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.by