Stigma in Mental Health: When Depression Is On Your Chart

Stigma is a word used a lot as it relates to mental health. One way the concept translates to reality is when a person is suffering from a physical issue and medical personnel assume it is because of a mental health diagnosis. Here are a couple of real-life examples.

When physical symptoms are dismissed

Not so long ago, I found myself in an unexpected hospital stay for several days following emergency gall bladder surgery. It came out of the blue, no symptoms prior to that day, and set me back a lot physically and, in some ways, still does.

About 3 days into my stay, a problem I had been having swallowing returned. After coughing and choking quite a bit during lunch, I had the sensation that a piece of food was caught in the back of my throat.

I had several nurses ask me about it and leave the room unimpressed and unconcerned while I, meanwhile, tried to dislodge it for quite a long time. No one attempted to look at my throat or take the problem seriously.

Mental health stigma is a barrier to care

I finally fell asleep that night and, in the middle of the night, was awakened by a female intern (it is a medical school hospital). She was young and sweet, and it became apparent early on that she had read the "major depressive disorder" and "generalized anxiety disorder" diagnoses on my chart. (They have been "on my chart" for a dozen years.)

She asked me what was going on with my throat, and I told her. By now, it was also very sore. Then she asked me a few questions about my mood, and from there, I could tell she was focusing on my mental health problems and not the fact that something was stuck in my throat.

I asked her if she wanted to look in my throat, even though I suspected they had sent in a psychology-focused intern. She declined.

At that point, I sighed and said, “Never mind. You don't believe me about this, but there is something caught there."

The priceless response? "Susan, I believe that you believe it."

I was not all that surprised. So, I answered, "No, I believe it because it is true."

My depression has nothing to do with it

She clearly knew about my depression (which was probably being triggered by then), and I think said something along the lines of, "Try not to worry about it. It’s difficult having a hospital stay. Try to get some sleep."

I asked her if I could ask a question. "Do you know what happened the last time I had a physical problem and the doctor thought it was all in my mind?" I asked. "I kept asking for help for more than a year, and it turns out, it is chronic myeloid leukemia. But no one wanted to take it seriously because they saw I have a depression diagnosis and thought I was looking for attention or was a hypochondriac. But I was right. And right now, there is something caught in my throat."

She fell all over herself telling me how sorry she was I had leukemia and how that had happened to me. I believe she said something about letting a colleague know and fled.

Validation: it wasn't all in my head

The next day, I received one cough drop on a tray. Ridiculous. A few days later, lo and behold, the culprit was a piece of rice.

The swallowing issues continued post-hospital. Two endoscopies later, there are real, tangible reasons why, and I cannot eat little things like sesame seeds, rice, etc. I knew that, but those around me could not bring themselves to believe it.

They may have "believed I believed it," but chalked it up to being "all in my mind."

More assumptions based on my medical chart

Another time, I was awaiting a procedure. While being prepped five hours late because of an emergency, a half dozen people tried and failed to put an IV in more than a dozen times. Obviously, very painful. Then, a nurse said I would have to reschedule the appointment.

I was dismayed. I asked if it would take another 3 or 4 months to get an appointment because that was how long I waited for this one. Plus, I had been there waiting all afternoon and jabbed relentlessly.

Another individual chimed in, asking several times, "Do not cry. Are you going to cry?" while reading my chart. I was fairly calm, seeing as though there was blood on both my arms and hands at this point.

"No," I told her. "But I also know I cannot wait a few more months to get this done and go through this again."

Not jumping to conclusions based on stigma

Eventually, it worked out. The doctor appeared in the hallway, saw what was going on, and sent in someone to insert the IV properly.

But how she jumped from a scheduling issue to being afraid I was going to cry puzzled me... But only for an instant. It was that pesky chart again – making her jump to conclusions.