Physicians face the same mental health challenges and stigmas as most people, but they experience additional burdens that come with the practice of medicine. These include the attitudes, high standards, and goals of perfectionism that are often found among physicians.

More than half of Americans will be diagnosed with a mental illness or disorder at some point, according to the Centers for Disease Control and Prevention. In any given year, 20% experience a mental illness. One out of every 25 Americans lives with major depression, schizophrenia, bipolar disorder, or another serious mental illness.

Despite the prevalence of mental health issues, the stigma associated with poor mental health continues to be experienced across most demographics and professions.

In medicine, that stigma is reinforced by state medical boards that require physicians to disclose mental health issues on their licensing applications. This may make physicians reluctant to seek diagnoses and treatments.

Mental health researcher Katherine J. Gold, MD, MSW, associate professor in the Departments of Family Medicine and Obstetrics & Gynecology at the University of Michigan, decided to explore that phenomenon after hearing physicians warn others not to seek treatment for mental health diagnoses or to go to a different city to seek care.

Gold interviewed physician mothers, representing all medical specialties, who belong to a closed Facebook group. More than 2000 physicians responded to an anonymous, 24-question survey about their mental health history and treatment, their perception of stigma, their opinions about state licensing questions on mental health, and their personal experiences.

Writing in the journal General Hospital Psychiatry, Gold reported that nearly half the respondents reporting feeling that they met the criteria for a psychiatric disorder at some time since medical school but had not sought treatment.

Other findings:

• One third of respondents said that they had received a formal mental health diagnosis since medical school.

• Respondents reported writing their own prescriptions in an attempt to manage their mental health issues.

• Others reported paying cash for visits to avoid having an insurance company record.

"There has always been a stigma and a fear around mental illness, and that's what's reflected in many state licensing board questionnaires," Gold said in a press release when her study was published. "There's a huge discrepancy between what states ask about physical conditions — such as whether those conditions affect their ability to practice — and what they ask about mental conditions, where the impact on their abilities is not asked about."

Medicine is a profession that places great value and pride in overworking and sacrificing oneself for others. Every step of a physician's education and training supports the idea that being fast, working long hours, and accomplishing much are essential for the positive reviews, recommendations, and supervisory support needed to earn top grades, get accepted into medical school, and receive a top residency placement.

Because mental health problems are stigmatized in society, some physicians — like much of the general public — have negative stereotypes about mental health issues and may be reluctant to consider their mental health status.

Failure to assess your mental health can cause you to misperceive feelings or misattribute the causes of your feelings. "This is what is required to be a doctor," "This is normal," or "This is how all doctors feel" may seem like common-sense statements, but they are actually declarations that misdirect attention from negative feelings.

Blaming the healthcare system is another way of deflecting focus on your feelings and mental well-being. The inefficiencies, administrative burdens, regulations, and technology requirements of medical practice are infuriating and well-documented drivers of physician burnout. These factors are often beyond the control of individual physicians and distract from core values that fuel rewarding and productive careers.

A physician's professional work may be diminished by poor mental health. Medscape's 2023 physician survey about burnout and depression found that 47% of physicians who reported depression said it affected their patient relationships:

• 34% agreed with the statement "I am easily exasperated with patients."

• 23% said they are less motivated to be careful when taking patient notes.

• 14% agreed with the statement "I express my frustration in front of patients."

• 11% acknowledged they make errors that they might not ordinarily make.

After listening to a panel discussion about physician burnout, a student at the University of Michigan Medical School suggested that faculty leaders telling their own stories might reduce the stigma associated with mental health problems and encourage health professionals to seek treatment.

Kirk J. Brower, MD, a professor in the Department of Psychiatry and chief wellness officer at the medical school, accepted the challenge. Writing in Academic Medicine in 2021, he reported his history of depression and suicidal thoughts; his shame and internalized stigma; and the treatment he received, including therapy from "a trusted psychiatric colleague, albeit in a different city from the one where I lived, one where no one knew me."

The culture of the medical profession perpetuates stigma, Brower wrote: "The good news is that our professional culture is ours to change."

He suggests several solutions:

Disclose personal stories. "I can share my experience with those who are reluctant to seek treatment because I know how it feels to struggle with feelings that inhibited treatment seeking even as I suffered with suicidal thoughts," he said. "Overall, I've had the professional career I wanted despite a history of depression, which I attribute in large part to obtaining the treatment I needed with the help of others."

Advocate with state medical boards and hospital credentialing committees to stop asking inappropriate questions about mental health . For example, the Federation of State Medical Boards currently recommends posing the following question, which has been endorsed by the American Medical Association and the American Psychiatric Association:

Increase knowledge about mental health. "Narrow perspectives lend themselves to unidimensional statements, such as 'mental illness is a weakness' or 'mental disorders are brain disorders.' Unfortunately, reductionist thinking or models of illness can contribute to misunderstanding and stigma," Brower said.

Physicians are trained to recognize the complexity of risk factors and benefits of treatment for medical problems, and that approach should be extended to mental health issues. As Brower further noted, "Members of our profession, of all professions, should be able to stop equating illness with weakness."

Proactively work to decrease mental illness stigma and discrimination in the workplace. Research shows that anti-stigma interventions — for example, education that dispels stereotypes about mental illness by sharing up-to-date research, along with professional and personal perspectives — can improve workers' knowledge and increase their support for people with mental health problems.

Stop using stigmatizing language. Labeling people may unintentionally subject them to discrimination. "Instead of categorizing people, we can view mental health and mental illness as part of a continuum," Brower said.

For example, physicians who have depression frequently struggle with substance use disorders. Referring to people as "substance abusers" or "addicts" is stigmatizing because these terms suggest a moral weakness or willful misconduct. The more useful terms include person with substance use disorder, person struggling with substance use (or alcohol use) disorder.

Create a professional culture of caring for one another within medical schools, hospitals and clinics, and professional societies. Speak with others in your organization whom you feel are sympathetic to and motivated to change the culture and interactions to become more caring and more concerned about the mental welfare of clinicians and staff. Lead by example.

Develop an ongoing relationship with a primary care provider. "Diagnosing and treating ourselves or asking colleagues to order tests or prescribe medications outside the physician-patient relationship is not a substitute for proper primary care," Brower wrote.

Acknowledge and address the hidden curriculum of medical students and residents who learn that mental disorders should remain undisclosed . Having discussions among peer groups, led by mental health experts, can help students and residents learn that many others struggle with the same issues they are dealing with — and that accepting and helping each other can be very fruitful in lessening the stigma.