134 Becoming a Patient
could generate more discrimination against her than carcinoma, because
she could be blamed for the symptoms.
Cancer’s not your fault. You can’t help it. But doctors view men-
tal illness as my own fault. I felt it in conversations about other
people: a lessening of respect for the person who had it.
In many ways, being held responsible for one’s diagnosis heightened stress.
Hence Ernie, for example, felt discrimination more due to his depression
than his HD, since the latter can produce psychiatric symptoms, but is
clearly genetic.
I have not faced any discrimination from HD. But the hospital was
not nice about the depression: they actually were going to fire
me! They sent me a letter saying they were not going to hire me for
the next year.
Coworkers differentiated psychiatric symptoms somewhat on the basis
of perceived voluntariness, yet these underlying assumptions were not
always accurate. Physicians, though empirically trained, did not always
think scientifically about this issue of causality—particularly when they
had other, invested reasons for not doing so.
Conversely, just as certain diagnoses elicited bias because patients were
blamed for them, physicians with other disorders sensed that they en-
countered less stigma because they were clearly ‘‘not at fault’’ for their
illness. The drug company researcher, Jim, thought that his lymphoma
was seen as less blameworthy than certain diseases such as lung cancer.
If you have lung cancer, people say, ‘‘You used to smoke.’’ Lym-
phoma is from blood cells dividing billions of times, and one
mistake getting made. You happen to be unlucky. Colleagues have
appreciated that I’ve done whatever I can: going back into the
office as quickly as I could, starting to work hard, picking up where
I was before.
Jim and others eschewed the sick role, and sought to prove to colleagues
that they were not ‘‘at fault.’’ When hospitalized, Jim even bought a cell
phone, in order to stay in contact with his office. Indeed, ill physicians can
overcompensate, working harder than necessary to return to full work
capacity, but potentially inducing added noxious stress.
Psychiatric illness could further fuel discrimination due to fears that it
would prevent the patient from fulfilling work responsibilities. As a result