When will the stigma of mental health end in medicine?

Imagine being a cancer patient afraid of seeing an oncologist because they would likely need to discuss chemotherapy and all the lifestyle changes that it entails. Imagine being a patient with heart failure afraid of seeing the cardiologist because they may be prescribed a diuretic to remove excess fluid from their body and may need dietary counseling. Imagine being a patient with severe rheumatoid arthritis with excruciating joint pain, who is afraid to see their rheumatologist because there is a stigma attached to being prescribed a biologic disease-modifying anti-rheumatic drug (DMARD). Imagine a patient with depression that affects daily responsibilities, who is hesitant to see a psychiatrist or a therapist due to the fear of having to disclose being prescribed an antidepressant when applying for a job.

Now consider Dr. X, a physician who has completed residency training, having overcome the stress of medical school, having learned the massive amount of information that is required while sacrificing family, relationships, and friendships. She worked 80-plus hours a week for three-plus years in residency — working weekends, holidays, birthdays, anniversaries, funerals, going-away parties, and other celebrations, while her peers were starting families, buying a house, taking vacations and living the life most of us want for ourselves. She completes residency and begins her first new job, gets married, has a child and struggles to balance raising a baby and meeting the demands of clinical work. With the breakdown of her support system, a sense of hopelessness seeps in when she is overwhelmed in trying to be the mother she wants to be, while also trying to be a wife and a daughter and a daughter-in-law and a friend and a dependable and hardworking colleague and a competent physician.

Does it make sense that Dr. X is fearful of seeking care from a psychiatrist, considering therapy and starting an antidepressant to control anxiety to help her function and thrive as a nurturing mother, a supportive wife, and a competent physician?

Many job applications, licensing applications, and credentialing applications will ask if the applicant has ever been on an antidepressant or been treated by a psychiatrist and if their symptoms have affected their ability to work. This will invite more scrutiny. And taking time off to try and put oneself back together? Not an option, if the applicant wants to convey dedication, hard-working and resilience.

And so the system discourages front-line physicians, who face and try and solve the health problems of their patients, take on the burden and responsibility of diagnosing and treating conditions (including depression and anxiety) from seeking the care that they need. The desire and ability to truly listen to patients, empathize and recommend treatment plans that take into account the perspective and background and real-life situations of the patient, only comes when the physician can take care of themselves.

Some physicians end up seeking psychiatric care privately by crossing state lines (if they have the time), bypassing insurance and using different names to avoid having that psychiatric care leave a stain on their record. Some continue to trudge along daily in a state of perpetual burnout, sacrificing the empathy and the high calling that led them into medicine in the first place, as well as leaving their own families to bear the brunt of the damage that has been inflicted with anger, frustration, impatience, dismissal, or just simply not being present. Some physicians limit their work to part-time (if they don’t have astronomical student loan debt) to use the rest of their time to try and seek the proper care. Some leave clinical medicine altogether to find a job that is not a calling or a career but allows them to be appreciated for their efforts, sustain personal lives outside of work and replenish their store of empathy and character. Some lie about the care they receive and use nontraditional or ineffective methods of obtaining care. None of these scenarios are ideal, but these are some of the scenarios that are playing out in myself and the physicians I know around me.

Admitting there is a problem with oneself is one of the most difficult and humbling things to do. Acting upon that and seeking the appropriate care is even more difficult. To stigmatize that action, especially when those seeking that care are responsible for the health and well-being of so many more people, is sending the wrong message to the public about how psychiatry, psychiatric conditions, and psychiatric care are not medicine like heart failure, breast cancer, and rheumatoid arthritis.

So when are we going to stop stigmatizing psychiatric care, both in the general public and amongst our own? Celebrities like Jim Carrey, Dwayne Johnson, Ellen Degeneres, Anne Hathaway, and J.K. Rowling have all been open about their battles with depression and anxiety. NBA players DeMar DeRozan and Kevin Love have also come out in public regarding their personal fights with depression. Other athletes like Oscar de la Hoya and Michael Phelps have also come out. And we admire them more for being open about their struggles and being vulnerable and for seeking care to continue to excel in their fields. As physicians, we need to de-stigmatize mental health in our everyday practice and our hiring of physicians before we can hope to optimally address the mental health needs of our patients.

Depression and anxiety are not a sign of weakness, a sign of incompetence in being able to work as a physician or a red flag that needs to be further investigated. There are risks, but we have an entire field of medical professionals that are specialized in managing those risks. If we don’t change, the number of competent, compassionate and hard-working physicians will continue to be limited, which only hurts our patients who suffer from the debilitating effects of depression, anxiety and other psychiatric conditions.

The author is an anonymous physician.

Image credit: Shutterstock.com

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