When it comes to mental health, the healthcare world is often riddled with stigma. Many still view mental health as a taboo topic, and those who suffer from mental illness are often left feeling alone or fearing repercussions. So, how can we tackle the stigma of mental health in the healthcare world? By breaking the silence and talking about it.

Episode 50 of the Hope4Med podcast features Dr. Courtney Markham, a psychiatrist with an interest in advocacy for individuals with mental illness and physicians experiencing suicidal ideation. Dr. Markham and I have an in-depth conversation on mental illness amongst healthcare professionals, physician suicide, barriers to seeking help, and how we can promote change for future generations of healthcare providers.

Transcript:

[00:00:00] Dr. JB: Welcome to Hope4Med.

[00:00:04] Hi, welcome back to the Hope4Med podcast. I’m your host, Dr. JB, and today’s featured guest is Dr. Courtney Markham. Dr. Markham is a psychiatrist with interest in advocacy for individuals with mental illness and physicians experiencing suicidal ideation. Welcome to the show, Dr. Markham.

[00:00:25] Dr. Markham: Thank you for having me. I’m excited to be here.

[00:00:28] Dr. JB: So Dr. Markham, let’s start from the beginning. Please share with my listener your origin story.

[00:00:34] Dr. Markham: All right. I grew up in a West Virginia, small town on the river, a little town called Point Pleasant, West Virginia. And my parents were both teachers. And when I was around, I think I was maybe in the first grade, I had to have an appendectomy. And I can remember just how in awe I was of the surgeon who operated and made the pain go away. And I believe it was after that time that I started saying that I wanted to be a doctor. So I went through high school with that plan and ended up at Denison, small liberal arts college in Ohio, and I still had the plans to go to medical school, but I ended up volunteering in a volunteer group that went to a state psychiatric hospital. And actually I met some of my best friends in that volunteer group. Two others, the three of the four of us are psychiatrists. And I really fell in love with the population at the state hospital, the chronic mentally ill, schizophrenia, bipolar those types of things.

[00:01:42] So I had an interest in psychiatry going into medical school. I did my medical school at West Virginia University and I entered really thinking that I probably would do psychiatry. But I really fell in love with pretty much everything I did. I really, really like, physical exam and the, the puzzle of finding out what’s wrong with someone, but in the end it was really, it continued to be psychiatry that continued to draw me the most. I met my husband in medical school and we couples matched, he’s a vascular surgeon. So, I started my residency in Lexington, Kentucky, and was very fortunate to have a wonderful female program director, Dr. Debra Katz, who kind of showed me the way and I really, really fell in love with inpatient psychiatry. And that’s, that’s what I’ve been practicing, first at a state hospital and then at the VA hospital where I’ve been for many years since then.

[00:02:46] I think though some other pieces of my story that kind of relate to my advocacy which is maybe a newer thing in a more public format. I have always been kind of vocal on Facebook and some of the social medias about kind of parenting. I had my oldest, who’s now, he’s now 18 and I had him the end of my intern year, so my husband and I were both interns. And he, when we brought him home, he cried 20 out of 24 hours and for the, for about six months. So it was just kind of…yes.

[00:03:26] Dr. JB: Wow. And you’re like, oh, it’s just going to be the first month or so of life, but six months. Wow.

[00:03:32] Dr. Markham: And so, I came from a, my personality as being kind of type A, and I can imagine myself being this tiger mom having these kids in all of these activities and things, and it’s like, and then I had like a polar bear, a squirrel, and a frog, and it’s like, what are you going to do now? And so I was always very open and honest on Facebook and things about parenting, I’m the one poppin’ the curb on the way to pick up my kids and never really knowing like where I’m supposed to be, what I’m supposed to be doing. And we missed the first day of school one time. I mean, just kind of the struggles of motherhood that I, that I think if we’re more honest about really can, can make us all feel better. And so, I kind of had done that.

