Understanding the Stigma of Mental Health in Medicine

As a medical student, much of our education revolves around concerns about improving patient care, patient safety, and reducing medical errors. However, as we progress through this journey to being physicians that patients can trust, more attention needs to be focused on examining how the management of mental illness among physicians might be improved within the profession. One idea for change is to reduce the stigma associated with mental illness. This is a social constraint that, if not destigmatized and approached with care in medical school, can have adverse effects on our medical practice, patients, and our personal health.

I believe it all starts with the culture of medicine and medical training. There are times where we are to work exhausted or, in turn, even more ill than our patients. That is just how we are taught to function as medical professionals. Resilience isn’t taught, but it is expected, and we come to expect it in ourselves and each other. There is a feeling of shame and fear of being judged if we ask for help or guidance. As a result, we tend to suffer in silence and carry on our professional lifestyle with pride. There have been studies done that physicians feel pressure to appear physically well and that a physician’s health is believed to reflect his or her medical competence. In other words, this can be viewed as a sign of weakness.

Although the stigma with mental illness is partly due to physicians, and even medical students, not admitting they have emotional problems, a major concern is that they are unwilling to accept the role of the patient. This role reversal has been known to challenge and undermine the physician’s personal and professional identities. This also plays a role in with the concerns of confidentiality and embarrassment in seeking treatment and help. As a medical student, especially earlier on, I felt my physical and mental illnesses weren’t well-tolerated and self-care wasn’t promoted as much as it is now.

With competitiveness being instilled in us long before we applied to medical school, we have always been afraid of what our peers and colleagues think of us, especially when it comes to our medical knowledge and clinical skills. We are afraid that our colleagues might see us as an “unfit” doctor (and might even tell their patients). An important obstacle I have learned to successfully cope with emotional struggles is the concept of silence. The tendency is that physicians and their colleagues believe the individual will work it out on their own or the problem will somehow disappear. This completely devalues the concept of mental health, and nothing is done as a result. Even as a colleague, there can be a reluctance in helping because they feel they may not have the appropriate knowledge or resources to offer. There have been a few instances where I felt I was unable to help a peer because I did not feel I had the necessary resources to solve the problem. This can lead to an ethical dilemma as well. Do I protect the privacy of my fellow unwell colleague or take their safety into consideration?

An important aspect we must learn to grasp is that illness is not synonymous with impairment. We may have one or more mental health conditions that may not necessarily affect our ability to provide safe and quality care to our patients. This plays into the concept of silence because it may be hard to be perceived as a professional within a hospital health care system if you are known to have mental illness. Patients are obviously the number one priority, but the culture we live in tends to punish and stigmatize ill and impaired physicians rather than offering considerate care that is typically offered to non-physicians suffering from similar conditions.

Although I mentioned above some things we can focus on to end mental health stigma, I believe we need a structured program that works on multiple levels by targeting individuals, structures, and systems. As future physicians, we need to be taught to recognize signs of distress in ourselves and our colleagues, recognize when help is needed, and feel safe and supported to seek help. Medical schools and the medical community need to be more committed to proactive health among physicians where personal health needs to become a part of the culture. Another way we can facilitate change is perhaps developing an anonymous self-evaluation screens for physicians that focus on stress, burnout, anxiety, depression, and even substance abuse. This could be done where the physicians are the only ones that know the results and could monitor their health in such a way. Having a confidential approach could help physicians and medical students recognize signs for help before they become hindered.

Mental health has been something that we as future healthcare professionals seem to take for granted. We are so focused on patient care in our training years where we forget about our personal care. There needs to be a system where we stop punishing those who are suffering internally, and instead offer a helping hand. We are taught to work together as a healthcare professional team, so why can’t we work together to support and encourage each other to be the best person and physician we can be?