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Music Heals
Song Title: Listen Before I Go
Artist: Billie Eilish
What does this song say to you?
“Listen Before I Go” is a deeply emotional song that really shows how it can feel to be hopeless and isolated. I feel that it is almost a cry for help. Billie sings, “If you need me. Want to see me. Better hurry, cause I’m leaving soon.” She is reaching out one last time to say goodbye as she has lost the will to live. This song allows listeners to step into the thoughts of somebody contemplating taking their life to end their pain due to depression.
Why did you choose this song to relate to depression and suicide?
The first time I listened to this song, it struck me in a place where no other song has been able to relating to depression. Seeing some of my closest friends struggle with depression and working to do research in the field of depression, it is sort of a comfort to be able to listen to something that captures the raw emotions of a devastating situation like suicide. It perfectly sends the message of the desire to feel heard in these moments of extreme despair.
Song Title: Make You Feel my Love
Artist: Adele
What does this song say to you?
“Make You Feel my Love” speaks to me as a powerful display of wanting to comfort and support another person unconditionally who may be struggling suicide ideation. I interpreted the lyrics “I know you haven’t made your mind up yet, but I would never do you wrong,” as Adele’s plea to help another individual wanting to end their life. It is like she is reaching her hand out saying, “you’re not alone.” Adele expresses her love as a lifeline for the individual she is singing to and is using love as their reason to stay.
Why did you choose this song to relate to depression and suicide?
I have always been a huge fan of Adele and her magical voice. “Make You Feel my Love” is one of my favorite songs by her because while it doesn’t directly tell the story of a suicide, it can help so many people that are struggling with depression. Adele’s ability to touch listeners allows her message of “there’s more love waiting for you” to reach those struggling and again provide a lifeline. It is a reminder to people struggling with depression and suicidal thoughts that they are not alone.
Song Title: 1-800-273-8255
Artist: Logic featuring Alessia Cara and Khalid
As someone who worked on a crisis text line for a year, this song excellently shows the impact of what these crisis lines can do and the importance of reaching out for help. The song starts on a low where Logic sings, “They say every life precious, but nobody care about mine.” However, at the end of the song the message turns to a story about hope saying, “I wanna feel alive.” This song is important to me as the lyrics reflect a topic that I chose to help with in my free time. As a crisis text line supporter, I am trained to guide hopeless texters to find hope and a reason to live. This song can do that for listeners, proving just how impactful music can be. It is especially important to note that the title of this song is the crisis hotline number. This was a choice by logic to encourage others to reach out for help. In my opinion, this is so powerful in creating a space of support for his fans and listeners.
Song Title: Friend, Please
Artist: Twenty One Pilots
While not in my usual favorite genre of music, this song has a powerful message that drew me in. In this song, the band Twenty One Pilots is pleading for their friend to keep on fighting. They write about asking the struggling friend what their plans are tonight and talk about being there with them to sunup. Obviously, this is from the point of view of a friend trying to help the individual contemplating suicide, but it allows those who are also struggling with suicidal ideation to hear these lyrics and find another reason to stay. Out of curiosity, I read the comments on the YouTube video of this song, and they are filled with other fans writing supportive messages in hopes of supporting people battling depression. One comment even talked about how they were very close to committing suicide but had listened to this song when suggested by a friend and they were able to find a newfound hope within the lyrics.
Song Title: Call Your Mom
Artist: Noah Kahan
Noah Kahan is hands down one of my favorite artists. Something about his lyrics are so touching, feeling like home. The song “Call Your Mom” provides supportive words that someone struggling with suicidal ideation will no doubt resonate with. This song is like a reaching hand, trying to connect readers to hope and let them know everything will be ok. There’s something so powerful in Noah singing, “Don’t let this darkness fool you. All lights turned off can be turned on.” He then goes on to list a bunch of reasons to stay and then pleads with the listeners, “So, won’t you stay, won’t you stay, won’t you stay with me?” As stated previously, I have personally been the one on the other side pleading for individuals and my friend not to give up. I only hope that my words are as convincing and touching as Noah Kahan lyrics.
Song Title: Forever Winter
Artist: Taylor Swift
Many people would describe Taylor Swift as one of the greatest songwriters of our generation and her song Forever Winter proves their point. She expresses the feeling of extreme stress while worrying that someone close to her will take their life. She writes “Live my life scared to death he’ll decide to leave instead.” This lyric along with the storyline of this song illustrates a heartfelt plot that touches a lot of listeners who may be going through something similar. I think what makes a good song is the ability to make listeners feel something and Taylor has done an excellent job with this song. She portrays the feelings of wanting to take the pain away from the individual that is hurting, which is often how I feel within my research and job.
