Stigma 101

Shalom, friends.  I have been thinking about my lost professional life a lot lately, as I have been working on my NaNoWriMo novel, which is loosely autobiographical.  NaNoWriMo means “National Novel Writing Month.”  It takes place every November.  It’s an organized event wherein several thousand crazed writers attempt to rough out a 50,000 word novel in a month.  It’s wicked fun.

This is my second year doing it.  So far I haven’t managed to get to the finish point, but what the heck.  I’ve learned a lot.  And who’s to say I won’t do it this year?  Oh all right, it’s November 19th and I’ve only got 20,000 words down.  You never know.

As I was saying, my novel is “loosely” autobiographical.  Deals with a, you know, woman pediatric emergency physician who, etc. etc. (I won’t tell you the plot yet, as I am still struggling to get a strangle hold on it myself and don’t want it to slip me a mickey while I’m sneaking up on it).

One of the things I have not done with my protagonist/heroine is to make her bipolar.  I just realized that tonight, while sitting down to write this post.  How extremely odd!  Imagine, if I had copped to the fact that she is bipolar from word one, I probably would have topped 50,000 by now!

Why haven’t I done it?  One word suffices:  Stigma.

I lived my entire career petrified that someone would find out.  Because in my personal experience, once a physician (psychiatrists excluded) has a known psychiatric diagnosis, s/he may as well pack up the old kit bag and light a shuck for Somewhere Else.  Wherever that is.  Because there is nothing that will turn one’s colleagues into non-colleagues faster than a psych diagnosis.

Once I ran into a former mentor from my pediatrics residency program during intermission at an American Academy of Pediatrics meeting.  She asked how I was doing.  For some odd reason, the words that exited my mouth were, “Actually, I’ve been struggling a bit with depression.”  Her mouth snapped shut and she did an abrupt about-face, and was off into the crowd faster than you could say “Stigma.”

The fear of discovery of my condition actually lead to my downfall, as I often went without treatment rather than take the risk of disclosure.  When I did get treatment, I paid out of pocket for my psychiatric visits, therapy, and meds, so that they would not be on my insurance records.

How strange that I found myself envying an alcoholic colleague, whose stints in rehab were looked upon with broad approval by all of our colleagues, when I was unable to disclose my own disability because those same colleagues had nothing but nasty talk about another of our brethren who had taken time off to deal with an episode of mania!

I’ve read several blogs by other physicians with affective disorders, and a common thread is the need to keep their condition secret, trying to juggle heavy meds with 27 or 30 hour shifts, all the while trying to keep the old brain between the ditches and function in the 99th percentile.

And I know some of you who are reading this are doing the same thing, being very careful that no one suspects that you have a “diagnosis.”

How long are we going to keep this charade up?  For me, it’s too late.  I’m out of the game.  But it makes me sick to think that my brothers and sisters who are physicians, teachers, and other professionals who deal with the public on a day to day basis, are not free to just “be themselves” but have to be very careful not to inadvertently “disclose.”

No, I wouldn’t have wanted all of my patients to know I’m bipolar.  But for some of them, it would have been a big boost if they could see that even doctors can be bipolar.  Kind of like having an endocrinologist who’s diabetic.  See, diabetic kids can grow up and become doctors, too!  Bipolar kids can grow up and be doctors, teachers, lawyers, folk singers!  Folk singers?  Oh, never mind.  You catch my drift.


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  1. Someday when enough people finally get disgusted enough to do something about it … willing to take that risk, things will change. It happened in ever other movement from civil rights to homosexuality and will happen in the medical profession. Ever think of hooking up with NAMI, for instance? You wrote it’s okay for psychiatrists to have a MI. That can be a starting point.

    • Yup, you are 100% right on. There are a number of factors that will have to be in place before doctors “coming out”will happen. One is the punitive stance taken by many state Boards that insist that doctors who admit that they have a mental illness go through their Physician Health program, which is nothing more than a monitoring oversight to make sure they’ve been taking their meds. Many times, mentally ill physicians will be lumped in with drug and alcohol abusers and subjected to drug monitoring. I tried doing this in one state and found it so negative and rigid, I couldn’t cope. It was run by a private contractor and they explicitly told me, either you comply with X number of visits at $200 per visit out of your pocket, or kiss your license goodbye. I don’t remember how I did it but I found a way out the back door that didn’t have national repercussions and just gave up the idea of being licensed in that state. It is that kind of piracy that has to be addressed. NAMI is helpful, but I think it will have to come through an AMA committee to make any difference.

