To keep my medical license, I was asked to write a letter to be published in a public newsletter, apologizing for my addiction.
The wheels of bureaucracy grind slowly, so more than a year after my voluntarily disclosed alcohol relapse in Oklahoma, a litigation process ensued. I owned a professional record devoid of malpractice claims, with no hospital-related or legal issues, and not a single patient complaint in over a decade of medical practice.
Shortly afterward, the phone calls from lawyers and investigators came, while a probe was opened up into the most intimate details of my life. I lived through a condescending line of questioning laden with doubt of every word I spoke, and an insistence on providing evidentiary proof that I, an “addict,” could be believed. All of this was carried out to determine whether I should retain a professional medical license and continue to practice as a physician. In a criminalization of my medical condition, I was forced to hire my own attorney to fight the implied allegation that I was a morally corrupt, legally deviant doctor, and a “risk to public safety.”
During the medical board hearing, I defended myself regarding the gaps in work history and the academic probation that had been assigned to me for being in a recovery program and taking thirty days away from medical practice for treatment. I was required to publish my medical history, for consumption by the public, so that I could continue to work in a field I had dedicated my life to.
On the day of the hearing, I arrived shortly before 9 a.m. to wait in a line of cases to be heard before the medical licensing board. I waited and I waited, with an anxiety culminating in bouts of stomach-turning nausea about the future of my life and career. In a public forum, I overheard private details of other people’s lives being aired for all to hear, as a local news reporter took notes in a corner of the crowded basement room.
After waiting around until 4 p.m., I heard an assistant make an offhand comment from across the aisle: “Oh, the alcoholic case is up next.”
Let the stone throwing begin.
As I walked up to the podium, I could sense silent heckles and snarls rising into a single-minded hysteria. In this public place, with sixty people present, a surreal moment of public branding was unfolding. The clear message was that I should be ashamed of my actions and needed to be punished. The board imposed a probationary status on my medical license and a monetary fine, and also demanded the publication of a letter of apology. Head down, I crawled away from the meeting, questioning why I had even disclosed my condition in the first place. I still bear the scars of this public wounding.
This is the face of stigma. But I would argue that it isn’t just that; it is also discrimination. Employers are not allowed to ask individuals about their gender, sexual orientation, religion, ethnicity, or physical health. Yet medical licensing boards are still asking intrusive questions about individuals’ mental health conditions, in a clear challenge to the principles of the Americans with Disabilities Act. This federal mandate seems to be conspicuously overlooked at the state and local medical licensing board level.
I knew I needed ongoing treatment and accountability, but those interventions can’t be equated with punishment and public shaming. I was stereotyped as a deadbeat alcoholic in a narrative that spun out of control before I could even attempt to reel it back in. Stigma is a mark of disgrace and deviation from the cultural norm that gets superimposed over one’s individuality. Because I dared to seek treatment for my medical condition, shame, judgment, and punishment followed.
In medicine, the greatest irony is that a majority of hospital systems tolerate rates of distress among their workforce of more than 50 percent. Physician suicide rates are significantly higher than the national average for all professions, and some of the highest rates of active, untreated mental health conditions occur among individuals working in medicine. I have to infer that this at least partly due to how we treat our own. Maybe what has been accepted as the cultural norm is unsound and needs to change. The reality is that, statistically speaking, the norm is to suffer as a medical professional, right alongside the patients. Unfortunately, the norm has also been a systemic indifference to this plight. Individuals like myself who live with these conditions are often left to feel different, afraid, guilty, and humiliated—if they’re fortunate enough to survive at all.
In recovery, I witness the persistence of this stigma every single day with colleagues and patients. I was privileged to become close friends with a young physician who was also in a recovery program for depression and anxiety. She was a few years behind me in her journey, and I served a mentoring role on her path of self-discovery. One day she came to me, tearful and distraught, because she was given a hard time by colleagues who called her lazy and selfish for taking two days off from work. The others were forced to rearrange their schedules to accommodate hers. This is a difficult situation, especially in the context of other individuals feeling overworked and distressed as well, but in this instance the others were at least aware of her ongoing treatment.
Would they have said the same thing if she were in treatment to recover from a broken bone?