Song Title: Carlo’s Song
Artist: Noah Kahan
This is another Noah Kahan song, but this time shows the perspective of life after loss due to suicide. It portrays Noah’s feelings of wanting to carry on his buddy’s spirit. This song was dedicated to Carlo’s family and anyone struggling with the loss of a loved one. He mentions playing that one song just to keep him alive. This song is a beautiful illustration of how life after loss can look. Grief from suicide is different. Many times, when someone you love commits suicide you often feel a tremendous amount of grief. Noah Kahan shows what this grief can look like in this song, making it a source that individuals can go to for support after loss of a loved one due to suicide.
Song Title: Reason To Live
Artist: Malachi Gagnon
Malachi Gagnon did an excellent job turning his pain into purpose through his song “Reason to Live.” He wrote this in honor of his friend who he lost to suicide. Personally, I always think ballads hit a little harder and get the message across just a little bit more, and this song is no exception. Behind the beautiful notes and touching lyrics is a wonderful message of encouragement. Through his singing you can tell how much he is affected by the worry of losing someone to suicide. He sings, “I know you can’t see past the hurt,” and then continues to sing convincing the individual to keep going saying “You’ve got so much to live for.” This song brings me to tears almost every time I listen to it. Many of the words he sings are things that I felt once in my life. That’s the great thing about music; being able to relate to something that evokes emotion and heal through the notes.
Song Title: Suicide is Painless
Artist: Johnny Mandel
During a light conversation about this topic at my Thanksgiving dinner, my dad suggested this song from the show “MASH.” Upon hearing it for the first time, I was a bit confused about the message. At surface level, it has a very light beat with some dark, devastating lyrics. This song discusses the option of suicide always being there. The singer realizes that when things are hard, you always take or leave suicide. It displays an emotional numbness that many people contemplating suicide feel. It reflects the hopelessness that many people feel when their pain has just become too unbearable. Although the purpose is not to convince listeners to stay, it can be something for struggling individuals to relate to which is always powerful. It can also display a numbness that listeners who are struggling can hear and feel a sense of realization, coming to reality and diverting them from their thoughts of taking their life.
Song Title: Don’t Try Suicide
Artist: Queen
This song by Queen takes on a very straight forward approach to try to stop listeners from committing suicide. The lyrics are very direct and clearly send the message to not attempt suicide, but couples it with an upbeat and catchy song. One of the lyrics, “Don’t try suicide, you’re just gonna hate it,” is an example of their blunt message. They repeat this phrase “don’t try suicide” throughout the rest of the song. This repetitiveness further emphasizes the urgency of the topic. Their goal through this song is to encourage individuals to seek help and not act impulsively. While this seems somewhat harsh and blunt, it can be what someone needs to continue their life. Some may call it tough love, but it is worth it if it means that they realize that life is worth more than any pain.
DJ Statement:
I am deeply passionate about depression and suicide prevention, so finding songs within my normal playlist proved to be quite simple. Throughout college my one goal has been to get involved and begin helping people now. Because of my personal experiences with friends struggling with suicidal thoughts in high school and early college, I wanted to get involved in something that is so personal to me. I now do research to find a treatment for treatment resistant depression and I work for a crisis text line where I respond to many individuals contemplating suicide. Through these experiences, I feel that I have a pretty good understanding of how it feels to be on the other side of suicide and how individuals may feel that are really struggling. With this experience, I have found that music can be a lifeline. Music connects individuals, can support us, can validate feelings, and is overall a powerful tool for mental health. While taking conversations through the crisis line, I often will ask individuals what makes them happy or what kind of things they usually do when they are feeling down. Many of them respond with “I listen to music.” Music can be so healing and songs about suicide can provoke emotions and make a big impact in many individuals’ lives.
