This past week I spoke with a patient who noted that since his wife’s death six months ago, he had lost 40 pounds, slept a maximum of four hours nightly, and stopped enjoying activities he used to take pleasure in. He found it difficult to concentrate at work, and getting out of bed each morning was described as his greatest struggle. While relaying this story, the man was on the verge of tears. His voice was soft and pleading; he needed help.
While the exact line between a “normal” grief reaction and new-onset major depression is controversial, my attending explained to this patient that — given the length and severity of his symptoms — he would likely benefit from treatment. Both medicine and counseling were an option at this point. After all, all humans need to eat and sleep, and this type of care could help get him back on track and into healthy habits.
Instantly the man straightened up, “So you think it’s the ‘D word?’ I really don’t want that diagnosis.” I had never heard of depression referred to as the “D word,” but it definitely struck a chord with me. This man was so uncomfortable with the idea of being associated with a mental health diagnosis that he couldn’t say the name. At one facility where I rotated, psychiatric services were hidden in a corridor known as “behavioral health.” Patients with diagnosed mental health issues saw “stress management” workers, a title intended to disguise psychologists and psychiatrists.
How can patients be expected to feel comfortable with a psychiatric diagnosis if clinics themselves refuse to identify the services as such? Such euphemistic doublespeak only serves to undermine the progress made in psychiatric care and reinforce the stereotypes associated with mental illness and its methods of treatment.
Despite this, the number of individuals in our society struggling with mental health problems is enormous. The CDC estimates that 1 in 10 American adults report depression, and as high as 18 percent of Americans have anxiety. At this time, we have effective and safe therapies that are proven to decrease the risk of suicide and other complications of these diseases. Still, these treatments can only be accessed if patients feel comfortable and safe seeking help.
The stigma of mental illness extends much further than patient perception. On multiple occasions, I have witnessed individuals with alcoholism and other addictions enter the ER only to be met with looks of disgust instead of empathy. Rather than providing these patients with resources for long-term stabilization, they are often sent back to the streets or into a short-term shelter where it is all too easy to cycle back into old and detrimental habits. Addiction is a terrifying struggle, and we must recognize that the issue is pathological and not a matter of choice. If we have the skills and the resources to provide care, it is our job to do so.
Even among medical students and residents, psychiatry is denigrated. When entering my psychiatry rotation, I was told to “enjoy the psych-ation,” an insinuation that psychiatry is an easy field. On other rotations, I have seen psychiatry mocked and trivialized. Far from combating the shortage of mental health professionals, we are devaluing the field and making it less appealing to young doctors.
The impact of mental illness is felt across all ages, races, and socioeconomic groups. Moving forward with effective and reliable treatment will require the open acknowledgment that psychiatric disorders are common, treatable, and do not reflect on the character of the patient. The more open dialog we have on the matter, the easier it will be for individuals in need to seek care, and for psychiatric health care workers to feel supported in the vital work that they do. As healthcare professionals, the burden is on us to provide help and encouragement to those affected by mental health issues, and to support this field of medicine that has been so unfortunately undervalued and concealed.
Natalie Wilcox is a medical student who blogs at The Doctor Blog.
