“I don’t need meds,” the young psychology major told me confidently. “Or therapy really. Maybe I’ll just touch base with you every once in a while. I should be able to handle this on my own.” The young woman’s physician had been concerned enough in a recent visit about this patient’s panic attacks and passive suicidal ideation to refer her to meet with me for a primary care psychology consultation. Yet just a few weeks later, she sat in front of me letting me know that she can “handle” these problems.
For better or for worse, this young woman picked a terrible day to talk about “handling” concerns with mental health. I had recently learned that one of my clinical training supervisors, a beloved and skilled psychologist, had taken his own life. We had not communicated in years, and I know nothing about the nature of the struggles that made suicide seem like his best option. But I can imagine.
Clinical psychologists share something with many of the resident physicians I work with every day – a strong need to care for others, a tendency to put one’s own needs last, and a deep reluctance to admit perceived weaknesses. These cultural traits common in health care providers, especially if combined with a stubborn streak, make it almost impossible to ask for help.
It’s especially tough when it comes to asking for help for mental health problems. There is a stigma associated with these concerns. One that I hope is weakening, but a stigma nonetheless. Furthermore the nature of the diseases themselves make it hard to reach out to others – the crippling fatigue and lack of motivation that can accompany depression, or the pervasive self-doubts that often come with anxiety can make it impossible to take the steps needed to get help, often at the time when it is most needed. I can relate. I think back to a period of acute depression I experienced following a miscarriage. My clinical mind recognized that what I was feeling was depression, and I knew what I should do. However, as I sat on the couch in a stupor, I just didn’t care. My clinical mind told me to get up, exercise, call a friend, make an appointment, do something. Although I knew I should listen to my clinical mind, I didn’t have enough motivation to pick up the phone. Even stronger was the worry about who I could trust enough to talk with. I’m a psychologist. I’m supposed to be stronger than that.
I want the culture of the family medicine residency where I work to be different. I want residents to know that, when they’re overwhelmed with depression, anxiety, feeling so burned out they can’t work, or recognizing that they’re starting to slip back in to a manic episode, they can tell someone, and to know that if they tell any faculty member, the faculty member will respond with the same empathetic, matter-of-fact practicality that they’d give for a physical illness. What do you need? How can we protect your patient care? How can we get you to your appointments? I want our culture to be one where it’s completely transparent that no stigma or judgment will be attached to disclosing mental health concerns.
Perhaps I overreacted when I jumped down this young woman’s throat. Perhaps I didn’t need to rant about how the first priority of health care providers, whether psychologists or physicians, needs to be self care, or we can’t effectively care for other people. I most likely didn’t need get on my soapbox about how avoiding treatment for mental health problems only contributes to stigma and barriers to seeking treatment. However, I do know that this young psychology major left my office with a plan to start cognitive behavioral therapy for her anxiety and depression, and to meet with her physician to reconsider medication. I can only hope that this will make a difference for her, and maybe for the future patients that she sees. If this puts a single health care provider a step closer to a culture where it is not only expected, but encouraged to seek help for mental health problems, I’m happy with my day’s work.
Katie Fortenberry, Ph.D. is the Behavioral Science Education Director and an Assistant Professor at the University of Utah Division of Family Medicine.