The whole weight of stigma as a cultural barrier comes into play in situations like these. The system we have built expects medical professionals to work even when sick, because someone else is always sicker. For the vulnerable individual seeking help, it feels unsafe to disclose personal struggles to colleagues, and the cultural expectations surrounding the decision to take care of oneself create feelings of guilt. In an often understaffed, under-resourced workforce, when one domino falls, the rest of the fragile infrastructure starts to crack as well. Exhausted, overworked, underappreciated colleagues mumble, “I should be the one who gets two days off,” and perhaps justifiably so. When my young colleague returned to work, gossip and rumors spread like they might in a high school cafeteria.
Stigma is often used as passive permission to avoid deeper understanding, and to perpetuate feelings of disapproval for any deviance from the social norm. The social norm is that physicians come to work even when sick, and this norm was allegedly violated by my colleague, propagating feelings among her colleagues that principles of fairness had been subverted. The problem here is that the cultural norm itself is faulty. Given that more than 50 percent of the medical workforce is distressed, the cultural norm should be that we take care of each other when we are sick.
In my own medical institution, we combat stigma and take care of each other by normalizing the conversation around seeking treatment. For our medical residents, a few colleagues and I started a process of opt-out counseling by scheduling sessions for everyone in the medical training program. An individual can decline the appointment without any repercussion, but we value and protect the time for people to go to the sessions. Since the norm is that everyone is scheduled to go, no one feels different for seeking out and receiving this level of support. As a result, once secretive conversations about attending counseling now happen openly, and the physicians actually feel more comfortable going.
However, the stigma persists. After a recent lecture I gave, a student approached me to ask if we could talk in private. She shared that both of her parents were in addiction recovery, and her father had recently lost his job as a therapist because of it.
She cried and said that every day, in every rotation, her colleagues, mentors, and other professionals make insensitive, hurtful comments about “addicts.” Coming to work on hospital rounds had become unbearable for her due to such stigmatizing and abrasive language. She would spend the weekend with her parents in acute recovery and feel as though she were living in a state of personal and professional shame. She wrestled with how to balance a façade of professionalism with an ongoing internal turmoil.
She expressed an unease about whom she could trust with this information and whom she could safely confide in about why she needed to leave work early on Fridays to participate in her father’s family treatment program. She was struggling to find her voice and play her role on her medical team while wanting to stand up and shout at the top of her lungs. She wanted to unleash a guttural scream of advocacy in defense of those she loved most dearly. All I could do was listen, give her a hug, and let her know I stood with her. It reminded me that stigma fails to acknowledge the collateral damage of what people in recovery go through, and sometimes even fails to reveal who is really being hurt.
Shortly after this lecture, I read an article about the recent suicide of a medical student. I saw another example of the pervasive nature of the stigmatization of mental health conditions there on full display. Unfortunately, like mass shootings, medical student suicides are happening at a rate approaching a critical mass, numbing us to their gravity and drawing them away from newsworthiness. This particular story told of a young woman who jumped to her death from of an eighth-story window. The article went on to review her accomplishments and her relationships, much like an obituary. Then I saw a comment beneath the article from another medical professional.
I am sure it was intended as an expression of sympathy, but instead the comment graphically exposed the truth about how a lot of people view individuals with mental health conditions in our field. The commenter wrote, “We were all worried she was not strong enough to be a doctor.”
After my initial shock and horror at reading such a thing about an individual who had just passed away, I collected myself and tried to process it.
Why was I even surprised?
This was probably the most truthful statement I had read in all my time experiencing and lecturing about mental health recovery. This was one person being honest about the culture we have created. Stigma declares that depression is a weakness, and strength and resiliency are prerequisites to protect against it.
My colleague Dr. Seagrams was diagnosed with breast cancer several years ago and took three months off to undergo treatment. She was successful in her initial therapy and remained in remission for about two years. She continued to work off and on during the next few years of her recovery, in a loving and supportive workplace now filled with pink ribbons, coworkers with shaved heads, and a break room stocked with snacks. A fundraising walk was organized on her behalf. After her long battle with the disease, the cancer returned and she lost her life to it, but she was a fighter and an inspiration. She was a hero and gave it everything she had. These are true statements about an amazing woman, but absent from the article reviewing her life was the statement, “She was not strong enough to beat her cancer.”