[00:04:19] But my husband and I, in residency and then subsequently in our careers over the years had, had had some big things happen. He had thyroid cancer when my children were younger, we had a pregnancy that at 18 weeks ended very traumatically, and then, it’s been about two, three years ago, I was diagnosed with ductal carcinoma in situ, so stage zero breast cancer. So I can remember somebody in my life kind of saying to me, probably because I had been so open on Facebook and things, don’t put about your breast cancer on Facebook and I can remember kind of thinking, hmm– and I don’t like to be told what to do– so I put that in the back of my brain and I said, as soon as I feel comfortable, that’s what I’m going to do. And so on the day I was done with my radiation, I put up a post about it. And the feedback I got was several people got their mammograms and one person actually got diagnosed with an early-stage breast cancer and was able to be treated and she said it was due to that post.

[00:05:29] So I began the, kind of the process to say that speaking out it is more powerful than I had ever let myself believe. And so I kind of started to say, Hey, I think this is something that you need to continue to pursue in whatever way that may seem, in whatever way that may take. And then about it was like, October a year ago, so two Octobers ago, I had found out that a person from my hometown, his name’s Dr. Ray Thorton, who I had grown up hearing my parents speak about so often about how brilliant he was and he was from little Point Pleasant. He went on to, he first went to Juilliard and graduated with piano, and then he later went to medical school and was a radiologist. And he ended up dying by suicide two Octobers ago. And I can remember when I heard that, how, how impacted I was. Here is this brilliant man in so many ways and what a loss to the world that his life was now over. And I wrote a piece about that and I got a lot of really positive feedback about it, but I also kind of learned in the process, things I didn’t know because I had, I had an understanding because I’ve only been licensed in Kentucky. And actually the licensing has changed in the, in the years that I’ve been here. I think it used to say, when you got your license and when you renewed it, I think it used to say “do you have any mental illness that would keep you from practicing?” Something like that. And now it just says, do you have any illness? But I totally did not realize that some states, and one of them I believe was New York, had asked if you had been in psychiatric treatment in the past two years or something very much more specific.

[00:07:26] And so that became something that I, I got really angry about because I, I just think that the stigma attached to mental health just keeps people living in shame and in the dark and not reaching out for help when there is help there for fear that they may lose their career. And it’s just really, it’s a really unfair thing. So that’s kind of where my advocacy and those types of things have arisen from.

[00:07:58] Dr. JB: Wow, what an amazing story and journey to get you to where you are now doing such importance and needed work.

[00:08:11] Dr. Markham: Yes. I really feel like we don’t talk about it enough. We don’t, I mean, I think even back in 1999, there was this paper written that even stated that 35% of premature deaths in doctors is due to suicide. And how profound is that? Like, I mean, it’s astounding. And women doctors, somewhere the rates they say may be two to four times the rate of the, the population to die by suicide, and I think that the continued stigma that surrounds it in our field, outside of the field, in the lay world continues to keep it from getting the focus that it needs. And I think that I have had a lot of time and have been reflecting a lot on bias and bias in medicine, and I think that we are impacted by a lot of biases in medicine as in so many other fields.

[00:09:18] But I think that we have a bias in that mental illness is different than physical illness. And I had to really dig deep and say to myself, I have biases like that too. I have biases about race and gender and all of those things, and we really need to be talking about them especially in medicine, such a humanistic field. And so, when I wrote something this week about a just beautiful, smart, young female who died by suicide just this week. And I think that police officer kind of said, at the scene said, she was beautiful. She was smart. She had, she had things everyone is jealous of. And then it’s kind of like that dot dot dot, and maybe it’s not said after that, but there’s this assumption, “so what was wrong with her that her life ended by suicide?” And we really got to change that, that conversation and flip it on its end. What’s wrong with us that we have to look for something to be wrong with her? Because I don’t know what, whether she was depressed.

