing about that helped some people understand that disconnect in a way that was helpful.

I didn't just go like, 'I took meds, I'm great, la la la.' I was like, 'Here's how come I never told you this.' And I think that's important as a conversation.

I think there are lots of these areas that we need to do better. Like, I think you talking about bipolar is one of them, too, right? We spend a lot of time on anxiety and depression. We don't spend a lot of time with people who — poorly titled — [have] sort of serious mental illness, right? We need to talk more about all the spectrum of stories so we understand: there is not a good mental illness and a bad mental illness.

There's just everybody's struggle on a spectrum and we need to be okay with all of it.

So like that same way that we need to talk about all of it, we need to talk about why we don't talk about some of it or why it's hard for us to talk about some of it. And that's what I wanted to do. I think people responded pretty well to it.

I think the hardest thing with me in storytelling is wanting to be authentic, while also knowing I want to hold stuff back.

I don't know that I think it's courageous. I think it's sad that it's courageous. Like I get why it is; I understand why people say that to me or thank me for telling it. But I also think, I am so boring.

Like, look at Chase [Anderson, MD, MS], right? He’s a good friend of mine, and Chase talks about having chronic suicidality. Like, the most thing that happened to me recently is I've been really burnt out. I'm still on meds, I go to therapy. I'm a pretty boring mental health story.

And yet, because none of us talk about it, it's still Earth-shattering that I do, right?

I appreciate that my story can resonate with people because it's so boring, probably, because also, if we only heard extreme stories or more severe stories, we would be confused about what I mostly see in my clinic, which is me, right?

But I'm aware my story is boring, and I think in its boringness, I can have conversations about how much further we have to go, and how typical things are hard for us.

It makes me sad that being on an antidepressant since college and having stable depression is... saying that out loud as a physician is huge.

It makes me sad that my story isn't boring to everyone because everybody's already said it.

DB: It's still profound to speak it out loud in your position — to be a doctor and say these truths about yourself. It's funny that [Twitter[ chain that you're talking about, I'm thinking back to it. I think it was 2020, right? And I similarly wasn't fully out or hadn't revealed my diagnosis yet, and I remember putting out like, 'I'm on therapy and I've used meds and that's helped my mental health.' But then the kind of the next layer of truth came later, right?

And so it is always fascinating for those of us who do decide to talk about things publicly, like what we hold back at what points in our life and then when we feel ready to give more details and what parts — it's one of those things you think so hard about, right?

Like what will the implications of — you know, this detail, or that story — be for the people in my life, the people who might come in the next generation? It's complicated.

JG: Yeah. I mean, I think some people don't think enough about it, right? I think some people just tell everything and then they regret it, not because of the backlash or something, but it's really hard to tell your story and then keep telling your story.

And I'm sure you've gotten like lots of people who tell you in return. It's like a domino thing. Sometimes you can handle that and sometimes you can't, and that's important to know that you're gonna get that.

And I think the layer part of it is important because it gives you control.

Some of it's subconscious, right? Like, I didn't actually mean to not say, I never intentionally in my head was like, I'm not gonna tell people I'm on an antidepressant. But then when I realized I didn't and everyone else felt fine about it, I was like, 'Oh, right… let's look at this.'

I think it's important to do things on your timeline if you do them. And it is just as fair if you only told me you were on meds or you had depression or whatever, and you didn't say you had bipolar depression 'cause you didn't want to. Right?

DB: Totally.

JG: And I think we all need to be more of the masters of our own story and know that you're allowed to have that control.

Because so much of it feels out of control. Like if something happens at work. You lose control, right? You have to tell somebody; it might not be what you wanted to do. You might have to step out of work and you might have to tell them, right?

Or if you're about to have something happen at work and you need to get off of work — same thing. You're going to tell somebody. And that is out of your control in a way.

Similar: Britney Spears shaving her head. Out of her control at some point to tell us something was wrong because everyone saw her shave her head.

That is not a fun way to have to tell your story.

That is a story that is out of your control, that is based on your behavior, that is people judging you based on whatever you did, as opposed to you being in a place where you processed it, felt good about it, told what you wanted to tell, knew what the repercussions were, all of that stuff.

And so given a choice — not all of us have it — but given a choice, the other one is better. And we should view storytelling that way. It isn't easy, it shouldn't be expected, and it should be seen as something that you're doing because you choose to, and in a way that you feel safe. When you feel safe, how you feel safe, what you feel safe telling.

And I hope people know that, and don't see us as: 'Look, they told all their stuff, I should, too.' If that's how you feel, cool. But I would just caution that impulse, and be like, 'What does it mean?' And think about it: ‘Am I ready to handle other people telling me their stuff? Do I want people to know everything, or should I test out the waters and see what it's like?'

You know, actually thoughtfully do it, instead of just feeling like, 'Oh, other people did it, I should do it. Or, there's a trend on social where everybody's doing it, I'm gonna do it. It's Physician Suicide Awareness Day, I'm gonna do it.'

I just want people to own that. And not just feel like the Internet expects it, or in order for us to have cultural change, we all need to do it. Because we don't, actually.

I think we would change culture if people just said medicine was hard. Right, if people were honest about the fact that most people don't like their jobs in medicine — lots has to change.

You don't have to tell me you're depressed, or you're bipolar, or you're on meds, or whatever. We can feel more safe talking to each other if we know that somebody can be a little vulnerable, just a little.

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