Physicians’ Stigma Around Mental Health
One would think mental illness, would best be understood and accepted among those who have had extensive training in the area of mental health. The literature and physician suicide rate seem to point to the opposite. Surprising and contrary as it might seem, physicians have long stigmatized mental illness. And sure enough, this is a well-known issue. A quick Google search of “physician mental health stigma” produced hundreds of articles from research journals to magazines. Such studies overwhelmingly implicate that the outcome is just as consequential for physicians as those stigmatized by general public. Fortunately examining further viewpoints revealed that times may be changing. At least at certain medical institutions, helping others, whether patients or colleagues, remains top priority. And at others, a few physicians who are brave enough to speak out are skating on the ice of a revolution. The stigmatization surrounding mental health among physicians seems deeply layered and certainly calls for reformation, but with more people recognizing this stigma and speaking about it, a catalyst for change may be in sight.
The literature continues to broaden surrounding the discrepancy between physicians and mental health stigmatization. As noted by Jean Wallace in her article Mental health and stigma in the medical profession, more current research has shown that physicians experience the same rate of depression as the general population. Another 10% of physicians are susceptible to substance use disorders within their lifetime. Part of the problem and irony lie in the fact that labeling mental health disorders is necessary among physicians for diagnosis and treatment. Yet as noted by Ms. Wallace, “labeling someone with mental illness can lead to assigning certain negative stereotypes associated with undesirable characteristics that are attached to that label and distancing oneself from those with symptoms of mental illness”.
The basic underlying fear around mental illness among physicians is that negative attributes associated with mental illness, such as violence and lack of willpower, will hamper their abilities to perform their jobs leading to licensing and career repercussions. Other self-involved fears about disclosing one’s mental health state include being treated as an outcast, losing credibility and facing rejection among colleagues. An unsurprising result is that many physicians choose not to disclose such information. Many will go so far as to cross state lines or pay for psychotherapy under a pseudonym or with cash to keep their mental health issues under wraps. And their fears are not unfounded. As Raquel Boton, a second-year Loyola law student who is pursuing a career health law, explains, “to apply for a medical license you have to list if you’ve been treated for mental illness … so a lot of doctors don’t get mental help because they don’t want to have to list it on their state medical license applications”. Consequently, Shanon Firth reports in her article, Docs’ Mental Health: Do State Boards Have A Right to Ask, as many as 40% of 5,800 surveyed physicians cited fear of “repercussions to their medical licensure” as a reason for avoiding treatment. Ms. Boton further illuminates the consequences, “that’s why there are so many physician suicides because they aren’t getting mental help they need.” And she is right Ms. Firth notes a study that found “a 21% increase in reluctance to seek help for a mental health issue”. Multiple articles from MedPage Today to MD Magazine report that the average physician suicide rate in the United States is 400 deaths per year, making the occupation one of the top professions associated with suicide.
Wallace’s report also illuminates the irony of the common practice among physicians to avoid and/or be disinclined to help colleagues struggling with mental illness. This lack of support only leads to isolation and confirming many physician’s fears about disclosing mental health issues to colleagues. Furthermore, there is a general consensus that superhuman expectations are placed upon physicians – similar to the pressures that athletes often feel are subconsciously forced upon them. It is only natural that doctors would be affected by day-to-day exposure to death and dealing with ill or injured patients. Ms. Firth’s Medpage Today article quotes Pamela Wible, MD, an expert in physician suicide and prevention, “’We’re holding physicians to super human standards’”. This certainly does not seem to be an understatement considering the long hours and the intense pressure that are inherent to the job.
