Overcoming Psychiatry’s Stigma
TAKING PRIDE IN HEALING THE MINDThe New Physician
“Oh no, you’re not gonna be one of those psych guys, are you?” inquired my attending trauma surgeon incredulously. Those words echo in my head almost daily when I think about what I went through when I chose psychiatry for my career. It is part of the hazing process many third- and fourth-years endure as they consider a career in treating mental illness. No, this isn’t the type of hazing you might see on “Fear Factor”; no one has to live with snakes or eat spiders. It is far worse, as it is a constant challenge to overcome the stigma associated with becoming a psychiatrist. Attendings in other specialties, similar to the trauma surgeon I worked under, were just part of the problem. The more relentless attacks came from family, friends and even classmates.
I happen to be fortunate to have good grades and respectable board scores, but this only seems to add fuel to the fire, especially with classmates. When they learned I was seriously considering psychiatry, some were quick to say: “Orthopedic surgery is so much more respected,” or “Radiology is much more lucrative.” Others asked, “Isn’t internal medicine what real physicians do?” These are just a few examples that stand out in my mind. It seemed that during every rotation, classmates and some residents urged me to abandon psychiatry so I would not “waste my medical degree.” My family chimed in, saying I would eventually come to my senses and choose to be a cardiothoracic surgeon or something that conferred power and prestige. All of this for simply considering psychiatry.
The definitive decision came two summers ago during my psychiatry clerkship. I had a wonderful day at work with a child who had a major breakthrough, and I could not wipe the smile from my face. I awoke the next morning eager and excited to go to work for the first time ever. I had been through my other six clerkships so I knew this was not a fluke. The specialty of psychiatry, which admittedly had been my main consideration, was now my choice for a career in medicine. First, I told my wife, who is matching in internal medicine, and she was supportive.
Second, I told my mentor, a senior citizen who had been teaching me about the issues facing the elderly and how to communicate with his age group. He hit me with a bombshell, asking, “Doesn’t it take much more skill and intelligence to be a surgeon? Why would you waste your knowledge as a quack?”
I was crushed, but instead of acquiescing, I decided to discuss the issue with my tutor, a child psychiatrist who began his career as a family practitioner. I hoped he would have some perspective about dealing with the stigma. And he did. When I asked why he chose psychiatry, he said it is a wonderful and interesting profession, and it never gets boring. It takes all of your knowledge and skill along with superior patience and interpersonal talents. There is no topic or age group that is off the table, ever, he added. I remember not needing a follow-up question; his words were enough reinforcement for me.
Choosing a specialty is one of the most difficult decisions medical students make. And for those interested in psychiatry, the decision becomes more difficult because future physicians must overcome the associated stigma. Being a student representative for a psychiatry interest group, I have heard students say that they sometimes won’t admit they’re considering psychiatry because they don’t want to hear the disparaging comments. Others have said they will probably choose another field, even though psychiatry is their favorite, because they won’t be able to face their families if they become psychiatrists.
Such stories motivate me to proactively support my chosen profession. I have counseled several University of South Carolina medical students who are considering psychiatry. I always begin by explaining some of the issues I had and then educate them about my surprise at the pervasiveness of mental illness in our society and how we need more good—no, great—psychiatrists in this world.
I am also active in school functions, presenting myself as a positive role model and encouraging students to accept their desires to become psychiatrists. I would encourage other future physicians to be proactive in supporting their professions. The only way to truly change the stigma accompanying psychiatry is to start at the bottom level—the student base—and work our way up through the ranks. Then we can educate the public and hopefully eradicate this stigma.
Christopher Stanley is a first-year psychiatry resident at the University of Kentucky. This article originally appeared in the spring 2004 issue of the American Psychiatric Association’s Medical Student Newsletter. Direct comments about this story to firstname.lastname@example.org.