[00:10:27] I know she was in agony or you don’t end your life that way unecessarily. So, what is it that we have to look at that and dig in and say, what, what made her different? That, that her life ended this way. And I see it a lot in the cognitive processes. I think that when we do those things, it’s based on a lot of fear, like we want to dig in and we want to see some more that tells us that she’s different than our daughter, our mother, our husband, the people in our life. And then we don’t have to worry about that. But in reality, there is, that’s not there. With all my experience, with all the people I’ve seen, I cannot predict suicide. And so if we can’t predict it, preventing it is a difficult thing. And so we really all have to recognize that this disease called depression, it can be deadly and the morbidity and mortality associated with it is very high. And until we can really look at it as an illness and not a flaw in a, in a person, we’re not going to be able to bring it out into the light where people not ashamed to come and talk to people and talk about their struggles and if they’re having suicidal ideation. And so, we’ve really got to change this conversation in the culture, but also in our profession because we’re being devastated by it.

[00:11:52] Dr. JB: That’s right. And so many people are suffering in silence.

[00:11:56] Dr. Markham: Right.

[00:11:58] Dr. JB: And I think that’s part of why it is so hard to know or even try to predict what’s going to be happening because we’re not talking about it.

[00:12:09] Dr. Markham: Exactly. And that, that’s the thing that is I don’t think you can define human pain, human angst, and so, when we’ve really looked at being able to predict if somebody is going to end their life by suicide, it really, the studies show that as a psychiatrist, I’m not really more able to be able to predict it than a lay person. Now there are multiple, multiple factors and things that we know can predispose, have the predisposition that your life might end in in suicide, but a lot of those are non-modifiable. So it’s age. It’s age, it’s if you have a significant other, it’s if you have a chronic illness, we used to talk that, that race was a factor. I tend to believe that it’s racism, that that is a factor and not so much race and if we were to able to quantify that, I think that that difference would fall away, but racism is a factor. But even if you have all those things, there are many people who don’t, whose life don’t end by suicide. And then you see somebody who has a couple of those things and their life ends by suicide. So that’s the hard part.

[00:13:25] Dr. JB: So if we revisit something that you mentioned earlier about the medical licensing, this fear of “if I report on my medical licensing application or answer this question and something’s going to happen to me being able to get my license,” is that a real fear or, or not? What have you seen in your experience?

[00:13:55] Dr. Markham: I think it’s a very real fear. And actually, the way that I kind of was alerted to this was it was a Facebook conversation between some people and somebody in another state had said, hey, my friend’s boyfriend or whatever, he just wanted some advice. He’s seeing a psychiatrist and the licensure says this, and so what should he do? Should he ask for a letter? Should he do this? And so, it complicates things. It’s kind of another thing that you need to worry about. Dr. Thorton was in New York where that, where I believe they had some of that language. And so, I do believe, I do believe it’s very real. There has been some progress, and in 2000– I think that this is from 2021, they reported that only one of the states was actually following the guidance. But in 2018, the Federation of State Medical Boards, they issued recommendations saying that they, that all licensures, all states should limit the mental health questions just to conditions that result in impairment and limit it to the last two years and use supportive language.

[00:15:13] So I think there is some change in that way, but I do think that. That it is still a barrier that we really need to address because if you talk about on the clause like, are there, “is there anything that would impair you from practicing medicine?” Then that’s a conversation between you and your doctor. So like when I worked during my radiation, I had a conversation with my doctor about if I was still going to be able to work, and so that was a personal health conversation. And that’s what I think needs to be for mental health as well. Not that you have to declare it and then jump through another hoop and it’s just another, it’s just another stigma.

[00:15:58] Dr. JB: Yeah. No, and I agree 100% with what you’re saying, the question that I’m trying to get some clarity on is, so say you say yes on the application, what happens?

[00:16:11] Dr. Markham: That varies by state. And so, I think that like in some states, if you say yes, then you have to get a letter from your psychiatrist or your therapist, and then submit that to the board. I believe there might be some states that you have to have a, maybe you have to have an exam from somebody that they designate. So I think there are things that happen after that if you mark yes.

