Psychiatrists Not Immune To Mental Illness—or Stigma

The stigma attached to mental illness is certainly not an abstract concept to psychiatrists. Their patients deal with it almost every day. But psychiatrists can be startled by how devastating stigma can really be when they are the ones on the receiving end.

When those psychiatrists are also members of a minority group, coping with and overcoming the effects of stigma add difficult, and often unexpected, challenges to the recovery process.

Three psychiatrists who have endured stigma from the public as well as their medical colleagues participated in an APA annual meeting workshop cosponsored by the National Alliance for the Mentally Ill. The psychiatrists described the anguish they experienced as they tried to recover from mental illness and overcome stigmatizing behavior.

Michelle Clark, M.D., began to experience some classic symptoms of major depression several years ago after a serious physical illness, but despite being an experienced psychiatrist who has treated many people with depression, she convinced herself that her symptoms were not signs that she needed treatment, but the result of the stress she was under.

A psychiatrist colleague at the University of California, San Francisco, where Clark is an associate clinical professor and has developed culture-based treatment programs, noticed her symptoms and eventually prescribed an SSRI for her, Clark said. She began to improve. Even after she acknowledged that she was suffering from depression, her family “remained clueless,” about what the illness entailed and how some of her behaviors were manifestations of it.

It took a long time, Clark emphasized, but she finally realized that the stigma attached to having a mental illness, added to the stigma that comes with being African American in this country, left her in the position of “colluding with” the stigmatizers. She came away from the experience with a vivid picture of how stigma and the resulting failure to recognize symptoms that would have been evident in patients she treats had slowed her recovery process.

Suzanne Vogel-Scibilia, M.D., is also familiar with the devastating effects of stigma, having had bipolar illness so severe since she was a child that she has had several psychotic episodes. After the birth of her third child, she told the workshop audience, she experienced a period of catatonia.

Now medical director of a consumer-run mental health center in Beaver, Pa., Vogel-Scibilia stressed that psychiatrists who are minority-group members can in fact confront a triple stigma—that of being a minority, a person with mental illness, and, in some communities, a psychiatrist.

She believes that as a psychiatry resident with a serious mental illness, she also was stigmatized by supervisors and other residents. One residency supervisor, she said, told her that other residents believed she needed ECT. While that supervisor agreed that such a response was “probably overkill,” he advised Vogel-Scibilia to “stay away” until her symptoms abated and she was no longer “scaring the other residents,” she said.

Too many physicians, and particularly psychiatrists, are convinced they’re immune from mental illness, she said. When it strikes, an additional source of stigma often keeps psychiatrists and mental health professionals from acknowledging it and getting treatment. That, she stated, is the belief that many people inside and outside of medicine harbor that a mentally ill psychiatrist “must have done something to cause it or isn’t qualified to be a psychiatrist.” When a clinician is part of a minority group, it gives people an additional reason to distance that person from other psychiatrists, Vogel-Scibilia suggested, since it supplies some people with a reason to explain why a psychiatrist can end up with a mental illness.

She also warned that mentally ill psychiatrists should not expect to find empathy in the “ex-patient community.” Many of those former patients refuse to view psychiatrists with mental illness as part of them, harboring resentment from what they consider to have been coercive medical treatment. Vogel-Scibilia calls these psychiatrists who have or have had mental illness “prosumers”—a blend of providers and consumers—and urged them to look for support in several arenas. These include through APA, which puts on educational workshops such as this one, and through the AMA, which is “welcoming of consumer-providers, especially those with minority status,” she said.

One of the worst things psychiatrists can do in response to having suffered a mental illness, she stressed, is to change the way they practice. Doing so “becomes a knife you’ve sharpened for others to use.”

A few years ago, when he worked at a Pennsylvania hospital, Raymond Reyes, M.D., refused to order restraints for a nonpsychotic patient who was exhibiting disruptive behavior. His refusal got him in hot water with his supervisor. Reyes, a son of Phillipine immigrants, wondered whether he would have taken such a stand if he had not suffered from a mental illness himself. Reyes explained that he has suffered from dysthymia and major depression, first realizing that he needed psychiatric treatment after he graduated from residency and joined the Air Force, where he supervised an inpatient unit.

After believing that as a physician he was expected to be “stoic” about his depression symptoms, he told a superior at the air base that he needed treatment. He asked the superior, who was also his friend, to treat him. “That ended both the friendship and our working relationship,” Reyes said. At that point he had second thoughts about whether he should have put himself on the line by admitting he had a serious psychiatric disorder, but he explained that he didn’t want to self-medicate or “do anything under the table.”

He said that he has identified one “silver lining” in his continuing battle with mental illness, namely, that he has even more empathy with other people suffering from similar disorders than he might otherwise. He wonders, he noted, whether he would have refused to restrain that patient in Pennsylvania if he had not seen mental illness from the inside. He currently works at a community mental health center in Solano County, Calif.

Workshop cochair Michael Myers, M.D., pointed out, “We have a long way to go in the house of medicine” when psychiatrists and other physicians with mental illness are still forced to overcome stigma directed at them by their colleagues. ▪