Surgeons Break Their Silence on Struggles with Mental Illness

Panelists offered insights and practical strategies to normalize treatment and discussion of mental illness for surgeons at all levels on the final day of Clinical Congress 2025.

Studies show that as many as 50% of surgeons experience anxiety, depression, and other mental health challenges at some point in their career, and it is estimated that as many as 400 physicians die by suicide each year, with surgeons experiencing some of the highest rates among medical specialties.

Carrie Cunningham, MD, MPH, FACS, from the University of California, San Francisco, and past-president of the Association for Academic Surgery (AAS), shared her own experiences with depression and substance abuse and described a pivotal moment along her journey to mental wellness that occurred as she delivered her AAS presential address in February 2023.

“Beyond bringing my two children into the world, giving this address was the most important thing that I had ever done,” she said. “From that day until now, I continue to receive emails, letters, and calls from those in crisis. I began my speech like this: ‘Yes, I was a top junior tennis player at the age of 16, and I competed at Wimbledon five times. I am an associate professor of surgery at Harvard Medical School, and I am the president of the Association for Academic Surgery—and I am also human. I am a person with lifelong depression, PTSD, and now a substance use disorder. None of my professional successes have protected me against this.’”

The title of her 50-minute speech, “Removing the Mask,” has generated more than 70,000 views to date on YouTube.

“My intention in continuing to tell my story is to provide a voice for those of you who suffer silently. As leaders and allies, we must become as knowledgeable about mental health disease as we are about every other disease. Psychological first aid should be a requirement,” she said.

Despite the high occurrence of mental health challenges experienced by healthcare providers, many surgeons avoid seeking help due to the long-standing culture in medicine that often considers mental health issues a sign of weakness rather than a treatable condition. This lack of transparency drives a cycle of silence with the misguided aims of protecting job security, opportunities for advancement, and relationships with colleagues.

“The unique and silent struggles of the surgeon include excessive workload, responsibility for patient outcomes, and a lack of a work-life balance—all of these can take a toll on a surgeon’s mental health,” said session comoderator Kamal Itani, MD, FACS, from Boston University in Massachusetts. “It is imperative that we acknowledge these challenges and have the resources to address these mental issue needs in order to protect our well-being.”

Surgeons can start their journey toward improved well-being by understanding the profound difference between pain—a physical sensation, and suffering—a broader emotional and psychological experience. 

“Pain is a normal part of the practice of surgery,” said Mary L. Brandt, MD, FACS. “We experience physical pain from ergonomic injury or medical-related causes, we experience emotional pain from the suffering our patients endure, and spiritual pain from moral distress or the inability to find meaning. Suffering arises from how we interpret the pain.”

To support surgeons in emotional distress, follow the ABC approach: Act if there is there is imminent danger to yourself or others; Be present (listen attentively and do not try to fix the situation); let Compassion arise. 

“How do you let compassion arise? Bear witness, choose to feel empathy—and tolerate the discomfort that arises in response to your empathy,” she said. “Any pain—physical, emotional, spiritual—that causes intense suffering can lead to the inability to see beyond that suffering,” said Dr. Brandt, urging session attendees to help their colleagues determine the source of their pain.

“There comes a point when we need to stop just pulling people out of the river. We need to go upstream and find out why they're falling in," she said, quoting bishop and theologian Desmond Tutu.

Sangki Oak, MD, MPH, in his fifth year of a medical residency program, provided the resident perspective on maintaining mental wellness. Dr. Oak—a former special amphibious reconnaissance corpsman with the US marine special operations—served in multiple deployments in Afghanistan after 9/11.

“When I got back from Afghanistan, I felt that I made it through my service relatively unscathed. But during the beginning of med school, I started questioning my life, and I found that I missed the military, so I began struggling with suicidal ideation. I had several times where I sat at the edge of my bed with my pistol in my hand contemplating putting a bullet in my head,” he said.

Dr. Oak started seeing a psychiatrist within the US Department of Veterans Affairs, and eventually he matched in surgery at Brigham and Women’s Hospital in 2020.

“My journey from the military to residency led to mental illness that has severely affected my life and my performance. I want to help others avoid the same challenges that I went through—challenges that others have not survived,” said Dr. Oak. “Residency has problems that need to be fixed. My primary goal is to try and nudge the culture regarding how we view mental illness.”

Studies suggest that one-third to more than half of all residents experience depression, and a post-pandemic survey found that one in seven surgeons and trainees had suicidal ideation.

“I’ve been asked by my fellow residents whether I found residency or the military harder. And I tell them that, for me, general surgery residency has been harder than war. I felt a greater sense of camaraderie in the military,” he said, noting that the armed forces—unlike residency training—features incremental learning of complex skills and a greater acceptance of mental illness.

Dr. Oak described how the concept of grit during training is a “double-edged sword because while it allows people to push farther, it also propels them to push past their limits,” and called on residents, especially, to engage in thoughtful introspection to determine if and when they need help and support.

“Surgery is tough for everyone,” he said.

The other panelists addressed the role of leadership, particularly program directions, in mitigating distress and supporting suicide prevention efforts and the importance of personal check-in tools and other preventative care measures.

Closing out the session, Timothy Mahoney, MD, FACS, a former mayor of Fargo, North Dakota, and the session’s comoderator, presented a brief video highlighting the Fargo Police Department’s Wellness Initiative as an example of the kind of unwavering and profound emotional support surgeons should provide to their colleagues experiencing burnout and emotional distress.

The ACS provides resources on mental health, emotional well-being, suicide prevention and awareness, and more.