Social & Personal Stigma in Seeking Emotional Help

This is an excerpt from my book, going to be released Near August 2017.  

The quote later in the chapter contains a true anecdote from my office visits with real patients. Some information has been changed to protect identity and other identifying characteristics.  My book is full of these types of stories.

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Sorry, No Zebras Allowed!  Only White Horses With Black Stripes.

You are not your illness. You have an individual story to tell. You have a name, a history, a personality. Staying yourself is part of the battle.

― Julian Seifter, MD―

Erving Hoffman defines Stigma as “a process by which the reaction of others spoils normal identity.”  No matter what the reason is for seeking help, it’s always a good reason.  We are perfectly flawed individuals, meaning that our flaws are about as normal as anything else.  I will use the word “flaw” to describe anything in our personality that causes problems.   Just being alive increases your chances of having more flaws, thanks for that!  The problem with flaws is that people don’t like to accept that they have any, or are in denial when called out on them.  It’s important to remember, we are whole individuals, see the chapter, We Are Complex Beings.  We are both the light (unflawed) and the dark (flawed), where each one defines the other (you can’t really know dark unless you know what light is).  I stated earlier, a blind spot by definition is hidden from your view, so how are you ever supposed to know the things you can’t see unless someone helps you see them?  So after your “flaw-awareness,” now what?  Maybe if your spouse pointed them out, you get divorced.  Maybe if your boss pointed them out, you quit or maybe you choose to do nothing.  But what if you just accepted the reality that we are flawed?  Or just allowed the discomfort to sit within us without resorting to popping a Xanax, finding distractions or trying to ignore it.  At this point you may come up with the question, what will the pain/discomfort teach me?   I’m not saying, roll over and play possum, but we sure don’t have to repetitively and unconsciously react to the environment, do we?  Are these so-called flaws disrupting your natural course of life as mine were?   If this is the case, then maybe it’s time to move on and seek help.  Men may say, “Isn’t therapy for the weak?” “That doesn’t work.” Or “What’s talking to someone going to do?” All the while they are really thinking, “I’m a man and men don’t seek help!  As long as men convince themselves of these ideas, they will be stuck forever, spinning in circles on the same emotional merry-go-round. 

What about women?  Simply said, women are just better at asking for help.  This is likely because they have a different chemical and anatomical makeup and aren’t under the same social influence when it comes to outwardly expressing their feelings that men are.  This doesn’t mean that all women are great at expressing themselves, nor is it an excuse for machismo men who say they “don’t cry” or express their feelings.  In my life I’ve been lucky to be in the presence of men that have the ability to express themselves deeply, and trust me, they didn’t get there without having to traverse their own issues and social stigma.  I’ve also been fortunate enough to know many good women who struggled to connect deeply due to their socio-cultural background.  Societal and cultural pressures with respect to gender norms are real and span both sexes.  Ambivalence about getting help is an issue both sexes must confront and are heavily influenced by social norms, gender, culture, religion, ethnicity, self-judgment, ability, genetics, and stigma. 

Josefina is a 46-year-old Mexican female who came to see me because she was having trouble sleeping.  I walked into the exam room and I could already feel the energy shooting from her pores, her hair was somewhat disheveled, and she looked tired.  I said “Hi Josefina!  It’s nice to see you again.  What’s going on?” In a heavy Spanish accent, “Oh doctor, I no sleep well at all, I up all night, I need something for sleep doctor.”  “Why? What’s going on?”  I responded.  “I don’t know doctor, I just no sleep and cry all the time.”  “How is work Josefina?” “Okay doctor.”  “How are things at home?” I asked softly. “Stressful doctor,” she started crying.  I sat down on my stool, rolled over to her and put my hand on hers, “What’s happening?” I said as I looked directly into her eyes. “My husband doctor, we are thinking divorce.”  I asked her softly, “Why?”  “He just tells me he no want to be married to me no more.” She puts her face in her hands and cries.  I gave her a tissue.  We spent the next 10 or 15 minutes talking about the dynamics in their marriage and how she is feeling. I asked, “Have you ever seen a therapist?” “Why doctor, I no crazy.”  I chuckled, “Of course not Josefina, but sometimes when we are going through a tough time, it’s nice to have someone to help us go through it who isn’t related to the problem at all.  A neutral third party.”  “Oh doctor, I no crazy, I don’t need no therapy.”  “I hear you Josefina.  I know you are not crazy, but it sounds like you could use some help,” I said as I rolled my stool backwards. She responded, “In my country doctor, we no do that.  We keep it in family.”  “Okay, so have you talked to your family about this?” I asked.  “No, I don’t want burden my family, doctor.”  I thought, “but what about ‘we keep it in the family thing?'” So I said, “It seems that your family isn’t a source of help for you at this time, so let me give you a recommendation for a therapist, and should you want some help maneuvering through this hard time, please reach out.”  She nods, “Okay, doctor.” I rolled forward again, closer to her and said, “Josefina, it’s okay to have ups and downs in your life and I’m so sorry you are going through this, it sounds very painful.  I too have had my ups and downs and have seen a therapist myself. Please remember, you deserve to help yourself and you don’t have to do this alone.  You are not weak.  You were strong enough to make an appointment with me today so I hope you take my recommendation…Oh, I almost forgot – you can temporarily use diphenhydramine for sleep,” as I wrote it on a piece of paper. She said, “thank you doctor.”  I left the room.

Obviously, in Josefina’s case, her reasons for not wanting therapy were at least two-fold.  First, she had her own per-conceived notion or stigma about what it means to go to therapy, “I no crazy, doctor,” and secondly, she had a fairly large socio-cultural influence on this decision despite her not “keeping it in the family.”  She was suffering alone because of preconceived notions of therapy or asking for help outside of the family.  It’s not uncommon to see many cultures including Middle-Eastern and Latin cultures to have misconceptions about psychotherapy even during times of constant suffering.  Usually, it has to do with either wanting to keep it in the family or within their religion./church. Regardless, I think it’s important to seek help, and if that’s in the confines of the family, church, synagogue or mosque, so be it.  However, if those sources aren’t helping, we owe it to ourselves to think outside of our self-accepted cultural box, otherwise our suffering once again, just seems masochistic.

Continued in book


Dr. Mike

About the author

I am a Board Certified Family Practice Physician (MD) that has a passion for the proper treatment of patients. We are more than just our physical beings. We are complex and the current medical climate is failing both patients and physicians. As a new author, I feel passionately about letting everyone know how the system is failing us, moreover, how to overcome these barriers!

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Michael Lewis, MD
I am board certified in family medicine and passionate about caring for the whole patient: mind, body, spirit. I am married to a wonderful woman Jenniffer, who is a clinical psychologist and works right here in Willow Medical Center. I have a 7-year-old daughter, Bailey who is the light of my life. I am a soul searcher for myself and others. I also love to help men reach their potential as a conscious male. I am also a musician/guitarist. I have found that nurturing this part of my brain helps me think out of the proverbial box and provide better medicine.