Too Often Doctors Stigmatize People Living with Mental Illness
“So what medications are you taking?”
I’m in a Brooklyn CityMD on a Saturday morning, waiting to be diagnosed with what I suspect is strep throat. The physician’s assistant is asking the standard screening items about allergies and surgeries, and she has now gotten to the question I’ve been dreading. I rattle off my list of medications, which she diligently enters into her database before asking, “And what are you taking those for?” I sit up straight, trying to look as calm and casual and normal as possible.
“I have obsessive-compulsive disorder.”
Despite her attempt to remain stoic, I feel the air getting sucked out of the room as she silently enters my diagnosis into her records. As she stands to take my vitals, she suddenly stops and, after a pause, hesitantly asks, “Can I...touch you?”
This well-meaning but misguided attempt to gauge the severity of my mental illness leaves me feeling uncomfortable, but I don’t show it. Instead, I react like I always do: by overcompensating. I cheerfully inform her that of course it’s okay to touch me. I downplay my symptoms; I am cooperative; I don’t ask too many questions. Essentially, I’m trying to prove that I’m not crazy—that unlike my obsessions and compulsions, my current symptoms aren’t all in my head.
One in five Americans may be receiving substandard medical care as a result of our society’s deeply ingrained stigma against the mentally ill.
Unfortunately, I’m not the only person who spends medical appointments trying to convince doctors to take them seriously. Diagnostic overshadowing—the process by which healthcare professionals wrongly attribute a person’s physical symptoms to their mental illness—is pervasive in medicine. In 2000, a survey conducted by the Mental Health Foundation found that 44 percent of adults with mental illnesses reported being discriminated against or dismissed by their physician. Nearly two decades later this trend still prevails, with reports consistently indicating that individuals living with mental illnesses feel that doctors disrespect them, judge their credibility as they describe physical symptoms, and ignore their concerns.
In recent years, research has corroborated these anecdotal experiences of prejudice. For example, one study found that doctors are less likely to believe that a patient’s severe headaches or abdominal pain are symptoms of a serious illness and order further diagnostic evaluations if the patient has a history of depression. Despite their education and expertise, doctors aren’t immune to implicit bias and actually perpetuate mental health stigma at equal or higher rates compared to the general public. Accordingly, medical schools, hospitals, and other healthcare institutions need to implement interventions that combat this stigma.
Many organizations across the globe are currently working to develop implicit bias trainings around mental illness. Ontario Central Local Health Integration Network has developed Understanding Stigma, an intervention that’s been implemented in numerous healthcare settings across Canada. Understanding Stigma features lessons designed to increase knowledge and skills around mental health, as well as action-oriented elements that promote behavior change. Importantly, the intervention also includes social contact elements in which medical providers meet individuals who have mental illnesses and learn about their lives and experiences. Evidence suggests that this kind of direct contact can disconfirm stereotypes, heighten empathy, and reduce stigma among medical students.
Recently, there’s been much discourse about the role of bias trainings in medicine. Some argue that medical school curricula and supplementary trainings are too focused on “social justice” and “cultural competency” at the expense of mastery of crucial scientific information, while others deny that the medical community has issues with bias around mental health altogether. But bias trainings don’t have to come at the expense of learning other information and, much like a physician’s mastery of hard science, they can actually mean the difference between life and death. Americans with serious mental illnesses such as depression, bipolar disorder, and schizophrenia die 15-30 years younger than those without a mental illness. Even after controlling for “unnatural” causes of death that disproportionately affect individuals with mental illnesses—such as suicide and drug overdose—the disparity still remains, with 60 percent dying of preventable or treatable conditions. Individuals with mental health problems are more likely to die from cardiovascular disease, cancer, stroke, and respiratory issues, and a growing body of research suggests that stigma, discrimination, and diagnostic overshadowing are all big drivers of this health disparity.
According to the Centers for Disease Control, one in five American adults experiences a mental illness in a given year. This means that one in five Americans may be receiving substandard medical care as a result of our society’s deeply ingrained stigma against the mentally ill. Implementing implicit bias trainings at healthcare institutions across the country is no small venture, but it is a necessary one. We need to do better, and we can start by allowing those of us with mental illnesses to speak for ourselves and not let our conditions overshadow our truth.
Veronica Karp is a 2021 MPH degree candidate in the Department of Population and Family Health. She is interested in reproductive justice, abortion access, sexual violence prevention, social determinants of health, and mental health.
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