It's Not All In My Head: Stigma in medical settings

Recently I had to see a dental specialist to have a tooth repaired. As I sat in the waiting area filling out the forms – insurance numbers, contact information – I eventually came to the dreaded “medical history” form. On it, I was asked to list all of the medications I currently take, any diagnoses or conditions, and my history of hospitalizations. As a person with a psychiatric history, I needed to ponder how much information to disclose. Did I really want to disclose my psychiatric diagnosis? Did this oral surgeon really need to know that I had been in mental hospitals? Should I write down the psychiatric meds I take or just leave them off the form altogether?

The situation I am describing is familiar to all of us who have a psychiatric diagnosis. Without even knowing it, many of us have become adept at carefully calibrating how much information to share with other medical professionals about our psychiatric condition. Why? Because of the stigma and discrimination, we so often encounter in medical settings, including emergency rooms, outpatient clinics and hospitals. Research literature suggests medical students believe people diagnosed with mental illness don’t recover, are violent and are “not easy to like”. Also “diagnostic overshadowing” is related to stigma and occurs not infrequently in medical settings. That means sometimes our real physical complaints get attributed to mental illness. Additionally, because of stigma we sometimes get lower quality or less comprehensive care.

Stigma in medical settings is real. It’s not all in our heads. How should we approach this situation? On the one extreme, we can omit information about our psychiatric history, but this can be risky. Doctors need to know all the medications we take, in order to provide safe and effective treatment. On the other extreme, we can openly confront stigma and educate the provider. However, this option runs the risk of alienating the provider and delaying the treatment we may need. Personally, I don't have a single rule that covers all situations. I calibrate the information I disclose based on the situation and what I feel the doctor needs to know about me. I'd be interested to hear how others handle situations like these.