The "Crazy" Patient: How a Psychiatric Label Can Influence Your Medical Care
Have any of you ever had the experience of feeling like you are a second-class patient because you suffer from anxiety or depression? Have you ever felt like your medical symptoms were dismissed or scrutinized because the doctor knew that you were being treated for a mental disorder? Did you ever feel like you were being labeled as the "crazy patient" after being seen by a medical professional? If so you are not alone. It is my opinion that in some cases, your history of being treated for anxiety, depression, or other mental disorders can influence the quality of your medical care.
This feeling that some medical professionals may treat you differently due to your mental illness is not all in your head. It seems there is scientific validity to doctor prejudice when it comes to treating people who also have some sort of mental disorder. A 2007 news story for Medical News Today reported on the findings of two psychiatric researchers who took a look at studies investigating the quality of medical care for those who had a history of mental illness and those who did not. During the 2007 annual meeting of the Royal College of Psychiatrists, Dr Alex Mitchell, a consultant psychiatrist, and Dr Darren Malone, a specialist registrar in psychiatry, revealed that 12 out of 14 studies showed inferior quality of care for those with a mental illness during health screenings. When it came to medical treatment (prescribing medications and recommending diagnostic procedures or surgical intervention) 14 of the 23 studies suggested inferior quality of care for those with a mental illness.
It seems that this medical prejudice is so great that it crosses geographic boundaries. In a 2008 the chair of the Mental Health Commission of Canada, Michael Kirby, had this to say at the annual Canadian Medical Association meeting:
It has been my personal experience that my history of depression and anxiety sometimes work against me when I seek guidance and treatment for medical problems. Although I do suffer from both anxiety and depression, I have rarely taken prescribed medications to treat either disorder. Yet when I have taken either an antidepressant or an anti-anxiety drug and the medical doctor sees this on my chart, I feel that it has definitely colored the doctor’s perceptions.
The following is one example from my personal experience in how medical professionals may show their bias when it comes to treating someone with a mental illness or mood disorder. I was in my twenties and I had just had a miscarriage. During this time I was also in therapy. This loss precipitated an episode of major depression where I was feeling suicidal. Although I was very opposed to taking medication, at my psychologist’s strong request, I began taking an antidepressant. While the antidepressant did lift me from the depths of my depression, I was also eager to get off of the drug. The reason was that I wanted to start trying to get pregnant again.
I saw a new gynecologist at this time and discussed my wish to conceive. I wanted answers to my questions such as "When can I start trying again to become pregnant after finishing with my antidepressant?" This doctor not only did not wish to answer my questions but seemed to suggest that I was too mentally fragile to contemplate another pregnancy. I felt as though I was a child being spoken to when she said to me, "You don’t need to worry about that right now. Talk to your therapist okay?" All that was missing was a placating pat on the head.
In the end I got a new gynecologist, tapered off the antidepressant and began trying to conceive. It is a good thing I did too as I found that I had infertility problems which took years to resolve. The main point of this story is to share how I felt demeaned by this doctor in her refusal to provide the medical information I requested or to take me seriously. It was clear to me that the underlying reason for her behavior was her perception of my mental health history. Would she have answered differently had I been a patient with diabetes or some other medical problem asking about pregnancy? I don’t know.
Just recently I experienced another instance of what I felt to be a doctor’s bias due to my history of suffering from anxiety and depression. In a previous post I discussed my trip to see a doctor about symptoms of chest pressure, feeling clammy, sweating, and like I would pass out. For anyone who has an anxiety disorder, you probably know that these symptoms can also be physical manifestations of anxiety or a full blown panic attack.
After the nurse did an EKG (normal) and checked my blood sugar level (high but not indicating diabetes) the doctor came to see me. As she was looking at my chart I asked what could be causing my symptoms. I asked if this could be some adverse reaction to the medications I am taking. The doctor replied, "You do have a lot going on here." I responded affirmatively "Yeah I have MS and asthma." But then she asked, "And extreme anxiety?" I felt as though I had been punched in the gut. I thought to myself, "Oh no she thinks this is all caused by anxiety and I know it is not." I know my body. I know how my body reacts to stress and this was not it. After waiting for nearly two hours for medical help I was quickly becoming concerned that they were going to send me home with no answers.
The doctor looked at my chart. "Prozac?" she said as if to make a point. "Isn’t the Prozac for anxiety?" I felt immediately defensive. "No the Prozac was for depression. I am no longer taking it." I felt like I was on trial. I quickly changed the subject "I have had some issues with my gallbladder in the past." This peaked the doctor’s interest who then examined me, pressing down on my belly and then on the spot over my gallbladder. When I yelped in pain her eyes seemed to light up at the discovery. After asking more questions the doctor seemed settled upon gallbladder disease as the most likely explanation for my symptoms.
I cautiously asked, "Can gallbladder pain cause all these symptoms?" The doctor replied matter-of-factly, "Yes, sometimes problems with the gallbladder can make you feel like you are dying." Somehow this statement brought relief as this was exactly how I was feeling. She was not going to dismiss me as a “crazy patient” after all.
After my doctor’s visit I mulled over the possibility that I was very close to being sent home with no follow-up tests or treatment for my medical problem. The reason? My mental health history and a record of taking psychotropic medication.
If I could give a message to the medical community it would be this:
People who suffer from anxiety, depression, and other mental disorders also get sick just like everyone else. A history of being treated for mental health disorders doesn’t mean that our symptoms are always imaginary or in our head. Please don’t make assumptions about what is wrong without due diligence to rule out underlying medical conditions as the primary cause for symptoms. Treat the individual who has a mood or anxiety disorder with same respect and dignity that you would give to any of your patients.
We are eager to hear from you on this topic. Have you ever felt that your medical care has been compromised due to your mental health history? Have you ever felt discriminated against from the medical community? Have you ever been denied treatment due to your mental illness? Let us hear your story. Your thoughts and opinions matter to us