Monday, January 5, 2009

Clinicians - The Worst Purveyors of Stigma?

In a previous blog, I mentioned an email interview I recently completed with I Am Bipolar.

"Have you ever experienced negativity or stigma from people who have become aware of your condition?" Michael, who runs the site, asked.

Hmm. Interesting question.

"Ironically," I replied, the worst stigma came "from clinicians and fellow patients, the very people who are also my best supporters."

Clinicians have long accepted me as a journalist. In 2007, in fact, they even honored me with a major international award. But I am not one of them and never will be. Last year, I was invited to give a grand rounds lecture at a psychiatric facility in Princeton. I accepted with some trepidation. It is not my place as a journalist to tell others how to do their jobs.

I showed up with a talk on medications compliance. I'm sure the 50 or 60 clinicians in the audience expected me to blame patients for being too stupid to work the child-proof cap to their meds bottles and such, and indeed I did touch on that. But I also blasted the pharmaceutical industry for aggressively marketing meds that often made us worse rather than better, as well as clinicians who should know better, at the expense of the individuals they are supposed to be serving.

I wasn't just some antipsychiatrist spouting off. My PowerPoint contained reams of citations from the leading psychiatric authorities, including conferences I had attended and first-rank journal articles and editorials. But it was also my duty to wrap it all up and tie it in a bow. With reference to the fact that over the long-term some 70 to 80 percent of patients either drop out of clinical trials or are in some degree noncompliant on antidepressants, mood stabilizers, and antipsychotics, I pointed out the obvious:

"Just sending a patient out the door with a prescription is not treatment."

I wasn't all negative. I mentioned how compliance rates could be improved upon by employing psychoeducation, support groups, various talking therapies, books, websites, and so on. But this did involve the need to build trust with patients and spending time with them, plus being proactive in referring them to other services and sources of information. Again, just sending a patient out the door ...

As soon as my lips stopped moving, the room emptied faster than a high school Latin class at the three o'clock bell. No one approached me for a polite handshake or to follow up on any points I made, or to request more information. Only one person bought my book.

As I said, it is not my place to tell others how to do their job, particularly when nothing I said could be interpreted as a pat on the back, and my discomfort clearly showed in my talk. But even taking all of that into account, I was truly amazed by the magnitude of this group snub. Had I a PhD or an MD or an MSW to my name, I would have been treated with far more civility. But I happened to be a journalist who was also speaking as a patient.

The biggest complaint I get from my readers, I said in my talk, doctors who don't listen. Boy, did they prove me right.

Future blog: Stigma from patients. Stay tuned ...


Virginia Jolly said...

I am glad you pointed this up with professionals: it seems to be a consensus with many of my my bipolar fellows. Many, including myself, have fired one or more doctors while trying to find someone who will listen to what we say.

I am very lucky to have a doctor at this time who listens to everything I say, respects the spiritual aspects of my life, clarifies and educates me, and works closely with me to define my treatment.

We bipolars must work hard to seek out the best treatment for ourselves. It may take time, but we eventually figure out when things aren't working for us. If the health care provider doesn't listen to our complaints, then we vote with our feet.

The general practitioner, internist, or family doctor will spend time educating a patient on how to take care of a wound, treat a bacterial infection, and prevent illnesses. Hospitals have entire educational programs and specially designated educators for surgeries, cancer, and heart disease. Psychiatrists should respond in kind with a patient's brain illness.

John McManamy said...

Hey, Virgina. This is music to my ears. Would you like to expand this into a guest blog? I'm dead serious about this. You can reply by going to my website ( and clicking the contact link at the bottom.