Overcoming Stigmas

The reader might be curious about the title of this chapter. Am I attempting to stigmatize the field of mental health? Is the term shrink or headshrinker a slur that devalues the field? To many, the term may be neutral and just an alternative to mental health specialist. However, to me and many other medical students deciding on their specialty, the term might denote an unwanted and perhaps even feared profession. This idea of asymmetric power dynamics may have potentially given birth to the term, headshrinker.

It is speculated that this term was first introduced by Time magazine in 1950 while discussing the success of a Hollywood actor [1]. The literal meaning likely stems from the rituals of the Jivaro Indians of South America [1]. Once the enemy was killed in battle, the Jivaro Indian warrior would shrink the head to the size of fist while maintaining its facial features. The traditions were based on assumptions that a shrunk head assumed magical power. The intention was to humiliate the foe while bringing good luck to those who possessed the head [1]. There are other speculations about the term, headshrinker, but most of the amorphous meanings symbolize similar characteristics: that the psychiatrist is an authority figure with special powers, even magical ones, and possibly threatening or hazardous to one who is being “shrunk”.

These ideas among many others fuel the stigma surrounding mental health. It highlights the experiences of many of my patients who not only struggle with their mental illness but also with having to see a psychiatrist. There is evidence from military population that perceived stigma increases with the amount of symptoms [2]. In other words, the greater the psychiatric distress in a soldier, the higher is his or her perception of stigma. Some of the factors behind it include fear of being seen weak, harm to career, or loss of confidence by leadership.

This stigma also existed for me when deciding on a specialty after medical school. It is not an uncommon phenomenon. Among physicians, there is perceived marginalization of the professional identity of the psychiatrist which acts as a deterrent when choosing psychiatry as a subspecialty [3]. Psychiatry has struggled in the recent years to recruit medical students into its ranks [4].

The stigma and aversion to the idea of becoming a psychiatrist developed much earlier for me. Prior to medical school, I served in the Marine Corps after high school. The typical story in my Marine unit among the young service members was threatening an underperforming Marine, typically referred to as a shit-bird Marine, with a “visit to see the headshrinker.” In the hearts of many of my fellow Marines, this developed a visceral negative response. With this professional “baggage,” then how did I ended up as a psychiatry resident at Walter Reed?

 
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