It’s no wonder mental health stigma still exists surrounding issues like depression, bipolar disorder and schizophrenia.
Physicians who are the front-line treatment providers for mental health issues don’t always recognize the value of mental health professionals for their own mental health needs. Or they recognize the value, but don’t use them because of concerns about privacy and confidentiality. In a just-published survey of 3,500 doctors in the UK, researchers found:
Nearly three quarters of respondents said they would rather discuss mental health problems with family or friends than seek formal or informal advice, citing reasons such as career implications, professional integrity, and perceived stigma of mental health problems.
Let’s go through some of those reasons. Career implications? If an organization is going to deny you career advancement because you’re being honest about a mental health condition, perhaps that’s a sign you need to find another organization to work for. Or work to change such mid-century, backwards thinking from within the organization. Would an organization rather a doctor work while depressed, potentially harming his or her patients because they aren’t as interested in the patients’ complaints and rigorous diagnosis?
Professional integrity? What kind of doctor has any integrity if they are not being honest with themselves about their own lack of treatment for treatable mental disorders? Could you imagine a doctor walking around with a broken arm, because getting it treated would somehow impact their integrity? Really?
And stigma. This is what it all really boils down to. I guess doctors don’t realize they are only perpetuating the cycle of stigma, by avoiding such treatment themselves. And whether they admit it or not, such thinking can’t help but influence the way they portray behavioral health treatments to their patients.
The researchers suggest that one of the big concerns amongst these UK physicians is the doctors’ privacy and confidentiality. In the UK, doctors are members of the National Health Service, and so they may be afraid that by seeking treatment within the same system, it will be used against them in the future. That’s a legitimate concern, and one that could be easily corrected by adding additional privacy protections for such professionals.
I know this is the same reason many in the military do not seek out treatment — because it can affect their career advancement, security clearance, and their perceived reliability or stability by others in their unit. In a system where such information is too readily available to others, and the group of people is dependent upon the system for their own career, well, you can see how the two will inevitably clash.
But none of this is of much concern when it comes to most (but not all) physical diseases. Which suggests that this is, at the end of the day, primarily about our old friend stigma. Career advancement would not be an issue of others did not stigmatize those with mental health issues. Science now recognizes that mental health concerns don’t come from people’s personal weakness, but rather from a complex interaction of biology, brain, genes, psychology, and social connections.
It’s high time for organizations like the UK’s NHS and others to work toward ridding our world of such stigma and ignorance, and stop the discrimination against professionals who have a mental health concern. If you lead, others will follow.
Physicians Avoid Mental Health Care
20 comments
“Physicians who are the front-line treatment providers for mental health issues don’t always recognize the value of mental health professionals for their own mental health needs. Or they recognize the value, but don’t use them because of concerns about privacy and confidentiality.”
Maybe they don’t use them because they don’t have a good impression of how effective they are in treating the illnesses?
The stigma is very real and you better expect to be discriminated against if you are resposibly trying to take care of a mental health issue and any one finds out about it. It is a problem I lost a brother to. I don’t know how to fight it but I really appreciate this blog and those who do fight to break the stigma. This is one problem that a negative stigma definetly perpetuates.
I was diagnosed at 15 years old of Bipolar Disorder and am now 34 years old. I began having problems at 7 years old and also began educating myself on this problem including University Neuroscience and Pharmacology as the doctors weren’t helping and I was hoping to find my own path of healing and I have but it has taken about 15 years.
I have experienced the worst stigma from working within the field and continually lie and feel shame for my problems even though they in no way are my fault.
Thanks for this article. Due to all my experience of stigma and discrimination, I am now striving for being a lawyer to really help those with mental health and addiction issues within the system through implementing better science and upholding laws relating to disabilities and discrimination.
I reckon some doctors avoid mental health treatment because they very sensibly do not want to risk adverse side-effects from psychotropic medication.
Yes, this is a big issue. I think the issue is part of a much larger problem, and/or issue. though.
I used to work on the crisis line at the U of Oregon in Eugene, OR. The University does not have a medical school at this location but it has many other graduate programs.
Now, if I were to say that one group of students in a certain department were much sicker than those in another, I would not only not be taken seriously, but I would be accused of prejudice.
But believe me or not, the quality of research one can do is not limited to …
The ‘sickest’ were by far the ‘Law’ students, and the healthiest the ‘Architecture’ ones.
PS: You can take this as a joke, or not.
I only tell when it is absoutely necessary. And I do mean Absoutely. It’s hard enough just being in an ungrounded state due to “too many questions” and of course, the trust issue.
Hello mentally responsible, I read your post and a lot of people experience stigma, especially young people. I have seen many feel ashamed to speak to their doctor about a mental health concern. In fact, many medical doctors (excluding neurologists) tend to downplay what could be a true mental health concern, or feel they don’t have the expertise to deal with it so they don’t. The patient suffers and lives with something that needs treatment.
