When I tell people I am a psychiatrist, it is not uncommon for them to ask follow-up clarifying questions. They generally ask if I am a psychologist or a medical doctor. Some people might comment: "oh, you can write a prescription!" To minimize confusion, I usually prefer to say that I am a physician, as it defines a professional who makes a medical diagnosis and offers treatment recommendations, usually including prescribed medications.
In conversation, I recently told Dr. Babbitt that this happened again during a long flight from Europe to the States last summer. A male passenger experienced a medical emergency towards the end of our 11-hour flight, which led to an announcement overhead requesting that any so-qualified passenger identify as a doctor to assist the flight crew in stabilizing him. I am usually quick to respond to such requests if I am not asleep or extremely jet-lagged. As usual, I notified the closest flight attendant by raising my hand, and we immediately made eye contact with each other across the aisle. She asked if she could see my physician ID, as their protocol requires that they verify my profession. I did not have my professional work ID with me, although I am usually in the habit of carrying it, even on vacation. I explained to her that I had been out of the country and did not happen to have it with me. She was apologetic when she explained that she could not let me assist the passenger, who appeared to be in discomfort. Feeling disappointed, I returned to my seat. As soon as I sat down, I remembered I had a scanned copy of my medical school diploma stored in an application on my phone. I walked to the back of the plane where the ill gentleman was seated and showed it to the chief flight attendant. The ill gentleman was now showing signs of significant distress, appearing pale and in a cold sweat. I immediately began considering a list of potential conditions (differential diagnoses) in my head. After I showed her my scanned diploma, she asked me what my specialty was. As I told her I was a psychiatrist, she said, “we need a medical doctor!” My disappointment was starting to turn into frustration, and I replied, "I am a physician." At that moment, she must have felt the frustration in my voice, as she was quick to apologize: "I thought you were a psychologist!"
May has been observed as mental health awareness month every year since 1949. One of my favorite mental health advocacy organizations, Mental Health Association of America, is leading a campaign and asking buildings across the country to consider lighting up green to raise mental health awareness. They are also promoting ‘cool hashtags:’ #LookAround and find a participating building or landmark near you as well as others #LookWithin, #LookAroundLookWithin, and #MentalHealthMonth.
There is no doubt that in recent years, the burden of mental illness and related disabilities has been recognized more often than before. It has become even more relevant to seek answers and help for mental health issues online or in-person. The landscape of psychiatric diagnoses is also evolving as concepts such as digital burnout, digital addiction, fear of missing out (FoMO) are becoming popular. Mental health researchers are now focusing on the impact of social media and digital technology on ADHD, autism, depression, and suicide rates, evolving beyond an original focus on internet gaming disorder. And finally, we have a three digit and easy to remember suicide/crisis hotline—988, as of 2022.
Despite improved awareness and support, according to the CDC, more than 1 in 5 adults lives with a mental illness in the U.S. Even more concerning is data showing that more than 1 in 5 young people (ages 13-18) either currently or at some point during their life, have had a seriously debilitating mental illness. U.S. drug overdose rates have been steadily increasing among persons aged 14–18 years, overdose deaths increased 94% from 2019 to 2020 and 20% from 2020 to 2021.[1] Sadly, suicide has moved up to the 10th leading cause of death since my training 20 years ago. Global economic problems, the societal impact of the COVID-19 pandemic, overall increased stressors of living, and isolation all undoubtedly play a significant role in our worsening mental health. We are desperately looking for connection, which can feel scarce among the distractions of modern life.
Even though mental health issues are being more widely discussed than ever before, and more people are seeking treatment, the confusion around the role of mental health professionals seems to be persisting. Perhaps, having to endure a global pandemic for three long years was the worst possible catalyst to enhance mental health awareness. I can’t help but wonder if our ongoing difficulty recognizing the interconnectedness of mental and physical health is largely to blame. I sincerely hope that the question: ‘what is health without mental health?’ can continue to guide us when we feel puzzled. We psychiatrists are here to help, albeit at times frustrated, ourselves, by the misunderstandings and barriers to care that so often arise.
And, if you are wondering how the sick passenger did during my flight, I have good news for you. With the help of another colleague, he received the urgent medical assistance he needed. Just before leaving the plane, as we were getting ready to hand him off to the ground EMS personnel, he thanked both of us with a sense of relief and a smile on his face. Before we said our good-byes to him, he asked what our specialties were. He smiled again after finding out that he was helped by a psychiatrist and added: “Oh, I really do need your services!”
[1] https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm