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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