Another colleague, Dr. Allen, was diagnosed with type 1 diabetes early in her career, and maintained an exceptional program of self-care. She was meticulous in her blood-sugar monitoring, and took pride in the work that she did to manage her disease. She would post online results from her lab reports, and tout the success she had controlling the disease.
The comments about her care regime proclaimed, “amazing work,” “inspiring,” and “tough as nails,” all the way down her social media page. She was diligent in developing a medical plan that worked for her; therefore she was an incredible success. Nowhere on that page did it say, “You are a weaker physician because of your disease,” or “You were not tough enough to cure your diabetes.”
That last line may sound crass or comical, but when you extrapolate it to include the experience of individuals living with mental health conditions, it is an appalling reality. Rarely heard are statements such as “inspiring self-awareness.” Instead there are offhand comments such as “lazy” or “weak,” or descriptions of character flaws and a need for a thicker skin.
While it is considered a sign of weakness when a person is unable to overcome a mental health condition without outside resources or support, no one called Dr. Seagrams lazy when she took three months off from work for her treatments, and we are inspired by Dr. Allen’s ability to focus on and execute a self-care plan for a disease that is not stigmatized.
The fact is that culturally, we view individuals with mental health and/or addiction conditions as flawed, broken, inferior, or weak. This stigma assigns a seat for us at the end of the table. Medicine is no different in this regard. It is astonishing that those of us actually treating individuals with these same conditions are not exercising the compassion needed to understand the harm it does to project a label of weakness onto other individuals. Viewing them or us as broken, flawed, and inferior reinforces a culture that does not permit changing seats at the table. These practices shame individuals into taking their assigned corner seat, fearful of seeking help and treatment that may actually save their lives. Stigma holds people down and actually works against the common medical knowledge that a lot of these conditions are treatable and not caused by character flaws.
Tragically, a lot of people suffering from mental health conditions already exist in self-deprecating cycles, while desperately seeking their own forms of affirmation. In the depths of my depression, I didn’t feel worthy of a seat at the table at all. I stigmatized myself, too, as I regressed into a childhood state of isolation, my own sense of worth being directly linked to the actions and attitudes of those around me. From an early age, I lived with the self-defeating belief that I deserved to be bullied. I desperately sought affirmations from other people, and when I didn’t find them, those absent affirmations morphed into cruel self-talk.
I am different from everybody else.
I should have done better.
I should be ashamed of myself.
In this cycle, I lived in a self-fulfilling prophecy of not feeling as though I was good enough, and then being told I was right about that all along. When I initially returned to work after rehabilitation treatment, a coworker who was returning from her maternity leave was greeted with balloons, hugs, and a celebration in a workplace meeting room. Colleagues clapped and cheered that a new life had been brought into the world. I sat quietly in my corner seat and almost chuckled, as my life had been brought back into the world too, but no one seemed to notice or care.
In sharing my story, I want other people to feel there is room at the table for their story too. I don’t want them to feel as alone as I did in those initial years of recovery. I stand up for my colleagues so they can feel showered with balloons, hugs, and celebrations for reclaiming their lives. But I don’t stand up just for them. I also won’t stand silently by while patients, their friends, and their families continue to suffer from the deleterious effects of stigma.
Her name was Chloe. She was a single mother, and her daughter was critically ill in the intensive care unit. Her baby girl was born with a complex heart condition and clung to life after two major surgeries. In the surgical wing of the hospital, the baby was enveloped by a tangled web of wires and surrounded by an array of alarms and blinking lights.
In the middle of an otherwise ordinary day, an alarm sounded, echoing out into the hospital halls. The blaring alarm signaled that Chloe’s only daughter, Alexis, was struggling to breathe while on her life-support machine. A flock of white coats crowded into the room in a flurry of action. In a corner sat Chloe, head in hands, caught in the depths of an uncertain fear I could never even begin to imagine.
