“I don’t need meds,” the young psychology major told me confidently. “Or therapy really. Maybe I’ll just touch base with you every once in a while. I should be able to handle this on my own.” The young woman’s physician had been concerned enough in a recent visit about this patient’s panic attacks and passive suicidal ideation to refer her to meet with me for a primary care psychology consultation. Yet just a few weeks later, she sat in front of me letting me know that she can “handle” these problems.
For better or for worse, this young woman picked a terrible day to talk about “handling” concerns with mental health. I had recently learned that one of my clinical training supervisors, a beloved and skilled psychologist, had taken his own life. We had not communicated in years, and I know nothing about the nature of the struggles that made suicide seem like his best option. But I can imagine.
Clinical psychologists share something with many of the resident physicians I work with every day — a strong need to care for others, a tendency to put one’s own needs last, and a deep reluctance to admit perceived weaknesses. These cultural traits common in health care providers, especially if combined with a stubborn streak, make it almost impossible to ask for help.
It’s especially tough when it comes to asking for help for mental health problems. There is a stigma associated with these concerns. One that I hope is weakening, but a stigma nonetheless. Furthermore the nature of the diseases themselves make it hard to reach out to others — the crippling fatigue and lack of motivation that can accompany depression, or the pervasive self-doubts that often come with anxiety can make it impossible to take the steps needed to get help, often at the time when it is most needed. I can relate. I think back to a period of acute depression I experienced following a miscarriage. My clinical mind recognized that what I was feeling was depression, and I knew what I should do. However, as I sat on the couch in a stupor, I just didn’t care. My clinical mind told me to get up, exercise, call a friend, make an appointment, do something. Although I knew I should listen to my clinical mind, I didn’t have enough motivation to pick up the phone. Even stronger was the worry about who I could trust enough to talk with. I’m a psychologist. I’m supposed to be stronger than that.
I want the culture of the family medicine residency where I work to be different. I want residents to know that, when they’re overwhelmed with depression, anxiety, feeling so burned out they can’t work, or recognizing that they’re starting to slip back into a manic episode, they can tell someone, and to know that if they tell any faculty member, the faculty member will respond with the same empathetic, matter-of-fact practicality that they’d give for a physical illness. What do you need? How can we protect your patient care? How can we get you to your appointments? I want our culture to be one where it’s completely transparent that no stigma or judgment will be attached to disclosing mental health concerns.
Perhaps I overreacted when I jumped down this young woman’s throat. Perhaps I didn’t need to rant about how the first priority of health care providers, whether psychologists or physicians, needs to be self-care, or we can’t effectively care for other people. I most likely didn’t need get on my soapbox about how avoiding treatment for mental health problems only contributes to stigma and barriers to seeking treatment. However, I do know that this young psychology major left my office with a plan to start cognitive behavioral therapy for her anxiety and depression, and to meet with her physician to reconsider medication. I can only hope that this will make a difference for her, and maybe for the future patients that she sees. If this puts a single health care provider a step closer to a culture where it is not only expected, but encouraged to seek help for mental health problems, I’m happy with my day’s work.
Katie Fortenberry is a psychologist and an assistant professor, division of family medicine, University of Utah School of Medicine, Salt Lake City, UT. This article originally appeared in Family Medicine Vital Signs.