[00:16:39] Dr. JB: There are potentially real consequences in terms of delays in you being able to renew your license, if you say yes?

[00:16:49] Dr. Markham: Yes, definitely.

[00:16:52] Dr. JB: Which is all the more reason why these types of questions need to be eliminated from these license applications.

[00:17:02] Dr. Markham: Yes. And I just renewed my license for Kentucky and I, I took a screenshot of the, of the question, which I, I think I’m proud of Kentucky. It basically said, “is there any impairment that you have would keep that would keep you from practicing medicine?” And I think that’s the right terminology.

[00:17:19] Dr. JB: I mean, and it’s true. I mean, if you are on certain medications that would potentially impair your ability to say operate or whatever, then that needs to be known. Right? And that’s like a, that’s a patient safety issue. But other than that, I mean, you have, it’s your own personal health, right? You think about HIPAA.

[00:17:44] Dr. Markham: Yes. And, also just to, to kind of point out that we operate under more impairment sometimes by not being able to sleep or working 24 hours, right? That we’re kind of forced into by the system, too, so it’s a slippery slope in my opinion in regards to that. And I don’t need a, I didn’t need a letter from my doctor saying that I could work when, the day I found out I had breast cancer and had to complete my call. I wasn’t, I was not feeling well that day. You know what I mean? So I think that we really have to, we have to have those questions on the licensing, “is there anything that would impair you from practicing medicine?” I mean, I think that’s a very important question. I just think that we need to be treating mental illness like the other questions.

[00:18:36] Dr. JB: Yeah. Like any other disease they don’t ask, do you have diabetes or high blood pressure or anything like that?

[00:18:43] Dr. Markham: Right.

[00:18:44] Dr. JB: And so, in relation to these questions that are on these licensing renewal applications or licensing applications in general, how does that affect the healthcare professional’s ability to go and get help? Do you think that because they’re going to be asked these questions, then they don’t seek out the help or do they seek out the help regardless?

[00:19:09] Dr. Markham: That is a good question. And I have talked to a lot of people and I think that it varies. I think that a lot of times what I will see is people do is seek out help and not run it through their insurance, so pay out of pocket so that it doesn’t show up on their insurance. I’ve had a lot of people tell me that they do that.

[00:19:32] Dr. JB: And have you heard of healthcare professionals seeking help and then it affecting like disability or anything else like that in terms of insurance, future insurance down the line?

[00:19:45] Dr. Markham: Do you mean if they, if they didn’t go through their insurance or…?

[00:19:51] Dr. JB: Or I had a conversation recently with another healthcare professional who voiced concerns about seeking mental health services and then probably it, I assume it went through his insurance because somehow when he applied for disability insurance, it was brought up that he had received mental health and he was at increased risk or something, something like that. Have you seen that or heard of anything like that happening?

[00:20:21] Dr. Markham: I haven’t heard, I haven’t heard that but I can absolutely see where that would be a consideration because the, I guess maybe the disability insurance would consider that a quote, unquote “preexisting condition.” So there’s a lot of kind of nuances around seeking mental health in the United States.

[00:20:44] Dr. JB: So it was a lot of areas that need to be addressed because of all these things, then it delays a person’s ability to seek out services that are actually needed. And then they suffer in silence.

[00:20:58] Dr. Markham: Yes. One other thing that I’ve been talking with people about recently, and I think that this is, it can be a good stop gap, but is there is a lot of now coaches and so that is a way around of kind of seeking mental health. But I, I don’t know a whole lot about the training. I do know several good coaches who I trust. I reached out to one and kind of said what happens in a scenario if somebody is suicidal, are you taught to triage that in the right way? And I think if a person is very reasonable and um, they would triage that the right way. However, I do have concerns about some of a higher acuity situation and maybe the person not knowing how to field that or those types of concerns. So I think there are a lot of things out there. But I, I just don’t know enough about coaching or some of those things to be able to speak a lot to it.

