on “medical leave” due to burnout/ mania/ suicidal ideation

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thursday, july 19, 2018

dear friends, family, and colleagues,

first things first, you might wonder why i am writing this in lower case– the reason is to emphasize that this is an informal blog post, not a formal letter which has been proofread by editors, friends, lawyers, etc. it is meant to get information out quickly and accurately and educate people about what’s going on with me, but also what’s going on with so many folks around the world.

I COULD HAVE WRITTEN THE ENTIRE BLOG POST IN CAPS BUT SOMEHOW lower case seems more informal and relaxed.

on february 1, 2018, i started my new job as assistant professor in the infectious diseases section at boston university school of medicine. previously i had been instructor of medicine at harvard medical school and assistant in medicine (attending physician) in the infectious diseases division at massachusetts general hospital. before that i completed my infectious diseases fellowship at mass general as well as brigham and women’s hospital. before that i had been a disease detective (epidemic intelligence service officer) at the centers for disease control and prevention (cdc) and before that i had been health sciences assistant professor at the university of california san diego.

my resume looked great, but i suffered from anxiety and depression intermittently while i was at the brigham and mass general, but nothing particularly serious. i took an ssri for a few months, for example, but was never admitted to a psych hospital.

on february 18, 2018 i received my faculty appointment at the boston university school of medicine. i was delighted and grateful. you can see my faculty appointment notification here.

it had always been my dream to become a professor, like my father albert lederer was, at the university of kentucky as well as other institutions.

as an aside, if you want to know where i got my sense of humor, you can spend a few minutes on my dad’s website.

unfortunately, things at boston university school of medicine and boston medical center did not go as I had hoped, and after a few months, in june 2018, i was placed on medical leave by my superiors. i am not going to describe the events here in any detail.

i am currently under evaluation by physician health services, inc, a non-profit corporation founded by the massachusetts medical society, that provides confidential consultation and support to physicians, residents, and medical students facing concerns such as burnout and depression.

i have also received outpatient medical care at massachusetts general hospital, at the depression clinical and research program. i have been impressed by the high quality of care from my psychiatrist dr david mischoulon, and my psychologist, dr. amy farabaugh.

i am grateful to all my friends, family, colleagues, and treatment team for their support as i try to get better and return to work.

my only goal is to stay alive, and not commit suicide, like my friend, the late dr. hamza brimah, did.

in 2002, sixteen years ago, my college classmate murtuza gunja and i went down to the rural mississippi delta after reading this article in the new york times by kevin sack, entitled, epidemic takes toll on black women, the story of dr. brimah’s work trying to stop hiv.

murtuza and i were inspired by dr. brimah’s enthusiasm and positive energy.

we were planning to write up our experiences but we didn’t do that at the time.

unfortunately when we returned several months later, we learned that Dr. Brimah had shot himself in the head. i am not sure why he killed himself, but do suspect it was related to burnout and depression. dr. brimah’s obituary, from the los angeles times, is below, as well as a video describing his work.

dr. brimah has always been my main role model as an infectious diseases doctor, even though i only met him once for an hour. his enthusiasm was contagious. but perhaps he was just putting on a good show for the visitors from brown university, and he was deeply depressed.

for folks who are struggling with burnout i strongly suggest you seek help from family, friends, colleagues, and mental health professionals. social isolation is one of the biggest risk factors for suicide, and there is tremendous stigma regarding mental health issues

the stigma for doctors and other health care workers about depression drives people underground, and that can be deadly.

i would be grateful if you shared this letter widely on social media with friends, family and colleagues. the best way to contact me is to leave comments on this blog below and i will approve them and then they will appear on this website.

feel free to email me at lederer at gmail dot com but it is unlikely I will respond for a while. i also may not ultimately respond via email (I am trying to write hand-written letters). you can also contact me on twitter or instagram @philiplederer or leave comments on this blog, below

if you would like to get in touch with me urgently, please contact my friend and associate, mike mclaughlin. his email address is mikedmc at hotmail dot com

for media inquiries/interviews please contact mike as well and you can also email me

just to be clear, i am currently feeling quite happy and well and have no suicidal ideation or plan, and i can “contract for safety,” to use psychiatric lingo. i have not been admitted to a psychiatric hospital. i am currently at home in jamaica plain, massachusetts and spending the days around the boston metro area.

