Recently I read Invisible Tattoos: The stigma of psychiatry by Dr. Henry A. Nasrallah in Current Psychiatry. Invisible Tattoos is an editorial piece on how the stigma of mental illness affects psychiatrists just like it affects the mentally ill. And my reaction?
Oh, cry me a freaking river.
I thought the piece was a little whiny and navel-gazing. I mean seriously, these people are respected professionals making lots of money – they don’t have an illness threatening to kill them every day.
But then I got a comment from a medical student and I reconsidered my position. Maybe antipsychiatry poster-boy Tom Cruise doesn’t just fuck around with the way people look at me, maybe he fucks around with the way people look at psychiatrists too. And maybe stigma is difficult for psychiatrists too.
Antipsychiatry vs. Psychiatry
People, mostly antipsychiatrists, tell me I’m evil because I’m a pharma-shill as evidenced by this site. And perhaps more insidiously, others insist I’m really just caught up in a giant web of pharmacology conspiracy and I’m just too stupid and naive to know any better – thus writing me and my opinions off nicely.
This is all falderal, naturally, but the antipsychiatry folks have to have some hatred to hurl at me, I suppose.
But consider for the moment, if I am evil for what I do, how despicable a doctor – someone who prescribes the evil for others – must be.
Psychiatry and Stigma
According to Invisible Tattoos psychiatrists face stigma from their family and friends, just like the mentally ill.
- Stigma: Psychiatrists aren’t “real” doctors.
- Reality: Psychiatrists are not only medical doctors who attended the same medical schools but they attended additional schooling to become a psychiatrist as psychiatry is a further specialty.
- Stigma: Psychiatrists are only money-driven.
- Reality: Psychiatrists make less money than many other specialties and in the US, health insurance companies reimburse at lower rates for psychiatric services than other medical specialties.
- Stigma: Psychiatry treatment is considered a failure.
- Reality: The success rates in psychiatry are virtually the same, and in some cases higher, than other specialties.
Medical Students and Antipsychiatry
And not only do all these ridiculous antipsychiatry statements affect practicing doctors but they also affect medical students considering going into the field of psychiatry as this medical students expresses:
. . . in medical school and in society I keep picking up a negative perception towards mental illness. My family members keep trying to persuade me to pick internal medicine and do cardiology or GI . . . They feel that the good pay is worth it and at least I get respect from society. Even within medicine, other students tell me not to pick Psychiatry as I won’t be paid nearly as much as the more lucrative specialties such as Gastroenterology. And I won’t have to put up with society’s bullshit and demonization.
This makes becoming a psychiatrist a very difficult proposition. Do you willingly become a pariah among your family, friends and colleagues or do you go with a branch of medicine that pays more and people respect?
It’s a wonder anyone becomes a psychiatrist at all.
Why Do People Become Psychiatrists?
Well, as I’m not a psychiatrist, I can’t say for sure, but I believe, hold onto your hats, they do it to help people. That’s right, the evil-pill-pushing monsters are really trying to help people with very severe, possibly lethal, illnesses. Imagine that.
Again, this medical student expresses his reasons,
I came into medical school wanting to do Psychiatry because I particularly enjoyed working closely with patients and people, and personally feel that Mental Illness can be far more devastating than other types of illness . . . some patients may also have heart disease and diabetes, but the schizophrenia when uncontrolled leads to them not taking their pills and a downward spiral culminating in disaster. Then when I see how most patients with mental illness get ripped on by family members and society in general I feel like helping them all the more.
Ah. Evil.
Please Become a Psychiatrist
I don’t know the person who left these comments here, but what I do know is we need more people like that in psychiatry. What I know is it’s hard to stand up against antipsychiatry, intolerance and hatred. What I know is there are more sick people than doctors can handle and one more with a good heart can save lives.
And while I have my problems with doctors, medicine, psychiatry and psychiatrists, I will stand behind their work and always say they are doing the best they can to help people that the rest of society would happily write off.
I will never stand behind those who are not good psychiatrists, those who would abuse their power or who don’t care about their patients. But these are not the average psychiatrist. The average psychiatrist is a caring person who sees psychotic patients not because it’s lucrative or fun, but because they honestly want to help better the lives of others.
