Healing The Healers
Reclaiming Mental Health in Oncology
“What would healthcare look like if those who heal were also given the space to heal themselves?”
Coral Olazagasti, MD and Dalissa Nevarez, Psy.D
Burnout in medicine has been widely described in the literature (Balch et al., 2011; Kumar, 2016; Wallace et al., 2009). The World Health Organization defines burnout as a “syndrome of chronic, unmanageable workplace stress” (World Health Organization [WHO], 2019). In oncology, a field steeped in life-altering decisions, loss, and high emotional stakes, burnout rates can reach up to 60% (Medscape, 2023). But beneath the layers of overwork, administrative burden, and emotional fatigue lies an even more insidious problem: the silent epidemic of mental illness in those trained to heal.
Oncology is uniquely grueling. Beyond managing treatment toxicities and high patient volumes, we face insurance barriers, prognostic uncertainty, and goals-of-care conversations that often edge into grief and loss. The emotional toll doesn’t end when we leave the clinic. It lingers in our bodies, in the way we interact with our families, in the heaviness of persistent loss. Burnout, though a distinct clinical entity, often overlaps with depression and anxiety (West et al., 2016). Studies have shown that burnout contributes to up to 72% of physician-reported depression (Brazeau et al., 2014). Yet, the subjects of depression and suicidality remain relatively untouched in oncology literature, even as physician suicide claims an estimated 400 lives each year in the United States (Oreskovich et al., 2012). For women physicians, the suicide rate is 250–400% higher than women in other professions (Oreskovich et al., 2012).
Why is this happening in a community so deeply committed to saving lives? Part of the answer lies in the culture of medicine itself, which values resilience and stoicism, sometimes to a fault. Vulnerability is quietly equated with weakness. The stigma around mental illness among physicians remains deeply entrenched. In one survey, 40% of physicians believed their peers with histories of anxiety or depression were less competent (Women in Medicine, 2022). Nearly the same proportion admitted they would avoid seeking mental health treatment for fear of professional repercussions, including threats to licensure (Federation of State Medical Boards [FSMB], 2018).
The Personal and Professional Toll: A Personal Experience of Dr. Olazagasti
As oncologists, we routinely offer compassion to others yet struggle to extend it to ourselves. Our identity is built around caregiving, strength, and control. But what happens when the very work that defines us also erodes us?
Dr. Olazagasti explains “I know this from experience. During my second year as an Assistant Professor, while juggling a demanding oncology practice and adjusting to life with a newborn, I began experiencing postpartum anxiety. Intrusive thoughts about death consumed me. The thought of leaving my children behind was unbearable, and the weight of delivering difficult news at work while trying to be emotionally present at home nearly broke me. I sought help: first, through my OB/GYN, who prescribed Zoloft, and then through institutional channels that led to more frustration than relief”.
She continues “When I searched online for mental health resources tailored to oncology physicians, I found pages of articles about supporting patient with cancer, but not the physicians who treat them. It’s clear why many studies focus on the mental health of patients with cancer, but it’s less obvious why the same attention isn’t given to oncology physicians. I called my insurance and found that we only have covered care with a therapist with less specialized training than trained psychologists, which reflects a broader systemic issue. The therapist I was paired with was well-meaning but lacked the clinical skill to address my needs, so I decided to explore a new avenue. I turned to a program partnered with ASCO, only to discover that most listed therapists weren’t accepting new patients.”
Dr. Olazagasti and Her Search for Healing
“Eventually, I found a therapeutic outlet in boxing”, she recalls, “What began as a fitness outlet became something deeper: a physical space where the grief, anger, and helplessness I had been taught to repress could finally move. With a prescription for Zoloft and a pair of boxing gloves, I began to feel like myself again. But I knew the deeper issue remained: why is it so hard for physicians, especially oncologists, to access meaningful mental health support?”
Beyond personal experience, there is increasing scientific evidence supporting the use of embodied practices like boxing for health professionals dealing with accumulated, unmetabolized survival energy—what we might understand as persistent physiological stress responses (such as dysregulated cortisol and adrenaline levels) that remain trapped in the body (Yehuda et al., 1995). Research shows that high-intensity physical activity, particularly combat sports, can serve as a somatic discharge for these lingering survival signals, helping to recalibrate the autonomic nervous system and reduce symptoms of chronic stress, depression, and anxiety (Van der Kolk, 2014; Gordon & Lindgren, 2010). However, while boxing offers a potent outlet for discharging physical tension, it should never be seen as a substitute for therapy. Just as exercise may help reduce the risk of cancer but cannot treat malignancies once established, true emotional health requires deep, reflective work to decode and resolve root psychological conflicts.
