Psychiatrists Not Immune To Effects of Stigma

When Suzanne Vogel-Scibilia, M.D., a psychiatrist practicing in Beaver, Pa., decided to speak more openly about her mental illness in 1996, it was a turning point. “I had become more comfortable with my role as a consumer and provider. I also knew that if I publicly acknowledged my mental illness, it would lend credibility to my advocacy work on mental health issues.”

Another major influence in her decision to disclose her bipolar disorder was learning that another psychiatrist had committed suicide six months earlier. The desire to help colleagues overcome the stigma of mental illness and get treatment was a major reason that Vogel-Scibilia and three other psychiatrists shared their personal stories at a session on overcoming stigma in psychiatry at the APA annual meeting in New Orleans in May.

About 35 out of 10,000 physicians commit suicide annually, according to panelist Carol North, M.D., an epidemiologist and associate professor of psychiatry at Washington University School of Medicine in St. Louis. “This is the equivalent of losing about half a medical class a year,” said North.

Physicians often prefer to self-medicate rather than disclose to another professional they are having problems, said North.

Psychiatrists are no exception. A recent survey by the Michigan Psychiatric Society found that half of all members who responded (567) to the survey would rather treat themselves than risk having a history of mental illness on their health insurance record.

Vogel-Scibilia understands their concern. When she was in medical school, her psychiatrist warned her not to divulge her bipolar illness because of stigma in the medical profession. Later on, she began to travel to a distant city when she needed to be hospitalized.

It wasn’t until she was well established in her private practice and in a community mental health clinic as director that she “came out” as a person with a mental illness.

“I began to question how I could tell my patients not to be ashamed of their mental illness while I was ashamed of my own. I also gradually became more comfortable with my role as a provider and consumer,” said Vogel-Scibilia.

Beth Baxter, M.D., another panelist at the session, said her honesty about her mental illness when she interviewed for psychiatry residency positions in the late 1980s came at a price.

“I felt I needed to explain that I took a year off from medical school because my schizoaffective disorder worsened. I went from being assured of a training position to being dropped completely.”

Baxter eventually found a residency position at the University of Rochester, “which helped me grow personally and professionally,” she said.

She is now the psychiatrist on a multidisciplinary team that provides a range of outpatient services at Park Center in Nashville, Tenn. She has told the staff about her mental illness and said she finds it gratifying to work with seriously mentally ill patients. Ironically, the same programs that turned her down for residency training a decade or so ago now invite her to do grand rounds on her experience with mental illness, said Baxter.

She and Vogel-Scibilia monitor their illness by seeing a psychiatrist and therapist at least once a week and having a plan to deal with hospitalizations. Vogel-Scibilia also has told the staff of the community mental health clinic she directs to inform her of changes in her behavior.

Baxter and Vogel-Scibilia are active in the National Alliance for the Mentally Ill (NAMI). Baxter helped write a psychoeducational program for patients called “Bridges,” which teaches them about how to access the health care system and mental illness.

Vogel-Scibilia advocates for psychiatric patients who have encountered discriminatory practices in local institutions and helps to educate hospital emergency room staff about how to care for psychiatric patients and make them more aware of behavior that could be stigmatizing.

Vogel-Scibilia has also written articles on her journey with mental illness for NAMI publications. At APA’s annual meeting in May, she was honored by NAMI as an “exemplary psychiatrist” for her advocacy work. ▪