Gratitude. I have been blessed to travel the world to work in other medical systems in Africa and Central America. Through this experience, while in recovery, I worked with people that had much less in terms of materialistic possessions, but exuded pure joy, happiness, and gratitude for the gifts in their lives. In the depths of depression, I callously walked by the flowers outside of the hospital every single day, but in recovery, I learned to find gratitude in the simplest things again. Out of this gratitude, I decided to start keeping a list of all the things in my life for which I am grateful. Now, years into recovery, the list is composed of hundreds of items, and when I am having a difficult day, I can pull out the list and ground myself in more positive reflections.
As a part of my series about “Mental Health Champions” helping to normalize the focus on mental wellness, I had the pleasure to interview Dr. Adam B. Hill. He is a human being, a husband, a blessed father of two young children, an avid Butler University Bulldog, a native Indiana son, and a pediatric palliative care physician at Indiana University’s Riley Hospital for Children at IU Health in Indianapolis, IN. Dr. Hill openly shares his own story of depression, suicidal thoughts, and alcoholism while working in the field of medicine. Now, years into recovery, Dr. Hill shares his experience to help other individuals still suffering. In the midst of a national epidemic of caregiver distress, Dr. Hill reveals a rare, open and honest perspective, which has garnered national/international speaking opportunities and assisted in lifting the veil of secrecy regarding caregiver mental health. Dr. Hill’s voice is leading a cultural revolution for how we approach mental health conditions in the professional workforce. In his lectures and writings, Dr. Hill shares the lessons learned during the course of his own successful mental health and addiction recovery. On March 23rd, 2017, these lessons were shared in the groundbreaking New England Journal of Medicine Article entitled “Breaking the Stigma: A Physician’s Perspective on Self-Care and Recovery”. In addition, Dr. Hill shares his own personal reflections on stigma, stereotyping, self-care and embracing humanity as a man living with a history of mental health conditions. These lessons have far-reaching applicability for anyone living and/or struggling with a mental health condition while offering a message of inspiration and hope for individuals to remain in the fight. Through all of this work, Dr. Hill uses his platform to explore the importance of human connection and human stories. Dr. Hill combines his work in palliative care, his perspectives of being a physician in recovery, and as a human being living with a mental health condition, in order to highlight our similarities instead of our differences. His work uncovers the importance of connecting to another human being while creating safe spaces for our own stories to be empathically heard, felt and understood.
Thank you so much for joining us! Can you tell us the “backstory” about what brought you to this specific career path?
I was raised in a family that taught the importance of community service, civic discourse and giving back to other people. My father worked as a community-based child and adolescent mental health therapist for 40 years. From an early age, I saw the difference he made in helping other people during their own times of illness. Following in his example, I hoped to serve other people too, by helping them to navigate their own experiences with medical conditions.
In my youth, I was living on the outside of a world of mental health treatment, inside my own home. But, running concurrent to this exposure, I was a scrawny, awkward child that was relentlessly bullied in my youth. I felt the weight of living as a vulnerable child. In choosing my own medical career of pediatric oncology/palliative care, I knew I wanted to support children (and their families) that were going through difficult times. I can’t explain it, but I always had a comfort working around sick children and I found those spaces of working with children living with serious medical conditions, as incredibly opportunities to help other people during the most difficult times of their lives.
I still practice pediatric palliative care, serving as the division chief of the palliative care team at Riley Hospital for Children at IU Health, but the detour of my career occurred after having my own brush with serious mental health conditions almost eight years ago. After years of depression, I started to cope with alcohol, and in a rapid downward spiral, became actively suicidal with a plan to end my own life. Out of the darkness, I found a road to recovery, and over the last three years have been blessed to share this journey with other people struggling with their own mental health.
According to Mental Health America’s report, over 44 million Americans have a mental health condition. Yet there’s still a stigma about mental illness. Can you share a few reasons you think this is so?
Stigma persists because we continue to look for superficial, convenient answers in a complex world of human beings. The fact that 20 percent of the U.S. population suffers from mental health conditions, and we continue to stigmatize them, is a cultural failure of empathy. Instead of taking the time to listen, learn and understand another person’s story, we rely on the convenient boxed version, and the perpetuation of assumptions writes the rest of the narrative.