To understand this more fully, we need a psychological lens, one that goes beyond burnout statistics and into the emotional architecture of those drawn to medicine.
A Trauma-Informed Perspective: Through the Lens of Dr. Nevarez
Dr. Dalissa Nevarez, a clinical psychologist specializing in trauma, adds another layer: “in my work, I’ve encountered psychologists, physicians, and nurses who carry the silent belief that their worth is tied to their ability to heal and serve others. Even as their bodies break down or their minds become weary, the impulse to continue often outweighs the instinct for self-preservation”.
Beneath this drive lies unprocessed grief, guilt, and emotional neglect, wounds that may have never been named but still echo in how these professionals prioritize others’ needs over their own. This is particularly evident in specialties like oncology, where mortality is ever-present. The psychological weight carried by oncologists, who must deliver life-altering news while walking with patients through treatment, decline, and death, is immense. From a trauma-informed lens, oncologists face unique psychological risks: vicarious trauma, secondary traumatic stress, moral injury, and compassion fatigue (Meier et al., 2001). These challenges intensify when a patient’s suffering resonates with a clinician’s own unhealed wounds. Emotional merging or over-identification can blur professional boundaries and evoke a sense of failure when outcomes fall beyond one’s control.
From a psychodynamic lens, unprocessed grief—especially when personal loss overlaps with patient stories—amplifies vulnerability to burnout and moral injury (McWilliams, 2011; Winnicott, 1965). Many oncologists enter the field with personal histories of loss, and unconsciously reenact attempts to ‘save’ others as a way of repairing what was once irreparable in their own lives. These reenactments serve a dual purpose: they are both an act of care and an unconscious wish for mastery over prior trauma (Kernberg, 1984). Recognizing reenactments is crucial, as they shape emotional reactions and may perpetuate cycles of guilt when outcomes inevitably fall short.
Many healthcare professionals are “people pleasers” by nature or survival. Their emotional radar is finely tuned to others' needs, often because they learned early on that their own needs would go unmet. When one is unable to voice their pain due to shame, injustice, or punishment, it becomes trapped within. The residual unused energy for survival—adrenaline, cortisol, and other stress responses—turns inward. Another way we describe this is as repressed anger, which doesn’t disappear; it turns inward, leading to depression, exhaustion, suicidality, and quiet self-abandonment, disguised as self-sacrifice (Kumar, 2016). This accumulated survival energy has also been linked to underlying chronic physical conditions—such as cardiovascular disease, autoimmune disorders, and chronic pain—as demonstrated by research on Adverse Childhood Experiences (ACE) and the neurobiology of trauma (Felitti et al., 1998; Van der Kolk, 2014).
“For Dr. Olazagasti, boxing became more than a physical release; it became a space where the accumulated survival energy of grief—what we might think of as residual stress responses, like unprocessed cortisol surges—could finally metabolize. Without an outlet, this kind of survival energy festers and embeds itself somatically. In the ring, it was allowed to discharge. It became survival,” explains Dr. Nevarez.
Choosing to practice the field of oncology may reflect an unconscious attempt to master earlier experiences of abandonment or powerlessness. Many healthcare providers recognize parts of themselves in their patients, parts that once went unseen or uncared for. (Meier et al., 2001). In trying to save others, they may be reenacting a wish to rescue parts of themselves that were never held, protected, or soothed.
At times, this can evolve into a "savior complex" an unconscious drive to repair something unresolved within. When the outcome is unfavorable, as it often is in advanced illness, the collapse of this fantasy leads to guilt and shame. This ties into the concept of moral injury: the distress providers feel when they are unable to prevent suffering, especially when systemic barriers prevent them from acting in alignment with their values. This sense of failure is compounded when providers are seen as the last source of hope, shouldering the impossible expectation of reversing irreversible decline (Shanafelt & Noseworthy, 2017).
Repeated moments of bearing witness to decline, delivering devastating news, and feeling emotionally entangled gradually wear down even the most resilient clinician. Without space to process these experiences, clinicians may spiral into burnout, depression, or compassion fatigue. These moments can also reopen old wounds of not being rescued or protected. In caring for others, clinicians often give what they never received offering themselves the care that was once missing.
