As a young doctor, I was admitted to a psychiatric hospital with severe depression. I recovered eventually, and applied for jobs, driven by the fear that I would never be able to return to work. I wasn’t surprised that I was initially rejected, or offered a shorter contract to see if I would cope, and just accepted this. Looking back, I have no doubt that I experienced discrimination in a way that—thanks to the 2010 Equality Act—would probably not happen now. But I don’t think that stigma ever disappears, it just re-emerges in different ways.
Stigma is born from the fear of what is different and threatening, and can be seen in attitudes to people of different sex or gender, race, disability and many other human conditions. But does stigma only arise from the views of others, or can it also spring from the way people start to perceive themselves as disempowered or unworthy?
In psychiatry, this so-called self-stigmatisation implies that people create their own negative views of themselves, and suffer as a result. This does happen, but I think it can also be an easy get out for the fact that patients will absorb the opinions of others, and internalise them. They don’t create these views all by themselves.
I was convinced that doctors and nurses thought badly of me when I was first ill, and this was because I had previously heard other staff criticise psychiatric patients, particularly those who were also health professionals. I’m not sure why this was, but there can be a belief that, as a doctor, one ought to know better, and not end up on a psychiatric ward. So it wasn’t a massive leap to assume the same might be said about me, and this could be described as self-stigmatisation. But to me, blaming patients for their own self-loathing just adds insult to injury.
Many years later, I worked with a lovely nurse who had cared for me when I was first ill, and asked her if she minded working with me after knowing me as a patient. Her response stuck with me: she asked why I hadn’t moved away, to England for example, given what had happened. There may be reasons to leave Scotland, but that is definitely not one of them.
There can be a belief that, as a doctor, one ought to know better, and not end up on a psychiatric ward
Diagnoses, or labels, can work both ways. Some people find a diagnosis validating, but not all diagnoses are viewed as equal; and some, like that of personality disorder, can add to patients’ feelings of rejection and shame. I work in a large psychiatric hospital, mainly with patients with drug and alcohol dependence, who are often viewed as less deserving, or as having brought their problems on themselves. No one would choose the lives they live, but it is easier to blame them for it—perhaps this makes us feel that what they are going through is less likely to happen to us. I also see many patients with severe schizophrenia, whose experiences bear almost no relation to the sanitised version of wellbeing and mental health issues that society presents to us. These are the patients who people cross the road to avoid, perhaps fearing them, alarmed by their often bizarre appearances. It makes me sad that I don’t know what these patients think about stigma—whether they find it oppressive or not. They have little voice.
My own diagnosis of bipolar disorder is relatively easy to bear, particularly because I am reasonably well most of the time. I look and sound “normal,” and I am accepted and known in the world of psychiatry. It’s not all easy, though, and I still doubt my diagnosis and whether others believe it. Psychiatry isn’t black and white. But my life is very different from when I was first ill. And how do I view others? Am I fair? The honest answer is that I don’t know. Like everyone, my opinions are coloured by my experiences.
I think my biggest mistake is that I don’t always believe in my patients enough and so lose faith that they can get better. And sometimes, I wrongly judge them by my own standards as a patient, instead of accepting our differences. It’s right to want to help people, especially when they are very ill, but also to remember that they are so much more than their diagnoses.
I often think about the fact I have been a patient in the same psychiatric hospital where I now work, and remember the stigma I experienced. Denying it would be the first step towards stigmatising others, and that’s something I never want to do.