Chloe’s story was as complex as her daughter’s heart we had once operated on, with enmeshed layers of life experiences. On the surface was a picture of a baby in a bed and a mother in the corner, but a deeper analysis would require a skillful, compassionate dissection. For months, only the superficial story remained. In the beginning, it became widely known that Chloe carried a diagnosis of bipolar disorder, and over time a crude portrait of her life and persona was painted. Soon the stigmatizations followed, in sweeping, abrupt, and insensitive characterizations of her supposedly compromised love for her daughter, her limited competence to provide ongoing care, and her absence from the bedside.
Chloe’s daughter was hospitalized for nine months, and during one five-day period she was absent from the bedside. I heard the rumors flow down the hospital ward hallways.
“The mom is crazy.”
“I bet she’s lost her mind.”
“She’s never here anymore. Must have gone off her meds.”
“How is she going to take care of this baby when she can’t even take care of herself?”
As I was a human being with my own mental health story, it broke my heart to hear this whispered negativity. I wanted to know the proper truth of her story. Upon her return, I pulled out a chair and listened, sometimes for hours at a time, as we built a comfortable space that was safe enough for intimate disclosures.
The truth was that Chloe had a difficult life. She was abused at an early age, and struggled for several decades with post-traumatic stress related to her childhood experiences. She had been diagnosed with bipolar disorder only a few years earlier, and was working hard to navigate her mental health issues while tending to the myriad responsibilities of being a young single mother. The child’s father had tragically died in an automobile accident while she was pregnant, only about six months before we first met. She didn’t even have time to grieve before the next hit came: a fetal ultrasound and an uncertain future.
When she wasn’t at the hospital, she was looking after her other child, working, or going to a multitude of appointments for her own health. She lived three hours away from the hospital, and finding transportation back and forth was difficult. Finances were tight, as she tried to save every last dime in preparation for her daughter coming home with complex medical needs. She wasn’t crazy or off of her meds, and she wasn’t being neglectfully absent from her daughter’s life. She was a great mom, doing the best she could to manage difficult circumstances and take care of the ones she loved, which at times required taking care of herself.
Her daughter’s surgery was important to reveal the true extent of her underlying disease, but dissecting Chloe’s story proved to be a valuable moment of humanity, helping me understand her needs as well as those of her entire family. In order to preserve this humanity, I realized that it’s necessary to start telling different stories. In my recovery, I learned to spend time listening with compassionate ears so that I can stand up to stigma when it confronts me head-on.
I meet patients’ family members like Chloe every day, as well as colleagues who shudder when sharing their own mental health stories because of fear of the inevitable stigma. It is time that we start telling more accurate stories by listening closely for a more complete truth.
I learned to stop judging people by these superficial means and convenient characterizations. But I also learned that sometimes listening for this truth alone is not enough. Sometimes, standing up for another person is required.
Recently, when I heard a comment about a person being “nothing but a drug addict,” I responded, “Awesome, me too.”
What followed was a beautifully awkward thirty seconds of silence in which a new way of thinking was born, one to challenge the status quo of offhand comments.
I continued, “I wonder how they are doing in their recovery.”
I was not being forceful or condescending, but rather trying to open their eyes to a world they may not have had any experience with. Inviting them into the dialogue and encouraging them to consider a fresh take on a tired old narrative worked. The same colleague came up to me a few days later and asked about my recovery, and then thanked me for sharing part of my story.
When a medical student presented a case during morning rounds, a cutting commentary of “Well, this patient is really schizophrenic” made its way into the summary of events.
After rounds, away from other people, I asked a follow-up question: “I was really depressed and suicidal once. How does that apply to the care we are giving this human being?” After a long silence came another moment in which eyes were opened.
Confronting stigmas with compassion, while taking the time to hear an individual’s story, has allowed me to advocate for the truth of a narrative to find the light of day. In doing so, I can help to show Chloe’s story through a different lens and promote a kinder, more accurate representation of her life.
I wasn’t always that kind to myself. During my own struggles, and as a young child, I was the one being pushed down in the mud, not the helping hand pulling someone else back up. I didn’t feel as though I was strong enough to get back up during those moments, nor did I feel worthy of doing so. I vowed that those events would never define my life, because my mental health story has made me stronger. And I promised myself I would not stand idly by when I see something like that happen to others.