[Editor’s Note: Born and raised in Cleveland, Ohio, Maggie Musso (née Skoch) earned a BA in Theology at the University of Notre Dame, where she developed a passion for working with and serving people with mental illness. During her senior year, she worked as the intern in the Division of Student Affairs on projects related to student mental health and was honored with the 2016 Student Voice of Mental Health Award by The Jed Foundation. She is now a fourth-year medical student at the Loyola University Stritch School of Medicine and will graduate with her MD and a concurrent MA in Bioethics and Health Policy in May. In addition to her clinical education, Maggie continues to develop her medical and psychiatric knowledge through her work as an intern with non-profit mental health advocacy organization, The Kennedy Forum, and as the co-director of a new wellness curriculum at Stritch. She spoke to Charles Camosy.]

Camosy: You’ve said that you became a medical student because you were a theology major. Could you unpack that somewhat surprising statement for us?

From the beginning of my undergraduate education, I intended to pursue a career as a physician. If you asked me why, I would have said something generic about helping others and being a lifelong learner. I also planned to select a major in the humanities, perhaps psychology, as I figured the pre-med courses preceding four years of medical school would offer sufficient engagement in the sciences. However, after a captivating introductory theology course, I was swept away by the exploration and study of mystery and meaning, the celebration of liturgy, the study of ancient texts, and the questions of life, death, suffering, and what it means to be human. This education of my mind and heart reshaped how I perceived the world and my place in it. Through the study of theology, I came to understand medicine as my vocation; sharing my gifts through service to my community as a physician is my response to this calling. I will be forever grateful to the University of Notre Dame for its world-class Theology Department, as well as its inclusion of two theology courses in its core curriculum. I may still have gone to medical school if I had not studied theology, but I imagine I would be a very different kind of physician without this education.

You took a gap year during your undergraduate experience that was very formative for your future vocation. Can you say more about this?

As a young teenager, I was diagnosed with Obsessive-Compulsive Disorder. I am blessed with two attentive parents who recognized my need for psychiatric assistance, and I did fairly well with limited medication management during the critical adolescent years. Despite this stability, the changes and stressors of college proved that I would need more than medication to effectively manage this illness.

I ultimately elected to take a yearlong medical withdrawal from Notre Dame during my sophomore year in order to participate in intensive treatment for OCD. This involved engaging in weeks of exposure therapy, a form of systematic desensitization in which I faced my worst fears (the obsessive, intrusive thoughts), avoided engaging in compulsions, and allowed my anxiety to elevate, peak, and decrease on its own. I was stunned – it worked. I have experienced sustained remission of the symptoms of OCD since then, and I will be forever grateful to the compassionate providers who accompanied me on a journey that involved some of my worst days.

Maggie Skoch Musso. (Credit: Courtesy to Crux.)

Inspired by the challenges that I faced during my withdrawal from and readmission to Notre Dame, I became involved in a multitude of mental health initiatives. I initially served as the President of the student chapter of NAMI (National Alliance on Mental Illness). I ultimately worked as the student intern to the Associate Vice President for Student Services during my senior year at Notre Dame to coordinate projects to promote and improve student mental health and enhance communication between students and administrators regarding this critical issue. Upon matriculation to medical school, I interned with The Kennedy Forum, where I learned about issues related to mental health parity, and developed a wellness curriculum for the pre-clinical students at Loyola in response to the disproportionately high rates of burnout and suicide in the medical profession.

Throughout my medical education, I have become increasingly aware of the disproportionate burden of psychiatric illness in people who are homeless or incarcerated, as well as the good work done by people like DJ Jaffe and organizations like Clubhouse International to advocate on behalf of those with serious and persistent mental illnesses. I love the field of psychiatry in its own right for its breadth, depth, and profound mystery. However, it was my own experience with a mental illness that was the spark for this passion.

As I mentioned before, the study of theology, and the formation from the good, kind, and brilliant people I met along the way, lead me to see my experiences in the light of vocation. I despise the phrase, “Everything happens for a reason,” a platitude that is frequently offered in response to difficult circumstances. It is an understandable and incredibly human reaction to pain and suffering, but it is ultimately absurd and lacking in honesty.

Do all manner of tragedy, death, and pain truly happen “for a reason?” In my experience living with OCD, there were many fractures to my heart, and yet so much beauty as come forth. This experience, though horribly painful, was a gift. It is a gift I am now called to give away in love. I share a unique sense of empathy with those for whom mental illness is a part of life. I owe my health to the compassionate providers who cared for me, and I hope to do the same for my patients. In particular, I hope to work closely with patients who have serious and persistent mental illnesses who are too often failed by a broken system – I was fortunate to have the support and resources needed to treat and manage my illness, and it is an affront to human dignity that such support and resources are often inaccessible to those in greatest need. I am committed to my vocation because of the people for whom I am, and will always be, privileged to care.

Thank you for being so open and direct about your experiences. You’ve rightly pointed out that there is relative silence in the Catholic Church on these issues. Especially when the mental illness is serious. Why do you think that is?

There are likely several factors contributing to this relative silence. Until relatively recently, the Church would not permit the celebration of the funeral Mass or burial in a Catholic cemetery for one who died by suicide, as this was viewed as a mortal sin. The Church’s response to the profound tragedy of suicide has fortunately evolved in light of increasing medical knowledge and improved pastoral care to its present teaching, namely that the gravity of mental illness and its associated suffering diminishes the responsibility of the one who dies by suicide. However, this history, as well as ongoing misunderstanding and occasionally inappropriate pastoral care creates an unsteady foundation for building a more robust approach regarding mental illness.

In addition, there are unique points of contact between mental illness and the Church that can be challenging if mishandled. Faith communities are a natural source of support for people with mental illnesses, in addition to appropriate medical care. However, those who provide pastoral care may feel uncomfortable supporting people with mental illnesses, especially those who experience symptoms of a religious nature (i.e., auditory hallucinations of the voice of God, scrupulosity-related OCD), leading to silence on such challenges.

Finally, this relative silence parallels the quietness of this conversation in society at large. Psychiatry is one of the latest-blooming fields of medicine – effective treatments have only been around for approximately 50 years and our diagnostic approach is still largely based on clusters of symptoms. The brain is truly the last frontier in medicine – with greater knowledge, I anticipate the volume and frequency of these conversations in the Church and in society will continue to increase.

Back to theology again. Do you think a better theology of mental illness could help? You’ve pointed out that there is lots of good stuff on disability, but most of it isn’t quite applicable to people with mental illness, right?

Right. There is a rather robust theology of disability that has been developed and articulated by various key thinkers, including Jean Vanier and Stanley Hauerwas. I have always been taken with its beauty and authenticity, and I think it has provided an important framework for being in relationship with people with disabilities. However, it is not quite applicable to people with mental illnesses, at least not in a one-to-one fashion. I recommend the writings of Abraham Nussbaum, John Swinton, and Warren Kinghorn for an exploration of mental illness and theology.

I am not prepared to offer a lengthy theology of mental illness in this Q&A (although it is a project that I am eager to pursue!), but I will say this: People with mental illnesses, like all people, are made in the image of God and imbued with profound dignity. As Dr. Nussbaum points out in a recent essay, the first psychiatric hospital in Western society was actually founded by a Catholic priest. The Church has a rich tradition of loving and caring for those on the margins, and it has an opportunity to dive into the brokenness and the beauty of its members who live with mental illnesses.

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