Monthly Archives: September 2014

Honoring Vulnerability

This post was originally posted on Dr. Becker-Schutte’s home blog.

 

This year, I had the chance to participate in two fantastic panels at Stanford’s Medicine X conference. You can see the video of the panel on chronic illness and depression here:
The video for the second panel will be available later this fall. The great thing about panels is that you get an authentic discussion, a give and take that is really valuable. The tough thing about panels is that you often think about the things you wish you had said later on (maybe that’s just me).

So, this post is about those things. The things I wish I had said–in both panels. Because at the heart of all of the work I do with my clients, the advocacy I do online, and the writing I share in this blog is this conviction: We are all unique, fascinating, fallible, fragile, resilient human beings. In spite of marketing that suggests that we should never be sad, never feel pain, never experience illness-each of those experiences is a part of being human. In spite of a culture that demands invulnerability and infallibility, we are both vulnerable and prone to mistakes.

So, I wish I had said these things:

  • We need to give our doctors and other health care providers permission to experience and claim their own pain, fear, sadness and vulnerability.
  • We need to talk about the amazing learning potential in our mistakes.
  • We need safe space (in our heads, in our workplaces, in our training environments) to have moments of vulnerability.
  • We need to counter shame and unrealistic expectations.
  • We need to challenge the damaging perfectionism that pervades our healthcare system.
  • We need to respect the courage it takes to admit when you are hurting, or scared, or depressed, or anxious.
  • We need to support one another’s humanity more and better.

The statement I made that was tweeted the most was about the need to decrease stigma around depression and other brain health struggles–both in medical patients and in medical providers. In order to decrease stigma, we need to increase our understanding that vulnerability is a fundamental human experience AND our compassion and empathy for the pain and difficulty that vulnerability can bring.

I’ve been having a conversation about vulnerability with the #MedPsych tweetchat community over the past week. We’re continuing that conversation tonight at 9:30 pm ET. You are welcome to join us.

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Medicine X and the Sneaky Impact of Stigma

Ten days ago, I had the privilege of joining the participants at Standford’s 2014 Medicine X conference.  I’ve written about this conference on my practice blog before, and it is a gathering with lofty aims.  The conference was initially envisioned as a space to explore how health and emerging technology support one another.  Over the three years it has been running, Medicine X has become the leader among healthcare conferences at integrating patient voices into the planning and narrative of the experience.  This year, Medicine X invited some discussion of brain health related issues.  One panel focused on the interaction between chronic illness and depression, and another focused on how brain health issues cut across diagnoses to be a “missing link” in whole person healthcare. I was thrilled to participate in both of these panels, and advocate for an issue that I believe is essential as we move into the future of healthcare.

Participating in these panels was a joy–I shared the stage with some courageous advocates whose stories are very powerful.  However, my participation also reminded me of a critical topic.

Stigma is the elephant in the room when we are talking about integrating brain health more fully into healthcare. 

I have written a bit about healthy privilege and the stigma of illness, so I won’t repeat that here.  There is also a great deal of powerful writing about the more obvious ways that brain health issues are stigmatized.  One of my favorite reminders of this is a pointed cartoon:


This cartoon cuts to the heart of the most obvious brain health stigma–which seems to be founded on the idea that brain health can be improved just by “adjusting your attitude” or “trying harder.” That piece of stigma is very real. So is the piece of stigma that has cost individuals facing brain health challenges their jobs or their relationships.

However, what I saw at Medicine X this year was a more challenging and subtle component of stigma. I saw an assumption that brain health issues are something that patients deal with, not a challenge that confronts health care professionals. People were willing to talk about providers who were burned out. They were much less willing to talk about providers who might be facing depression, anxiety, unsustainable stress levels, etc. That language still seemed taboo. And that’s a problem. As long as brain health challenges are something that “they” experience, stigma will continue. As long as it is not acceptable for a medical student to own that the intense demands of their training are difficult emotionally as well as practically, stigma will continue.

I also saw brain health discussed as something “other.” Medical students talked about not knowing how to approach a referral for brain health services without upsetting their patients. Until a referral for a brain health consultation is as automatic as a referral to an endocrinologist, stigma is still at play.  Until we are trained to think about the brain and our social functioning as a vital component of health that we wouldn’t dream of ignoring, stigma will still be an issue.

I don’t want this post to be construed as pessimistic.  At Medicine X, I heard medical students ask questions that showed they truly want to be part of this conversation.  I saw patients who discussed their depression  as a medical challenge on the same stage with diabetes or autoimmune disorders.  I saw that there is so much hope and potential for the future.

I also saw that we have work to do.  Let’s keep the conversation going. Shining a light is how we challenge the grip of stigma.

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