Moreover, repeated exposure to suffering and helplessness carries a heavy psychological toll. Clinicians who carry unresolved wounds of their own are at risk of becoming entangled in patients’ pain, blurring personal and professional boundaries. Without spaces for deep psychological processing, the emotional residue of witnessing death and decline may accumulate, manifesting as somatic symptoms, emotional numbing, or chronic exhaustion (McWilliams, 2011; Meier et al., 2001). This highlights the need for structured therapeutic spaces tailored to healthcare workers—not just for crisis intervention but for sustained emotional maintenance.
Physicians with a history of perfectionism, shame, or early helplessness often can have an unconscious need to always appear in control. This manifests as a belief in omnipotence, the sense that "I can handle it all", which functions as a defense against vulnerability. (Shanafelt & Noseworthy, 2017). However, the cost is high. These internalized demands are reinforced by healthcare systems that are rigid and dehumanizing. Systems that expect perfection while shaming the vulnerability of those meant to heal others.
However, we cannot rely solely on clinicians to seek support on their own. When burnout, depression, or anxiety set in, the very symptoms of these conditions make it hard for providers to reach out. Anhedonia, apathy, and shame can create internal barriers, silencing the need for help. This is why access alone isn’t enough, we need visibility, encouragement, and repeated reminders that mental health care is both available and deserved. We must intervene before things fall apart. Leaders within medicine need to model this shift, demonstrating that taking care of one's mental health is not a sign of weakness, but a professional imperative. (Wallace et al., 2009). By normalizing reflection and emotional support, leaders can send a powerful message: healing ourselves is part of protecting the next generation of healers and improving the healthcare system as a whole.
The Invisible Cost of Compassion: Suicide Among Physicians
This issue becomes even more urgent when considering the disproportionately high suicide rates among physicians. From a psychodynamic perspective, this isn’t just about job stress, it’s about what happens when repressed anger, hopelessness, and helplessness are turned inward with no outlet. (Oreskovich et al., 2012). When emotional pain has nowhere to go, it takes root and begins to feel inescapable, even for those trained to heal others. The cancer that oncologists are trained to treat is not just external, it also grows inside the minds of providers, fed by chronic stress, moral injury, and the systemic realities of working in a system that often doesn’t care. The relentlessness of trying to find solutions, the commitment to patients, and the unwillingness to give up on them, make healthcare workers extraordinary. But this very same drive makes them vulnerable to collapse.
Without spaces for psychological reflection or specialized care, these patterns don’t shift. Healthcare providers deserve better. They deserve places where they can process their pain. Especially in systems that obstruct care, such as those driven by insurance and bureaucracy, the helplessness and frustration providers experience often echo earlier wounds when no one fought for them, when they were told to keep going, even while breaking. Yet, even as these burdens accumulate, shame keeps them silent. Expressing emotional pain can be seen as weakness, even risk.
And perhaps the most dangerous reinforcement of suffering is the silence surrounding it. The emotional equivalent of feeding cancer allowing it to grow because naming it would force us to admit that even healers are in pain, that they too need healing, that they too carry wounds.
A Call to Action
We must redesign our systems. Institutions should offer on-site or virtual therapy with psychologists trained in physician mental health, reduce administrative burdens, create quiet spaces or chapels for reflection, and develop peer support programs. These aren’t luxuries. They’re lifelines. (Shanafelt & Noseworthy, 2017; APA, 2022).
But perhaps even more urgently, we need to dismantle the deep psychological scripts that tell us we must be invulnerable to be effective. We must ask: What wounds am I still carrying? Where did I learn that self-neglect is strength? What would it feel like to let someone care for me, too? As an oncology community, organizations and physicians each have a responsibility to openly address the stigma surrounding mental health, foster open communication, and create a safe environment for oncology practitioners. It's crucial that we openly discuss the high rates of depression and anxiety within our field and work to develop strategies for early education and intervention.
The oncology community is filled with mission-driven individuals. But without reflection and repair, that same passion can become lethal. If unaddressed, the emotional toll becomes a slow-growing malignancy, one that eats away at the very clinicians we depend on to save others. Let us build institutions that honor the full humanity of physicians, that recognize emotional labor as real labor, that offer mental health care as a right, not a reaction. Let us normalize emotional reflection, not as a fringe activity but as essential clinical hygiene. Let us train the next generation of oncologists to ask not only, “What does my patient need?” but also, “What do I need to continue this work with integrity and presence?”
Healing the healers is not just a clinical call. It’s a moral one. It is time we met the emotional needs of oncology physicians with the same urgency and compassion we offer to our patients. Because even healers need healing. and until we name that truth, we will continue to lose the very people we depend on to save others.
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