How Mental Health Care Providers Can Address Stigma, With Dr Michael Myers

Michael F Myers, MD, caught up with Psych Congress Network (PCN) after his American Psychiatric Association (APA) 2023 annual meeting session, "The End to Stigma Begins With Us: How Physicians Can Address Stigma in the Medical Profession and Beyond." His session, co-presented with Devika Bhushan, MD, Linda Worley, MD, and Dionne Hart, MD, explored tools and strategies for optimizing physician mental health, including reducing public stigma, self-stigma, and institutional stigma, as well as improving access to early evidence-based treatment.

In this video, moderated by PCN Managing Editor, Meagan Thistle, Dr Myers shares key takeaways from his sessions, including best practices for reducing stigma, common misconceptions on this topic, a moving personal anecdote from his own personal and professional journey, and places physicans can go for resources on this topic.

To stay in the know with the hottest topics from the 2023 Annual Meeting, visit our APA Key Clinical Topics hub.

Read the transcript:

Meagan Thistle, Managing Editor, Psych Congress Network: Hi Psych Congress Network, welcome back. I'm here with Dr Michael Myers. If you'd like to introduce yourself, Dr Myers.

Dr Michael Myers: Hi everybody. I'm delighted to be here.

Thistle: Dr Myers spoke at the APA 2023 annual meeting and we will be discussing his session along with his colleagues who presented “The End To Stigma Begins With Us: How Physicians Can Address Stigma In The Medical Profession And Beyond.”

So, let's get started. Could you tell the Psych Congress Network audience what are the 2 to 3 main takeaways you hope clinicians gain from your session?

Dr Myers: I'm happy to. First of all, we were very pleased with the session. We decided to drill down on this subject of stigma in psychiatrists this year by having all of us share some personal anecdotes about our own experience with internalized stigma or even external stigma, or something like that. 

This was an invited workshop, and I was delighted to work with Dr Devika Bhushan, who is a pediatrician and public health specialist, and last year was the acting surgeon general of California. During that year, in fact, right at the beginning of the year, she disclosed in a keynote address that she lives a bipolar illness. This was picked up by the Los Angeles Times because she wrote an op-ed piece there. This was a real watershed moment actually, where somebody of that stature, even though she's not the first, spoke so openly and, well, just very movingly about her experience with the illness.

This has resonated a lot with the general public, including us in the rest of medicine, in particular in psychiatry. We were also joined by Dr Linda Worley, who I've known for some time, and she's a chief wellness officer at the University of Arkansas Medical Center. She's got a long experience in working with the Vanderbilt Center on Physician Health. The moderator was Dr. Dionne Hart, and she is an assistant professor of psychiatry in Minnesota, adjunct professor actually, with a long history of working in the area of substance use. She's been awarded accommodations by [National Alliance on Mental Illness (NAMI)]. The other panelist was myself.

Our learning objectives, we think were well-met. One of the things that we wanted to do was really highlight the Dr. Lorna Breen Health Practitioner's Act to make sure that everybody is aware of it, but also to know where to access this online. There's a number of things that they're doing in the world of physician health, but, the one that we mainly focused on was the toolkits that they've come up with for individuals and for institutions in contacting their respective state to find out what questions are asked on both the application for a medical license and also, the renewal. That, as well as credentialing applications. Because for too long the questions have been discriminatory, very intimidating, very intrusive, and also violating the Americans with Disability Act. Not all states.

But since the Dr Lorna Breen Health Practitioner's Act has been formed, increasing numbers of states are changing the language on these applications, and reapplications or renewals. So, we're very happy about that. There's still a lot of work to do, but this will ease individuals who have sought help in the past or even more commonly, if they're not feeling well, that they're reluctant or hesitant to go for help because they're afraid that they're going to be penalized for this down the road.

Thistle: So, it sounds like you were the perfect group to be speaking on these topics, a well-renowned group, I'd say. It's really great to hear that we are moving in the direction where patients are more comfortable going to receive the help that they need and deserve. So in that same vein, could you go into a bit about the key best practices that clinicians can use in recognizing and addressing stigma, aside from what you just discussed with those laws and regulations shifting?

Dr Myers: Yes. As you know, stigma is such a buzzword in so many respects, and it's so much a part of what we do. But when we think about it a little more seriously, we also need to pay attention to at least two things. One, is our own internalized stigma. Despite the fact that we're mental health professionals, we're psychiatrists, we're attracted to the field. I mean, we want to help people. We're trained. We look after people with stigmatized illness. So many of us still walk around though with residue of having grown up in a society that has been so afraid of or negative about people with mental illness. So, we have to pay attention to our own internalized stigma and be humbled by it, especially when it comes to thinking of our own hesitancy if we reach out for help, or judging our colleagues when and if they reach out for help too. So, that's the internalized piece.

The external piece is when and if we actually witness discrimination against individuals because of the fact that they have suffered and been treated for psychiatric illness before themselves. Sometimes, we see this in medicine, that people aren't given a fair shake if they get in trouble at work. For instance, they don't seem to get in trouble at work because they had multiple sclerosis (MS) or perhaps diabetes, but sometimes things like psychiatric illness can be sort of held against them or more commonly, just not understood. That gets into the area of what I call “disruptive physician.”

