Bethany struck me as being very sad from the moment I walked into the exam room.
At 27, she had a number of small physical complaints, but nothing I could put my finger on. I came to the conclusion that the problem was depression, but over the years I have never been very good at telling young women that I think we need to be treating the cause of their depression rather than their physical symptoms.
Often, patients become defensive when they come to see me with physical complaints and I ask them questions about their mental health. This is understandable: if a patient sees a doctor about their chronic stomach pains and they’re asked if something in their life has been causing them turmoil, they may think that the doctor is implying that their symptoms are “all in their head”. We all want to be taken seriously, especially when we’re experiencing pain of some sort. Unfortunately, on more than one occasion, patients have left before we finish the appointment because they are insulted by the thought that their physical pains are rooted in anxiety or depression.
As a society, even though we’ve come a long way in accepting, loving, and successfully treating those around us who struggle with mental health issues, the stigma surrounding mental health is still very real. Whether it’s a social stigma that perpetuates the myth that mental health sufferers are broken, lost causes or a patient’s self-stigma, the topic of mental health remains taboo, even in the exam room. A patient will openly admit that their hip hurts, but they’re less forthcoming in admitting that they can’t remember the last time they felt joy. The fear of admitting “weakness” prevents them from receiving the very treatment that can help them get better.
I hoped that Bethany was open to seeing our counselor, but I was still afraid that an abrupt this-appointment-is-over response might be coming. I just couldn’t justify performing a number of expensive tests or giving her medicine for “feeling bad,” which would in effect be a placebo.
At first, Bethany declared that all was well and that her life was going fine. But near the end of the appointment, long after I had brought up the possibility of seeing the counselor, she asked, “Is the counselor on the premises here?”
“Yes, she is. Would you like to see her?”
“It couldn’t hurt.”