Psychiatry stigma in medicine

Today I led a small group session for 3rd year medical students on their first week of their psychiatric service. Every week they do a reflective writing piece based off of a prompt, and come together to discuss this. I vaguely remember doing this in medical school when I was a student. Normally the course director leads the group, but he was busy today and asked me to instead. Each of the four students sent me their reflection ahead of time. This week's was general: what are you nervous about for your psychiatry rotation? I decided to write my own reflection, but I couldn't really remember the start of that rotation. It was the last one I did in my third year (well, except for surgery which I had to make up at the end of the semester. I had failed my board exam and was pulled out of the surgery rotation to study). Maybe by that point I wasn't as fearful about a first day. Maybe I've just forgotten about it. Either way, I could only reflect on my first day of intern year instead. Having not planned to go into psychiatry, and only having done one rotation in pediatric psychiatry, I was pretty scared of psychiatric patients. I wasn't sure what to expect, or what I was going to do. I wasn't sure about what medicines to use, or how to treat people. I felt like I'd be going in at a distinct disadvantage to everyone else. And yet, I loved it. It was the start of my love affair with psych. The students all had somewhat similar reflections. Worries about 3rd year in general (this is only their second rotation of the year). Wondering how to talk to psychiatric patients. Worries that they'd be in harms way. What were they supposed to do with a psychotic patient? How does one even talk to a person who is sharing their trauma? What if I say something wrong and insult someone? or make them feel worse? Even though I remember worrying about these same things when I started my internship, now, years later, it makes me sad how nervous people are to be on their psychiatry rotation. Specifically, how different, other, and scary the patients seem. The preconceived notions people have about our patients, like they aren't "normal" or are somehow more dangerous or fragile. And I recognize how we perpetuate this stereotype within medicine. On the general wards, as soon as someone mentions depression, they're "one of those psych patients." A consult is called and everyone else ignores the problem. The patient is then treated differently for the rest of their stay. In medical school, we are teaching the students to fear their psychiatry rotations. Everyone has images of violent, aggressive, "crazy" patients that they couldn't possibly relate to. If even our doctors carry that bias, that psychiatry is somehow "other" or scary, how can our patients feel supported and safe in our communities? Imagine already being so scared by the voices you hear that no one else can, and yet you're seen as the scary one. How do we help patients get the care we need, if we continue this way of seeing our psychiatry patients? I don't think many of the other rotations ask for reflective writing. I imagine a general prompt of "what are you worried about starting your medicine rotation" would bring responses of "I'm worried I don't know anything, or I'll fail my patients, or hurt someone with my inexperience." I doubt they walk into a room fearful of the patient themselves, or the disorder they are presenting for. Yet there's no difference between the patients. They're all human beings asking for help, needing medical care. I asked the students today to think about this bias. I reminded them that psychiatric patients are more likely to be the victims of violence than the perpetrators. I expressed to them all the joy they could find in psychiatry. I tried to give them tips and pointers in how to talk to patients, be present with them, acknowledge their life stories, and remember they are regular, normal, human people needing and deserving of our care. There's such a shortage of psychiatrists in this country, and all over the world. How can we get our medical students more interested in this rotation? If we can't end the stigma of psychiatry within medicine, how will we be able to continue providing care for these vulnerable patients. I remember loving psychiatry in my third year, but not even considering it as a career for a second. I had to be a pediatrician. A "real doctor." I couldn't imagine enjoying this forever. I couldn't understand going through medical school to be "just a psychiatrist." I thought I'd "hang up my stethoscope forever." What would my family think of me? Or my community? Psychiatry had never crossed my mind until third year. Even with all the joy it brought me, I didn't give it much of a thought. I was blessed enough to not get into pediatrics. It was a tough blow at the time, but a blessing from God himself nonetheless. And yet, there are still some times when I feel like I'm "not a real doctor." I feel like I don't really help people. I'm not saving lives like a surgeon or a pediatrician. If they asked for a doctor on a plane, I'd be terrified. Why do we allow psychiatrists to feel ostracized like this? Why do we stigmatize psychiatry so much that even the profession has to face the bias. Being a psychiatrist still didn't stop me from being so biased against my own patient population that it took me years to get back on Zoloft, when I knew I needed help yet refused to ask for it. It's made me wonder whether I would want my daughter on the medicine I prescribe so many other children. Would I make her suffer unnecessarily with symptoms that can be treated because I'm worried what other people will think of me? How do I reconcile these warring thoughts and feelings in my head. Thankfully, I'm have a robust response to Zoloft. Being able to feel my mind clear, and my anxieties become more manageable, has helped me become a stronger advocate for my patients. Why should people suffer because of some stigma we've put out there? I'm hoping we can all continue to do better. I'm hoping I can help future doctors, one medical student at a time.