Blog | Tuesday, November 27, 2018

Stigma


I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help.

Like really help.

I think what gives me the most angst is the math of it all. The numerator of too much always, always, always divided by that denominator of not enough.

Remainder: Too much.

It looks like a lattice. This network of scarred remnants of self-mutilation covering your limbs. I heard this lady say on television once: “Why would someone take a knife and cut themselves on purpose? Why would someone do that?”

The girl she was talking to on like Dr. Phil or whatever it was countered sharply: “You sound stupid. It is never about the cutting.” Then she rolled her eyes hard in this way that made that point stick for me. Focusing simply on the concrete act is asinine. Because it is never just that.

“I think we can discharge you from the hospital,” I said. “How does that sound?”

You nod and shrug. “That's fine.” And that's it. Your eyes float over my head and somewhere else. Where I do not know.

“Are you still hearing voices?” I ask. You shake your head no. “Good,” I say. Though I feel everything but.

The medical part has resolved. The psychiatry team has given their recommendations for the mental health parts. Our team has kept you firmly on the balance beam through this hospitalization even after a few topples. Now is the time to prepare you for the dismount. But that's the problem, the dismount. This life that awaits you just won't let you stick the landing.

Nope.

The math is bad. Too much divided by not enough. Too much is left over every time.

You are sitting on the edge of the bed. Yawning and rummaging through the sheets for a cell phone or a wallet or some other personal item. Shoulders slumped and resigned to whatever is next. I stifle an inward sigh. Whatever is next? It's just too much. Still divided by not enough.

But too much what? Divided by not enough what? Too much awful divided by not enough better? Too much need divided by not enough resources?

Or am I a part of the problem? Too much learned helplessness divided by not enough optimism? Too much ignorance divided by not enough courage? Too much darkness divided by not enough light?

I tell myself: Speak in tones that aren't patronizing and sorrowful or as if you're irrevocably broken. Then coach yourself away from the fear of not being able to help. Like really help.

Then help. Like really help.

Or at least make up your mind to try.

Yeah.

Kimberly Manning, MD, FACP, FAAP is an associate professor of medicine at Emory University School of Medicine in Atlanta, Georgia where she teaches medical students and residents at Grady Hospital. This post is adapted from Reflections of a Grady Doctor, Dr. Manning’s blog about teaching, learning, caring and growing in medicine and life. It has been adapted and reprinted with permission. Identifying information has been changed to protect individuals’ privacy.