I tried to choose songs from all perspectives of suicide; from the person struggling with suicidal ideation, family members, and friends. Within my selection of songs, there are different types of beats ranging from upbeat melodies to heartfelt ballads. All songs make listeners feel something and promote the same message: suicide is not the answer. These songs talk about emotions felt when depression reaches a maximum leaving to suicidal thoughts. Songs like Listen Before I Go, 1-800-273-8255, and Suicide is Painless discuss suicide from a perspective of actually feeling the pain of suicidal ideation. On the other hand, the rest of the songs discuss the feelings involved from an outsider asking for the person to keep going. Although written from different perspectives, both have the same target audience of anyone who is struggling with their own battle of depression. Listeners who are struggling with suicidal ideation can listen to songs that come from the perspective of an outsider, like Make You Feel My Love for example, and feel the emotions that they may be putting on their friends and families. This will hopefully defer them from taking their life. They also both evoke emotions within family and friends that are watching the individual go through these difficult times, making them another target audience of these songs. I believe the most important thing from these songs is the glimpse of hope they have. While they can seem very dark and gloomy purely based on their topic, there is always a hope that can be found within the lyrics. Hearing Billie’s “better hurry” in a final outreach for help, Noah Kahan’s “won’t you stay with me?” Malichi Gagnon’s “you’ve got so much to live for,” Logic’s “I wanna feel alive,” and so many more memorable, hopeful lyrics make listeners believe in continuing life and supporting others who are struggling with finding a reason to live. In the darkest times, there is hope. Sometimes, healing may come in the form of some powerful set of music notes accompanied by a talented singer.
Rounds and Resilience: Depression in Future Physicians
Medical school is no easy feat. Between the immense amount of pressure of learning to keep patients alive, the high expectations, and long hours, many students begin to feel the burden of the academic life of a medical student. This combination of stressors contributes to an increase in the number of depressed students within medical schools. In fact, a study suggests that 14.3% of medical students experienced moderate to severe depression during their studies in medical school. Generally, medical students experience much higher rates of depression when compared to the general population (Schwenk et al., 2010). The emotional strain of feeling extreme self-doubt coupled with the stigma surrounding mental health within future health care providers leads to a major increase in depression in this population. Depression can have serious implications as these individuals are the future of medicine. Some of these implications may include an increase in undocumented cases of depression and lack of utilizing support due to the stigma surrounding mental illness. Steps need to be taken to prevent this increase in depression in our future physicians.
The prevalence of the issue of increased depression in medical schools was assessed in a study produced by the University of Michigan (Schwenk et al., 2010). They began by addressing that medical students experience mental illness at a higher rate than the general population. By using a web-based survey, they proved that medical students have higher rates of burnout, higher risk of suicide ideation and suicide, as well as a lower quality of life. Within these numbers, they were able to see a significant amount of students that reported being moderately to severely depressed, with third and fourth years being more likely to be depressed. Of the total participants in the study, 7.4% reported suicide ideation and that they were either third- or fourth-year students. Their findings also analyzed the stigma within how depressed medical students feel about the social receival of their condition in medical school. For example, their research found that depressed medical students were significantly more likely to report that when being depressed, fellow medical students would respect their opinions less. Although the number of depressed medical students reported within the University of Michigan’s medical school is a number to recognize, the implications of the data on stigmatization may mean that there are some students who are too ashamed to admit their depression symptoms in fear that they be regarded as less competent. It may present as a barrier to seeking treatment and lead to these students partaking in harmful coping mechanisms.
Another similar study was conducted in New York where they also determined that the rates of depression in medical schools is an issue with their data showing that medical students screened positive for anxiety and depression five to eight times higher than the general population (Mousa et al., 2016). They sourced their results from a medical school in New York in an anonymous online survey. They found that 16.4% of medical students had major depressive disorder compared to the 2.8% of individuals within the same age demographic in the general population. In these findings, they concluded that the stress of medical education has a high impact on the mental health of the students. They stated that they hope that these alarming findings can be utilized in implementing mental health awareness campaigns in medical schools.
In another study that examined multiple medical schools, 12% of students reported major depression and 9.2% reported mild/moderate depression. Of the total participants, nearly 6% reported suicidal ideation (around 108 students of the total 1800) (Goebert et al., 2009). This data suggests that depression is a significant issue in medical schools that needs to be addressed. Their goal was to include a larger demographic to more wholly encompass minorities and display a larger sample size to ensure validity of their findings. They addressed that the common stressors of an intense workload, lack of sleep, challenging patients, inadequate learning conditions, financial pressures, overwhelming amounts of information, and concerns about career development are the well documented reasons for the high rates of mental illness. They connect the stressors of medical school with the decreased psychological well-being of medical students. They follow up their findings by encouraging medical schools to educate their students on the importance of taking care of their mental health and suggesting resources for help.
According to a four-year longitudinal study, school related factors are associated with a risk of developing depression by year four of medical school. They analyzed a large sample size of 3,743 students in 49 different medical schools where they compared a baseline survey and a survey after four years of medical school to see if there was an increase in depression (Dyrvye et al., 2019). They established a concern that medical student depression is an ethical liability for educators. They address that it not only can affect the individuals’ suffering but can also cause declines in academic success and suicide. In this unique approach of following students’ mental health during their four years in medical school, they found that 31.2% of fourth year students were depressed, which is higher than the initial percentage in year one (specific percentage not stated). This proves that medical students are at a significantly higher risk of developing depression by the time they graduate.