In a search for our own understanding of human behavior, we lump individual people into stereotypical boxes. These boxes create imaginary barriers, in an attempt to understand groups of people, without the nuanced commitment required to seek out the individual person’s story. Once in these boxes, it becomes easier to superficially highlight the differences between us, instead of focusing on what connects us closer to together.
We live in a fast-paced, social media-driven culture of sound-bites, memes and shorthand versions of the truth. Fighting stigma requires time, effort, perspective and a willingness to delve deeper into an individual person’s story. Stigma persists, because most of us don’t take the time to listen, learn and truly feel in another person’s story.
Can you tell our readers about how you are helping to de-stigmatize the focus on mental wellness?
I have a history of depression, suicidal ideation, and I am a recovering alcoholic. In medicine, over the last three years, I have become a national leading voice for individuals with their own substance abuse and mental health conditions while working in the field of medicine. Not a lot of us speak out for fear of retribution, punishment, shame, and loss of our professional livelihood, in a professional field where employment opportunities can be stripped way for sharing such vulnerable truth. Inside and outside of medicine, I focus on destigmatizing mental health conditions by putting a face to the faceless and sharing my own story of being broken by the field of modern medicine.
In addition, I lift other people up to allow for the depth of their own beautiful stories to be authentically heard as well. In the face of an ongoing epidemic of medical distress, suicide, and untreated mental health conditions, I attempt to normalize the conversation by sharing a new perspective. In sharing this voice, I hope to show a positive role model of a successful physician with a recovery story, to drown out the stereotypes and stigma and show us all a better way forward.
Specifically, I travel the country to speak, while creating empathic, safe spaces for other people to share their own stories. I strive to spark revolutionary thoughts on how we view, approach and treat people with their own mental health conditions, by showing what connects us all together and not what drives us further apart. On this journey, and in this space, I have found that vulnerability can be contagious, in seeing colleague after colleague open up to share their own intimate truth — a truth longing for an empathic ear to listen.
At Riley Hospital for Children, I have worked hard to create empathic spaces for individuals to share this truth as well. In our own offices, we create space to process, debrief and share our own emotional processing of the difficult work we do in caring for seriously ill children every single day. Outside of the offices, I have helped to create spaces for students, residents, fellows, and faculty to debrief tragic events, emotionally complex situations, and our own feelings. In these safe spaces, often the conversations turn to mental health and the appropriate treatments needed to support and sustain our own wellbeing. Out of these spaces, over the last three years, I have been able to help countless people get the mental health help they need and deserve.
On a larger scale, I founded and direct “Compassion Rounds” at Riley Hospital for Children, which is a safe, confidential town hall event that focuses on the processing of human emotions. In these events, members of the hospital community, from every walk of the walk, position, and title, gather together to share in their experience. The events don’t focus on medicine per se, but on humanity, and are not limited to medical professionals, but is all-inclusive, and all are welcome. In the fast-paced world of modern medicine, we are constantly barraged by trauma, death, grief, and loss, and we often fail to create safe spaces to process our own human emotions. Compassion rounds, and debriefing these critical incidents, attempts to provide a safe space so that the medical professionals can acknowledge that we are all human beings too.
Was there a story behind why you decided to launch this initiative?
In medicine, there is an ongoing, evolving epidemic of medical professional distress, mental health conditions, and suicide. Every year, 400–500 physicians die from suicide, a rate significantly higher than the general population. Over the course of my medical career, I have lost six colleagues to suicide. After the 5th suicide death of a colleague, I was asked to comfort, console and help my colleagues process and heal during their own time of mourning. In secrecy, I was hiding the fact that I had my own story of depression, addiction, and suicidal ideation. In those moments, I realized it was time to take a larger stand. I knew, to authenticity help our medical communities heal, it was time to tell my own story too. As a survivor, I possessed a level of empathy, understanding and lived experience that could help other people in their own struggles. In 2016, I opened up about my own mental health story and the years of recovery once I accepted help for my disease.