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

i hope you have a wonderful, relaxing day. if you find yourself feeling stressed by your work, or the news, I suggest taking a break with a walk outside and talking with family/friends. playing music, painting, or dancing, helps as well. human beings are artistic creatures. also, as an experiment, pay attention to the food you are eating. is it healthy?

i will post additional updates here when i have them.

thank you for your concern.

best regards,

philip albert lederer

tuesday july 24, 2018 update

dear friends, family, and colleagues,

i remain on medical leave but am doing much better and hope to go back to work soon. my interest is how we can end STIGMA about mental illness and burnout among medical professionals. i have been doing a lot of exercising, reading, writing, and meditating.  please continue to share this blog post widely.

if you have read camus, proust or foucault, i especially want to talk to you. i am working on an op-ed for the new york times or boston globe and camus, proust and foucault figure prominently in it. but i am not an expert on their work, and i need help from some real scholars. my area of scholarship is tuberculosis transmission, not literature, philosophy or history

finally, remember the history of the hiv/aids epidemic in the 1980s. groups like act-up spoke out and committed civil disobedience to help save their lives. they coined the motto, silence = death. it is the same for stigma about mental illness. silence about your depression leads to social isolation and can kill you like it probably did hamza brimah

as camus said, ‘life is absurd… a lucid invitation to create… amidst the desert…”

camus preferred football (soccer) to the theatre. he played as goalkeeper for the local algiers team. team spirit, fraternity, and common purpose. he was also an enormous fan of nudity and the sun, referencing the atheletes of delos.

in addition i hope you take 40 minutes and watch the important video by my friend lakshman swamy below. 

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

merci beaucoup

dr philip lederer

wednesday july 25, 2018 update

dear friends, family, and colleagues,

each day has been getting better overall and i am hopeful that i might be able to go back to work sooner rather than later. one highlight yesterday was biking all over the city of boston . i hope to discuss with my friend colin harris from minneapolis ways that boston could reinvent itself as a bike friendly city. i think it will require a new mayor, however. i also enjoyed hanging out with my friends mike mclaughlin, suzy sacher, and simca horowitz.

finally, i have been doing a lot of reading and writing about psychosis– in literature, medicine, and history. i received a nice email from a world expert who defined it as such: 

“Psychosis is in fact a technical term in psychiatry and refers to the breakdown in the orderly relationship of the human mind with an external reality.  This can be in the realm of sensory perceptions (hallucinations), of thought (delusions), and of behavior (disorganized behavior – e.g. putting on heavy winter coats in the summer).  Although we talk about “psychotic disorders”, the prototypical one being schizophrenia, psychosis as a symptom can be seen in many disorders, including drug intoxication, dementia, mood disorders, personality disorders etc.”

i have been thinking about how my behavior appeared erratic or psychotic over the past weeks to some people, with random text messages and emails, etc. here is a review article in the new england journal of medicine which discusses psychosis, written by Drs Jeffrey Lieberman and michael b first from columbia university in new york city.

but just as important as the pathophysiology of psychosis is the social impact. 

most people with abnormal behavior are shunned, stigmatized, and isolated, rather than embraced, taken care of, and brought back to normality.

recall the emily dickinson poem:

assent– and you are sane. demur, and you’re straight away dangerous. and handled with a chain

i have also been thinking about suicide and climate change, see the recent paper by sanjay basu from stanford. it’s convincing.

finally i am wondering about vaccine research and am trying to think about researchers in boston who are working on virus vaccines. perhaps i could help one of them in their laboratory..

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

thursday july 26, 2018 update

dear friends, family, and colleagues,

i have been touched by the many emails and calls i have received from family and friends. please keep them coming, but understand i cannot reply to them, because there are so many and i am trying to limit my use of technology.

the best ways to contact me are 1) in person, 2) via my blog comments section, http://www.philiplederer.org and 3) twitter. i am hoping to get a po box set up at the local post office so i can switch over to snail mail and stop responding to electronic communication too frequently. obviously i have a phone for emergencies but i am trying not to use it. mindful technology as prof levy from the university of washington says.

i am feeling too tired to write much new, problems with sleep last night. but i did pick up the novel ‘regeneration,’ by pat barker. i believe we read it in professor arnold weinstein‘s course at brown in 2003, but it might have been another course. in any event, this novel feels very true to my lived experience.

