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Mental Health Stigmatized Among Health Professionals

I recently received a message from a friend struggling with anxiety and ADHD, who had been prescribed medication by her doctor. Coming from a South Asian Muslim background, her family was not supportive of her decision to take antidepressants and felt she just needed to strengthen her iman (faith). She wondered if I had any reading material for her family or someone to talk to that could convince them otherwise. I advised her that ultimately, as an adult, she was to make the decision for herself; the unfortunate reality being that even with the right resources, her family might never come around!  However, I admit that I was annoyed by the family’s reaction. Although we have made great strides in community education on mental health issues, I am still surprised by the amount of stigma that exists within our community. We have built bridges with Imams in our community to build a multimodal approach and stance. We have weekend seminars and lectures at our mosques to start the conversation about mental health. Yet the stigma still exists, is real, and continues to affect us all.

Stigma towards mental health is widespread and exists in our society at large, not just within the Muslim, Arab, or South Asian community. My friend wanted advice on what she could do to convince her family that it’s okay to get medical treatment for her struggles. I thought about the adults I see who struggle with issues of acceptance and finding support from their families. Individuals from Western backgrounds, whose siblings will criticize their choices blatantly on vacations, holidays and around the Thanksgiving table. These individuals have to make a conscious effort to hold their head up high, make the decision to seek treatment to get well and live up to their full potential. And they have supportive doctors backing them up.

Because if we truly believe in the body, mind and spirit connection, it is high time that we recognize and face the stigma against mental illness that exists, even within our own medical profession.

But there is one aspect of stigma that we don’t always talk about.  As a practicing Child Psychiatrist, I remember glimpses of this stigma as I think back to my years of schooling and training.  I remember the emergency room doctor who was impressed with my differential diagnoses and bedside manner.  As he filled out my rotation evaluation, he said, “You’re smart.  Why are you going into psychiatry?”  I still remember that moment – I wasn’t sure if it was a compliment or an insult – as it was a bit of both. I remember thinking later – was he implying that we want our psychiatrists to be dumb? I remember a very good family friend who, after I shared with her that I would be pursuing psychiatry after medical school, couldn’t hide her disappointment.  And that same gnawing feeling rose in my chest. I remember in intern year, my senior would assign me, the rising psychiatrist, all the “difficult” patients – including the nonverbal ones – as if I had some magical powers that would be able to elicit a chief complaint with a wand I kept hidden in my white coat.  As if I, the budding psychiatrist, would be the only one dealing with depressed, psychotic, anxious, manic, alcoholic, drug-dependent, demented, and delayed patients and the other residents would happily treat the “normal” ones. I remember how the other members of my team would roll their eyes after we rounded on my patient with heroin addiction. I relayed the difficulties of always getting these patients to my father, a retired anesthesiologist, and was surprised by his response: “Saba, you might be the only person who actually hears them. Everyone else has turned their back on them.  They have an illness and nobody is listening.”  These words resonated with me as I went on with my training.

It is a fact that there is a huge shortage of psychiatrists in this country. My wait time for scheduling new patients confirms this.  In spite of the huge shortage of psychiatrists, especially child psychiatrists, only 4% of graduating U.S. medical students apply for psychiatry, and many training programs fail to fill their spots with U.S. or foreign graduates. Truthfully, I’ve had friends that for a moment considered psychiatry as a profession but the response they were sure to get from their parents and family, that feeling of “not being a real doctor” and a sort of public shaming, kept them from pursuing this interest. We want our best and brightest to pursue the top subspecialties in medicine. At the same time, there has been a huge push to recruit primary care physicians in the past decade.  But where does that leave our providers for mental health and wellness?  Do we want subpar doctors providing this care – those who do the most intimate work of all, looking into one’s soul?

As physicians, we need to be mindful of using terms such as “shrink” or “crazy” when talking about our colleagues and patients. As providers, we should aim to show psychiatry the same respect we show other specialties. As doctors, we see the reality of mental health and illness in all of our patients, across all specialties. While we know the reality of untreated psychiatric illness, our patients will detect any hesitation, doubt or suspicion in our demeanor or voice. Discomfort arises from fear of the unknown. Reach out and collaborate with the psychiatrists caring for your patients. Because if we truly believe in the body, mind and spirit connection, it is high time that we recognize and face the stigma against mental illness that exists, even within our own medical profession.