After the loss of another colleague, I realized that personal self-care and wellbeing was only a drop in the bucket of the role I needed to play. In my lived experience, I realized that there are too many obstacles and barriers in the way of getting people the help they deserve. Often, a lack of mental health services are cited as a primary barrier for treatment, but this is only the tip of the iceberg. In medicine, and culturally at large, I see the deleterious effects of stereotypes, stigma, fear, punishment and a lack of empathic vulnerable/honest conversations as immense obstacles as well. Specifically, with medical professionals, we have continued to tie mental health conditions with a concept of professionalism, and it detours people away from seeking help out of fear of losing their license, their job or their career. In my own recovery, I was publicly shamed for voluntarily self-disclosing an addiction treatment. I was asked to write a public letter apologizing for my addiction to keep my medical license. And out of this disclosure, I lost several career opportunities, despite never having any legal, malpractice or patient-related incidences. Ironically, in a field that takes care of the suffering of other people, it is alarming to see the suffering we have continued to impose upon our own people.
I launched these initiatives so that other people will not feel alone. I launched these projects because when I was a child, I didn’t stand up for myself or for other people. For good people to get the help they deserved, I knew I had to use my voice to address these obstacles and barriers. I couldn’t rest knowing that I only found a way to help myself, without trying to give it away to other people.
In your experience, what should a) individuals b) society, and c) the government do to better support people suffering from mental illness?
On the individual level, I think it starts with holding space, showing up, being present and searching for new perspectives. Individuals can create safe spaces for their friends, colleagues, family by crafting an environment that allows for vulnerable truth to come organically forth. In this space, an individual can be persistent, while listening patiently, and learning about what it is like to walk in another person’s shoes. In doing so, an individual can create a silo, a protective environment, that will attract people to share in their own suffering. And over time, these silos grow and expand, and start to connect and can lead to a larger, grassroots movement of spaces worthy of honest discussions of ongoing mental health needs.
On the societal level, I wish we would take more time to seek out the truth behind a person’s story instead of relying on a dime-store version of it that sells a larger cultural narrative. I wish we would stop connecting mental health conditions with visuals of mugshots, morally corrupt minds, mass shootings, straight-jackets, and prison cells. The truth is, 20 percent of Americans live with mental health conditions, and in medicine, that number is actually higher. In medicine, a striking percentage of professionals go untreated for these conditions, because of the barriers and obstacles cited above. The truth is, people, work successfully every day, as valuable members of society with their own mental health stories. In medicine, some of the most caring, empathic, and successful medical professionals are those with their own mental health stories, because they understand what it is like to be sick themselves.
On the governmental/legislative level, I hope we can work towards removing barriers that prevent people from getting help. One step forward is improving access, resources and insurance coverage for mental health treatment, with a significant investment in this infrastructure. Living as the son of a community health social worker, I saw the budget cuts year after year, the long lines for new appointments, and the copays people were unable to afford. Alongside this investment, we must stop the discriminatory practice of subjecting medical professionals to a process that ties their own mental health history to their opportunities for employment. In our current culture, state medical licensing boards, and then individual hospitals, practice groups, and insurance malpractice companies are still allowed to ask questions such as, “Have you ever been treated for a mental health condition?” In a winless situation, professionals are forced to answer, while not asked about their sex, race, religion, or physical health conditions because of the Americans with Disabilities Act that prevents discrimination. Over the last few years, several national groups have been working on addressing this issue, but the problem still remains. I hope we can put in place policies, regulations, and guidelines that will ultimately encourage everyone to seek help, regardless of their profession.
What are the 6 strategies you use to promote your own wellbeing and mental wellness? Can you please give a story or example for each?
For years, I have relied upon counseling to emotionally process my ongoing recovery, and the gravity of the work I do every single day. Inactive depression and addiction, I lost a sense of who I was as a person, and I had to work hard to claim my own identity.
In one of my first counseling sessions, a kind therapist asked me, “Do you love yourself?” I paused in a long awkward silence. In the silence, I answered her question. In counseling, I had to learn to find ways to love myself, be kind to myself, forgive myself and accept myself for who I am. In doing so, I learned to develop self-compassion. In the formative process of searching for self-compassion, I developed own mantra to acknowledge the impact I can have in this world while accepting the limits of what I can do.
