Squashing Stigmata


Borderline queen. It’s the title my Attending gave herself after our 5th borderline personality admission last week (while the other teams had 1-2 each). So I made her that crown as a joke and she LOVED it. Borderline personality disorder is characterized simply by unstable mood, volatile relationships, and bad self-image with feelings of emptiness and they often act impulsive… and are consequently manipulative and demanding and see us as either good or bad (and can change their opinion in a split second). A personally frustrating example of this was my 4 interviews of patients who all said they wanted to become health care providers because we were just SUCH a great team and SUCH an inspiration to them… then later that day, 3 of the 4 told me how much they hate us because we are keeping them at the hospital against their will, and we obviously can’t do our jobs correctly. It can become difficult to remember they are sick because they can get under your skin… something my doctor calls “Hospital Acquired Personality Disorder” (haha!).

I’ve had to really adjust my collection of stigmata about mental illness. Everyone knows there is a huge societal stigma against psych patients and psychiatric illnesses. I’ve known this and truly thought I was “above” that stigma… until I did my first patient admission on my own. I was the first person to talk to her after the police dropped her off for having a psychotic break in a busy intersection. She was in school for a health degree and didn’t want us to tell her supervisors why she had to miss a week. She wanted us to keep her mental health needs private because it could ruin her future career. I found myself thinking, “wow, I definitely don’t want her taking care of my health in the future!” Then I stopped and realized how guilty I was for harboring the same stigma. Would I care if a healthcare provider of mine had pneumonia or diabetes? Probably not as long as they sought treatment for those illnesses. So why now did I suddenly care if a provider had mental health needs as well, if they were seeking treatment? My viewpoint was flipped on its head and I was honestly pretty embarrassed and ashamed for my initial belief that I was above the societal stigma.

On the other hand, mental health can be incredibly entertaining and rewarding! Some interesting things I’ve seen…

A manic patient with bright pink lipstick smeared across her lips and onto her cheeks and chin came into our office crying because she “wanted her mommy,” then immediately perked up and told my Attending and me how beautiful we were, elaborating by saying she loved my earrings, and “how did you do your hair like that, doctor?” It was so intriguing to see her mind flip like that!

Another patient we had was religiously preoccupied (which is really common). She told me that “God is clear and sparkly, like a clean and clear commercial.” At first I was just amused and confused, then I thought she probably has a point and understands spirituality on a level I don’t. If God doesn’t cleanse us and leave us feeling better than before, then why bother? I started wondering multiple times during this rotation why religion is so appealing to the mentally ill population. I came to the conclusion that it provides a constant in people’s lives- something they can always depend on, no matter what else in their lives turns upside down… and I realized that’s exactly what religion provides to me as well- it’s a constant source of comfort and constancy. Why wouldn’t they seek that out when most of them have been abused or traumatized by life?

In the midst of the ups and downs, the staff is amazing. They had an impromptu dance party on the floor last week that was just plain awesome to watch. They have karaoke for the patients- and some of them are really good singers! And even if the staff discourages it, these patients are human and make connections. Some patients we’ve had have made meaningful relationships with each other and have kept in touch… two of them even claim they are in love! I’m not sure why I expected any different. These are normal people in a stressful situation in a closed and safe environment- wouldn’t I try to make meaningful human connections too to help deal with my emotions and stress? Isn’t that what we do in medical school (a stressful situation in a safe environment)? Why would I expect any different from them?

To sum it up, I went into this rotation with a certain expectation set, and am constantly being corrected and taught by those around me…. And I don’t mean the physicians and nurses. The patients have challenged me in so many ways to dig deeper, see the full picture, and truly embrace the DO philosophy of treating the whole person. After all, we are all so much more than the sum of our parts.