After addressing these problems as a concern for the future healthcare leaders of our nation, some studies got involved in implementing plans to try to improve mental health within medical students. One group of individuals created an intervention that was implemented at the University of Hawaii’s medical school where their goal was improve the overall mental health of their medical students (Thompson et. al, 2010). In the program they implemented a more anonymous process of obtaining psychiatric help and tried to educate students on ways to improve their mental health through providing a 24-chapter handbook. They also incorporated director led discussion pertaining to symptoms to look out for in themselves and others. Their goal was to reduce depression and suicidal ideation by increasing the normalcy of mental health struggle and decreasing the stigma. The results following the study showed a slight decrease in the number of self-reported depressed students.
Another similar study planned an intervention at the University of California, San Diego School of Medicine. The program was implemented with two approaches: screening, assessment, and referral as well as education (Moutier et. al, 2012). They sent out a mass email to all students that invited them to fill out an optional anonymous mental health screening. Of the total 2,360 students that were sent the email, 374 individuals (13%) completed the form. The educational portion of their intervention was a campaign that was broadcasted through Grand Rounds to all medical students. It provided lectures on how to handle stress, physician burnout, depression, etc. Results of this intervention showed that only 48 medical students that were involved in the intervention accepted a referral into mental health treatment. With these numbers, they admit that they have room for improvement including a more active participation idea requiring revision of their original intervention.
The question I am wanting to address is: How do the pressures and expectations of medical school influence how medical students experience depression? With the knowledge that medical school takes a huge toll on the mental health of medical students, I propose a plan to implement organized ways to keep morale high, destigmatize mental health, and promote the importance of reaching out for help. Other interventions explored above fail to recognize the best ways that already overwhelmed and overworked medical students are willing to learn and get support is to not make them read more or listen to authority figures lecture. Additionally, the use of even anonymous mental health screenings can be frightening for students and therefore are not often filled out by many. My goal would be to increase the magnitude at which their results showed a positive change in the mental health of medical students. Within this intervention, I will implement at least one lecture a month educating students on some strategies to cope with depression and other mental illnesses related to being in medical school. Some examples of lecture topics would be ‘how to prevent burnout,’ ‘stress management,’ and ‘study tips.’ The goal of these lectures would be to address some of the characteristics attributed to depression stated in the four articles described earlier including extreme pressure, lack of sleep, intense workload, and more. Although using the word “lecture,” these classes would rely more on student participation and involvement other than their usual style of lecture that can seem depersonalized. These would be loosely monitored by counselors and would be mostly student led to ensure that intimidation and dominance is not a factor.
Understanding that some students would not always willingly want to attend a class that is not medicine focused, I would incentivize it by offering easy points through a participation quiz that would be taken at the end of the class. Most medical school lectures have optional lectures, so including an easy way to obtain points would encourage students to attend. Using one of the mandatory lecture times for all medical students, I would organize a more laid-back day where students can hopefully become more educated on mental health and relieve some stress. The lecture would begin with a structured check-in where the students have the opportunity to find a friend nearby and chat for a few minutes. It would start with a few well thought out, leading questions that are centered around mental health to start the talk and break the barrier that can sometimes be present when discussing personal feelings. The goal in doing this is to encourage students to feel more comfortable discussing common feelings of stress and depression that many of their peers also experience. Sometimes just relating to others that are feeling the same way can feel very reassuring and can lead to this subject being destigmatized.
From there, each monthly lecture would focus on a different health related story where the feelings involved with being a health care professional are under the spotlight. Some of these health narratives would focus on shame within medical school, resilience and burnout, failure and growth, imposter syndrome, work-life balance, and mindfulness and self-compassion. These stories will come in various types of media such as Ted Talks, readings, podcasts, lectures, and more just to ensure that the information they are receiving is well rounded and interesting. Instead of just teaching how to cope or the symptoms of depression, the goal is for medical students to see and hear about other individual’s experiences to be able to recognize their own struggles and hear what other students or healthcare workers may have done to persevere. An example of a story that I could use is a surgical resident’s personal story about depression. Simply titled, “Depression: A Medical Student’s Perspective,” the author writes about hiding her feelings and pushing away the things she used to enjoy the most. This story and others can show how many individuals experience depression or other mental health issues. As shown in the articles above, one of the biggest issues is that medical students will not reach out for help when struggling due to the high pressures of feeling like they always need to be at their best. Hopefully by seeing that it can be normal to struggle, they will feel less scrutinized for receiving help. They can hear other’s stories and have a moment to reflect on their mental health at the moment to assess their need for outside counseling.
