A Jefferson surgeon talks about his straitjacket - and recovery from depression

Two years ago, Michael Weinstein was depressed, burned out and suicidal. It got so bad that his doctor ordered him to take a medical leave.

He went to a psychiatric hospital outside Baltimore, but did not improve. He was taken, literally, kicking and screaming to a locked unit.  He learned how it felt to wear a straitjacket and receive electroconvulsive therapy. Later, there was talk therapy and medication. He started practicing mindfulness. His wife's love sustained him. He got better and went back to work.

His is a sad, hopeful, common-enough story made extraordinary by two things:  Weinstein is a trauma surgeon at Thomas Jefferson University Hospital and his first-person account of his mental-health struggles and subsequent re-entry was published last week in the prestigious New England Journal of Medicine.

It comes at a time when academic medical centers are starting to pay more attention to physician burnout and suicide, but it is still rare for a practicing doctor to be so forthcoming about his own problems.

Salvatore Mangione, a Jefferson internist who studies how exposure to the humanities affects emotional functioning, said he was riveted by Weinstein's essay.  "These are our forbidden topics," he said.  "These are our family secrets. We don't write about this."

Anthony Mazzarelli, chief physician executive at Cooper University Health Care, was also impressed. He is especially interested in burnout, both because it is associated with medical errors and because it may lead doctors to quit at a time when more of them are needed.

"Hopefully, physicians who read [Weinstein's essay] will see it's OK to reach out and get help," Mazzarelli said.

That was Weinstein's goal.

The level of his distress may have been extreme, but Weinstein, 49, said his willingness to discuss his mental-health problems has opened the door for other doctors to share their feelings.  Doctors are more prone than many other professionals to commit suicide, with an average of 400 a year killing themselves across the United States.  He hopes that health systems like his will create places where professionals can talk freely about their emotional pain, and cultures that allow doctors to pursue work they feel passionate about.

"From the outside, it can look like someone has everything going for them but, if we're all suffering in our own silence, it's hard to help each other," said Weinstein, who is co-chair of Jefferson's ethics committee.

Lots of people seem to see his openness as courageous, he said, but he doesn't.  "I find it so important to put it out there, and it was natural to do so," he said.

Weinstein, who grew up in Villanova, has struggled with depression for much of his life and he has a family history of it.  He had considered suicide before, but had never felt as desperate as he did before his hospitalization in January 2016.  In his essay, he described grueling hours, exposure to patients' deaths and disability, and his own tendency to beat himself up over any shortcomings.  He saw himself and others with mental illness as weak.

He felt he had "end-stage depression."  He walked into traffic without looking, hoping that someone would hit him.  He considered taking pills, thinking his wife and two teenage children would be better off without him.

From his current vantage point, Weinstein struggles to describe how his psychological pain felt. "It feels like you really cannot live another moment," he said. "It's a feeling that everything is just wrong. Everything you're doing is wrong.  Everything you've ever done is wrong."

He tried to hide his agony.  "I just thought we're supposed to be strong and plow through it," he said.

Now, he is amazed at the power that his brain and its habitual thought patterns had over him.  "Thinking about it now," he said, "it's ludicrous the way my brain thought these things, and this is what everyone was telling me — 'You're not seeing things the way they are,' and I did not believe them."

Weinstein hated the locked ward, but he wanted to leave badly enough to try to get better.  His doctor found a combination of drugs that helped.  Therapy taught him to notice those negative thoughts and think about them more critically.  After all, by almost any standard, he was a successful man.  He found mindfulness meditation so helpful that he now tries to meditate 30 minutes every day and is learning to be a mindfulness instructor.

He's been back at work since August 2016 and is more aware when the stress starts getting to him.

He's developed a fondness for tattoos. There are semicolons, a symbol of suicide awareness, on a wrist, behind an ear and in place of the i in "Warrior" on an upper arm. He's got purple highlights in his short, graying hair just for fun.

He is the happiest he has ever been.

"I am just so thankful to be alive," he said.