finally, has anyone seen moulin rouge? it is playing in boston and i would like to get tickets for a matinee on august 8 or 15.

when i talk to people who work in local businesses it is interesting to see the different emotions they express. i see nasty people, worried people, laughing people, people who are covering up their true emotions, people who wear their depression on their face….

we need “emotional intelligence” so we can figure out how/when to communicate information.

i realize i have been emotionally unintelligent at many points in recent years, because of my technology addiction, and am trying to get intelligent.

we need to be able to read and document our own emotions and those of others, and help “mirror” the emotional state of others, vs be “yin” when someone else is feeling “yang.”

last night my friend mike and i went to the support groups at dbsm at mcclain hospital in belmont mass. it was a very useful experience. i want to get a pet, even if it is only a goldfish or hermit crab or turtle. i want something to take care of and feed. ideally it would be a dog but that might not be possible.

i have been thinking about the concept of the family doctor who makes house calls. that’s what we need more of… the old school family doctor.

i need to get my schedule set up so i know what i need to accomplish each day. things feel like they are in flux and that is difficult. i need some goals and a coach.

i got a haircut at the local barber shop. that felt really good. because for 20 minutes someone was taking care of me, and i was distracted from my job situation and other problems.

Interesting words today from Simon Talbot and Wendy Dean: “burnout is itself a symptom of something larger: our broken health care system. The increasingly complex web of providers’ highly conflicted allegiances — to patients, to self, and to employers — and its attendant moral injury may be driving the health care ecosystem to a tipping point and causing the collapse of resilience.”

i enjoyed cal newport’s interview on technoskeptic. and learning about the work of Dr. david greenfield on technology addiction. and i wonder why technology addiction doesn’t seem to be in the dsm

ultimately though gandhi says our focus needs to be on Truth. that is my focus now. ultimately we need to enjoy our lives.

regards

phil

friday july 27, 2018 update

dear friends, family, and colleagues,

happy friday.

i am feeling well. i think things have gone in a positive direction. i met with a psychiatrist yesterday who is associated with the physician health service and had a great conversation. then this morning i had a great walk outside.

i am thinking about the importance of asking for feedback and implementing it quickly.

asking for feedback is essential if we are to achieve transformation.

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

regards

phil

saturday july 28, 2018 update

dear friends, family, and colleagues,

i had a wonderful day yesterday. a few dark moments but overall very positive.

as an experiment today, try to ask your family or friends or colleagues for some feedback on your behavior.

then spend some time on this website: http://www.principles.com

hope you enjoy this song, ‘will the circle be unbroken.’

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

regards

phil

sunday july 29, 2018 update

dear friends, family, and colleagues,

I am doing well this morning and hope you are also doing well. However, I am deeply saddened by the suicide of South African cardiologist Bongani Mayosi. The 51-year-old dean of health sciences at the University of Cape Town had battled with depression for years. We need a huge movement of people saying we must END SUICIDE BY ENDING STIGMA. Check out the work of the American Society for Suicide Prevention. I don’t know if a similar society exists in South Africa or globally.

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

phil

monday july 30, 2018 update

dear friends, family, and colleagues,

good morning! i hope you had a wonderful weekend. i did. some highlights included time with family/friends, lots of biking, and good food. hopefully this week i’ll continue to make progress on getting back to work at bu/bmc…

a little bit of existential humor here from my friend dan king…

and yet i feel guilty for not spending time advocating vociferously for an end to the war in yemen, to people with power, like my senators, ed markey and elizabeth warren. as you may be aware, the war in yemen has been devastating and yemeni fishermen from the port city of Hodeidah are increasingly desperate as severe restrictions on sailing cuts them off from their livelihoods…

nonviolence or nonexistence…

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

thanks,

phil

tuesday july 31, 2018 update

dear friends, family, and colleagues,

doing very well today. thinking about auditioning for the longwood symphony orchestra in 1-2 months…

thanks to my friend Susannah Graves who mailed me three books by Kay Redfield Jamison, about mania, depression, suicidality…

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

have a great day!

thanks,

phil

wednesday august 1, 2018 update

dear friends, family, and colleagues,

not too much to write right now. i’ve just been busy trying to get organized and figure out what’s next for me, in terms of when i can return to work and what ways to maximize my positive impact there. any thoughts would be welcome.