As stated, the class would end with a short quiz that is not comprehension based. It would simply be a form where they filled out their name and select “yes” that they attended the lecture. This quiz would also include links to mental health resources that are available within the medical school such as counseling that is available and then also resources outside of the medical school. The reason for this is that some students may not want to receive help within the school in fear of the shame that they may experience. Although the goal is to reduce the shame felt around getting help for your mental health, it’s impossible to assume that this will be cured for all students, so it would be important to include and array of resources that students can pick based on their own comfortability level.
Ultimately, once implemented, these scheduled mental health lectures would increase the conversation around mental health within medical schools and allow students to have resources to go to when needed. Medical students who focus on improving their mental health will lead to healthy future physicians. To promote the acceptance of this as a normal practice in medical schools, I would like to start by focusing on Carver College of Medicine and contact the director of medical curriculum and individuals involved in assigning lecture content and include counseling services they already have. With knowledge of the mental health of medical students being poor, I will encourage a simple change to the curriculum to greatly improve mental health. It would not be any additional cost to the school, just a little bit more planning directed by the counseling services. From here, the long-term goal would be to extend the hopeful success of this proposal to medical schools across the nation and decrease the number of suicides and depressed medical students. The conduction and results of this proposal when implemented at Carver College of Medicine can be summarized in a paper written by me that can be provided to other medical schools in hopes that it will convince them to do the same.
References
Anonymous. Depression: A Medical Student’s Perspective. Academic Medicine 96(5):p 765-766, May 2021. | DOI: 10.1097/ACM.0000000000004001
Dyrbye LN, Wittlin NM, Hardeman RR, Yeazel M, Herrin J, Dovidio JF, Burke SE, Cunningham B, Phelan SM, Shanafelt TD, van Ryn M. A Prognostic Index to Identify the Risk of Developing Depression Symptoms Among U.S. Medical Students Derived From a National, Four-Year Longitudinal Study. Acad Med. 2019 Feb;94(2):217-226. doi: 10.1097/ACM.0000000000002437. PMID: 30188367.
Goebert, Deborah DPH; Thompson, Diane MD; Takeshita, Junji MD; Beach, Cheryl PhD; Bryson, Philip LCSW; Ephgrave, Kimberly MD; Kent, Alan PhD; Kunkel, Monique MD; Schechter, Joel PhD; Tate, Jodi MD. Depressive Symptoms in Medical Students and Residents: A Multischool Study. Academic Medicine 84(2):p 236-241, February 2009. | DOI: 10.1097/ACM.0b013e31819391bb
Mousa, O. Y., Dhamoon, M. S., Lander, S., & Dhamoon, A. S. (2016). The md blues: Under-recognized depression and anxiety in medical trainees. PLOS ONE, 11(6), e0156554. https://doi.org/10.1371/journal.pone.0156554
Moutier, Christine MD; Norcross, William MD; Jong, Pam MD; Norman, Marc PhD; Kirby, Brittany MSW; McGuire, Tara MS; Zisook, Sidney MD. The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine. Academic Medicine 87(3):p 320-326, March 2012. | DOI: 10.1097/ACM.0b013e31824451ad
Notebook LM. (2024). Google. https://notebooklm.google.com/ (retrieved 12/17/2024) (Notebook LM’s summarize feature was utilized for understanding some of the complex sources and research within this subject. None of the content was plagiarized as it was simply used for a better understanding. These ideas from AI were revised and refined to fit the subject of this paper.)
Chat GPT (2024). https://chatgpt.com/ (retrieved 12/17/2024) (Chat GPT was used in aiding the correction of grammar, spelling, and sentence structure of the final paper. All suggested corrections were assessed and reviewed for accuracy.)
Schwenk TL, Davis L, Wimsatt LA. Depression, Stigma, and Suicidal Ideation in Medical Students. JAMA. 2010;304(11):1181–1190. doi:10.1001/jama.2010.1300
Thompson, Diane MD; Goebert, Deborah DrPH; Takeshita, Junji MD. A Program for Reducing Depressive Symptoms and Suicidal Ideation in Medical Students. Academic Medicine 85(10):p 1635-1639, October 2010. | DOI: 10.1097/ACM.0b013e3181f0b49c
