Today on the Bipolar Burble blog I’m pleased to offer an interview with Prakash Masand, M.D., the CEO and founder of Global Medical Education (GME). Dr. Masand has been published in several peer-reviewed journals, serves on editorial and review boards for psychiatric journals and is a Distinguished Fellow of the American Psychiatric Association and the Academy of Psychosomatic Medicine. Dr. Masand offers his view on psychiatry, mental illness and stigma.
And make sure to check out the end for your chance to win an iPad!
What drove you to specialize in psychiatry?
When I was a medical student I had the good fortune of having a wonderful mentor during my psychiatry rotation. He exposed me to the incredible disability and consequences of psychiatric illnesses and the tremendous impact that medications and psychotherapy could have on a patient’s life. That is what excited me about psychiatry. When I started medical school, I thought I was interested in cardiology, but after my psychiatry rotation, I knew I wanted to pursue a career in this field.
Do you feel that stigma affects your work? How?
Unfortunately, since time immemorial, patients with psychiatric illnesses have faced a significant stigma. We even see this reflected in the perceptions of other physicians towards psychiatrists, who have not always been regarded as “real physicians.” In fact, when I decided to pursue a career in psychiatry I was often asked by colleagues why I was wasting my talent going into psychiatry because it was not a desirable speciality. This is also reflected in non-psychiatrists, including therapists and psychologists, who often tell patients they are not “crazy” and that they do not need to see a psychiatrist, they just need to speak to a therapist, which stigmatizes psychiatric illnesses even further. Fighting against the myth is extremely important even today.
How do you feel stigma affects patients?
Patients and their families often minimize psychiatric illnesses and do not seek treatment because of the stigma associated with it. Patients are rarely hesitant to discuss a diagnosis of heart disease or cancer with their friends and colleagues, but are extremely ashamed to discuss that they have bipolar disorder, depression or schizophrenia. Recent studies have found that even though the rates of cancer in psychiatric patients are lower ,the mortality rates are higher often higher than in patients without psychiatric illness because of the inadequate care that many psychiatric patients receive. Stigma against patients is reflected in employment, insurance coverage and even friendships.
What do you think is the cause of stigma against psychiatry and psychiatric illness?
Before the advent of modern medical research and treatment, there was no understanding of, or rational explanation for, psychiatric illnesses and their symptoms. A long-standing ignorance and misunderstanding on mankind’s part about psychiatric illnesses and its treatment is one basic reason for the stigma. Another reason for the ongoing stigma is that the media often feed into it by their sensationalized descriptions of incidents, especially violent ones, involving patients with psychiatric illness. This can perpetuate the perception amongst the general public that all psychiatric patients are dangerous, but that is simply not the case. In addition, the media rarely emphasizes how deinstitutionalization of psychiatric patients and the reduction in resources available to them, led to homelessness or incarceration for many. Rather than address the tougher societal issues, the media focuses on the sensational.
What can patients do to reduce the effect stigma has in their lives and treatment?
Patients need to educate their family, friends, and colleagues about the facts about psychiatric illnesses and help to dispel some of the myths. They also need to seek out treatment that is centered on evidence-based science and not on biased opinions or religious beliefs. Patients can be active participants in organizations like National Alliance on Mental Illness (NAMI) and National Institute of MEntal Health (NIMH) so that they can lobby Congress for more research funding for the diagnoses and treatment of psychiatric illnesses. They can lobby the insurance companies to ensure parity in the reimbursement for the treatment of psychiatric illnesses. Fortunately, Congress has acted recently to ensure this nationwide as a part of the Affordable Care Act.
How can doctors reduce the stigma against psychiatry?
Physicians can be very effective proponents in the education of the general public, the media, and their colleagues about the tremendous advances made in recent years in the diagnoses and treatment of psychiatric illnesses. It is our inherent duty to remind everyone that psychiatric illnesses, like all other medical illnesses, are biopsychosocial in nature the only difference being the organ affected. But, the disability experienced by psychiatric patients is often greater than that experienced by patients of more common medical illnesses, like heart disease, cancer, and chronic pulmonary disease.
What is the role of education in stigma-prevention?
Educating healthcare professionals, the media, and the general public is extremely important in reducing the stigma associated with psychiatric illness. Psychiatric treatments should be based on science, not on fear, unfounded opinions or religious beliefs. Providing evidence-based education is one reason I founded Global Medical Education (GME), an online medical education resource created to optimize patient care around the world. GME’s mission is to provide timely, unbiased, evidence-based medical education from the world’s leading medical experts to health care professionals and patients around the globe.
For more information on GME and links to many psychiatric resources for both patients and their families, visit www.gmeded.com.
For your opportunity to win a free iPad and a free subscription to the GME website (which I highly recommend) see GME’s Facebook page.
(Yes, I have a business relationship with Dr. Masand and GME but the subscription really is free, as is your chance to win an iPad and the site really is amazing. I’m not being compensated for your subscription.)
Thanks for doing this interview! Mental health professionals themselves facing stigma is definitely something that’s not discussed as often as it should.