So please become a psychiatrist and I will stand with you against the hate. You deserve to be respected every bit as much as I do.
Header image by Flickr user Vic.
What data are you using to say that psychiatric patients improve? Is it just some behavioral checklist items that occur within the following weeks inside the office? The data I’ve read in studies on psychiatric drugs indicate they barely work better than placebo and only for short times. This is without even taking into account the side effects as well as the systemic and neurotoxic damage, disability, drug/system dependency, and negative consequences to physical and mental health that last years or a lifetime, of which none of these factors are even measured when calculating the effective value of drug ‘treatments’. Of course if you happen to use non drug treatments then this is all moot and hats off to you.
Hi, I have been following you for a while now. I finally became staple on one medication 3 months ago so my memory of the previous 2 years suck so I am guessing on the amount of time that I have been following you. Thank you for this post. It is probably one of my favorites. Thank you for how well you advocate for us.
Hi Tracy,
Thank you for the kind words. Contragulations on getting stable!
– Natasha Tracy
I am also a 4th year medical student. Long story short, what you write about the anti-psychiatry sentiment is true. I feel it every day. There are those among us in medicine who plan to make substantial change in patients’ lives in the future of this field in the right direction. I beg all of you reading this, please try and be open minded about psychiatry. Every profession contains evil, but we swear an oath at the end of our training to devote all of ourselves to patients.
I was called bipolar, told I might have ADHD, because I couldn’t focus. Then I was told I only went manic, because there was no depression. To make a long story short, after a real Doctor ordered an MRI and an eeg, turned out I had epileptic seizures. So do Psychiatrists guess what you have without any tests or proof? I told the Psychiatrist epilepsy ran in my family, too. Then I found out Psychiatrists do not treat epilepsy. So do you think maybe they were calling it what they wanted so they could treat me. The drugs the Psychiatrist gave me did not work, they caused me to have gran mal seizures and I would have died if I kept taking them. They were feeding me the wrong drugs. Great job! I am really impressed. How Professional.
Thank you for your voice of reason, Natasha. I agree, most psychiatrists truly want to help, amd for those of us with a mental illness, we deserve the help.
I know what you’re up against. And I promote you every chance I get. You make a huge difference, you take on the things that even seasoned professionals are wary to tackle. Thank you, Natasha.
I am a Social Worker with 44 years of experience. I have worked closely with many other professionals, including psychiatrists. My philosophy is try being one before you criticize. It’s easy to blame and call someone evil or whatever label you want to level at them, it’s another thing to live in their world and deal with their reality.
I am anti psychiatry because I maintain the system and medication made me `ill’. I was mildly suicidal and prevented from surfing and swimming in the sea – which apparently were my poor coping mechanisms.
I wish you well but it is a complete lottery as `assessments’ on wards (in my experience) are not carried out by any professionals but the reports of care assistants If by chance my consultant had been a surfer he/she would not have prevented me from undertaking such activities.
I think family members submitting their views without the knowledge of the `patient’ is unethical..
I have suggested to staff on the wards that they stay confined without any fresh air for 30 days, have lights switched on every hour through the night, and not conclude it is some form of torture.
I was a happy and gregarious individual with no history of mental disorder (I was 50 when I entered the system)`.
the patients smoke like chimneys in response to antipsychotics, the core of the on hands work is by the poorly rewarded care assistants who employ their common sense `values’. The qualified nurses spend a large proportion of their time form filling on computers.
A picture tells a thousand words, and any visit to my home, with pictures of my family on the beach and surfing would have convinced any sane person to leave me alone, or to carry on in that vein.
killing is a sin, and I have ben killed by the system.
I never thought that psychiatrists was looked down upon in the medical field and I don’t understand that. As someone seeing a psychiatrists it’s already shameful for me to go talk to one and find out whats going on with myself. Shameful as in society thinking. Oh well I really don’t care anymore what people think. I’ve met people who were completely lost in their own mind to the point of non communicative and become very violent if interrupted , but yet society would like nothing more then to lock these people up forever with no help. It’s evil to look at any life like that. So Mrs. Tracy to hell with what people say about what “they” believe is evil.
Actually, same thing in nursing: psychiatric nurses “are not real nurses”. The stigma probably affect other fields too like social work, occupational therapy, psychology, and so on.
