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Chances are if you live with mental illness, you've had negative experiences at a healthcare professional's office.

Medical shaming is the term given to this negative treatment by doctors and healthcare providers. It happens when individuals are judged to be less than the ideal fit and healthy patient.

Studies report that medical shaming occurs as an attempt to motivate patients to change their behavior or, worse, as a blatant disregard or disgust by physicians for the patients themselves.

The Double Stigma

When it comes to medical shaming, the highest rates of shame by health professionals occurs with individuals who are both mentally ill and obese. Studies report that doctors express more irritability, impatience, hostility, reduced , and less willingness to help individuals with and mental illness. This double stigma at the hands of professionals who take an oath to first do no harm has been shown to worsen patient health, deepening and helplessness.

Many doctors and healthcare professionals perceive overweight individuals as failed citizens, less likely to be compliant with healthcare instructions, lazy and oppositional, and generally less concerned about their own health. Statistics show that doctors spend less time with overweight patients and perform fewer diagnostic tests than average weight patients. It's also been reported that stigma results in doctors underprescribing antibiotics and chemotherapy for obese patients.

When mental illness is factored in, physicians engage in diagnostic overshadowing, reducing any current physical symptoms or complaints to the patient's mental illness or obesity. Given these negative exchanges, it shouldn't surprise that over 1/3 of patients avoid medical care because they've encountered negative experiences at the doctor's office.

So, why does this shaming happen?

What is Health?

In 1948, The World Health Organization defined health as a state of complete physical, mental and social well-being. Regrettably, it didn't take into account or disease and the layered challenges individuals face with such conditions. While the definition of health has changed over the years, most professionals - and the general public - believe health is a state of well-being that a person "earns" or "maintains." This social construct goes like this:

If you eat well, you will be well.

If you exercise, you will be fit.

If you don't have good mental health, you just aren't trying hard enough.

And that those who can't, won't or don't achieve well-being are just weak, lazy - or worse - need to be shamed to get it done.

Now, not all doctors and healthcare professionals engage in medical shaming. There are many who maintain respect and integrity with patients they treat. However, the medical profession needs to do more to reduce medical shaming. But data says things aren't going too well there. Medical school curriculum aimed at reducing stigma of mental illness and related obesity hasn't been successful. In fact, studies suggest that medical students’ attitudes toward patients with mental health problems deteriorate as they progress through medical school.

Mental Health Struggles

For those of us who maintain serious mental illnesses, these reductionistic approaches about health can be soul crushing. For many, the goal for the day was getting up. Or maybe the win for the week was being consistent with . Or the challenge for the month was following your treatment plan so you were successful at school or work.

Children and adults with mental health issues often face enormous daily challenges and many health professionals fail to be sensitive to these struggles. Good eating, and physical activity are not givens. In fact, the neurobiology of many mental illnesses affects the frontal lobes of the brain where planning, regulation, and multitasking take place. These brain related issues make self-care very difficult. I haven't even delved into the side effects from medications that cause weight gain, gastrointestinal distress or serious neurological impairments. Or the struggle of maintaining remission or slipping into , or finding recovery of mental health symptoms so elusive. So when doctors shame patients for being obese or not taking more control of their well-being, they've done great, great harm.

A Recent Shaming

An appointment I had at the doctor for a sinus infection was frustrating for me. My usual physician wasn't in and a new, young physician assistant was scheduled to see me. He was initially warm and friendly, but became insistent on weighing me on the scale - which was not a ritual for a sick visit. I finally agreed and stepped on, moving the gadgets to the exact weight.

"Oh, so you know how much you weigh?"

"Uh, yes. I do."

I thought to myself, this guy thinks I'm out of touch with my health.

"Tsk," he said shaking his head. "You're too young to weigh this much."

"Actually, I'm almost 60 - and my weight's been steady for nearly a decade."

This guy doesn't know how old I am. Really?

"Well, I don't want to be all doom and gloom, but being obese raises your chances for stroke or heart failure."

This guy thinks I'm stupid too.

"I know that," I said, flatly. "I understand what you're trying to say, but, really, I find it condescending. I'm here for a sinus infection. Can we address that?"

After I sat down, he looked into my ears, eyes and nose. I thought we'd moved on from his shaming lecture. But he glanced at my file another time.

"I see you have high blood pressure," he said, and placed a too small cuff on my arm.

"You need the bigger cuff," I said.

"No, we can make this work."

"Stop," I said, feeling great discomfort. I put my hand up, palm out, and got off the examining table.

I wanted to say, "I live with and take medication that keeps most symptoms in check. The trade off for managing my mental illness is weight gain. And sweating. And hand tremors. But I don't have thinking, negative thoughts or despair. I'm here and alive and that's a miracle. I'm not weak, lazy or stupid. I choose healthy foods, but exercise is hard because I'm often physically and emotionally fatigued. But all my blood work is excellent, and my heart has been found to be splendid and healthy. I watch my sodium, drink tons of water and my blood pressure hangs at a solid 130/60. And yes, I measure it at home several times a week. I work, take care of my family and manage to find meaning in life in spite of struggling with mental illness - so, really, you need to stand in awe at how good my health is - all things considered."

But I didn't. I didn't have the fortitude to reach and teach this professional.

Instead, I just said, "We're done."

I left and went to the walk in clinic to get a further evaluation. Thankfully, there was no medical shaming there. I'll tell my physician about my experience with the PA next time I go. But I will not make an appointment with that PA again.

How to deal with shamers

Here are some tips to consider if you find yourself in a medical shaming moment.

1) Be empowered: Read more about Health at Every Size, the approach that accepts diversity and ranges of health. Learn to embrace your strengths and weaknesses when it comes to your physical and mental health. No one is perfect. Practice self-compassion and treat yourself kindly.

2) Say something: If you feel a healthcare professional is being disrespectful, share your concerns. "I feel like you're not listening to me," or "I don't like how you're talking to me," or "This is medical shaming, and you need to stop." Of course, this may not be easy to do. Sometimes we feel vulnerable at a doctor's office or have been taught to revere doctors. Other times, you just don't have the strength to advocate for yourself.

3) Don't beat yourself up if you get visibly upset: Expressing the pain of shame or can happen with a real human reaction. And that's okay too. I've had several of my own patients tell me that they cried on the examining table when medically shamed by doctors. These tearful episodes immediately shifted the doctors' approaches. Some were embarrassed at their insensitivity to their patient. Others apologized. And a few said nothing but stopped the negative shaming.

4) Take control: You don't have to continue working with a doctor or healthcare professional if you are continually shamed. I've moved round and round for decades until I found a series of doctors that respect me and provide me with excellent treatment.

5) Talk about your experience: When we've been made to feel unworthy or devalued we get stuck in a circle of pain. In essence, shame fosters more shame. To break this cycle, talk about your medical shaming experience with a trusted friend or family member. It will help you rebuild your and reset your outlook about your health.