A quick quiz for you: You have friends coming over for dinner, and your antidepressant is in its usual place, the kitchen counter.
Do you: A) leave it where it is, since you have nothing to hide? B) put it in the cupboard to make more room for food? C) stick it in the cat food bag, where no one will find it? D) put it on the table so you’ll remember to compare notes with your friends who are on other medications?
Next question: Would it be different if your medication was for your diabetes? What about if it were for an STD? Erectile dysfunction? Cancer? AIDS?
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Am glad this article recognize that people should “open up”. If those affected by mental illness hide it, no wonder people think there is something shameful. I also wish the article, after defining ‘stigma’ as ” “a mark of disgrace associated with a particular circumstance, quality, or person: the stigma of mental disorder” had made the obvious statement that there is no stigmal to having a mental illness. (Google: “There is no stigma to having a mental illness Jaffe” to find my article on this, since I don’t think links are allowed.)
Reading this article, I realized that I’d rather discuss my recently-diagnosed personality disorder with my boss rather than with my friends. So far my therapist is the only one who knows. Some of my friends would be very understanding, but I couldn’t stand the ‘fragile, handle with care’ attitude. And my boss would probably just say something like, oh, well, you wouldn’t be the best in our team without it, would you? (I’m a journalist, by the way)
So I think it’s a question of choosing the right people to be open with, I mean those who could make you feel better about it
Sadly and surprisingly, at least one area, emergency coronary care, can be negatively impacted by disclosing a history of depression. A study of individuals who have had a heart attack and have a charted history of depression found that they received significantly worse (as measured in time to procedure) coronary care. It’s a paradox since we are constantly told that with education stigma will be eradicated. Given this I would like to believe that medical staff would be the most educated and hence the most likely to afford persons with depression the same timely medical care afforded others; however, this study found otherwise.
(Of course this begs the question, “How are individuals with a disclosed history of depression generally treated by other groups?” Is it as we would hope with the help and compassion we would like from close friends?)
From the April 5, 2011 Canadian Medical Association Journal, “The effect of a charted history of depression on emergency department triage and outcomes in patients with acute myocardial infarction.”
Results: Of 6784 patients with acute myocardial infarction, 680 (10.0%) had a past medical history of depression documented in their chart. Of these patients, 39.1% (95% confidence interval [CI] 35.3%–42.9%) were assigned a low-priority triage score, as compared with 32.7% (95% CI 31.5%–33.9%) of those without a charted history of depression. The adjusted odds of receiving a low-priority triage score with a charted history of depression were 1.26 (p = 0.01) versus 0.88 (p = 0.23) with asthma and 1.12 (p = 0.24) with COPD. For patients with a charted history of depression, the median door-to-electrocardiogram time was 20.0 minutes (v. 17.0 min for the rest of the cohort), median door-to-needle time was 53.0 (v. 37.0) minutes, and median door-to-balloon time was 251.0 (v. 110.0) minutes. The adjusted odds of missing the benchmark time with a charted history of depression were 1.39 (p < 0.001) for door-to-electrocardiogram time, 1.62 (p = 0.047) for door-to-needle time and 9.12 (p = 0.019) for door-to-balloon time.
Interpretation (in part): In this population-based study, 10% of patients with acute myocardial infarction who were seen in an emergency department had a history of depression recorded in their chart, and this history was associated with an increased risk of receiving a low-priority emergency department triage score as well as delays in diagnostic testing and definitive care. Interestingly, other components of medical history, including the traditional cardiac risk factors of diabetes, smoking, hypercholesterolemia and hypertension, were not associated with triage score in the models; only depression affected the score.
Conclusion: A charted history of depression was common among patients with acute myocardial infarction presenting to the emergency department and was independently associated with lower-priority emergency department triage, as well as delays in benchmark diagnostic and reperfusion times. A history of depression should not be assumed to be the cause of presenting symptoms in emergency department patients with possible cardiac ischemia.
Link to full text: http://www.cmaj.ca/content/183/6/663.full
A shameful title. I do not assign “stimgas” and would avoid anyone who did.