Also a quote, from my friend Vaughn:

I have always thought what is needed is the development of people who are interested not in being leaders as much as in developing leadership among other people” (Ella Baker).

if you are experiencing suicidal thoughts, or know anyone who is, please call the national suicide prevention lifeline at 1-800-273-8255. i have called them and they are very helpful.

have a great day!

thanks,

phil

 

Hamza Brimah; Mississippi Delta Doctor Cared for HIV Patients (2002)

Hamza Brimah, a doctor credited with dramatically improving health care for HIV patients in the Mississippi Delta, has died. He was believed to be 40.

Brimah, a Nigerian who received training in AIDS care in London and New York, was found dead of a gunshot wound to his head Monday at his home in Greenwood, Miss., authorities said.

Sheriff’s deputies found a note from Brimah specifying his burial wishes. The coroner ruled the death a suicide.

“It’s a big loss to the community because he was very much involved in improving the quality of life here in the Delta,” said Dr. Alfio Rausa, a health officer who worked frequently with Brimah to promote HIV and AIDS prevention.

The region, one of the poorest areas in the nation, has one of the highest HIV infection rates in Mississippi.

Before Brimah started a local HIV program in 1997, many HIV patients in the Delta had to travel up to 90 miles to Jackson for treatment.

Brimah opened his clinic in 1997 with about 10 HIV-infected patients. By September 2001, there were nearly 200.

His efforts to care for his patients were bolstered in the last year or so by a $1-million grant from the U.S. Department of Health and Human Services to provide primary care services for low-income people living with HIV.

Brimah is survived by his wife and two children.

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From my father’s website:
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37 thoughts on “on “medical leave” due to burnout/ mania/ suicidal ideation

  1. Phil,
    As always, I am grateful for your candor in letting us know about your current situation. The black dog of depression is a real thing in our society, and many avoid it, and just stumble through it as it everything was going fine in their lives. I truly appreciate your lucidity about this, and will meditate/pray about your road back to better health. Your friend, Aaron

  2. Hi Phil,

    I am here for you anytime, I know you will come through this experience with renewed energy and perspective. Your passion for your fellow man is a great asset, and I know from our time in San Diego and Mozambique how heavy the burden of all that is wrong in the world weighs on your shoulders. I believe those burdens are balanced by all that is beautiful in the friends and family you have made throughout your life. Take care, reach out anytime.

  3. Dear Philip,

    Please stay well. I will be in Boston for AIC book writing between July 29 and August 2. Would be great to see you and talk to you in person.

    1. Dear Jim Tobias,
      Lets get together sometime soon!
      I may be down in Atlanta, and hope you will be up in Boston this year. We could also meet somewhere else (I could buy a plane ticket to fly down to Atlanta for the day, for example, although that wouldn’t be ideal).
      I have some important GIS mapping work we need to do together. I don’t know if I am allowed to pay you for the work, given your position at CDC/Northop Grumman.
      But if it would be possible, we could talk to an employment lawyer about hiring you to do some freelance coding for me.
      Thanks so much!
      Best regards,
      Phil

      1. Hi Phil — It would be great to get together in Atlanta. I apologize for delays in my response. I have been on back-to-back TDY travel and struggling to keep a good work-life balance. I deeply appreciate your blog and you share so many great articles and thoughts about maintaining a healthy work-life balance. I am also interested in the geospatial collaborations that we might have and wanted to suggest that we could co-author some spatial epidemiology papers together and perhaps I could work on this as a non-paid adventure. I really wish that I could introduce you to my 2 sons who are both musicians and would be inspired by your music as well as many other amazing talents. I wanted to share this link with you about the Japanese secret to a long and happy life — Ikigai: https://medium.com/thrive-global/ikigai-the-japanese-secret-to-a-long-and-happy-life-might-just-help-you-live-a-more-fulfilling-9871d01992b7

      2. thanks Jim!
        lets stay in touch — as you know i am passionate about maps and look forward to the next time we can talk in person.
        thanks also regarding your sons and the japanese secret.
        regards,
        phil

  4. Phil,
    Thank you for your well-written post. I do not know what to say, but from my experience I can say things do get better with time. I appreciate you being open and honest on the matter. Good sign of a caring physician that has retained humility.

    -Andrew, D.O.