[00:22:08] Dr. JB: And when you mentioned coaching, are you talking about just coaching in general? Are you talking about physician coaches?

[00:22:14] Dr. Markham: Physician coaches. I have some concerns about that triaging piece. Although I also think that talking to somebody and if it’s helpful, then I really I’m happy that that’s another modality that can help people who are experiencing pain.

[00:22:32] Dr. JB: No, I do think coaching is a very powerful tool in terms of helping people process, but there’s, there’s a clear distinction between coaching and therapy. Coaching is not therapy.

[00:22:42] Dr. Markham: Yes, exactly. And so I think that I kind of see coaching– and I could be wrong because I haven’t studied that much about it– as more enhancing your life and goals, seeking goals, and therapy is something very different in some ways.

[00:22:59] Dr. JB: Yeah, no coaching is not about looking in the past and processing what your experiences in the past have been that have contributing to what you’re experiencing right now. It’s really just, if they glance back into the past, that’s really just to see what tools did you utilize in the past that worked well, that you can apply to the present and then keeping it forward, moving forward.

[00:23:19] Dr. Markham: Okay, good. Yeah. I have some, some things to learn about that too.

[00:23:24] Dr. JB: Circling back to what we were talking about in terms of not accessing the mental health services that you may or may not need and then suffering in silence and then, tying that into suicide and suicide amongst healthcare professionals, do you know any statistics or data regarding suicide rates amongst healthcare professionals? I know you mentioned a little bit about how it’s higher amongst physicians and even higher amongst female physicians.

[00:23:54] Dr. Markham: Yes. there is a something I saw recently it’s kind of hard to, to get a number. But I think that, it is thought that there are about  300 to 400 physicians that lives end by suicide annually, yes.

[00:24:11] Dr. JB: That’s a med school class.

[00:24:13] Dr. Markham: Yes. so, it, it’s a big number. And I think what we’re seeing now is only exacerbated by the pandemic, is a lot of depression, a lot of problematic drinking and a lot of mental illness and things that are present, more exacerbated now. And two and a half years into this pandemic, and I think that we’re making some, we’re making some positive movement in the areas of addressing well-being and burnout and those types of things. But I, I saw this cartoon that I really like and it was kind of like a healthcare worker and they’re standing in a fire and somebody is standing outside and saying, “well, why don’t you practice yoga?” So, it’s wellness, it can be practicing yoga, it can be practicing these things, but it, it’s really much bigger than that. And so if you tell a person who’s severely depressed, “well, I think you ought to start yoga,” while that might be a good thing for them to do, that’s not going to probably fix the depression.

[00:25:34] Dr. JB: That’s correct. Everybody’s unique and everybody’s needs are unique. And so it’s really just finding out what that person needs and providing them the resources that they need at that time.

[00:25:45] Dr. Markham: Yes. And I think what is so, so sad about with healthcare professionals is you probably know somebody from med school or somebody you worked with, you’re probably two, at least two– one, two, three phone calls away from a psychiatrist or somebody in the mental health field, but we just aren’t there yet to where we’re talking about it.

[00:26:10] Dr. JB: And some people are a little bit surprised to find out that there’s so much stigma around mental health in healthcare professionals.

[00:26:19] Dr. Markham: Yeah. And I, I think that we, You know, psychiatry the practice, and we have to be kind of honest about our history, psychiatry has a very sordid history and there have been human rights violations and things like that. And so I, I think that we have to rebuild our reputation and so I think that it exists in the culture and I think we are part of that. And so I think, even psychiatrists, we have these biases that we have to address. So I think that it’s just the stigma is present pretty much everywhere.

[00:27:01] Dr. JB: So how do we tackle the stigma?