-Dan
I don’t know what Obamacare covers, because I get good coverage through my husband’s work. Only problem is a separate $500 deductible for mental health from “regular” health care. But one of the provisions of Obamacare that helped me was that it forced insurances to cover pre-existing conditions. So before this year insurance wouldn’t cover any treatment or meds, and now it does cover my meds and will cover my doctors after I meet the deductible
Thank you for such a balanced and thought provoking blog. I know that when I get bouts of paranoia I get caught up in the lines of the anti psychiatry crowd. The last time I got that way I stopped taking my meds until I was forced back on them cause things got out of hand and to hard to handle, but I still had a mistrust of my psychiatrist the took a little to get over. But I do believe that he really dose care
I feel like too many people confuse psychiatrists with psychologists. I’ve personally never had a psychologist who has helped me in any way… I’ve moved around a lot and I think all but one psychiatrist has worked well with me. Other than people who are specifically anti-psychiatry, anti-medicine treatments, I think they’re just a little confused about the distinction. I don’t know how to tell people in a simple way the distinction. Does anyone know a mnemonic to help out?
I don’t mean to say psychologists are useless, though; it just doesn’t help for people who want to just fix their chemistry and don’t need counselling. It’s fine for those dealing with stress or relationship problems. I just know what’s acting wrongly when I compare my experiences to others and am frustrated with that.
As a psychiatry resident I can definitely attest to the stigma against psychiatry in the medical profession. However, it is dwarfed by the stigma I face as a bipolar patient. I just returned to work after a course of ECT. Coming across your blog is a breath of fresh air. Thank you for your advocacy… yours is a message that more people need to hear :)
Thanks for helping our patients. We need more people to speak out so that our patients are willing to seek help. They don’t because their illnesses are so stigmatized. So many times we are only able to intervene in serious mental illness after much damage has been done to the patient because of patient fear of societal response to their acknowledging that they have a mental illness.
Your strength in commenting on this inspires me.
Michael Golding, MD
Hi Michael,
While I’m honoured by everyone who chooses to read my writing, I’m particularly so when a doctor takes the time to do so. I find it tremendously comforting that a doctor is taking the time to read the perspective of a patient. I believe it speaks very highly of the doctor.
Your leaving a comment inspires me. Thank-you.
Natasha Tracy (not an MD :) )
Well, I’ve been a physician assistant and am now in medical school, and I can DEFINITIVELY tell you that statistically doctors have:
1) HIGH suicide rates
2) HIGH alcoholism rates
3) HIGH divorce rates
4) HIGH bankruptsy rates.
They’re right up there with cops, nurses, and priests–especially when it comes to divorce, substance abuse and suicide.
My qualified medical opinion is that MOST doctors SHOULD see a shrink–the STRESS is what drives doctors to have all the negative sequelae listed above. At least they can AFFORD it; because mental health is NOT covered by a lot of insurances, and I wouldn’t want a NUT-CASE treating me in the emergency room. Its just common sense. Go talk to somebody, just as they tell their psych, cancer, or other mentally disturbed patients. Its just good medicine.
“They’re right up there with cops, nurses, and priests–especially when it comes to divorce, substance abuse and suicide. ”
Helping humanity is a selfless act that never justly receives it’s due.
Talk to someone. Yes I agree, dialogue is the healthy imperative.
I have the utmost respect for psychiatry and get annoyed when people get angry at or make fun of those who obviously have mental health issues. No one chooses to have an illness, mental or otherwise. I have a mild anxiety disorder along with mild OCD. It has been controlled very well since 1993 with medication. When I had my first attack of OCD, which was obsessive thoughts, it terrified me, which only made it worse. If it hadn’t been for zoloft and klonipin, when I needed it, I might have ended my own life. The anxiety attacks are few and far between now, but when i first got them, my friends couldn’t understand ‘what was bothering me’. It was difficult to make them understand that nothing was bothering me, they would just come on for no reason, at any time.
I urge anyone who has any mental health problems to seek help, there is no more shame in having a malfunction in the brain, than a malfunction in any other organ of the body. The fact that insurance companies are so loathe to pay for psychiatric treatment is disgraceful, is tantamount to ‘organ discrimination’ and only perpetuates the stigma associated with it.
