On shame and stigma in mental health: A medical student's view on how we can bring change
I am a fourth-year medical student studying at the University of Southampton. Though I don’t know what I want to specialise in yet, I have always found psychiatry interesting and I enjoy reading and writing so I thought I would lend my voice. I enjoy long walks on the beach, warm sunsets, and the green bloom that Spring brings – and these are some of my thoughts I had while reflecting on my psychiatry placement, during my long walks.
Being a medical student and having just finished my psychiatry placement, it has been a real privilege, as always, to listen to patients’ stories and be able to get insight into their health and private lives. I can only speak about my experiences and discuss what I have personally witnessed but I find it incredible how much stigma there still is around the topic of mental health.
The stigma that we – those in the profession of healthcare – are fighting so hard to break still exists in our communities. A great starting point to this discussion was written by Melisa Kose for InSPIre the Mind. This piece will be a continuation of that discussion and an opportunity to lend my voice, having seen first-hand how the stigma of mental health can affect patients and doctors.
There are many misconceptions towards the work that mental health professionals do. A good example that I have witnessed is surrounding electro-convulsive therapy (ECT). The stigma towards ECT can be split between three parts: my own views, the general public’s, and the stigma from the patients receiving ECT themselves.
If we go back to the theme of movies as described in the previous blog mentioned, ‘One Flew Over the Cuckoo’s Nest’, one of Jack Nicholson’s most well-known roles, portrays psychiatry and ECT in an intense manner; pretending to walk like a zombie after a round of ECT, Randall jokes “they was giving me 10,000 watts a day… The next woman that takes me up is going to light up like a pinball.”
Developed in the 1930s, ECT has suffered in popularity throughout the years, due to films like this. Having heard individuals use words such as ‘barbaric’ and ‘controversial’ a lot of people aren’t aware that ECT is still a part of clinical practice and can be life-saving for those with treatment-resistant depression, resistant mania, and catatonia.
The fact that I was apprehensive myself, an open-minded medical student interested in the field of Psychiatry, shows that the stigma around ECT really runs deep. I was not even aware that it was a treatment that was offered; the media had portrayed the idea as so ‘crazy’ to me that I never thought it could actually be used in a controlled manner to save lives.
My ignorance was short-lived once I attended an ECT clinic and I saw the benefit that it brought to patients, especially in those that are at high risk to self.
The same stigma is shared by psychiatric patients themselves; a lady I saw in the clinic said that she felt ashamed to tell people she was receiving ECT. She felt that people would often judge her, saying she was ‘brainwashed’. Though shame in psychiatry is not new phenomenon, it disheartened me to hear this, finding myself surprised at how little progress it felt like we were making in breaking these attitudes.
On another day, I was shadowing a consultant when a woman came in presenting with low mood. Her opening sentence as soon as she sat down was “I’m ashamed that I’m here and that things have gotten to the point of seeing a psychiatrist”. The tone she set for the appointment was clear: that she wishes she was anywhere else but here.
It is difficult to deal with a patient who doesn’t want your help; no one enjoys seeing a psychiatrist. But from what I’ve seen over the last few months, it is one of the specialties for the most scope of change in people’s health.
Saving lives is just a small aspect of medicine – the majority of it is management of conditions. To go from psychotic episodes, rapid mood changes and extreme self-harm to being able to go work, afford rent and back into a somewhat relatively ‘normal’ lifestyle, I have seen psychiatry change lives for the better. And psychiatry saves lives too: one person dies due to suicide every 40 seconds, and psychiatry tries to prevent as many suicides as possible.
Other remarkable examples that hit the news include the thousands of mothers who are helped by the expansion of services and the thousands of children who are treated two years earlier than the government targets set out.
So, changes are happening. But what does the future hold and what else can we do?
With a high prevalence of the public experiencing a mental health condition each year and an increase in the use of mental health services, this isn’t something we can ignore. It’s time to take it further than just acknowledging the importance of mental health, and the time for doing is long overdue.
Attitudes amongst my peers and I shifted drastically after the 8 weeks of placement and seeing first-hand the effect of the specialty is one way to change views and debunk myths.
Politicians can do an awful lot of change by using their platforms, and mental health was a big topic across the campaigns in the latest general election, including the three biggest UK party campaigns bringing the important issue to light in their manifestos.
Stories being written, whether it is through the use of anecdotes in the likes of Adam Key in ‘This Is Going to Hurt’ or through more formal accounts, have highlighted important matters in healthcare and have enabled the public to get an insight into the profession of medicine.
Celebrities have gotten involved with the ‘Time To Change’ campaign, the Royal College of Psychiatrists have written a manifesto outlining points on how to improve the country’s mental health and improve services, and even the Royal Family has gotten involved, showing that even royalty suffers like the rest of us.
So, here’s a dedication of hope for this decade and the prospect of bringing better change in the UK in what sometimes feels like trying times.
Perhaps I’ll go into this field, a tad too hopeful about the change that I, a single human, can bring. I often hear that “no truly sane person goes into psychiatry” and I wonder if maybe I’ll find myself like Randall did in ‘One Flew Over the Cuckoo’s Nest’:
“I must be crazy to end up in a loony bin like this.”
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