It’s a real concern and should continue to be an issue in the forefront of psychology so that we can hopefully eradicate this problem once and for all.
There is a really great organization, one in which I was a member of during my college days not too long ago called Active Minds: http://www.activeminds.org. This website will lead you to a plethora of helpful resources that can help you fight stigma.
It’s an enormous job, but a job well worth pursuing.
Best wishes
p.s. another great one is Mental Health America at: http://www.nmha.org/go/action
What is really important is that we keep calling it “stigma.” That way all the discrimination is hidden behind one word. It is a good tool.
That is what we do with rape is it not? Call it stigma? No? Not any more? Why?
Women taught us. It was a tool to demean and control. Its psychology is very effective. It is a well proven tool.
Harold A. Maio
[email protected]
You will not see a good number of my colleagues in mental health treatment for several reasons, the top of the list being that the pervasive narcissism is not just impossible to treat, but my colleagues cannot accept direction and challenge.
Plus, what meds do you think they do take when they accept a prescription? Benzo’s and other controlled substances first and foremost.
Having spent two separate trials in therapy with psychologists, I am glad I made the effort and can appreciate what the patient is going through sitting across from me.
“Do as I say, not as I do” should be on the walls of most of my colleagues’ offices.
skillsnotfirst
I am bipolar and am now in my second year of PA school. At time of application, I was very guarded with my diagnosis and some of the withdrawals on my transcript which were due to complications of my bipolar disease.
Indeed, I am still very careful in regards to the people with whom I chose to share that information about myself. It is incriminating. I don’t know how many times I’ve seen a flash of surprise or whatever emotion cross a person’s face when I divulge that fact. With the utterance of one word, I go from being a competent person to being a fundamentally crazy person.
Of course, this isn’t the case with everyone, but there are enough stupid people out there, including in the world of medicine, that it is a very difficult topic to address. The stigma shouldn’t still exist, but it does. It’s about a perceived unreliability, unpredictability, and lack of competence, even if you have been nothing but responsible, reliable and competent in the past. It’s usually better to not share.
Those who are in acute distress should seek treatment, and there are organizations and programs for exactly that (although I can’t recall what they’re called at the moment), but they are confidential and designed to address the mental health needs of practitioners in a way that does not jeopardize license or career in medicine.
Options are out there, but I think we’re afraid of each other. How can we weed out the jerks?
One of the biggest problems facing society and especially for the mental health patient is the number of doctors on the front lines who still will not recognize mental illness.I took a family member to our emergency centre( i called to ask if they had access to the mental health wing of the hospital and was told yes, just come right in) and he looked the doctor right in the eyes and told him he was afraid he was going to hurt himself or somebody else. He told him he could not control his emotions or feelings and can never shut his head off so he drinks to try to shut up his thoughts. Then he drinks too much and gets very very angry and does stupid things.
We have been 4 years getting this family member finally to this stage of asking for help. I could not believe my ears when the doctor told him he was just in a bit of depression because of the economy and his home life!!!!!!!! I even repeated to the doctor what was just said, and i said ” did you not hear what he just told you?? He asked to be put in the hospital for help so he doesnt hurt anyone. The doctor laughed , yes laughed, slapped my family member on the leg and said
” the last thing you want is to be over on the physche ward with all the crazies and the schizo’s!!!! A frontline doctor said that to a mentally ill patient who was there asking for help. this family member may very well have schizophrenia and here this doctor is insulting the mentally ill and making a joke of it!! I’ve never felt like striking another human being, but im telling you it took everything i had in me not to drop that doctor on the spot! 4 years of trying to get him help and then a doctor treats him like this!! Absolutley outrageous! I fully believe this doctor should have his license revoked. There is all this talk about mental health being so much more in the open and so much more treatable…. can somebody tell me where to go to find a doctor who will take it seriously?? I have never been so ashamed our medical system. We have tried 2 other places sice then and they only do outpatient visits once a month. Is there no hospital that a mentally ill person can go to and get help anymore?? We will probably never talk him into going back anyway, after the unprofessional and humiliating way he was treated.
Nothing that we are all susceptible to should be “incriminating.” We can all be in each others shoes when it comes to facing mental suffering. It is a shame that something that is so very human can become “incriminating” information when given or spoken about.
That needs to CHANGE!!! Compassion and understanding is very well needed.
As a former surgeon, I have much to say on this topic, but the hour is late. Plus this conversation winded down some days ago. So I’ll stop with just one story:
Recently, I applied to some psychiatry residency programs. I made a deliberate decision to be very up front about my diagnosis and my history with medications and hospitalization. I was warned this would prevent my acceptance, and it did. Not one program even wanted to interview me, despite a stellar academic background.
