Mental Health Stigma and Health Care Practitioners

~ The one thing more exhausting than having a mental illness is trying to pretend that you don’t have one ~
When mental health patients seek non-mental health medical services, sometimes being ‘seen’ by medical professionals can be both unusual and paramount to your care. Most of us simply want to be seen by others as the authentic and multi-layered individuals that we are throughout our lives. Twenty-five years ago however, after a bipolar diagnosis, I was surprised to learn that the stigma surrounding mental health was alive and well even among medical professionals. I am even more amazed that it continues to exist today.

“It’s not our differences that divide us. It is our inability to recognize and accept those differences”.

Audre Lorde, Poet

I think of a ‘stigma’ as a mark of disgrace or discredit that sets a person apart from others. I often experience a palpable shifting point whenever I have routine medical care appointments as soon as the medical practitioner gets to the section on my intake form that notes a bipolar diagnosis and several in-patient hospitalizations. During the initial minutes of a medical intake, the doctor, nurse or medical technician seem to admire my high energy, optimism, and extroverted personality. I have learned however, that there can be invisible forces and currents that can change in a minute the way in which I’m perceived by others. That moment typically comes when the words bipolar disorder appear alongside a lengthy history of anti-psychotic medications and ECT treatments on my medical chart. The attitude in the room seems to shift and the staff no longer sees me as they did in those first few minutes of breezy intake and fact finding. The high energy, very accomplished older woman is now suspect… (excessive energy? overly expressive and upbeat? too direct and confident?) — From that point on, I often feel that the practitioner-patient interaction has become compromised and negatively impacted.

“A diagnosis is burden enough without being burdened by secrecy and shame”

Jane Pauley, Journalist

Here are a few examples of the ways in which I have had challenging experiences with medical professionals after they become aware of my history of mental illness:

  • My accounting of symptoms can often become devalued, dismissed, or considered to be exaggerated.
  • When being assertive about posing questions or asking for explanations from the health care provider, I can be viewed as difficult or attention-seeking.
  • Physical symptoms have been erroneously misattributed to my mental illness diagnosis.
  • While being taken by ambulance to a psychiatric hospital the EMT’s continued to talk freely about their party plans for the evening and their anticipation of the various women they would meet there, from start to finish. I felt completely invisible, irrelevant (and apparently deaf as well). It bears noting that the only other ambulance trip I have taken was for a physical incident that occurred while I was running the Boston Marathon. In sharp contrast, the EMT’s in that situation were extremely respective, attentive and even admiring of my running performance and passion.
  • Bottom Line: These examples of negative interactions have often resulted in my reluctance to disclose my mental health history at all at times, and/or to avoid seeking medical help when I need it. This same reluctance on my part has also created delays in diagnoses and treatment options for physical health issues at times as well.

I have however, also been fortunate to be treated by some health care practitioners whose attitudes toward me were not at all impacted by my mental health status. These professionals varied by gender, age, geography and specialty, yet had one distinct commonality; they each approached me as a multi-faceted individual first and foremost, and sought out details of my overall background as a person. They then used my personal strengths when designing any/all subsequent medical treatment plans. A high level of both communication and collaboration in these instances resulted in a high level of care. Consequently, my openness to treatment options and my compliance overall with medications, prescribed testing and screenings also increased under their care.

“You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.”

Julian Seifter, MD)

The issue of how the healthcare culture prioritizes and perceives individuals who have a mental illness is vast and complex. Here are a few personal thoughts about some initial steps for medical practices to consider that may begin to make a difference:

  • View those who are living with mental illness as educators as well as patients. Perhaps individuals who have a mental health diagnosis could team up with mental health professionals to offer in-service staff meetings to discuss stereotypical thinking, help to diminish any staff anxiety, heighten empathy, and discuss ways to make personal connections, along with improving general understanding of mental health recovery phases.
  • Revise Intake Forms for medical practices to first include a brief description of the patient’s interests, hobbies, etc. to communicate the value of being aware of and integrating a patient’s life background and interests into their care.
  • Expand opportunities for personal contact with those who have a mental health diagnosis, since actual contact, vs. solely factual knowledge can be crucial to understanding. By targeting medical school students or even high school students who express an interest in a medical future, round table discussions/courses and workshops may help to address various issues and to increase positive attitudes.
  • Stress the concept within medical practices that there is no health without mental health, and that these two components are equally important within an overall wellness protocol.

~ My illness does not define me. My strength and courage however, do. ~

Mental illness and high achievement can and do occur in the same individual. It’s my thought that one way in which strength can be defined is to be vulnerable and to allow others to see the real you. This type of strength is only possible however, if the person facing you is willing to see.

And for all of us who have a mental health diagnosis, we have a responsibility as well:

~ To Risk being Seen in All of our Glory ~

Let’s do this thing…. Together.

Written by Pam Landry

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