Research shows that only 16% of medical professionals under age 55 who are experiencing significant distress will reach out for help.

Over age 55, that percentage drops to 6%.

There are a number of both internal and external barriers to accessing needed mental healthcare. While they are real and valid, external barriers can sometimes absorb all of our focus so that we neglect the important role that internal barriers can play. 

Externally, there can be significant logistical challenges around finding a free hour every week or every couple of weeks for psychotherapy. Telehealth, of course, cuts out travel time and can be easier to manage. Many psychotherapy practices offer evening and weekend hours that may help (at my own practice, appointments start at 5:00 AM and we have robust asynchronous messaging options to accommodate healthcare schedules). The point here is not to try to enumerate the different ways in which there may be schedule flexibility, but to emphasize that there are different ways in which there is schedule flexibility.

Another external barrier is the very real threat of licensing or credentialing problems. Just a couple of years ago, my home state of Georgia finally updated the license renewal form so that it asks doctors if their ability to practice medicine is affected by any condition “for which you are not being appropriately treated.” Before this update, license renewals included an unconscionable request for 7 years of mental health history. Intrusive and stigmatizing questions have no place in licensure decisions, and robust efforts are underway for their elimination. This topic will be explored more fully in a future piece.

Yet another external barrier is stigma, which we can differentiate from shame. Merriam-Webster defines stigma as “a set of negative and unfair beliefs that a society or group of people have about something.”

Shame is defined as “a painful emotion caused by consciousness of guilt, shortcoming, or impropriety,” while Dr. Brené Brown goes further in calling it “the intensely painful feeling or experience of believing we are flawed and therefore unworthy of love and belonging.” Stigma is negativity that comes from the outside, while shame may occur when we internalize that stigma and begin to self-stigmatize.

An individual can be in a program in which mental health needs are accepted and validated and still feel shame because of a need for those services.  

Addressing stigma requires awareness and advocacy. But to address shame, we have to work within ourselves.

It is an unfortunate truth that psychotherapy can be extraordinarily helpful in working through shame, but only if shame is not an insurmountable barrier to that therapy in the first place. 

When it comes to the idea of pursuing psychotherapy, shame may tell us that we “should” be able to deal with our distress on our own. But once we begin putting those kinds of constraints on our emotions, we introduce inauthenticity. We are no longer dealing with our actual emotions, but with our interpretation of which emotional responses are acceptable.

One of the most effective initial ways to address shame is to name it. 

Shame says: “You feel bad because you are bad.”

We can say: “I feel bad because I’m feeling shame.”

Feelings are real but they are not facts.

If you read a sad novel and cry, you are experiencing genuine sadness about a situation that never happened.

If you berate yourself for something and feel shame, your shame does not make your perceived shortcoming real any more than your sadness about a novel made that story real. 

You may really have made a mistake. You may have fallen short of what you and others expect. But your feeling of shame isn’t what makes that so.

And a reminder that the opposite of ashamed isn’t shameless. It’s unashamed. We don’t need shame to help us acknowledge our errors and shortcomings, admit when we have a problem we can’t solve alone, and strive for greatness.

Resource:The American Psychiatric Association Foundation’s Center for Workplace Health has an arm specifically dedicated to workplace health in medical settings, with emphasis areas in fear and shame, peer support, clinician cultural competency training, and suicide prevention, among others. https://frontlineconnect.org/toolkit/