  2. I had a private practice in a small … not the point.

    Thank God I’m retired now and free to be myself. But I don’t know about you’re letting other shrink off the hook. My psychMD friends were as you said other doctors were. Determined to me ‘upstanding role models’ of ethics and practice. Until you scratched the veneer a bit and…The Black Bird of ‘Casablanca’ appeared…full of greedy hands and evil minds.

    Wow…What an image I’ve drawn. Yucko!!

  3. I believe that many people hide it in their professional life. A corporate executive may hide it because subordinates, superiors, and clients may start questioning her judgement. I think that’s probably across the board throughout various industries. Some may fear that person would “snap out” and harm others. Suddenly, the person with bipolar is looked upon as unreliable, although they’ve missed work less frequently than their peers. Perhaps, it would even get to the point where the person with bipolar is looked at as a complete liability.

    As a pediatrician, there is a special consideration. You worked exclusively with children and their parents.

    Many people know that I am an educator, even if they don’t know that I have bipolar disorder. And I’ve imagined what it would do to my career if that were to leak out somehow. An employer can’t flat out fire you, because that’s discrimination. But, that won’t stop them from preying on your symptoms until work conditions are so intolerable that you are forced to quit.

    I can see it. Suddenly, my class schedule is extremely reduced. I’m no longer exclusively responsible for any group, nor am I ever left alone in a classroom for any amount of time. I’m no longer asked to cover other classes and tutor, especially if it comes to a child with special needs. I am excluded from clubs and extra activities because of a “limited budget”. Other people start “assisting” with my own duties. Finally, if I manage to make it to the end of the school year, I’m told that I will not be returning due to “budget cuts” in the upcoming school year. Even if they can’t cut me, they can cut their music program for a semester, and then bring someone else on later when “money becomes available”.

    I get it. I get the stigma. Suddenly, people will start to worry if I’m fit to be around children. It will become a question among my bosses and co-workers. Eventually, it will leak out to the parents, and they’ll start raising a fuss. I will become an extreme liability instead of their greatest asset, as I stand today.

    No thanks. Seriously. I know it’s terrible of me to say, but I’d rather not say anything about it. Just like everyone else in the world, I’ll write about it in my autobiography when I’m retired.

    • And there you have drawn an eloquent picture of the villain in our story: STIGMA.

      So we just keep our heads down, do a really good job, and hope to G-d we don’t get “outed” by something as undeniable as a hospitalization. What else can we do?

      My therapist laughs when I tell her I feel like an invisible leper. She really thinks I’m joking. She’s a very sweet lady, and in general has good ideas. But I’m not joking at all. I don’t believe that a person who does not have a mental illness can come anywhere near understanding what it feels like to know that if the people around you knew, life would change for the worse very quickly. I wish I could be more optimistic, but my experience has embittered me, I think.

      • I agree. People that have never suffered this just don’t know the intricacies involved. They can read it in books, study hard as they can, but it’s not the same. Experience is the best teacher. Honestly, I’d feel better about seeing a therapist who has been there and come back from it.

      • Having a “there and back again” therapist IS the best….but you know, the nature of the beast is that it has a diabolical propensity to recur. So it’s a double bind there, because the therapist has to take care of her/his own needs, including time off, yet the patient can’t wait. My own psychiatrist teeters on the edge of major depression a lot (what, did you think I don’t notice, T, if you’re reading this?) and is unavailable more than I’m comfortable with. But he’s also the best in town, with his brilliant brain and his empathy born from experience.

        • I see exactly what you’re saying about the “there and back again” therapist. Someone close to me went to a psychiatrist regularly for treatment. One day, he went in for a med check, as he had been having some serious problems on Prozac (suicidal thoughts for the first time in his life). The doctor, shrouded in a headwrap and a big, dark pair of sunglasses, threw another prescription at him and was all too eager to get him out of the door. While he was in there, he got a glance at her face. She had a shiner the likes of what a boxer could have given her. And that is when he made the decision that she could not be responsible enough to care for him if she couldn’t care for herself first.

          There is a certain stigma behind that. Who knows what was going on behind closed doors? Looks can be deceiving. I’m not going to doubt his theory because she was very distracted and clearly embarassed. (I happened to have taken him to his appointment that day).

