Circumventing stigma

[dropcap]T[/dropcap]hanks to good health and pure luck, I have had little reason to go to the doctor for more than a regular annual checkup. However, since I only interact with medical professionals about once a year, I have cultivated a deep mistrust of them. The reluctance on my part to accept even the simplest of advice comes from a lack of meaningful relationships with any of my doctors.

As I get older, I find it more difficult to see a doctor and not feel personally attacked when they tell me to live my life differently.  Whether they say to exercise frequently or drink more water, I scoff and roll my eyes, thinking it’s not that important.

Because there isn’t trust between my doctors and me, I continue with a reluctance to be open and listen to what they have to say. This is a cause for concern for many reasons, the largest of which is the understanding that if I ever develop a mental illness, circumventing the stigma around that illness would be extremely difficult to approach and admit given my distrust of doctors. 

The stigma around mental health is exactly what Professor Thomas Ungar has dedicated his life to defeating. Ungar is the Psychiatrist-in-Chief at St. Michael’s Hospital and an associate professor in U of T’s Department of Psychiatry, where he says he’s become a “bit of an anti-stigma scholar,” having published several articles on mental health equity.

For Ungar, there need to be both attitudinal shifts and structural shifts in how we approach mental health. Throughout our interview, he equated mental health ailments to physical ailments to demonstrate why there shouldn’t be a stigma when a mental health specialist provides you with a diagnosis.

But what if you’re already skeptical of doctors in general?

“You should have the same degree of skepticism as you would your cardiologist or your neurologist or any other diagnosis,” said Ungar. “I wouldn’t be more or less. That’s my issue: why do we think [differently]?” 

For many people, considering mental illness as just as important as physical illness is the first step to combating it. Bobbie Kerr, a former U of T student, was recently diagnosed with bulimia. Kerr told me that she has always had a strained relationship with food, which reached its peak when she was 16 and lost 45 pounds in three months. Kerr said she never really saw her relationship with food as a disorder.

Kerr’s bulimia diagnosis actually stemmed from a physical ailment. At the beginning of the fall semester, she went to see a specialist because she was having difficulty sleeping at night. During an extensive general assessment with a U of T psychologist, they touched upon Kerr’s relationship with food and wound up spending a good portion of the appointment discussing it. It was through these appointments that Kerr eventually received her diagnosis.

Kerr said that during her third appointment, her psychologist said that her eating disorder was severe and had an immense impact on her overall mental health.

“After hearing this, I wasn’t quite sure how to process it,” said Kerr. “I knew that it was something I struggled with on a daily basis, but at the same time, I also felt that I wasn’t a danger to myself and that I wasn’t harming my body like I had in previous years.”

Kerr said that her psychologist never explicitly said that she was a danger to herself, but rather that if she let the illness go untreated, it could lead to that severity. Either way, Kerr was shocked, and she said that it took her a week or so to accept the idea from her doctor that this was something that needed to be addressed.

Ungar said that a patient’s reluctance to accept a mental health diagnosis is due to a misunderstanding of what that diagnosis means. “What’s behind that is probably the misconception on the patient’s side, that it’s somehow a reflection of them as a person.”

He added that it is important to separate the illness from your view of yourself. “I tell them it’s not their fault, it’s nothing they’ve done wrong, but they’re not weak, it’s not that they’re not smart, it’s a health condition like any other,” he said.

Kerr said that she has always supported feminism and body positivity, but that while she understood the severity of eating disorders, she never thought that she would be “that girl” who had one.

During the worst bouts of her eating disorder, when she was about 16 or so, Kerr said that she received a lot of positive reinforcement from her parents because no one at the time considered it to be a disorder. She added that to this day, she excludes her parents from any discussions she has about her eating disorder.

However, despite the initial shock and reluctance she felt after receiving her diagnosis, she does not currently feel debilitated by her eating disorder, though she recognizes the fact that it is still something that should be addressed.

Claire Abbott, a second-year student at U of T, also has a history of mental illness. Abott was 13 when she mentioned to her mother that she was not feeling like herself. She said that at the time, she did not know much about mental illness and was inclined to speak to someone who would have a better idea of what was going on.

The doctors diagnosed Abbott with major depressive disorder and generalized anxiety disorder. She was prescribed medication for her illnesses. However, the medication failed to work properly. She was experiencing manic episodes and pushed her doctors to try different methods of addressing her illnesses.

The challenges that Abbott faced with her illnesses reached a point where she was becoming suicidal. While simultaneously having mononucleosis, a virus with flu-like symptoms, it was increasingly difficult for her mother to take proper care of her at home, resulting in her hospitalization.

During that time, Abbott said, her doctors realized that she also had bipolar tendencies. With this diagnosis, they were able to prescribe her medicine to address that illness, which then started her recovery.

Abbott has been off her antidepressant medication for over a year. She sees a psychologist about once a year and a therapist every two months or so. She said that she is in a much better place with her illness and does not tie it too closely to her perception of herself.

“I was lucky to never be in a position where I felt extremely ashamed of my mental illness so it didn’t negatively impact my perception of myself in that sense, but on an individual level sometimes it [was] hard to grapple with the fact that I used to need antipsychotic medication to live a normal life,” said Abbott.

Today, Abbott is very vocal about her experience and encourages others to circumvent the stigma surrounding mental illness and seek help.

Abbott also stressed that due to her own issue finding the right medication, there is nothing wrong with “being skeptical of the diagnosis that you’re given. There’s so much we still don’t know about the brain, and nothing is black and white.”

She said that you should definitely trust your doctors, but that it is okay to do your own research and to speak up if you feel like your medication is not doing what it’s supposed to do.

Ungar called this being an “active participant.” He said that he loves when his patients do their own research, because it allows for a much more informed conversation.

“It’s their decision; it’s their health. I’m just here to recommend and encourage and I want to see them do as well as they can. And I’m very open to debate and discussion,” said Ungar.

Having trust in your doctor does not mean that you have to take everything they say word for word. You know your body, and properly educating yourself will lead to an overall greater understanding of what needs to be treated.

At the end of the day, medical professionals are people who have gone to school for a long time to help determine diagnoses and treatments so that you can live a long and happy life. Reminding yourself of this each time you step into a doctor’s office might give you the courage to accept diagnoses and treatments with a much more open mind so that you can begin the journey of recovery, whatever the ailment.