I never try to hide the fact that I am on zoloft and why. I have never been looked down on because of it and several co-workers have even confided in me that they too are on psychiatric medication and the reason(s) why.
Hi Gary,
Thanks for your comment. I think your situation is a more common one than people recognize – you had a problem, you got help, it worked, and now you feel better. I think that’s more common than people think, it’s just that people like you – people with positive stories – generally don’t talk about them because they’re off living their lives.
So thanks for coming by and reminding us sometimes things do work pretty much as intended :)
– Natasha Tracy
In actuality Medic’s are realising that there is less and less that they can do as ‘psychiatrists’ for the mentally ill, and even less for people with learning disabilities. Unlike in the USA where psychiatrists have a wider focus including more therapeutic awareness and understanding not from a biomedical approach in the UK they do not fill this function,
They are more the guardians of risk.
People have realised that if they really want to help people who are mentally ill they will become clinical psychologists. Slowly the paradigm is changing, CP’s are becoming the registered clinicians and prescribing nurses are here and ready for further responsibility.
Becoming a psychiatrist is a waste of a medical education and the decrease in numbers is a reflection of their skills being best suited elsewhere.
Hi James,
It’s unfortunate that you have not yet mastered the use of the apostrophe. Perhaps the teaching profession could have put their time to better use?
Hi Sarah,
Careful. I don’t like personal attacks here.
– Natasha Tracy
Natasha –
Excellent, well thought out article. It was nice to read.
I don’t know about what psychiatric/psychological or other mental services Obama-care covers. It’s not very popular down here. I wouldn’t be surprised if it were repealed or struck down unconstitutional.
Keep up the good work!
Jeff
Thanks Jeff.
I’d be interested in knowing what Obamacare does cover in terms of mental illness. I haven’t heard anything about it. I hope for all of your sakes it doesn’t get repealed. It could help a lot of people.
– Natasha Tracy
I have had both bad and good Mental Health providers, some very bad. I am lucky now to have found a kind open caring doctor. Because of him I have moved so forward in my care and recovery especially my BPD.
I am also returning to school to become a Psych Nurse, because I wish to help and offer a kind voice for those who come after me, especially the newly diagnosis and those in crisis, to show them some of the same humanity that I received.
Steven –
Congratulations on the decision to go back to school! The more people like you who get into mental health care the better.
– Natasha Tracy
Natasha,
Thanks for providing some balance and perspective in your post. After having read through rolls the length of my arm of psychiatrists that are on big pharma’s payrolls, I have been pretty cynical. Your post has reminded me that just like politics has extremists, so does medicine, and like the former, they are probably also the minority. Now, the issue of psychiatrists getting paid by pharmaceuticals (in the U.S. at least… keep forgetting that you’re a Canuck) is still one that I find appalling, and I absolutely fear that the pharmaceuticals wield an ungodly amount of power over the profession, but as you have pointed out, there are many that work in the psychiatric field for all the right reasons and are doing their best to navigate.
Hi Laura,
I do like to think that balance and perspective is one of the things I’m better at. I try to look at both sides of an issue and be reasonable.
“After having read through rolls the length of my arm of psychiatrists that are on big pharma’s payrolls, I have been pretty cynical. Your post has reminded me that just like politics has extremists, so does medicine, and like the former, they are probably also the minority.”
One day I’ll write a post about pharma money and doctors, but I will say that just because a doctor accepts pharma money, that doesn’t make them bad. Those that would allow themselves to be swayed by any pharmacology campaign are the minority.
“I absolutely fear that the pharmaceuticals wield an ungodly amount of power over the profession, but as you have pointed out, there are many that work in the psychiatric field for all the right reasons and are doing their best to navigate.”
It’s a reasonable fear. It’s one I share. But I like to think the information I try to share can help people make better decisions and no slick pharma executive can fight that.
– Natasha Tracy
Bad politicians are minority? I wonder where you live and what’s your immigration policy, because I would like to live in such country.
Or maybe I am more realist. Money is more tangible then moral profile and helping people for both politicians and doctors (and you know what degree have the worse of our politicians? Yup, they are doctors. So much for puttin’ ’em on piedestals).
I find it scary how some people with issues are so naive when it comes to authorities. I am not saying doctors do harm deliberatelly. But they do, and when they do… they don’t really take responsiblity as they should. Just like politicians.
