Marco Antonio Ramos

Campus activism and the recent surge of academic interest in the history of science and race, especially through the study of slavery and eugenics, has pushed universities to reckon with their legacies of racism ( Willoughby, 2022 ). A variety of “anti-racist” programs have emerged that claim to challenge racial discrimination, from mandatory implicit association testing to university-sponsored historical research on slavery and offices of diversity, equity, and inclusion.

Across the global South during the Cold War, US-sponsored regimes “disappeared” thousands of people through imprisonment, murder, and torture to stem the tide of Communism. This essay turns to disappearance as a case study for opening up a new direction in the historical study of violence. Rather than focusing on what violence did in the past—its causes and consequences—I present an ontological method for analyzing the reality of terror, for tackling the question of what violence was. In the 1970s, the reality of disappearance shifted across time and place, emerging as a human rights violation in Europe, then as a biomedical syndrome, and finally as a “haunting” in Argentina. These multiple realities were constituted through material practices along postcolonial networks, from forensic analysis of gravesites to psychological work with survivors. This essay traces how these practices fixed the reality of disappearance—the kind of “thing” it was—which determined the meaning of justice in the wake of terror. Ontology raises pressing questions about how violence's reality gets made today and who has the right to speak for victims, like the disappeared, who cannot speak for themselves.

In 1813, the American government passed An Act to Encourage Vaccination, the first federal endorsement of a medical practice in American history. The law tasked a federal agent with maintaining a supply of the smallpox vaccine and distributing it nationwide. James Smith, a well-respected physician and proponent of vaccination, was appointed as vaccine agent. Smith was skeptical of claims that only well-trained physicians should be allowed to perform vaccination; he felt it was a simple procedure that should be available to all American citizens. In 1822, he made a tragic error that caused several deaths and left him vulnerable to criticism from political opponents and his medical peers. This ended Smith’s professional career and led to the repeal of the act itself. In this article, we use the rise and fall of James Smith to provide a historical perspective on contemporary debates surrounding delayed vaccination schedules. We explain how physicians—in the 19th century and today—have worked to build public trust in vaccination in an American culture suspicious of medical expertise.

Studies have suggested that medical students experience high rates of depression and suicidal ideation.¹ However, estimates of the prevalence of depression or depressive symptoms among students vary across studies from 1.4% to 73.5%,^2,3 and those of suicidal ideation vary from 4.9% to 35.6%.^4,5 Studies also report conflicting findings about whether student depression and suicidality vary by undergraduate year, sex, or other characteristics.^6-11

Purpose: To compare the subjective experiences of interns with and without symptoms of depression using a mixed-methods approach. Method: In 2007–2008, interns from six institutions were screened for depression before and during internship using an online survey that included the Patient Health Questionnaire (PHQ-9). At the end of internship, participants were asked what made the year difficult, easy, and memorable, and how they had changed. Computerized lexical and qualitative thematic analyses were performed to analyze their free-text responses. Results: Sixty-three percent (244/388) of invited interns participated in the original cohort study. Of those, 42% (103/244) answered the open-ended questions for this analysis. Thirty-five percent (36/103) screened positive for clinically significant depression (i.e., PHQ-9 score ≥ 10) during their intern year. Respondents with symptoms of depression were more likely to report problems with cynicism, exhaustion, and stress, while those without them were more likely to mention positive patient care and educational experiences. Respondents with symptoms of depression preferentially described experiences that “broke” their confidence, sense of well-being, and belief in the medical profession, while those who did not described profoundly positive, life-changing experiences regarding interactions with patients and supportive colleagues, through which they grew personally and professionally. Conclusions: Depression during internship affects not only objective outcomes like medical errors but also how interns value the profession and themselves, with potentially profound consequences for their future career decisions. Residency programs should implement reactive interventions targeting depression and proactive interventions promoting resilience and well-being to address the issues that lead to depression.

In Reply Ms Levis and colleagues comment on our finding of high levels of depression and depressive symptoms among residents—based primarily on data from self-report inventory studies—and question whether these levels are truly elevated compared with criterion-based MDD in the general population. We included multiple subanalyses to assess whether the depression found in residents was due to inaccurate self-report inventories rather than a true increase in pathology. In a subanalysis examining 7 prospective studies on more than 4200 residents using the same inventory to assess depressive symptoms before and during residency, we found a median absolute increase in symptoms of 15.8% (relative risk, 4.5) with the onset of training. This analysis, which controlled for inventory and cutoff score, showed that the prevalence of preresidency depressive symptoms was essentially the same as that of the general population and suggests that the depression levels identified in the primary studies were an effect of residency. If Levis and colleagues were correct that elevated resident depression was an artifact of self-report inventories, then spuriously elevated depression levels would likely have appeared in the preresidency assessments as well. However, this was not the case.

Studies have suggested that resident physicians experience higher rates of depression than the general public.^1-5 Beyond the effects of depression on individuals, resident depression has been linked to poor-quality patient care and increased medical errors.^6-8 However, estimates of the prevalence of depression or depressive symptoms vary across studies, from 3% to 60%.^9,10 Studies also report conflicting findings about resident depression depending on specialty, postgraduate year, sex, and other characteristics.^4,11-13 A reliable estimate of depression prevalence during medical training is important for informing efforts to prevent, treat, and identify causes of depression among residents.¹⁴ We conducted a systematic review and meta-analysis of published studies of depression or depressive symptoms in graduate medical trainees.