Opinion Medical students in crisis: Why we need to address their mental health

It is also shocking that colleagues, even closest friends, remain unaware of the stressors that pushed them to the edge. Most repeat what reports already mention — the girl was a happy-go-lucky child, had come that day from home, got them home-cooked food, and shared nothing that could even mildly hint towards an impending mental health crisis. Sceptical ones, though, trace it to the preponement of final exams two months after a rumour made students careless about their studies. There is no tangible reason for the second one, as students tell me casually, third-year mein padhai itni kahan mushkil hoti hai?

The underreporting of and under-reaction to medical doctors’ suicide is attributed in part by many to the stigma attached to a doctor’s deteriorating mental health. In our idealist culture, we confuse them with messengers of God, who are robot-like in their construction (with no head or heart) and have a healing touch. But even the far more progressive West suffers equally. This silence, as multiple researchers have found, never allows the entirety of the problem to emerge, thereby, allowing the cycle to repeat. It is then not surprising that the first-ever research on medical doctors’ suicide in India is as recent as in 2021 when M Kishor et al skimmed through national dailies to gather their data.

At the same time, while mental health concerns are real and need to be addressed — with the suicidal ideation among medical students ranging from 1.8 per cent to 53.6 per cent which is much higher than the general population, that too, tilting towards women — the real problem begins when a child decides to get into medicine. Most doctors come from middle-class backgrounds, either when the family has a host of doctors or when the aspiration of climbing the social ladder is pressing. The latter are often families with businesses or other well-paying jobs where the income is sufficient to afford basic amenities and some bit of luxury, but never (the illusion of) enough respect in society.

Then, a deadly mix of two components pushes a child into medicine — money and respect. At best, saving somebody’s life is a platitude that might give them an air of self-righteousness. But at an age when all of this is happening, the late teens or early 20s, a young person is too self-absorbed to look beyond themselves. It would be unjustified, if not cruel, to ask them to think of humanity when the self crumbles from within their grasp.

They are not prepared to pay the huge cost that the profession demands. The illusion soon bursts. But by then, two to three years into it, there is hardly a chance of opting out. One either makes peace with it or continues to crib, the latter causing frustration and anger to build up. Not to mention that there has been a steady rise in opting out of residency as the stress, scolding and sleeplessness get on one’s nerves. A similar trend can be noticed in students’ preference towards non-clinical and paraclinical branches or exploring other options after MBBS — in this technologically advanced, social media-driven world, how difficult is it to earn money, or its by-product, respect?

The culture of medicine further strengthens the recalcitrance of the problem. While the ethos of slogging and ignoring self-care remain important components, the far more pressing problem is the unilateral, worldly idea of success borrowed from the aspirational middle class, which is sharpened in a medical college. Performing well and securing good grades becomes central. When high-performing, perfectionist students enter a medical college, they are shaken back to reality as they come to terms with mediocrity in a class full of brilliant students.

The revised NMC curriculum is a welcoming step in this regard. One-month-long yoga and meditation classes at the beginning of medical school have been proposed to acclimatise the students. Electives have been suggested to allow students early exposure to certain subjects, and AETCOM (Attitude, Ethics and Communication) classes to help with soft skills. In actuality, these classes are often skipped or considered as surplus time to study. We circle back to the same thing: unless the conventional attitude of people in medical colleges changes, no amount of provisions will help.

The writer is a doctor, and author of Yeh Dil Hai Ki Chordarwaja