          I think it was the right decision for him, especially since she was not very concerned about his psychiatric needs. He did some research before taking the meds, and found that what he was prescribed had a serious risk of serotinin storm. Not only was she dismissive, but she was negligent. And unfortunately, because of that event, this man stopped receiving treatment entirely. Thankfully for him, he has an anxiety disorder that he has learned to manage through diet, exercise, and lifestyle choices.

          But, there’s a problem there. The stigma exists because of situations like that. No one will pay any mind to someone who is doing sterling work, or living an exemplary life. The only stories that exist in the public eye are those displaying what happens when a person is improperly treated, refuses treatment, or was never educated enough to seek treatment. The latest one was about a man suffering from schizophrenia, who opened fire in an iHOP. A family member said to me, “Well, I won’t be going to an iHOP anytime soon.” I asked, “What does iHOP have to do with it?”

          *Frustrated Sigh*

          At least psych 101 is a requirement for all undergraduate degrees now. If you are going into anything that is health and human services, additional psych classes may be required. I went to a health fair earlier this year, and there was one lonesome, stone silent table about local behavioral services. And I thought, “Why aren’t they being more aggressive about this?” 1 in 4 people in the U.S. has a Dx and 1 in 16 have a serious Dx. Why is education not a priority?

  4. “Why aren’t they being more aggressive about this?” 1 in 4 people in the U.S. has a Dx and 1 in 16 have a serious Dx. Why is education not a priority?
    Yes, WHY?

    • You’ve hit upon the essence of stigma. Even though there’s one in four, and I highly suspect over a lifetime more, because of situational depression, anxiety, etc., ours is the FIRST generation that is beginning to speak about mental illness AT ALL.

      It is following the same pattern as cancer stigma. Fifty years ago if someone had cancer it was hushed up to the point where EVEN THE PATIENT was not told!!!! Then, about 20 years ago, things eased up and people would say in hushed tones, “Did you know Aunt Sadie has The Big C?” As if saying the word CANCER was going to somehow rub off on them.

      Well it’s the same with mental illness. My great uncle was carted off to a state hospital and never heard from again by the family (I did find him on the web. He married and had children and grandchildren.).

      So what I am trying to say here is that it’s a long slow process of education and acceptance. We are having a very big setback right now in that the idiots in the media and lawmaking are making a one-to-one relationship between mental illness and gun related murders, which I think is nothing but heinous scapegoating.

  5. Yep..people can get away with murder if they can slap you in shame and get you
    to be grateful for being treated badly…

    That’s why stigma is such a deadly weapon.

    You might be interested in Andy Weisskoff’s blog, 90 Days to change:

    And the activity of Sonoma County Supervisor, Shirlee Zane, who is holding
    Kaiser to task for refusing to comply with California’s Mental Health parity

    • Thanks, I’ll check your links out. You are right in a lot of ways. I will have to sit with this a while. Thanks for your thoughtful comment.

      • Your welcome,

        Thank you for your blog…it is an inspiration and helps
        me to move from fear in posting my own story…:)

        • Aw shucks, thanks once more. I’m glad my blog is helpful to you. I just try to keep on chugging along.

          Your story is important. Tell it however you’re comfortable telling it. But get it out there for people to see, and be inspired by, and know that they’re not alone. Even if you touch one person’s life, it’s as if you saved the world (old Jewish wisdom, borrowed;-) )

          • Thank you, Speaking as an old Jew I agree with the wisdom. 🙂

            It has taken me a few years to get my bearings…I have had to understand that the DID is not only real but that the denial of those who want to dismiss it is toxic to me.

            Any situation that will feed my own need to deny
            the existence of the DID will only make my life worse…

            The same is true of the smiley faced descendents
            of Norman Vincent Peale. It must be great to be a
            pain free person but I’m not one of them..

            In fact, a pain free life is probably pathological.

            • Ah…for some reason your last sentence put me in mind of Allen Ginsberg’s “Kaddish.” Maybe it’s because my father is now in the act of dying, and the pain of seeing him go is almost unbearable….

              • How difficult this time is for you…I wish I knew what
                to say…this is where the problem of not forming attachments is a handicap.

                I can only know certain aspects of life on an intellectual level…The loss of parents is foreign to
                me as is the loss of anyone. I simply have no
                memory of parents.

                So I know that anything I might say will sound superficial…But I will say that my thoughts and
                prayers are with you.

                • Thank you for your words of comfort, very much appreciated. I am so sorry that your state of dissociation has put so much of life out of your reach…I have lived my own version of that, do now in fact, and now I am losing the only person who ever really really understood…mortality is cruel. But at least I have this pain, so I know I’m alive


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