Perhaps some of the data doesn’t give the full picture. In this politically correct era where people are becoming more accepting and open to the fact that mental illness is a medical disease, times may be changing. Dr. Robert Silvers, head of Diagnostic Radiology at Highland Park Hospital, in Highland Park, IL, offered a very different viewpoint. While Dr. Silvers was clear that physicians are loathe to openly “sit down and talk about the stigma surrounding mental health”, at least in his department, “mental illness is viewed the same as any other medical problem”. And it is dealt with as any other medical problem. Dr. Silvers explained that individuals have privately disclosed to him that they were suffering from a mental illness that was interfering with their abilities to perform their jobs. His department’s response is plain and simple; to deal with it just as if that individual were needing treatment for cancer. “I have had people come to me with issues and we help them. I take it as any other medical issue. We have helped people find help, helped cover working hours when they couldn’t be there, and addressed some of the structural things on the job that were contributing to the problem. I don’t think there’s really a stigma that people look down upon people with mental illness, it’s more so that people are very fearful of losing their job.” Research studies back this perspective: career repercussions were certainly a big part of the rationale for not disclosing or seeking treatment for mental health issues.
Dr. Silvers elaborated that despite fear of job repercussions, mental health problems can certainly take a toll on a physician’s ability to perform; it is crucial that, when a problem appears, it is identified so that the individual can receive adequate help.
This revealed another side of the issue. The nature of their work implies that doctors are responsible for ensuring they can perform their jobs optimally. Anything that affects this ability could lead to dire mistakes. Therefore, as Dr. Silvers pointed out, at least where he works, physicians and employers want their colleagues to receive help when they are struggling. This brought up the question of whether or not medical licensing boards and renewals should “probe” as one physician put it, a doctor’s medical history. “Your knee-jerk reaction is no, of course not”, Dr. Silvers said. “But keep in mind that the licensing exam is a government regulation and the government is there to make sure that someone can do their job appropriately. It does not ask you for a medical history. It asks it in the form whether its going to impair your job. I think these are reasonable questions to ask. Not specifically do you have this or that, but rather do you have something that would inhibit you from doing your job properly?” Interestingly, Dr. Adam B. Hill, MD, a recovering alcoholic who struggled with severe depression and suicidal ideation confers, “the professionals who pose the greatest risk to patient safety are those with active, untreated medical conditions”. When put this way, asking these types of questions is not only reasonable but an assurance to patients that the government is giving licenses to doctors who are in the best position to care for their needs. Unfortunately though, as Dr. Hill later revealed, boards’ standards differ from state to state, and questions can certainly be invasive.
Dr. Hill gives a somewhat opposing viewpoint to Dr. Silvers. In his article, Breaking the Stigma—A Physician’s Perspective on Self-Care and Recovery, Dr. Hill stresses that physicians face stigmatization for mental health problems, going so far as to call it an “ongoing national epidemic of neglect of physicians’ mental health”. He details his fight against mental health stigma, and how he is using his own personal recovery to embody a “cultural revolution” and break the ongoing cycle in which he lost two friends and colleagues last year.
Dr. Hill feels that burnout from the high stress and intensive work the occupation entails ultimately sets up physicians for an increased risk of developing mental illness, including addictions. Combine this with the fear of asking for help and the lack of support from colleagues, and it sets up a breeding ground for mental health struggles. He emphasizes that the fear of ramifications surrounding licensing and career consequences is a real threat. In fact, in one state, a licensing board asked him to write a letter to the public describing his condition and treatment. as “an archaic practice of public shaming”. Dr. Hill,in contrast to Dr. Silvers, has felt firsthand the stigma and repercussions of receiving treatment. Still, he believes licensing boards should ask certain questions to determine a physician’s ability to appropriately serve a patient. Yet, they should praise physicians for recognizing and treating their condition, not subject them to job repercussions. “The professionals who pose a risk to patient safety are those with active, untreated medical conditions who don’t seek help out of fear and shame”, Dr. Hill elaborates.
Dr. Hill’s story turns out to be one of hope rather than darkness. He received unexpected support when he did share his recovery during a grand-rounds speech to over 200 physicians. After receiving hundreds of supportive emails in which colleagues shared their own struggles, Dr. Hill says, “a floodgate of human connection opened up”. And likewise when he was truthful and confident sharing his story during an interview for a job promotion, the benefits far outweighed the consequences. Not only did he get the job, but he found support in opening up to others. Although it seems that there are still many layers to cut through when it comes to the mental health stigma surrounding physicians, there is hope for a system that soon recognizes mental health as a medical issue and treats physicians as people who deserve the same compassion and help as any patient.
