Should Psychiatrists and Therapists Disclose Their Own Mental Illness?

I’ve spoken to medical students at the University of Pennsylvania about the experience of being a psychiatric patient. Inevitably, after the class a student or two would quietly take me aside and thank me while relating a hushed story about their own, or a family member’s, struggles with mental illness.

This was a secret to be closely guarded, for to the student its revelation could destroy their training and derail their career. The stigma that holds that people with mental illness are less capable, less reliable and less dependable, as well as dangerously inconsistent in moods and behavior, holds fast in Psychiatry and Psychology.

It’s unlikely that anyone who meets the dispiriting profile the stigma maintains could ever make it to the peak of the medical profession. But stigma paints all it targets with the same bad brush. Even a clinician that suffered from situational depression long since treated fears being discounted or possibly even removed from practice.

An article in Psychiatry Advisor offers well-explained data on the problems psychiatrists and psychologists face. For those with mental illness, encouraging patients and clients to disclose and honestly confront their illness is crucial to treating them.

However, the clinicians themselves are less likely to fully face their own experience with mental illness.

32% of Canadian psychiatrists face the challenge of mental illness, but only 42% would disclose this fact to family or friends. 62% of psychotherapists self-identify as depressed, and over 40% have considered suicide. Few of them are disclosing this to colleagues, and certainly not to clients.

Many licensure exams include a disproportionate number of questions about the test taker’s mental health. Many with a psychiatric history who take the test lie. They feel that while few physical diagnoses could keep them from the sanction to practice, many mental health experiences would give the licensing body pause and possibly prevent them from being allowed to practice their specialty.

Whether or not their fears are founded is debatable. But the fears are honest. The stigma is that bad.

In the late 1990s, when my life was obliterated by my experience with bipolar disorder, I lived with the panicked certainty that no one, especially not a doctor, could fathom what I was going through. How could one who made it through such professional rigor understand the inconsistencies of rapidly cycling moods and psychosis.

I read Kay Redfield Jamison’s An Unquiet Mind and was enlightened. Doctors could understand, and success was possible for people like me. But the fact the book was written and the things that it revealed threw Jamison into walls, as the Psychiatry Advisor article details.

For me it was enough to learn of Jamison’s success to quell my curiosity about my own caregivers.

I’ve had an open, mutually honest relationship with my psychiatrist for over 20 years. I’ve asked him personal questions that he has answered. We’ve shared stories of significant moments in our lives. He came to my wedding. But I have never asked him if at any point in his life he has struggled with mental illness.

I don’t want to know, and to me it’s not important. Still, I wonder why I feel that way.

Psychotherapy is a tremendously self-absorbed practice on the part of the patient. Perhaps I don’t want a doctor’s experience to steal my spotlight. Maybe, God forbid, I’m a victim of the wrong side of the stigma myself, and if I knew a doctor had mental illness I’d think less of him. Most likely, as the statistics on psychiatrists show, my doctor has no problems with mental illness anyway.

It doesn’t matter why. I’m content just the way things are, and this balance of just enough information about my doctor has served me well for years. I care for and about him a great deal. But I know my place and respect his professional distance.

I do hope that if he ever encounters problems like the ones he treats he would have the confidence to seek help and the professional security to back him up and not punish him for his health challenges.

In some sense, as it comes from so many patients, help in a quiet, symbolic way would come from me and everyone he treats. We struggle with mental illness, so everyone’s struggle, even a clinician’s, is valid and deserves the best, most caring attention. 

Psychiatrists and Psychologists warrant the same care they provide without the stigma that holds so many people locked in situations of despair.

That they face the stigma too is revelatory. When the doctor patient relationship works it works because of honest sharing. But perhaps we share things left unsaid as well. Perhaps it should stay that way. Perhaps we know each other even better than we think.

My book Resilience: Handling Anxiety in a Time of Crisis is now available.