March 04, 2020

By Dimitrios Tsatiris, M.D.

I was a third-year medical student when I decided to become a psychiatrist. As part of my medical training, I worked for a primary care physician. My responsibilities included interviewing patients and presenting my findings to him.
I remember the appointment that changed the trajectory of my life. As I entered the exam room, I could feel the weight of his depression. He sat slumped over his chair, resting his head in his hands. I remember feeling uneasy as he struggled to muster the strength to answer my questions. The interview lagged as he spoke very slowly. His answers were brief, but his suffering was palpable.
As I was about to exit the interview room, I told him, “You have battled and defeated this illness before. I believe you will defeat it again. We are here to help.” Then something amazing happened. I saw him break a faint smile. He had regained a flicker of hope. The feeling of earning his trust and witnessing the change in his facial expression was invigorating. I knew I had finally found my calling. 
I was so convinced that I had to share the news. I decided to call a close family member who had played a pivotal role in my upbringing. My inner child was coming out as I was seeking the sound of validation in their voice. 
Their response was quite unexpected. It left me feeling hollow and dismissed. In their words, “I think you should become a cardiologist. You will make more money and not work with the insane.”
Though painful, I appreciate their response because it taught me a valuable lesson. I saw firsthand the stigma surrounding mental illness. I was on the path to becoming a physician and experienced judgment from a close family member. I could only imagine what those who actually battle mental illness must go through. 

Overcoming Stigma

The stigma against people with mental illness is real. If you have any doubt, consider there is a median delay of 11 years between the onset of mental health symptoms and receiving care. One reason for this delay may be that people try to hide their mental illness due to the fear of being judged.
In the workforce, people with mental illness may be less likely to be hired if they are incorrectly labeled as unreliable or incompetent. In addition, employees may be reluctant to seek mental health treatment out of fear that revealing their mental illness could jeopardize their job security. 
In a mental health crisis, people are more likely to encounter police than get medical help. About 15%of male inmates and 31% of female inmates in jails have a serious mental illness, compared to 3.3% and 5.7%, respectively, in the general U.S. population. Once in custody, people with serious mental illness tend to stay longer than their healthy counterparts. 
Stigma is also present in subtle ways. Consider the language we use to describe mental illness. We often label people with their diagnosis. For example, one may perpetuate stigma by saying “he/she isbipolar.” A more appropriate statement would be “he/she hasbipolar disorder.” Please recognize that one’s identity expands beyond any physical or mental health diagnosis. 
Each one of us has an obligation to play a role in overcoming the stigma of mental illness. Here are three ways to make an impact. 


It is important to educate people that mental illness is common. In 2018, there were an estimated 47.6 million adults in the U.S. with mental illness, or about 1 in 5 adults. 
Research also shows that mental illness is on the rise. A new Lancet Commission report on mental health found that mental health conditions are on the rise in every country in the world and will cost the global economy $16 trillion by 2030. 
I share such statistics with my patients to convey the message that “you are not alone.” This statement does not intend to minimize the experience of having mental illness, but to remove any shame associated with seeking help. People do not feel shame when seeing their family physician for a physical complaint. Why is there a double standard when it comes to mental health treatment?


Empathy is the ability to emotionally understand another human being. You are standing side by side with them and seeing things from their point of view. 
Please recognize that people may face truly debilitating symptoms due tomental illness. When someone has major depressive disorder, they can struggle with a host of symptoms such as depressed mood, fatigue, a lack of pleasure or joy, insomnia, feelings of guilt or shame. People with an anxiety disorder might be tormented with worrying thoughts, irritability, concentration difficulties or panic attacks. 
Mental illness can become so unbearable it affects one’s ability to function. Many people with mental illness experience suicidal thoughts. Why worsen someone’s situation by being judgmental?


Be an advocate for mental health awareness. Contact your community leaders to officially recognize national events such as Mental Health Awareness Month in May. Connect with local businesses and media outlets to spread the word.
You can also support orginizations, such as NAMI, that educate, support and advocate for individuals and families affected by mental illness. 
To this day, I think fondly of that gentleman who changed the trajectory of my life. Through my clinical work, writing efforts and speaking engagements, I try to break down the barrier of stigma and make mental health care more accessible. I hope you will join me in the fight against stigma.
Dimitrios Tsatiris, M.D. is a practicing Board Certified Psychiatrist and Fellow of the American Psychiatric Association. His interests include the treatment of anxiety disorders and mental health advocacy. He also teaches psychiatry resident physicians and supervises therapists.
He completed his Psychiatry Residency training at University Hospitals Case Medical Center where he served as Chief Resident. Upon completing his training, he was awarded the Outstanding Resident Graduate Award and the American Psychiatric Association Resident Recognition Award. 
To read more of his thoughts, follow him on Twitter @DrDimitriosMD.  

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