The stigma of becoming a psychiatrist

I’m coming out, but it isn’t what you’re thinking.  I’m writing this to finish answering a question that I was asked 25 years ago by an attending physician.  He was a Scotsman with a ruddy complexion and it was early in my third year of medical school.  I had been up since 4am rounding on patients and then assisting on a general surgery case.

Answering the esoteric questions the Scotsman posed had gone well that morning and I was feeling as though I would get through the difficult rotation without a hitch.  That’s when he lobbed over what would become the most important question of my career.

“What specialty do you want to go into?” he asked.

“Psychiatry,” I answered without hesitation.

“Why would you want to do that? You’re too bright to be a psychiatrist.”

At that point I realized I’d clearly given the wrong answer and any confidence I’d felt earlier went out the window.   I attempted to recover by telling him that psychiatrists have the opportunity to assess their patients from a biological, psychological and social standpoint, but I could see his attitude toward me changing.  After that experience, I was teased unmercifully about wanting to go into psychiatry, even called a “spook,”  and I learned that the stigma of mental illness existed within the medical community — directed toward mental health departments, clinicians and unwitting medical students.

Today, the stigma is evident with the continued shortage of good mental health care, fewer dollars spent on mental health programs compared to other specialties and hideous crimes committed by people with untreated mental disorders.

Which brings me to the rest of the story, the part I left out when answering the Scotsman’s question.  What I didn’t tell him that day was that my mother’s severe, unrelenting mental illness and the devastation it wreaked on our family was what inspired me to become a psychiatrist.  At the time, I shuddered to think of what his reaction might have been to that revelation, but today I realize that if I don’t talk about it openly, the stigma will remain and we must all do our part to diminish it.

My mother, an exquisitely beautiful, bright woman who had once planted petunias and dressed my sister and I in matching outfits, suffered from a mental illness that changed her life forever.  An  illness that wasn’t correctly diagnosed or treated for over twenty years and by that time our family had been torn apart.  We saw her deteriorate into someone who was, in many ways, unrecognizable.  Not long after she finally got some relief from her symptoms, she was diagnosed with lung cancer and died at age 56.

Her story has always inspired me in my work with patients and now my hope is that sharing it publicly will inspire others to work harder to get the diagnosis right, to support mental health initiatives and to encourage inspired medical students who want to become psychiatrists.

Angela Marie Andrich is a psychiatrist.

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  • Suzi Q 38

    Good for you, doctor.
    You should choose what you want to do, rather than what others think is best for you. After all, it is you who has to do it every day.

    As for your family challenge with you mother, we all have at least one family member or friend that has a mental illness, either borderline or severe. You do not need to explain.

    You also do not have to tell him or anyone else why, other than ” …I have my reasons, and I have thought this out very clearly, thank you very much.”

  • Kobukvolbane

    I so appreciate bright psychiatrists, and so do the patients. I see it every day.

  • PamelaWibleMD

    Maybe by embracing the value of psychiatry in medicine we would help our suffering doctors to also access the care they need without fear of repercussions. Wondering where Teleka Patrick is now. She is the distressed psychiatric resident who went missing over one month ago.
    We all need mental health: http://www.kevinmd.com/blog/2013/05/learned-saving-physicians-suicide.html

  • MentalPatient

    Today I learn that my problems are so unspeakable, that my relatives must be brave to face the stigma if they should ever mention that I have a mental illness, such as when their doctor is taking a family medical history. We aren’t so far past the unmarked graves at the institutions, are we? LOL, and my spouse tells me I’m paranoid and that people don’t really care if I have a diagnosis or not. Whom to believe, my spouse who tries to make me feel better, or those who bravely out their mentally ill relatives and then blog about it or go on TV, like Glenn Close? I don’t think it’s a bad thing to talk about it, not at all, and I’m glad the author did, and glad the author followed their own dreams. I have no gripe with Glenn Close and if she and her sister reduce stigma, that’s GREAT.. The reason I comment is that I’ve noticed a pattern of people saying how they try to help stigma by talking about someone ELSE with mental illness, and how they need to be brave to do that. Or, other people call them brave. Wow. I am really a pariah, that I taint everyone I know with stigma!!

    • DoubtfulGuest

      Quite a few celebrities have told the public about their own battles with depression, anxiety, or eating disorders. I haven’t paid attention to the Glenn Close situation, but I would wonder about someone’s motives when publicly “outing” another person. Did that person really give informed consent? I have experienced a very negative response when giving a family medical history, so I agree with you on that. It shouldn’t be any different than reporting, say, thyroid or heart disease in the family.

  • eqvet2015

    Maybe if more people had mentally ill family members and knew the people outside of the illness, society as a whole would be more understanding.

    • DoubtfulGuest

      That’s a good point. I think it is very, very common, but I don’t understand the continuing stigma either.

  • DoubtfulGuest

    8Pi, since I liked SuziQ’s comment, I thought I might respond here? I never thought she was labeling anyone in a derogatory way. She didn’t say “crazy” at all. Perhaps the word borderline in this context refers to mild illness? That’s how I took it. I also thought she might be referring to the DSM revisions and all the controversy over what counts as normal behavior vs. diagnosable illness?

    I was kind of on the fence about “You do not need to explain.” I thought, well, since it’s so common, why is it not okay to say something? Just like if a med student was inspired to become a cardiologist after Dad’s heart attack, for example? Then I came down on the side of, it seemed like Dr. Andrich did not want to explain at the time, even though she does now. She shouldn’t have had to justify her choice to this attending physician.

  • DoubtfulGuest

    You’re right…I have actually experienced what you describe as a thyroid patient, which is why I brought it up. I see what you’re saying, though, and I apologize. I meant only that both thyroid and heart disease are very common and don’t generally carry a social stigma, just for having them. I also thought that heart disease can contribute to depression, so I wasn’t drawing any clear lines in the sand. How doctors perceive and treat us is a very different matter!

  • patient advocate

    You must be an amazing psychiatrist! You know what it is like for both the patient and the family! That is priceless in my humble opinion.

    My mother also went undiagnosed for over 20 years and sounded a lot like yours, and the toll it took on the family. With treatment she improved immensely but, not without the up’s and down’s. Unfortunately, my mom was diagnosed with Lung Cancer at 67 and within a year died.

    Even with privacy concerns, I think it is important to include and listen to the family because I do remember my mother lying about her condition to her doctor.

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