A Psychiatrist to Doctors Is Witness to Impact of Stigma on Physicians

Adam was a 23-year-old third year medical student in the final week of his psychiatry clerkship. At the end of the day, he approached a teacher. Looking pale and frightened, he said to the instructor, “Got a few minutes?”

“Sure, what’s going on?” The instructor was Michael F. Myers, M.D., who also happened to be the director of medical school education in psychiatry at the institution where Adam was training.

Adam began talking, and Myers—switching hats from educator to diagnostician—quickly realized that the student was severely depressed. Adam spoke of feeling like a failure, feeling “old.” His grades were dropping, and he was withdrawing socially. He confided that, 10 days previously, he had loaded his father’s shotgun in his car in case he “needed it.”

Recognizing that Adam was at risk of suicide, Myers had him hospitalized. Following discharge, Myers began seeing Adam for weekly and later biweekly psychotherapy and medication management for about eight months.

That was 38 years ago. Throughout the following years—through educational and career advancement and career and personal changes and upheavals for both men—they remained in contact. Adam, who earned a medical degree and became a highly skilled physician, returned as a patient in 1991, again in 1999, and one more time in 2008.

“He had come in and out of my life over the years, and we grew older together,” Myers told Psychiatric News. “I was a very young psychiatrist—in my third year of practice—when he approached me, and he was a medical student. Now he is retired.”

In the intervening years, Myers, who is a clinical professor of psychiatry at SUNY Downstate Medical Center, built a career in education and had a half-time private practice in which he made a specialty of treating physicians—a psychiatric physician to other physicians. For him, the story of Adam is emblematic, because it runs counter to perceptions about physicians held by the public and, importantly, by physicians themselves.

As a doctor’s doctor, Myers has spent years listening to accounts of his physician patients who have felt shunned or judged by colleagues and the institutional rules of medicine because they are experiencing a mental illness or substance use disorder. Stigma, magnified by an unforgiving professional culture, courses like a poison through their stories.

“There is still a lingering mythology that if a medical student or resident becomes ill, he or she may not return and may not have been cut out for medicine,” Myers told Psychiatric News. “It simply isn’t true. Throughout all the years and the periods when his depression returned, Adam advanced in his specialty and was and is a strong, functioning individual.”

Helping Others Who Help Others

Early in his life, Myers came to know the force of stigma when he lived with and saw up close—at age 12—his mother’s alcoholism and the family secrecy that surrounded it. “She was a woman with an alcohol problem in the 1940s and ’50s—when the shame associated with that was far greater than it is today,” Myers said. “It took me a while before I could mature enough to realize how much my mother was struggling with it in those days—raising five kids, a husband who was a workaholic. She gave up her own career—she had been a legal secretary—to embark on motherhood.”

Later, in medical school, Myers was confronted with another stark example of the silence that shrouds mental and emotional distress—this time in the medical community he was joining—when his first-year roommate, a fellow medical student, died by suicide.

Myers felt obligated to announce the tragedy to his peers and recalls the shocked silence from his first-year class. After a period of silence, Myers recalled, the professor—evidently at a loss for how to respond—said, “OK, … let’s return to the Kreb’s cycle.”

“At the time, I don’t think I realized how really indicative this was of the stigma that gripped our society around suicide,” Myers told Psychiatric News. “I felt I had this obligation to make this announcement to my class. The silence was deafening.”

Funeral plans for his roommate were kept under wraps, as if he had died an embarrasing death, died of some shame. “It was as if he had never existed,” Myers said. “If he had died of cancer or in a car crash, the funeral would not have been so secretive and private.”

In a book self-published last year, Becoming a Doctor’s Doctor: A Memoir, Myers shares the story of his mother, his medical school roommate, Adam, and dozens of physician patients he has treated over the years—physicians with mental illness and/or substance use disorders and physicians with HIV/AIDS.

It is a chronicle of a remarkable journey of a psychiatrist who has devoted his private practice entirely to the treatment of other physicians. Myers has complemented his educational and clinical work with advocacy for nondiscriminatory policies toward physicians with a history of mental illness.

He was a consultant on “After a Suicide: A Toolkit for Physician Residency/Fellowship Programs,” developed by the American Foundation for Suicide Prevention. For years, Myers regularly presented at APA Annual Meetings about medical student and physician health and mental health with the late Leah Dickstein, M.D., a colleague and friend who had devoted a private practice to treating medical students. “Leah and I would get excited when two or three residents or early career psychiatrists would attend and say they just saw their first physician patient,” Myers said.

Together they advised psychiatrists to remember that their physician patients were struggling individuals, no different from other patients, who happened to share the same profession. When possible and with the patient’s consent, they urged psychiatrists to interview family members who could provide a more comprehensive appraisal of the patient. And they emphasized that many physician patients need and welcome psychotherapy.

In the years since Myers began practicing as a doctor to doctors, the culture of medicine around treatment of physician mental illness and substance use disorders has dramatically improved. But stigma persists, and Myers said that there is a great need for psychiatrists to “be there” for their colleagues.

There is also a great reward in helping physicians recover from mental illness or substance use disorders. “I grew up in the era of what was called ‘professional courtesy’—the idea that as fellow professionals, we look after our own,” he said. “It’s very gratifying work. You can help so many people who are in turn helping others get well.” ■