I have no more idea than any media consumer about the particular motivations for Nidal Malik Hasan's killing spree at Fort Hood yesterday, 
and today's rampage in Orlando shows, of course, that violent behavior does not come with a job description. But there is evidence that mental health providers labor under a greater fear of stigmatization than the rest of us.
This fear may also mean that mental health professionals are less likely than lay-people to receive treatment.
Stigma affects the treatment of millions annually. According to statistics from the Department of Health and Human Services, 44 million Americans experience some sort of mental disorder in any given year. Mental health professionals-because of the stress of their work-are even more likely to experience depression and other disorders.
Fear of stigma and discrimination means that about half of the 44 million do not seek any treatment. If you are a psychiatrist or any other mental health provider, you are well aware of these kinds of numbers and attitudes and probably even less likely to seek treatment. Or, you are likely to-as the Bible says-try and heal thyself.
Richard Balon, PhD, Wayne State University, surveyed 567 Michigan psychiatrists, and found that 15.7 percent had treated themselves for depression, 43 percent said they would treat themselves for mild depression, and 7 percent said they would even do that for severe depression and feeling suicidal.
A similar survey in Finland found that physicians were less likely to consult with health care professionals for a wide range illnesses-physical as well as psychiatric.
Apparently the godlike image that doctors like to promote for themselves-at least in the popular imagination-does not allow for admissions of perceived weaknesses. All of us shrinks and general health care providers have the additional stress of trying to appear bulletproof-so to speak.
These attitudes appear early on in training. Studies cited Michael Myers, MD, University of British Columbia indicate that medical students do not even trust assurances about the anonymity of surveys about their mental health. Overall, there may be an underestimation of mental illness among medical specialists in all specialties.
The treatment the Michigan psychiatrists provided themselves was anti-depressant medications. It's hard to put yourself on the couch. Although I could not find statistics for nonprescribing providers-psychologists and social workers-avoiding treatment, I would estimate the numbers are high for them too. When nonprescribers avoid treatment, they get no treatment at all. (Depending on your view of antidepressant medication, this may be either a good or a bad thing.)
Aside from the general stigma for mental illness, professionals have additional specific bars to reporting a problem.
In Balon's study, the number one cited reason for self-treatment was the desire to keep a clean malpractice insurance record, which demonstrates that the stigma extends to purely technical aspects of doing business as a psychiatrist. Another problem is that licensing boards contribute to the stigmatization of mental illness even as they license professionals to treat it. In many states, when you apply for or renew a license, there are specific questions about mental illness. If you pop some pills on the sly-or fail to seek treatment at all-you can honestly answer these questions-avowing not having sought treatment for a mental illness. But having these questions on a licensing application becomes another barrier to treatment, and puts mental illness on the same level as questions like, "Have you ever been convicted of a felony?"
This is a complex problem. We would like to identify those who are vulnerable and at-risk among our psychiatric professionals to improve their work and protect their patients. But can we do it in such a way as not to injure the careers of those we are trying to help?
Balon, R. (2007). "Psychiatrist attitudes toward self-treatment of their own depression." Psychotherapy and Psychosomatics, 76, 306-310.
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My book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare (Avery/Penguin, 2009) provides a unique, insider's perspective on aging in America. It is an account of my work as a psychologist in nursing homes, the story of caregiving to my frail, elderly parents--all to th accompaniment of ruminations on my own mortality. Thomas Lynch, author of The Undertaking calls it "A book for policy makers, caregivers, the halt and lame, the upright and unemcumbered: anyone who ever intends to get old."