I have had some horrible psychiatrists and some great psychiatrists over the 21 years I have been treated for bipolar disorder. Right now I have the best psychiatrist I have ever found, and I feel really lucky. I appreciate psychiatrists, and I can tell you that my friends and family do too. Most people know someone with a mental illness, and most people think that treatment helps. I don’t like talking about stigma. I prefer to refer to it as discrimination, because that’s what it really is. No one deserves to be discriminated against because they have accepted the diagnosis of mental illness and are being treated for it, just like psychiatrists should not be discriminated against for helping people to become contributing members of society even though they have a mental illness.
Hi Andrea,
“I appreciate psychiatrists, and I can tell you that my friends and family do too. Most people know someone with a mental illness, and most people think that treatment helps.”
I agree. Most of us “in the trenches” if you will, do appreciate psychiatrists but it’s unfortunate that those who take issue with them have the loudest voices.
“I don’t like talking about stigma. I prefer to refer to it as discrimination, because that’s what it really is. No one deserves to be discriminated against because they have accepted the diagnosis of mental illness and are being treated for it, just like psychiatrists should not be discriminated against”
That’s an excellent point. Stigma is an odd word and I use it but you’re right, it’s really discrimination. Stigma is something we, as a society, allow to occur and is the _feeling_ around certain subject like mental illness. Discrimination is the act of stigma. And unfortunately, we see plenty of both.
– Natasha Tracy
As someone who works full time in psych (RN), about half inpatient and half outpatient, I understand the stigma when it comes to psych nurses especially. As someone being treated for bipolar disorder and severe ADHD, I have had bad providers, fortunately a very good one for a few years now.
I am a particularly difficult patient. Nurse’s tend to think they know everything, and do tend to be the ones saving the patients from the doctors, so we get drunk with power and think we should consider MD decisions just a suggestion. The thing is, I do actually consider my treatment decisions my own, with some really good insight added, and willingness to discuss or have a heated debate. I don’t have to do anything I don’t agree with and worst case, I have to wait for my psych NP to come around when I feel that my treatment should change in some way. Peer reviewed journal articles usually help to make my point. Sometimes she is right and I am way off. Not usually with meds- I know myself. She knows how to get me to really think about what she is saying (she stops debating and says “OK”). She knows what my world is like as a psych RN and can really make a point, in a way that slams it home. I am lucky to have her. Moved 2000 miles away and she still treats me via skype and the good old US postal service.
As far as the nursing angle of psych stigma, most people don’t know what we do. They see the lack of IV’s, life support equipment, and gushing wounds and think we must not do anything requiring skill. I’ve had to work with tons of medical nurses who spend a whole career doing non psych jobs but then decide they don’t want to lift patients anymore and see it as something that requires no effort. We are told that we will “lose our skills” and new nurses are discouraged from working psych until they have a “solid base of real skills” (aka 2+ yrs on medical). My mom works neuro and even though she has admitted that I have very good clinical skills of a different type she has told ppl that she’s the “real” nurse. It is gratifying when she needs a resource and I’m the only one she can call. They are told they are not to address the pt’s psych issues bc they are there for medical. Try that with someone who has a personality d/o and is feeling vulnerable! Anyway- we get paid less, and very few ppl treat us equally. It’s considered a step down.
I do it because I love my job. It helps that I’m someone who hasn’t always had the keys but I don’t disclose.
Hi Neurodeviant,
Nice to have a professional around :)
Psychiatric nurse practitioners are an interesting thing. I’ve never seen one and don’t know if they exist in Canada. It feels weird to think of a non-doctor making medical decisions for someone, but I know in the US it’s done quite a lot of some people are very happy with their care.
I believe every link in the chain is important and that goes for nurses on the front line. Personally, I had some very bad experiences with inpatient nurses and they really left a bad taste in my mouth, but I have no idea what their official titles were. They could have been “patient ignorer and insulter” from what I could tell, but they may just have been a bad bunch.
But I also think respect for trained professionals is mandatory unless they are proven unworthy. People who are trained and work in a field day in and day out deserve respect whether they work in psych or anywhere else. As you said, it requires a different skill set but not a less important or less challenging one.
