The Alluring Mistress: Reflections From My Affair With Medicine

Frank A. Clark, MD;

Society is fraught with infidelity. According to the American Association for Marriage and Family Therapy, national surveys indicate that 15% of married women and 25% of married men have had extramarital affairs.¹ We are aware of the acute and chronic deleterious effects that these nefarious behaviors can have on the family unit. They include distrust, low self-esteem, depression, and anxiety.^2,3 Often, affairs are in response to an individual’s attempt to fill a void in their relationship—to find something that they feel is missing. They ingest a concoction filled with enticing nutrients that provide the false promise of dopaminergic zeal. This promise quickly fades, leaving the soul once again parched and searching for its next lover.

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We as physicians are not immune to this gravitational pull toward extramarital affairs. I can attest to this as someone who has been involved with my mistress throughout my career. She tempts you with long leadership titles in your signature line when sending emails. She whispers in your ear that ascending the social/professional ladder is the true meaning of success. She recognizes your moxie and suffocates you with unrelenting opportunities. She masquerades as an angel in a white coat, but her looks are deceptive. Her name is Medicine.

Throughout my life, family members, friends, and colleagues have posed the same question to me again and again: “Frank, do you ever slow down?” I would usually smile in response to their query and figure out how I could rationalize my pervasive hustle. In retrospect, I was in denial. Until recently, I did not have the courage to say, “I do not know what it is like to slow down.” Unfortunately, this denial would hunt me like a ravenous lion throughout my residency and for my first few years as an attending psychiatrist.

There is truth to the idiom that hindsight is 20/20. Years of therapy can help to foster insight and to bring unconscious behaviors and beliefs to our conscious awareness. My hustle, I came to realize, was rooted in a core belief that my identity was based on success in the forms of accolades and titles. Resting on my laurels was not an option for me. I started engaging in further exploration of myself. Of course, like any good psychiatrist, I had to reflect on how my childhood shaped these core beliefs.

I grew up in a single-parent household in which my mother, a now-retired Chicago public school teacher, was intent on keeping my mind ever occupied. The importance of education was ingrained in me from an early age. My mother’s goal was to ensure that I was exposed to diverse educational experiences that would prepare me for my future. That exposure extended into the fine arts. I developed an affinity and passion for music and dance at an early age. I grew up playing several instruments and I enjoyed learning different forms of dance—tap, ballet, jazz. I enjoyed the exposure, but it came at a cost. I was always on the go with no time for solitude or respite. There was no such thing as a Sabbath in our house. Monday through Fridays consisted of school and music and dance lessons, and on Saturday and Sunday, I would practice my instruments from 5 AM to 3 PM. I became acclimated to this routine but, in retrospect, I see that it set me up for a trajectory that would lead to burnout.

My journey through high school and college presented arduous but not insurmountable challenges. That all changed in medical school. I received the ultimate blessing—a full-tuition scholarship—but it was ultimately rescinded due to my academic struggles. I was diagnosed with depression, and for the first time in my life I had to sit with an array of emotions, in very unfamiliar and uncomfortable territory. I could not run and hide behind the curtain of busyness that once protected me from my adverse childhood experiences.

Nonetheless, I persevered and graduated from medical school after 7 grueling years, with the aid of my faith, family, psychiatrist, and academic advisors and mentors. Entering residency, I was on a mission to prove that I belonged in the herd of white coats. It was then that my mistress made her first appearance, but I refused to acknowledge her presence. This lack of insight would have repercussions.

Residency was an enjoyable and transformative experience for me. I became engrossed in patient care—and in teaching medical students, organized medicine, scholarly activity, multiple committees, and leadership roles. And I joined a local running group, too. Paid time off was primarily utilized for attending conferences and for medical mission trips. Vacations? Unheard of, for me. This cycle continued during my first few years as an attending and eventually spilled over into my personal life.

I consider being a husband and father the 2 most important blessings and accomplishments in life. However, I was not fully present in these roles because I was hyperfocused on my mistress. My identity was about being a successful physician. Most days, I was exasperated, and on occasion, I would even cry in the shower before going into work. The bond between my daughter and me was fragile, and at times, my wife and I were like 2 ships sailing in the wind that could capsize at any given moment. I did not like the person I had become. I was a stranger in my own body that was is need of repentance and rejuvenation.

The providential moment of enlightenment descended upon me when I turned 40 years old. Transformation occurred with the aid of prayer, family support, and numerous sessions with my therapist. I become more aware of and in tune with my true identity. My faith in God has always guided me through the joys and storms of my life. I had to remind myself that my identity lies within him. I realized that being a physician is just part of my identity puzzle. I am a father, husband, son, friend, visionary, creator, and poet.

It is refreshing to rediscover who one truly is in a world that offers the deceptive fruit of success. In October 2021, I advocated for myself and made the transition to a new clinical environment and out of a leadership role. My spirit has been at peace since the transition. I am present more than ever in my wife’s and daughter’s lives. I have had more time to focus on the pieces of my wellness puzzle that I neglected, such as writing poetry. I embrace the power of saying “no” and setting healthy boundaries. I have nothing to prove.

The journey of discovering the self requires a growth mindset and a willingness to admit that we are constantly evolving. My hope is that we all confront our mistresses of life that latch on to our unhealed wounds. The love affairs will persist and invade various areas of our life, until we finally face vulnerability in the mirror and embrace it.

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times™.