The thing is, if I had applied to a neurology residency and said I had a history of multiple sclerosis, or an internal medicine residency and said I had a kidney transplant and wanted to become a nephrologist, these revelations would have helped me get accepted. But applying to psychiatry programs, and saying you have a psychiatric illness, means you not only will get rejected, but also reported (as I was) to the state licensing board as a potentially ‘impaired’ physician.
If even psychiatrists have this attitude toward those with a history of psychiatric illness, then is it a surprise that doctors at large stay away from mental health care, where they might risk getting ‘found out’?
WillSpirit, thank you so much for sharing your story. It’s really horrible what happened to you. I would like to very much hear more. Was it OK for you being a surgeon, or were there maybe problems not only with stigma, but perhaps also with side effects from medications? Thanks again, Katrin.
Well, I am not too concerned about speed; it’s all relative, I guess. My son almost died from Abilify, and became bipolar from Luvox. (which is to say that the Luvox came first, understandably) Luckily, he got into trouble, and which led to him being taken off the Luvox after six years? A case worker had to call the psychiatrist, and tell her that.
Katrin
Much of my story can be found on the various pages of my blog, http://willspirit.com. Especially the ‘about’ page.
I suffered from chronic and severe depression from age twenty until a few years ago. I also had what would now be called ‘bipolar 2’ though that diagnosis did not exist until pretty far into my story. At the time I quit practicing, I was taking Prozac, Wellbutrin, and a very low dose of lithium. Although I took much less lithium than my doctor wanted, because it caused tremors (bad for performing surgery, obviously), side effects otherwise had little impact on my work.
My neck was the proximal cause of my career loss. I pushed myself too hard, operated too much, and since I have some family history of arthritis, my neck developed severe disc problems. These led first to unbearable pain while operating, and then to my giving up my surgical work. I also believe that clinical medicine, given my emotional vulnerabilities, involved more stress than was good for me. This probably also contributed to my muscular tension, neck degeneration, and terrible pain.
My psych history really exploded after I gave up my career. I went into a hospital for suicidality, got started on Effexor, and five days after discharge my mania (which had been building for some time) blasted into a full-blown psychosis that lasted (though at slowly reducing severity) for more than a year despite hospitalization and a lot of medication.
I gained fifty pounds, had trouble thinking from all the drugs, and felt awful about myself. Over many years I gradually pulled my life and personality back together. Given how much progress I made, and the work I’d devoted, I felt almost ‘called’ to become a mental health worker. I had read huge amounts about psychiatry (including a 1700 page textbook) my moods were solid, and I was actively volunteering in mental health settings. I felt comfortable in that environment, and worked well with clients.
That’s the story my applications told. I thought they described someone who had overcome a lot, was doing well and working effectively, and would be in good position to become a compassionate psychiatrist.
The depth of stigma within the psychiatry community revealed itself at that point. I had not seen it as a client, or even as a medical student. It had always looked like psychiatrists were compassionate and had respect for those with mental illness. But I had overlooked that the professionals still looked at the mentally ill as fundamentally ‘different’, ‘challenged’ and ‘damaged’ from the doctors.
There. Now you don’t need to read the ‘about’ section. You know the story. My blog writing centers on my take on mental illness given my medical background, the fact that I spent time in graduate school studying cellular neurophysiology, my profound spiritual revelations while ‘psychotic’ and a innate tendency to see things a bit differently from others. In case you want to take a look…
Thank you for all this, WillSpirit.
This is really the most important contribution to this article by far. (I am sorry, BTW, that the other comment by me got thrown in. It was meant for a different article but was my fault.)
I did go to your website last night, as I also have sleeping problems, major.
But just as I finished commenting, my computer died as it was not plugged in, and I was too tired to do it again.
I’ll comment late, OK?
Thanks again! Katrin
I was diagnosed with depression in 91′, went through medical school, house jobs and I am still working (and still depressed and medicated but functional). Does it affect the way I work? Probably, but not necessarily in a negative way. The general insecurity and paranoia that comes with this condition forces me to check and recheck (x10) what I have done and what I will do.
My experience with the medical profession has shown me that there is alot of prejudice towards mental illness. In moments of normalcy I have even had similar feelings myself and have had to remind myself not to be a hypocrite.
This prejudice appears to be a reflex almost as strong as a knee jerk. I have thought a lot about this the past decade or so. Are we prejudiced because because we are scared that a ‘mental’ might attack us. Thats bollocks. A lot of the prejudice reveals itself as low grade hatred rather than fear.
I think that the real reason there is prejudice is because mental illness destroys our illusion of free will. That impulse that we have power over our thoughts and emotions is carved into our psyches. The ‘mental’ comes along and shatters the whole facade. Thats why people hate ‘mentals’, because ‘mentals’ remind them of their total and absolute lack of control. Oh, and thats why we hate ourselves.
reason I avoid it is cause mcat and usmle put a flag right next to the score and ur name. bring up the ADA and they actually encouage you to lawyer up. Not gunna ruin my professional career over it.