My mantra: “There is a lot of pain and suffering in the world that I did not cause, all I can do is stand in the face of it and try to make a small difference.”
For decades, I felt like I was stuck in an emotional adolescence of processing complex human events. Working in medicine, seeing death, dying, tragedy and suffering, I spent little time processing the gravity of this work. In recovery, I learned that I have to take time to actively process my own mental health, to allow for the privilege of caring for other people.
Early in recovery, I began to understand that I was my own worst critic. I often existed in self-deprecation cycles where I lived true to the feelings of being an imposter. Every morning, I told myself that I was not good enough, I should do better, and then found these self-affirmations met validations in the stigmatization of my disease. In mindful activity, and spending time in personal reflection, I learned to analyze my own thinking, in order to find ways to break the continuous cycles of self-hatred. I discovered ways to take self-awareness into direct action, and rewrite the detrimental narrative I was writing in my own head.
I have been blessed to travel the world to work in other medical systems in Africa and Central America. Through this experience, while in recovery, I worked with people that had much less in terms of materialistic possessions, but exuded pure joy, happiness, and gratitude for the gifts in their lives. In the depths of depression, I callously walked by the flowers outside of the hospital every single day, but in recovery, I learned to find gratitude in the simplest things again. Out of this gratitude, I decided to start keeping a list of all the things in my life for which I am grateful. Now, years into recovery, the list is composed of hundreds of items, and when I am having a difficult day, I can pull out the list and ground myself in more positive reflections.
For years, I wrote poetry and journaled as a therapeutic tool, and it helped me to get my thoughts and feelings out onto a page for a greater reflection. Since living openly in medicine with a mental health history, I have written a book, entitled “Long Walk out of the Woods: A Physician’s story of depression, addiction, hope and recovery” scheduled to be released by Central Recovery Press in February 2020. Writing this book has been one of the greatest gifts of my life, as an ongoing process of healing through sharing my own story. Writing has gifted me an opportunity to share my own creative expression while connecting to other people with their own stories of mental health conditions. In writing an online blog, and actively sharing on Twitter, I have found a community of people that are also willing to stand up to stigma, and support each other in our forms of authentic truth.
5) Setting limits and boundaries
In the depths of depression and addiction, I didn’t feel worthy of setting my own limits/boundaries and continuously let work and other people’s definitions of success define me as a person. In the end, I was apathetic, broken and lost my own personal identity. In recovery, I decided that I will not let that happen again. Some simple strategies have been taking my email off my phone and finding ways to concretely separate work from home. When I have offered a promotion a few years ago, I shared that I was honored, but I wanted them to know that I would still go home by 5:30 p.m. every single night to cook dinner and eat a meal with my family. Being a husband and father is central to my core identify and have a profound meaning to my life, so I will not sacrifice that again.
6) Empathically helping other people
One of the greatest gifts of my life has been the blessing, the privilege to help other people on a daily basis. I feel honored to help patients and families navigate the most difficult times of their lives, and I found ways to highlight a greater meaning and purpose for my own life through this process. Concurrently, working with colleagues, students, training physicians in their own mental health treatment and recovery process has gifted me an incredible ability to give back the gifts that were given to me. In essence, sharing my own empathy with other people has helped my own recovery, in that I know I am making a difference in other people’s lives. In this process, my own personal well of mental health is constantly being filled back up by the gratitude and grace of human connections. At the end of the day, I know that I showed up, did my best, and worked hard to help other people find healing in their own lives. That is deeply meaningful to me, and it continues to sustain me in my own recovery.
What are your favorite books, podcasts, or resources that inspire you to be a mental health champion?
Resources: My wife, my children, family, friends, community of supportive colleagues, and recovery community (AA)
Brene Brown — Daring Greatly, The Power of Vulnerability, The Gifts of Imperfection
Susannah Cahalan — Brain on Fire
Melody Beattie — Codependent No More: How to Stop Controlling Other and Start Caring for Yourself
Happier by Gretchen Rubin
Recovery Unscripted by David Condos
Terrible, Thanks for Asking by Nora McInerny
The Struggle Bus
Headspace — Mindfulness and Meditation
Calm — Mindfulness and Meditation