Harold A. Maio
khmaio@earthlink.net
You have to be careful who to confide in. Some people can use any illness not as a stigma but as a weapon against you. Also, I find that with certain medical doctors I don’t share that I have psychuatric problems because they stop looking for physical reasons for complaints and tend to say and the physical illness is all in your head or imagined. They stop looking more easily and quickly refer you to your psychiatrist. If you say you have a pain or headache it must be related to your psychiatric problem. They won’t do tests they might prove otherwise and make you feel like a hypochondiac. You begin doubting if you are imagining that you are REALLY experiencing symptoms and should just go away and think positive and the symptoms will go away or perhaps increase your psychiatric meds. You feel primary doctors just won’t take you seriously.
Please forgive all my typos in my previous post. I am using a virtual keyboard. My point is that I don’t think telling everybody about your disorders mental or physical, or about your personal life – finances, romances, family problems – is a good idea. Put up those medicine bottles when the neighbors, friends even extended family come over. Put up your bills, your appointment books, etc. Everybody doesn’t need to know all the intimate details (medicine,doctors’ names, salary, etc)of your life. You can speak up in appropriate conversations about your opinions on mental illness and be an advocate for causes. I would share my experiences with someone in a confidential conversation if I thought it would help them in some way but I would not just go around blabbing my entire life to anyone who would listen. That could have terrible repercussions and you might come to regret it very much. Don’t hide in shame, but be discreet and cautious.
Thanks for writing this important artcle.Opening up about having and living with mental illness is a scary thing to do. Through years of therapy with wonderful supporting people I have decided not to hide out that part of my life anymore.It is scary though but if more of us did it less people would need to feel the stigma:)
Once someone finds out I have a mental illness they become uncomfortable because they don’t know how to speak with me. They become conscious of themselves and the teeny tiny conversation begins and it doesn’t matter that I have a Masters degree and am very well read. I am seen as a question mark – they are thinking how do I handle this – what exactly does mental illness mean. It is not easy.
One of the remaining issues with the stigma surrounding mental illness is the continued propagation of myths surrounding their nature and treatment. There are many quacks selling books promoting untested theories or treatments that are given legitimacy by mainstream media. As a result, the average American has decided that depression medications, for example, are unnecessary and the illness itself seems bogus. I wish some times we had rashes that showed that yes, we are sick.
I wouldn’t tweet an embarrassing picture of myself to the world but on the other hand I wouldn’t leave a bottle of Celexa on the kitchen counter either. Leaving out your medicines just for the purpose of letting other people know what you are taking seems a little passive-aggressive. If you want someone to know about your condition, tell them; but don’t just leave out your medicine as a conveesation starter among neighbors and friends who happen to drop by your house. First, it is dangerous to leave drugs around that others might take or tamper with. Second, just casually talking about mutual drug taking with the neighbors trivializes the illnesses you are taking the medicines for if you are making it the popular fad or the in thing to do to be taking a certain drug – for example: if one person says : I am taking Celexa, and then another says : Me, too. and then another says : yeah, I really like it and so forth. It becomes a fad to take Celexa. Additionally, there are some people who try to relate to other people by imagining and pretending they have the same symptoms when they really don’t. For example, if you say: I have been feeling really anxious. The other person comes back with: Me, too. I know exactly how you feel – and they really have no idea how you feel.
About the second question, I would not leave my medicines out for those illnesses either. It is a BAD idea to leave medicines out for any reason. It is not a matter of being ashamed or embarrassed necessarily. It is about being sensible and precautious. The person wrote this article sounds like a person who is trying to overcome low self esteem issues. Many people try to prove to other but really to themselves that they are not ashamed of a condition or disorder by shouting from the rooftops their problems. If you have good self esteem, you realize this is not necessary and that it is perfectly okay to keep some things private, to set boundaries, to choose carefully to whom to disclose certain things and whether to disclose certain things at all.
Your article is great and it would be the ideal to tell others without risking harm. However, in my own experience early on with bi-polar, I told it with no shame. At the time my life was in trumoil and the people in my life were either the scum of society or my family who seemed to hate my dignosis. ANytime I was put in a bad position in coverstion or otherwise, it thrown in my face. Any disagreement was blamed on me because of the mental illness. After a while I became a scapegoat. Now that my family accpets it more they love me and help me a lot in life. The scum friends I had are now long gone and new friends are fairly understanding. Although I must admit some do not know what bi-polar really is. Its so simple to read about these days, I think there is no excuse not to know the truth if you have a loved one suffering with it. Just as I have read and informed myself about their illnesses. Yet, still even today in my new and improved life after treatment, I see so much fear and mis-understanding. I’m very careful now what I tell to others. I’ve learned to see who can handle it and who will imagine bad things about me.