So, the evidence with all of this is that we need to pay attention to it. We need to not just be, I think, better informed clinicians when we look after our patients, but certainly in our advocacy work, that our work extends way beyond the "therapeutic hour.” Our patients need us to speak out for them or on behalf of them, whether it's as simple as filling out a disability insurance form, or whether or not it's giving a talk in our local communities, such as town hall or something like that. Or, writing a letter to the editor or something like that about the injustices in our society. So, that's what we were really trying to convey in this session. And as I say, we were very pleased because it was almost like a call to arms, we know a lot about this, what can we do now?

Thistle: So thank you for sharing. You could take those pieces and act now. So, thank you for sharing those. And would you mind sharing perhaps a personal anecdote regarding what led you personally to become an effective physician and a mental health advocate?
 

Dr Myers: Yes. In fact, this is part of our individual respective presentations when we introduced ourselves. I started out by just being very candid about growing up in a family with a mom who suffered from alcoholism and an unrecognized and untreated depression—functioning, but suffering in many, many respects. I remember so much as a boy being embarrassed and being confused about this. I knew nothing about it. I had to get higher education, especially in medical school to realize this isn't so uncommon, and especially in families of origin, of people who are attracted to medicine. So that helped me to be much more mature and much more forgiving, I must tell you.

Then fast-forward, I lost my roommate in medical school to suicide. I was only 19, Bill was a little bit older than that. This is in 1962. There was so much stigma in those days. In fact, we didn't really hear anything from the dean's office. Nobody reached out to us. I mean, we just buried ourselves in our studies. It was as if Bill didn't even exist. I've often thought of this, if Bill had been killed in a car accident or died of leukemia or something like that, there would've been a proper sendoff and grieving on our parts. But, this was just swept under the carpet. So, I realized early that there's stigma, not just in our society, but in medicine.

Then, the next piece I shared is that when I was an intern, this was actually, or after I was an intern, this is back in 1967, I was struggling with my own sexual orientation. That I really wasn't quite clear. I had no same sex experience, but, I began to get a little bit of that, and then realized after a few months that this was not cool. What I meant by that, it was that in those days, homosexuality was illegal.

Secondly, in DSM, which I had never really heard of, but I looked up, I was either sociopathic personality, or a sexual pervert, or a deviant, or not very pretty stuff. The other thing too is that I had never ever heard of a gay doctor. I mean, obviously they were there somewhere, but I'd never heard of one. I was just so isolated with this. So, I quickly jumped back into the closet. I'm laughing about this even though it wasn't really that funny.

But I was bisexual enough and had enough heterosexuality that very shortly after that, I met my person who became my wife, and we had a very, very long marriage. Actually, 40 years, 2 beautiful children and actually a very good, strong, happy marriage until the latter few years or whatever.

I'm not going to go into any more detail, but at the age of 65, I came out as a gay man. So, I shared that as well because of the fact that deep inside I lived with uncomfortable feelings about that. As you know, our world today is so different. LGBTQ matters, we've advanced so far, but look what's happening now with our trans brothers and sisters. So, our work is not finished, that's for sure. This just an example of a few things that I shared where I've lived with internal embarrassment or shame, or feeling less than or different, or things like that.

Thistle: I really appreciate you sharing that. Again, I know that you shared it with the audience at your APA session, but it is getting your personal story out there to the audience. I think it's going to have an immense impact, so thank you again for sharing that. I am very honored to be speaking with you today based on, of course, your vulnerability and also, your knowledge as a clinician. 

So, let's keep going here because I really want to dig a little bit deeper. Your knowledge on these topics is both personal, and also it's the work you've been doing for a number of years. So, keep going here.
What common misconceptions exist, right? You discussed some that you've experienced in the past and also some today personally, but also with your patients. What common misconceptions exist about the mental health of psychiatrists themselves, right? You spoke of your own misconceptions that you may have experienced, also of your colleagues you presented with at APA, and how do we continue to combat those misconceptions? As you mentioned, we are progressing, right?

But, there are still misconceptions out there. So, would you mind sharing how, possibly clinicians could continue to combat those?

Dr Myers: Meagan, thank you. That's a wonderful question. Back in 1999, the late Dr. Leah Dickstein, who was a colleague and wonderful friend, she and I put together a workshop called “Psychiatrists Living with Psychiatric Illness.” We had four volunteers, and we did that for the next 11 years at the annual meeting of APA. That was our effort. And, oh my God, I can't tell you how grateful we are to all of the psychiatrists, including psychiatry residents who came forward over the years. This is part of a new book that I'm working on for APA Publishing House called Physicians With Lived Experience: How Their Stories Give Clinical Guidance. So, it's going to be a composite of that.

And that was an example, to answer your question, of decreasing stigma when psychiatrists just tell their story and come forward like that, because they make connections too. We know that in the audience were individuals who would come afterwards and speak to almost every one of the speakers. They would exchange phone numbers or email addresses because they say, "I've experienced what you've experienced, but I'm really in the closet about it. I just have never told anyone that sort of thing."