    1. Dear Andrew
      I sincerely appreciate your comment.
      Where do you live/work?
      I agree that things get better with time. Could you write a bit more about your experience and lessons learned?
      We all need to be humble, that’s the only way to go forward. Open communication, crossing borders..
      Best regards,
      Phil

  5. Dear Phil,
    I am so sorry to hear of your pain and struggles, and so happy that you have the courage to share this, suffering in silence prevents recovery. I hope you take the time to care for yourself, you care so deeply for your patients, community, and the world as a whole, maybe it is time to put some of that compassion towards yourself. Much love

  6. Sorry to hear about all of your suffering and I appreciate your vulnerability in sharing. Glad you’re feeling a bit better these days. I can relate to work related stress as a social worker and have sought treatment in the past for PTSD as well as anxiety/depression. Wondering if it would work to meet up with you this fall-we will be in Boston and Cape Cod Seashore in mid-September. We’d love to see you and the family if it works out!

  7. Phil: Yesterday, the same day you asked if anyone is familiar with Camus, Proust, or Foucault, I happened to be reading William Styron’s “Darkness Visible,” his short and powerful memoir of depression and anxiety. Styron mentions having been greatly influenced by Camus. If you have energy for email/phone, feel free to contact me. I am around.

  8. Phil, thank you for posting about your struggles and I hope you continue to feel better! Ironically I was just thinking about writing a memoir about my father’s struggle with mental illness, the stigma attached to his suicide and my attempts to overcome this as a psychiatrist.

  9. Hey, Phil, I’m just seeing this now, Wednesday night. This is not a “media inquiry.” It’s just me, wishing you the best and hoping you’re feeling better soon.
    Felice

  10. Dear Friend, Have you read Kay Redfield Jamison’s books: The Unquiet Mind, Night Falls Fast, and Exuberance? If not, I will send them to you.
    Kay was a dear friend of my mother’s in highschool in the – they used to torment the librarian by giggling over the sections of Gray’s Anatomy with dissections of genitalia, which was the closest thing the library had to a dirty book. She has done a lot to bring depression and mania out of the shadows and destigmatize. I think you would like her very much. Call or write me anytime.

    1. Dear Susannah Graves,

      Thanks so much.

      I have actually not read the books, but I am aware of them, as my partner has read them.

      If you want to send them I’d be grateful, you can DM/Tweet me for my mailing address if you don’t have it.

      Best Regards,

      Philip Albert Lederer

  11. So incredibly brave and powerful to have shared this Phil. We’ve met very briefly a couple times, and sending strength and good wishes your way.

    1. Dear Arjun,

      Thanks so much.

      I don’t think it is brave or powerful, I think it is natural and essential.

      I think bravery is children sitting in at the Hart Office Building with signs saying, “I am a Child.”

      I think bravery is people traveling to Yemen to stop the deaths.

      What do you think?

      Best regards,

      Philip Albert Lederer

  12. Hi Phil,
    Thank you so much for sharing your story on social media. I have gone back to practicing psychiatry and I am amazed at how powerful the stigma of mental illness remains despite the numerous amounts of people who are affected by it. We all need to share our stories more because I am convinced that everyone is somehow affected by this mental health epidemic.

    Best,
    Duke

  13. Dear Phil, Your voice is important for helping to destigmatize mental illness especially amongst healthcare professionals. Thank you for sharing your journey so openly. I wish you ongoing healing. You exemplify the imperative of taking care of oneself before being able to take care of others.

    -Ni-Cheng

    1. Dear Ni-Cheng,

      Thanks so much for writing.

      It looks like you are still at UCSD. There’s a chance our paths will cross soon!

      If I can help in any way, please don’t hesitate to reach out.

      After studying the work of Adam Grant, Ray Dalio, etc, I’ve become convinced that’s the way to act.

      Best regards,
      Phil

  14. Hi Phil. I really you get well. The world needs more and more people like you. Wishing all the best.

    1. thanks so much Tshwarelo

      We should have a phone call soon.

      I want to make sure that things are going well over in RSA. I have talked with my friends in Cape Town and I am very concerned.

      I think that if we stay positive, and have a creative, entrepreneurial outlook, however, and stick together and work in teams, we will be fine, if we live in South Africa, or in the USA.

      We are all one people.

      Best regards,

      Philip Albert Lederer

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