Fallible: A Memoir of a Young Physician’s Struggle With Mental Illness

Book Title: Fallible: A Memoir of a Young Physician’s Struggle With Mental Illness

Author: Kyle Bradford Jones

Publication Information: Castroville, TX, Black Rose Writing, 2020, 333 pp., $21.95, paperback

“I have major depressive disorder and generalized anxiety disorder” (p 1), says Kyle Bradford Jones, MD, an associate professor of family and preventive medicine at the University of Utah. His intended audience includes individuals who suffer from mental illness as well as “anyone who interacts with someone with a mental illness” (p 2). The book is written in simple prose; even the segments that explain key concepts like anxiety and depression are for the most part easy to follow, so its message can be understood by “all of us.”

Fallible includes information about residency training as experienced by the author; although regulations have since changed to mitigate the “torture” (p 24), the message rings true to those exposed to similar circumstances and is vividly described for those who were not.

This memoir spans 11 chapters. The first shows the author in a season of struggles during residency, leading to loss of empathy, and introduces his concept of anxiety as a disorder: dread amidst ideal circumstances, different from normal anxiety that may be provoked by present happenings. He illustrates normal anxiety in chapter two using a baseball game his team lost after he made a “momentary show of poor athleticism” (p 35), talks about his early years, then discusses the Diagnostic and Statistical Manual, 5th Edition’s criteria for anxiety. In chapter three he is a missionary in Ukraine; although regular engagement in religion and spirituality has been thought protective against mental illness, Kyle says “it’s not religion itself that affects mental health; it’s how we individually relate and interpret it” (p 70). Chapter four documents his successful quest for medical school admission and how he met his wife Becki; it also presents his first panic attack, the subsequent diagnosis of generalized anxiety disorder after the “wind of anxiety” had built slowly for 10 years, and the author’s first experiences with pharmacotherapy (helpful despite side effects) and counseling (disappointing). Chapter five covers the author’s starting medical school 1,000 miles away from extended family, having moved with his wife and baby son Weston. In his excitement he stopped his anxiolytic. Anxiety grew as he struggled to keep up with study material and grades; it worsened when his wife showed signs of postpartum depression complicated by seasonal affective disorder. He did a second trial of medication and counseling, neither of which went better than the first. Chapter six shows the author working through different medical school rotations with some difficult preceptors, and the jading effect that had on him. He discussed outbursts of anger at his young sons that may have stemmed from anxiety; he saw Weston develop fear of wind after a tornado.

Dr Jones chose family medicine because it offered “the potential and expectation of looking at patients in their entire lives” (p 191), and he matched to a community hospital in Utah. In chapter seven, the author documents his life as an intern and shows him sinking into depression while working with a depressed senior resident, disconnected or shady attendings, and a hospital that seemed not to value quality care. Chapter eight contrasts burnout and mental illness; Kyle used the SIG-E-CAPS mnemonic to show he was depressed. Notable in chapter nine is how Kyle surprises himself by showing open frustration with a patient who declined a precious placement opportunity; fortunately, the patient saw the breakdown as a display of empathy. Chapter ten gives an account of his becoming faculty in his program on completion of residency, which brings some relief from anxiety, and allows more availability to his family. However, soon after, Kyle was named in a lawsuit brought by a patient of a resident that was settled out of court 2 years later, but the process wore on him. The closing to chapter eleven closes with the author’s reflection, “I hope, and thus I am whole” (p 332).

The book is a good value for the price and I am unaware of any similar memoirs. I see Fallible as an engaging, well-written exposé of how persons with mental illness see life; reading it can improve the ability of a primary care practitioner to support patients through treatment. I believe its message to young people (and their parents) is that they can achieve real success despite pervasive anxiety. Indeed, Fallible is a noble contribution toward the destigmatization of mental illness we all hope for. I recommend it to present and future practitioners of primary care, from premedical scholars to residents and fully-licensed providers, to help them calibrate their own journeys and/or mentor those coming along with and after them.