Changing the Culture of Mental Health Stigma in Healthcare

From the time undergraduate students start taking their pre-medical courses such as introductory biology, organic chemistry, biochemistry, and others, there is unfortunately a deep sense of competition that can often overpower even the kindest of souls. This is understandable as gaining admission to medical school continues to become more and more competitive. However, even from this stage, an inappropriate, dangerous, and maladaptive sense of machismo is infused in those hopeful to earn an MD or DO down the road. Bear in mind this is just my humble opinion as someone who has gone through the process to apply to and graduate from medical school in the United States. I certainly am not saying that all pre-medical students are the same, but if you were to ask most how they view themselves and their peers, you will hear similar tales and reflections.

Instead of focusing their efforts on mastering the content and collaborating on quality public health initiatives or research projects, many pre-medical students nervously eye one another during their group activities and lab sessions. I did not feel comfortable expressing my true self because there was this illogical fear that if I expressed my emotions, my anxiety about the process, that I was showing weakness. I quickly found that in my case, I could not sustain this inhuman sense of confidence, superiority, or complete lack of self doubt.

When I arrived in medical school I was shocked to find that things were even worse. Every other person around me was exhibiting signs of almost primal like competition. Along with this attitude of needing to prove oneself to be the best, to impress the supervising physicians and researchers who taught our preclinical courses, it become apparent there was a facade of 100% strength and fortitude that the majority of those around me displayed. An unspoken culture of repressing any emotional or spiritual issues we might have regarding what we were learning developed and was perpetuated. It was taboo to discuss our feelings regarding our patients except in the confines of late night conversations with our best friends. Even then, we were all nervous, somehow. Imagine – training to be a physician, tasked with being a healer and guide to others toward better health, yet we ourselves expected to maintain some kind of fortitude few if any could.

Here’s the reality, after 10 months of being a physician.

I do have doubts. I wake up every day wondering whether I have made the right decisions. Often I go to bed wondering whether the choices I have made that day, which today impact my patients and their health, were the right ones. I question my judgment on a minute to minute basis. I seek help when I am not sure of what is best. I have learned that without accepting that I am human, that I am allowed to experience uncertainty, I will not only be unhappy but I will endanger my patients.

I think that it’s important for physicians to break down the culture of stigma around mental health ailments and depression perpetuated across the generations. I have heard time and time again from seasoned physicians of all kinds with gray hairs purporting wisdom that “In my day, you would have been deemed unfit to treat patients!” Scary is an understatement.

You could identify many issues with health care today. Out of the grave financial and ethical burdens we face as a society all the time, quite a bit of the issue lies in the way we train our future physicians. How can we expect a young physician who is expected to never feel emotion, never express emotion, never exhibit signs of depression or even the slightest emotional response, to be emotionally supportive to his or her patients? How can we expect physicians, who are some of the worst at perpetuating stigma about displaying “emotional weakness” or seeking help for mental health, to continue to bear the weight of their calling day in, day out, without breaking?

Recently, a nurse, mother of two boys, and paramedic who I follow on Twitter, Jess Morton, delivered a talk at a Paramedicine conference entitled SPANZ16 on the issue of mental health stigma among care givers. I am eagerly awaiting the video of the talk and will link here when I have access. From what I followed on Twitter, the talk was well received and applauded. It was so wonderful to see an individual with experiences such as Jess deliver a talk on such crucial topics. I hope that as time goes on, we in the medical profession incorporate more and more discussion about mental health wellness and breaking down stigma for those who need and seek help.

We need more doctors, nurses, paramedics, EMTs, nurse practitioners, and physician assistants to speak out and break down stigma around mental health. It’s time that we dropped the facade. It’s time we stopped chastising care givers who themselves need care. We should welcome and celebrate honest and respectful discussion among those who deliver care in our health care system. In fact, it must be a priority to break down stigma surrounding mental health and wellness for everyone, regardless of who they are or what they do.