I’m glad you love your job, I think that makes a big difference. And know that we appreciate you, even if some other people in your life don’t.
– Natasha Tracy
Thank you so much dear love! You are a blessing!!! My two oldest are facing extreme emotional and behavioral difficulties for which they have been given a bipolar diagnosis. As a result of all that we have been through as a family I have begun taking classes full time to become a licensed mental health counselor. I can see and feel the stigma from both sides and you are right. Shamefully, so very right.
Stigma however, will not prevent me from pursuing my degree and licensure! I believe in psychiatric care as well as counseling with whatever theory and techniques work for the individual and family in need. I believe this form of science and art SAVES lives! There is nothing else I am called to do, aside from being the best parent I can be to my children. :)
Melody~
Hi Melody,
Thank-you for your kind words.
It’s good to hear that other people’s hatred won’t stop you from pursuing what you consider to be right for you. I believe this science (and yes art) saves lives too. Thank-you for becoming part of the solution.
– Natasha
Well, I’ve had good and bad psychiatrists in my long time in and out of services. Ten years plus ago things were much worse. I remember being completely ignored while two p-docs argued over whether I had anorexia or not and should I be sectioned. I never had an eating disorder in my life. They only spoke to me to order me to look in a large mirror and tell me what I saw. I was all over the place and had sat in silence for around an hour in the waiting room then half hour in their offices. When I said, “Look, I know what you’re looking for in my reply, but I just don’t have anorexia. I don’t vomit and I don’t want to lose any more weight.” They then argued whether my issues were so deep seated I was unaware of them. So they sectioned me. Blah!
My brother never got the correct diagnosis in all his considerable exposure to them. – and through way too many suicide attempts – or treatment – and so died.
Now, they’re not so bad. They are obsessed with medications and I’ve never been treated with anything else. I’ve had to ask for therapies which never came. IF I admitted to my p-doc I was coming off my meds he’d have a fit.
I do think they have a difficult job because research is always wavy and funding for it is never fashionable. Other illnesses always seem to get the biggest slice of the budget. It must be frustrating treating people with unreliable and so subjective treatments. There are no hard and fast absolutes with mental health and that is perhaps a pleasure and pain of the job.
Great post as per Natasha. Shah – its shared ;D
Thanks Shah, for your comments and the share, of course.
I’ve been in treatment for over 10 years too and have had many psychs and I can’t say that the care has gotten any better or worse. Well, except when I started they could see me frequently as I saw them through my university health clinic and they didn’t seem to have the same constraints as you normally see in psychiatry around time of appointments or frequency.
It’s good that your care has improved though. Do you feel you are perhaps interacting with them better and that has helped in your care? As we get used to them, I think we can improve the quality of our own care. We know too little at the beginning to do that.
It’s unfortunate your doctor would not support you reducing your medication because in my opinion, a good doctor would. I believe mine would. He wouldn’t like it, or recommend it, but if I had a good reason (like trying to get pregnant) I think he would be supportive.
And I think doctor support during medication changes of any type is critical. By denying him the information that you are reducing your meds you are actually putting yourself at greater risk as he doesn’t know what to even look out for. (Not that I’m saying you should tell him – that’s your call.)
And while research is “wavy” as you say, it’s similarly wavy in other areas of medicine too. It’s just the uncertainty that all docs have to live with. And patients. Unfortunately.
– Natasha Tracy
Could be, but my insurance company (until next May when I won’t be able to get insurance I can even begin to pay for) only pays 45% of the fee billed. Pshcologist or psychiatrit, they are paid the same. They could make more money in less time if they had chosen a different speciality. He’s right a lot of people do not consider them to be real doctors.
April,
But see, that’s just it; by not redeeming your psychiatric services they are revaluing the profession. Insurance companies are suggesting that psychiatry isn’t as important or as “real” as other medical professions. This isn’t fair for anyone (most especially the patients, obviously).
(Quick note, anyone know if Obama-care will cover psych costs? I have no idea, just a Canadian up here.)
I’m sorry you’re having such trouble with insurance. You are not alone in that. I talk to people everyday with the same trouble. The only thing I can suggest is to see a provider who allows payment on a sliding scale. There’s a mental health services locator linked here that might help: https://natashatracy.com/get-mental-illness-help/
– Natasha Tracy