By Mr. K (Anonymous)
Physicians are oftentimes cloaked with an aura of confidence, self-assuredness, and omnipotence – or at least that’s what they hope the public perceives of their profession. And thus, it is natural that any form of perceived mental weakness or incapacitation, including mental health issues, is frowned upon within the profession.
The 21st Century, however, has clearly shown that previous notions of mental health stigma in society are actively being dismantled. It is now okay to talk about your mental health issues in the general population. Celebrities and important figures in society now openly disclose their mental health issues. More data has come out that shows how prevalent mental disorders are in society. Conservative institutions like medicine are the final bulwarks of defiance against the progressive notions about mental health. And while some movements are addressing physician wellness at certain forward-thinking institutions, they are largely independent and localized.
Earlier this year, the former First Lady Michelle Obama openly disclosed that she was struggling with depression.1
This past week I saw that December 3rd was International Day for Persons with Disabilities. In a couple days, we’ll be observing Human Rights day on December 10th. These days carry great significance for those who face scrutiny just for simply having mental health issues. Yes, mental health is a human rights issue. Yes mental disorder is a disability. You would think that in an increasingly progressive world that has been advocating for human rights for decades through policies like the Americans with Disabilities Act of 1990, we would be more receptive towards physicians and health practitioners with mental disorders. But it’s not. Not yet.
Stigma Exists. And it Starts Early.
The fact is, mental health is stigmatized and a culture of unwellness is facilitated at every single stage of the medical pipeline, starting from the youngest members of the medical community. From day one, pre-medical students are thrust into a competitive world where grades and extracurriculars are more important than sleep and wellness. Students are subliminally told that in order to succeed in this profession, your wellness will take the back seat. For example, there are dozens of resources and YouTube videos out there that show students “How to get a 100th Percentile on the MCAT”, but almost no videos on how to maintain mental health as a pre med. In this environment, anxiety and stress are rampant. A Kaplan study showed that “more than a quarter (26%) of pre-meds say they experience stress ‘pretty much always’, 45% say they experience it ‘frequently’, and only 1% say they do not face stress.” Another study showed that “nearly twice the number of premedical students belonged in the category of ‘severely depressed’ as nonpremedical students”. Clearly, this culture is the root of the high burnout and suicide rates in the medical profession.
Twice the number of premedical students belonged in the category of “severely depressed” compared to non-premedical students.
Additionally, it is made clear early on to aspiring physicians that mental health is not a topic that is appropriate to discuss in their future profession. When applying to medical school, mental health issues may be seen as red flags for admissions committees, and a hindrance to your chances of getting in. There are ample online forums on reddit and SDN, and other platforms for pre-meds that highly recommend applicants not to disclose their mental health issues in their application or personal statement, even if it was an integral part of their journey in medicine. This sends a message early on to the aspiring physician that mental health has no place in medicine, incentivizing students to hide their mental health issues, and discouraging help-seeking behavior.
This sends a message early on to the aspiring physician that Mental Health has no place in Medicine…
At medical schools, there have been several independent efforts by progressive institutions to address physician trainee mental health. Given the high rates of burnout and stress in medical school, this stage is where most of the progress is being made to help promote a culture of wellness. Despite these efforts, many medical students still find themselves struggling with finding time to seek help, or still adopt evasive tactics when seeking treatment in order to prevent any records of mental illness. Like medical school applications, medical students applying to residencies routinely hide their mental illness if they have one (in one study, 63% of students anonymously surveyed through the Electronic Residency Application System said they would not disclose their disorder if prompted), or apply to residencies in states that don’t scrutinize mental health issues as much. There is data that shows that disclosing mental disorders does in fact place applicants at a disadvantage for residency programs.
When an individual finally gets to become a physician, they are stigmatized even more. No longer can you slide by via passive nondisclosure like in medical school or residency applications – you must actively lie to the medical licensing board to avoid scrutiny if you practice in a state that asks directly about mental health issues. Some states are more progressive than others and might only ask about current debilitating disorders, but the majority are not as lenient. A study showed that only 18 state licensing boards have questions about mental disorders that comply with Americans with Disabilities Act standards. Consequences of disclosing mental illness can be everything from undergoing monitored treatment to losing your medical license. This intrusive level of scrutiny discourages help-seeking behavior by physicians, and promotes evasive or unethical behavior such as lying, paying cash to seek treatment, or self-prescribing. There is no wonder why 44% of physicians are burnt out and physician suicide rates are double the rate of the general population.
This intrusive level of scrutiny discourages help seeking behavior by physicians…
Why Should The Scrutiny Stop?
1 in 4 adults aged face mental health issues. This means that 25% (if not more, due to stress of the field) of young adults are entering a medical profession that will not be kind to them for simply being human and having flaws in their mental health. They must hide, evade, and live in fear, knowing that they may one day face consequences for their secret in a profession in which they dedicated their lives to.
This advocacy is immensely urgent as the healthcare community struggles with the global pandemic in 2020. Already there are reports of increased levels of burnout and talk of an entire generation of medical professionals potentially facing PTSD and other mental disorders. Those who are courageous enough to face this crisis should not be penalized, discouraged, or scrutinized for needing treatment for their psychological disorders.
Conclusion
I often wonder how many physicians, medical students, and pre-medical students have been lost because they had nowhere to turn in a system that seemed to hinder their continued wellness. It doesn’t make sense that a profession of healing can discourage the healing of their own, and it’s time that the medical community should start questioning these discriminative and harmful practices.
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1. Michelle Obama. Gage Skidmore, 2016. From Wikimedia Commons.
Copyleft: This is a free work, you can copy, distribute, and modify it under the terms of the Free Art License
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Posted on December 7th, 2020. Follow us on Instagram at (@medical.minds.matter).
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