As a RN with mental illness I would like to be able to educate my colleagues, especially since I work with patients at high risk for new or worsening depression (postpartum mothers) and since nurses themselves are at high risk of burnout and subsequent depression. Nine times out of ten this potential problem isn’t even mentioned to new moms before they are discharged and when it is mentioned its a brief “if you feel bad, talk to your OB at your 6 week appointment”. But I’ve been explicitly told by supervisors that I am not to discuss mental illness with colleagues. Once upon a time, after having been hospitalized, I told a coworker who I trusted why I had been off of work. The coworker went to our supervisor and I was reprimanded. Of course we all know that wouldn’t have been the case if I had been out with cancer or surgery. The stigma is prevalent even among medical professionals. We definitely need to get the word out about mental illness to reduce that stigma. Thank you for posting this interview.
Insightful article. The Dr. is partly discussing moving docs away from a medical model, “Itell you what you need” vs a recovery model which is patient centered and outcome drriven. I currently serve on a Reducing Stigma team. One way we are doing this is by addressing suicide prevention team including a Speakers Bureau made up of consumers, family members etc. One of the best ways to reduce stigma is to talk openly about your illness as a teaching/informational model. If your comfortable putting yourself out there, give it a try, change one mind at a time.
This is great… great interview, great resource. I will bookmark the page. I wish I was as eloquent as this psychiatrist when I’m talking to people about stigma.
My most recent severe experience with stigma was when I lived in Virginia. Because I take psych meds that are on the DMV’s “list”, I had to have a psychiatrist fill out a long form every single year saying that no, I still don’t have epilepsy and no, I am not going to get a wild hair and start ramming my car into other drivers or bridge abutments.
I can see them having the doctor fill out a report the first time they find out someone is taking an anticonvulsant to find out what’s wrong. I can see them requiring a review if the driver gets a ticket. I never got any tickets of any kind in Virginia, nor was I in any car accidents.
I don’t have a pristine driving record, because I’ve lived most of my driving life in Atlanta where the traffic is hazardous. I can’t say I’ve never had a ticket ever in my life. But I haven’t had any in years, and even years ago never had chronic driving violations–I never had to worry about the points on my license.
Bigotry is when you discriminate against someone based on your fears instead of the evidence. While *some* people in the middle of a manic episode drive and drive badly, the only reason for discriminating against us in making us jump through more hoops than your average driver with ADHD is because neurotypicals are scared of mental patients.
*In the absence of a bad driving history*, bipolar people are no more likely to drive badly than any random joe without a psychiatric illness.
Virginia should be ashamed of itself, we all ought to be up in arms over this, and prominent people with bipolar disorder should be engaged in an organized boycott of Virginia.
Drunk drivers, drugged drivers–statisticians can show us the bodies.
Old drivers with progressively worsening impairments–statisticians can show us the bodies.
Texting drivers—statisticians can show us the bodies.
So, tell me about bipolar people with moderately clean driving records. Not commercial-driver pristine records, just your moderate average joe driving record. You want to say I should jump through more hoops than any other driver *just because I take meds for bipolar*? That just the diagnosis and taking my meds make me more dangerous than the driver over there with no diagnosis and a moderately *bad* driving record?
Fine. Show me the bodies.
Seriously, if you can show me hard statistical evidence not that the whole swathe of bipolar people (many of whom have substance abuse problems and many of whom *do not* have substance abuse problems) has an elevated risk but that bipolar people with moderate driving records have increased risk, then I won’t raise a peep. If you can show me that hard, statistical evidence that your discrimination is *objectively justified by the facts*, then that’s not stigma, that’s just truth.
But I don’t see it. As far as I’m concerned, the gold standard is that the actuaries at my insurance company don’t think I’m more dangerous or less dangerous than any other driver with the same driving history. If I were more dangerous than other drivers with the same driving history, my insurance would either be cancelling me or rushing to raise my rates. They’re not.
Interesting. It’s the same in the UK – my insurance premiums are not directly affected by my Bipolar Disorder. However, my safety to drive IS questioned every three years by the authority who issues driving licenses. For most people, once you receive a drivers’ license, you keep it forever unless you’re very bad and commit a driving offence serious enough to lose it. But since I have been diagnosed with BP, my license has to be renewed every 3 years, a process that requires them to get references from my family doctor and my pDoc. It’s a pain because the whole process takes about 3 months, which has me driving without a license to show the cops if I were stopped! All I get is a cover note from the DVLC to explain where the license is. But at least I am allowed to drive during that period.
I am truly shocked that such laws exist. I can see myself telling others and having no one believe me – it’s just too medieval. Yes, we have a mental illness, but last time I checked there weren’t hordes of bipolars playing bumper cars on the world’s highways. Drunks, NASCAR wannabes, and idiots on cell phones, yes, but bipolar only as an incidental, if at all.
Stupid does not even begin to cover it. You have my sympathy. I wish I could give you my vote.
Great article. I really like this Doctor!!