[00:27:04] Dr. Markham: That’s a good question. I think that we talk about it more. I think that that’s number one. I think that we try to make the resources necessary for treatment of mental illness embedded in the workplace in some situations. So you talk about like employee assistance, but in reality sometimes then the physicians or healthcare workers are going to be more scared to access at their own facility. So what is, what is the network for a physician who wants to seek mental health and maybe wants to go through that avenue, a list of psychiatrists, therapists that are recommended. We’ve got to kind of compile our resources, I think, and make them available and just really keep talking about it. And I also think that we really need to be, starting to talk about it, about depression, about alcohol use disorder, substance use disorders, in our profession from the time that they’re in medical, that someone’s in medical school. So we need to hear about this early on and continue to talk about it throughout the cycle.

[00:28:18] Dr. JB: And why when they’re in medical school, why start then?

[00:28:22] Dr. Markham: Well, I believe that first of all, if you start talking about it and try to start normalizing it early on, I think then that helps them to from the front end, kind of understand that this is, depression is an illness that is more common among physicians and you may experience this and here’s what you should do or might do if you were to experience it. Alcohol use disorders and substance use disorders are common among physicians, so here is what you would do and how you might help a colleague. I think that that letting the students know that these are things that you might encounter in your career, you may be faced with some of these problems and you may have suicidal ideation and many of your other colleagues have as well. I think that we are such creatures that we need to not feel like we’re the only one. And so I think that if people that you trust and respect kind of say, Hey, I suffered from depression and I’m feeling better now, I think it really helps to put that seed in medical students, residents, minds that, Dr. So-and-so overcame or is feeling better, and I can do the same if I ever experienced that.

[00:29:52] Dr. JB: Some of the things that you said, I just want to highlight a couple of them. Starting early, I think is definitely key. And part of that is because these symptoms, these symptoms of burnout these mental health conditions, they start early, right? We talk about suicide, suicide amongst physicians, medical students also die by suicide.

[00:30:21] Dr. Markham: Yes, absolutely. And I don’t know off the top of my head what the statistics are, but I know that medical students die by suicide.

[00:30:32] Dr. JB: Yeah. And so do residents. When I was going through residency training at my institution, there were two residents who died by suicide while I was there.

[00:30:42] Dr. Markham: Oh, I’m sorry.

[00:30:44] Dr. JB: Yeah. And it’s, and it’s a topic that’s really not talked about, right? but that’s what this podcast is about.

[00:30:52] Dr. Markham: Yes. And I thank you for kind of getting it out there cause we, we have to really talk about it and Also I, one thing I like to talk about is if somebody has experienced a family member, a friend, a resident, a coworker resident that their life has ended by suicide, how to talk to the people who are left behind. I think really the survivors I’ve talked to, they want to be asked about their loved one. They want to, they want their names spoken. They want, they want people to appreciate that their life was so much more than that last day. And that’s what people focus on, at least in the immediate aftermath, is that last day, those last minutes. Well, there were hundreds of minutes and days before that.

[00:31:45] Dr. JB: Sometimes people don’t know how to bring up this topic, right? Especially to, to a colleague or to a family or a loved one of somebody who died by suicide, so how, how do they do that?

[00:32:01] Dr. Markham: I mean, I think that the best way is to just say first, how are you doing? And I am, I’m so sorry about and, and say their name, I’m so sorry about your loss and how are you doing? And I think that we also know– and I have seen a lot of violations of this in the past week about the young female whose life ended by suicide– is we know that there are journalists, it’s two things that shouldn’t be done. So really it’s discouraged from talking about the method of suicide, and I’ve seen several headlines stating the way this person’s life ended, and we do know that thereis a contagion of effect sometimes with suicides. And so the line between not speaking about suicide in a way that’s harmful can be, it can be difficult to navigate because also, we need to be asking people if they’re suicidal or those types of things. Soit’s difficult, especially for someone who hasn’t practiced it, or hasn’t spoken to a lot of people. It’s difficult to know what to say.

[00:33:16] Dr. JB: But we also have to create an atmosphere where people feel safe to be vulnerable and to share.

