Stigma and the Ailing Physician
In an earlier blog piece, “Depressed Psychiatrists and Self-Prescribing,” I referred to stigma as one of the core reasons that psychiatrists self-medicate. I now want to expand on this notion, highlighting how much stigma reinforces denial and minimization of illness in doctors. Simply put, who wants to recognize the signs and symptoms of an anxiety or mood disorder or a substance use problem when its acceptance is terrifying and shameful? Who wouldn’t want to just bury themselves in work and hope it’ll all go away? And if it doesn’t go away, who wouldn’t want to wait a little longer or in today’s vernacular “just suck it up”? Instead of feeling strong, smart, or wise about reaching out for professional help - too many ill physicians who do consult us feel defeated and diminished. This is sad and needs to change.
But stigma has even more pernicious effects. Stigma kills. I believe that perceived stigma killed a patient of mine, a young doctor who ended his life with a lethal injection of stockpiled potassium chloride, while out on pass from our psychiatric inpatient unit. My hunch is that one of the final determinants in his decision to kill himself had to do with a perceived threat to his professional identity—that he would not be allowed to continue his residency, his lifeline to normalcy and security—and his dreams. Distorted thinking? Largely. Cognitive impairment due to depression? Yes. This handsome, bright man should not have died this way, struck down. I will never forget him. At his memorial service, I made a silent pledge—a pledge not to be silent, that his death would not be forgotten, that his death would not be in vain.
This tragedy occurred 15 years ago but he has been on my mind the past few weeks. I’ve just started a research project interviewing the loved ones (and other intimates) of physicians who have killed themselves. These subjects are largely family members—but not exclusively—some are the medical colleagues, treating professionals, close friends, trainees, supervisors, and patients of the deceased. These are all survivors—individuals whose lives have been touched by someone lost to suicide.
Although early in this endeavor, I am struck by how much internalized stigma in the physician loved one was a driving force from day one. Several of the doctors received no treatment at all and pushed away overtures from those who cared deeply about them to seek help. I asked one woman, the widow of a physician who shot himself, if her husband might have sought help and didn’t tell her. She replied “I don’t think so, we were very close, he didn’t keep secrets like that from me.” There was a long pause. She continued “Well I thought he told me everything but obviously I was wrong. He made this very big decision without consulting me.”
Although it is well known that physicians delay and avoid seeking help for many ailments, not just psychiatric ones, and frequently do not have a primary care doctor; most non-physicians with similar illnesses seek professional help. I do not know of psychological autopsy research comparing the suicides of physicians and non-physicians. However I have heard from several interviewees that they think their loved one would be alive today if he/she were not a physician.
In a future blog I will return to this theme and discuss other ways in which stigma affects ill physicians who do seek help.
References
1. Myers M: Depressed psychiatrists and self-prescribing. Psych Congress Network. https://www.psychcongress.com/blogs/michael-myers-md/depressed-psychiatrists-and-self-prescribing
2. Myers M: Presidential address. New century: overcoming stigma and respecting differences. Canadian J of Psychiatry. 2001;46.10:907-914
Dr. Myers is Professor of Clinical Psychiatry and immediate past Vice-Chair of Education and Director of Training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, NY. He is the author of seven books the most recent of which are “Touched by Suicide: Hope and Healing After Loss” (with Carla Fine) and “The Physician as Patient: A Clinical Handbook for Mental Health Professionals” (with Glen Gabbard, MD). He is a specialist in physician health and has written extensively on that subject. Currently, Dr Myers serves on the Advisory Board to the Committee for Physician Health of the Medical Society of the State of New York. He is a recent past president (and emeritus board member) of the New York City Chapter of the American Foundation for Suicide Prevention.
The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.