So, the more we do that, the more we normalize, the more we share our vulnerabilities, we do feel that that is, I think, restoring the humanity of psychiatrists because we don't always get a good rap. I think, sometimes we're seen as just too technical in our approach with patients, that we are not zeroing in enough on, sort of the empathic dimensions of our work, getting caught up too much in some of the business of psychiatry or something like that. That was really one of the messages that we really tried to get through, and I think that by all of us doing that, I think we're practicing biopsychosocial medicine, and I think that our patients, of course, hopefully, do well in terms of that kind of approach.

Thistle: Great. Something I've been hearing in the field, and just to echo what you've been saying is, treating the whole person, right? You're using multiple facets. You're working as a team to treat the whole person. I appreciate you continuing along that same vein. And also that goes for, as you mentioned, for yourself as a clinician, right? Treating yourself with grace in order to treat your patients.

So, thank you for sharing that.
Dr Myers:  Thank you.

Thistle: As we continue and we get to the end of our conversation, before we get to next steps, do you have any resources that you recommend, aside from that book that you mentioned? Do you have any resource you recommend clinicians look out for, for their own mental health and that of their colleagues?
Dr Myers: Yes. Well, the shortened answer to that is that there are a number of resources that are available that are more often position papers or published articles, peer reviewed published articles--there's so many of these. My thought and suggestion would be for people to go to NAM, the National Academy of Medicine, because even though they're not restricted just to physicians, it's all health professionals, but it's a clearing house of information. There's a way of finding all kinds of wonderful resources there.

When I'm researching the topic too, I often head to Google Scholar. You can easily pick up many things there under the rubric of physician health. The same way with the American Medical Association. I'm on the committee on Physician Wellness and Burnout of APA. We're also compiling all kind of anthology of resources as well. A number of us have also published books on this area too, that are both for the practicing clinician like technical skills and looking after patients, but also ones that are a bit more personal too in certain areas like substance use disorders for instance in physicians, or depression in physicians. The doctor-patient relationship, when a physician is your patient, those types of things too. So, there really are a lot of resources out there.

Thistle: Great, thank you. We can as well link some of those that you mentioned below. Is there anything else that you'd like to share, Dr. Myers, that we haven't gotten to today based on stigma for clinicians themselves out in the field?
 

Dr Myers: Yes, there's two things. It has to do with references. We also provided the APA with quite a lengthy reference list as part of this, that anybody who has registered for either the in-person or the virtual APA would be able to access theirs. Because, there's a great updated physician paper on stigma published in The Lancet, for instance. And the other thing I wanted to say, which is kind of earlier, is the whole notion of self-compassion. Because, this has become a field of study actually over the last five years or so because of misunderstanding about it.

Self-compassion was confused with self-centeredness, or with selfishness, or whatever. Self-compassion is basically just treating ourselves with the dignity, and respect, and the love and care that we provide to our patients, or to our family or friends. That's basically what we're trying to say, that we need to do more of that for ourselves. In the long run, it makes us better at looking after others. Caring for the-

Thistle: Yes.

Dr Myers: ... caretaker helps the caretaker care for others.

Thistle: Yes. Right. Right. Caring for yourself and this way, you can care for your patients.

Dr Myers:  Exactly.

Thistle: Dr Myers, it has been an honor to talk with you today. Thank you so much. I'm really, really excited to see where your talks head. Would you mind sharing, are you doing any further speaking engagements where folks can see you live and in-person?

Dr Myers: Nothing else at the APA meeting. But what I do though is, I keep a list of upcoming events on my website, which is www.michaelfmyers.com.

Thistle: Great.
Dr Myers: 
My blogs, podcasts, things like that, that I try to keep up to date with regard to contemporary issues in physician health.

Thistle: Great. Thank you so much. So as you've heard folks, you can go ahead and keep up with Dr. Myers and all of those places that he mentioned, as well as on Psych Congress Network. You can also keep up with APA key clinical topics in our newsroom. And, we hope to see you again soon. I'm Meagan Thistle, your managing editor, and it's been a pleasure.

Dr Myers: Thank you.

Michael F. Myers, MD, author of "Becoming a Doctor's Doctor", is professor of clinical psychiatry and recent past vice-chair of education and director of training in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Health Sciences University in Brooklyn, NY. He is the author or co-author of 8 other books, more than 150 articles covering such topics as marital therapy, men and reproductive technology, divorce, sexual assault of women and men, AIDS, the stigma of psychiatric illness, gender issues in training and medical practice, the treatment of medical students and physicians, boundary crossing in the doctor-patient relationship, and ethics in medical education and suicide. He has received multiple awards for excellence in teaching and has served on the editorial boards of several medical journals - and in 2021, the board of the Bellevue Literary Review. Along with his continuing clinical research, teaching and outreach in the field of suicide, Dr Myers is a recent past President of the New York City Chapter of the American Foundation for Suicide Prevention. Dr Myers lectures widely throughout North America and beyond on these subjects.