[00:33:24] Dr. Markham: Yes.

[00:33:26] Dr. JB: And to feel like there’s not going to be some kind of adverse consequence if they really share how they’re feeling, right? So that they no longer feel isolated.

[00:33:35] Dr. Markham: Yes.

[00:33:36] Dr. JB: And that is one of the missions that we’re trying to do here at Hope4Med is to really be that, that safe harbor, like you mentioned before, where this is a place where we, as healthcare professionals, can come to that’s separate from our work, place of employment, right? Where you can connect with other peers and create this– we already have the shared experience, sometimes we don’t realize it because we don’t talk about it.

[00:34:06] Dr. Markham: I’ve got– right, and I saw a quote from Fred Rogers, I think in the past month that I, I don’t think I had read it before, but it was just so profound. It’s longer than this, but the first part is, is that, “anything that is human is mentionable and anything that is mentionable can be made more manageable.”

[00:34:30] Dr. JB: So let’s mention it. Let’s talk. Cause that’s the way you tackle stigma is by addressing it, putting words to it, and talking about it more and more and more.

[00:34:46] Dr. Markham: I totally agree. And I’m so glad that you’re opening up these conversations because I hope that if people hear more people talking about it more, I think that it’s such a profound experience for people to hear if somebody that they look up to admits that they have struggled with these things. You look up to these doctors and people who you trained with, and in reality, we’re all human and we all have a human experience. And in that, for a lot of people, is depression or some sort of mental illness, and so to hear that a person who you look up to has suffered it, it really helps normalize the experience.

[00:35:39] Dr. JB: And then continuing with the work that you’re doing in terms of advocacy is also very key because these questions should not be on our medical licensing applications.

[00:35:51] Dr. Markham: Correct.

[00:35:52] Dr. JB: And I think that will also go a long way in giving permission, for lack of a better word, to seek out the help that you need.

[00:36:03] Dr. Markham: Correct. Because it, it may just be a letter. It may just be something like that, but there’s that mental load of also thinking about that and worrying about that. And it’s like a, another strike to your, your humanity in some way that I have this problem that there is treatment for and I’m scared to, to get that treatment because I want to keep my job.

[00:36:32] Dr. JB: And if going to keep my job, I’m going to have to go through all these different hurdles when all I’m trying to do is stay well.

[00:36:39] Dr. Markham: Yes. And as a healer, we’re healers, so why are we, why are we putting this barrier? And also I think strongly, this is important, I think, in addictions as well, is that if we have these types of questions and the stigma, then a person is much less likely at the beginning of realizing they have problem drinking to go to therapy, so it is allowed to, to continue and worsen. And then maybe they truly have an alcohol use disorder, but there’s a lot of people engaging in a lot of problematic drinking. And if there was more freedom, less stigma to get help early when you acknowledge that, then that could really impact lives.

[00:37:31] Dr. JB: Because sometimes the reason why they get treatment is because it gets out of control and they’re forced to.

[00:37:38] Dr. Markham: Yes. And there are so many people on that continuum who just need tools and help with problematic drinking that could keep from it becoming a true alcohol use disorder.

[00:37:54] Dr. JB: That’s right.

[00:37:55] Dr. Markham: And so, CBT, motivational interviewing, we have lots of different modalities that if, if were sought out early could help with the supports to keep the progression of the illness.

[00:38:10] Dr. JB: So with that being said, and unfortunately our time is coming close to completion, do you have any final words of wisdom for my listener, Dr. Markham?

[00:38:26] Dr. Markham: I want to encourage us in our healing profession and in medicine to keep talking about suicide, to keep mentioning the names of individuals whose lives have been lost by suicide, and to keep asking about it. And to keep the conversation going and reach out to people and be patient as we can. We’re all under a lot of stress with this pandemic, but I want to just encourage people to keep talking about it.

[00:39:07] Dr. JB: Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic. The greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.