140 Becoming a Patient
Views of Self as Contributing to Fears of Discrimination
Deeply-seated feelings about oneself can enlarge the wound that others’ perceptions cause. These self-views can exacerbate fears of discrimination. At times, sick doctors may feel shame, and their concerns about possible discrimination can reflect their own worries and psychological projections— their own views of themselves as flawed.
For example, fears of subtle cognitive deficits can warp selfperceptions. Belief that one’ s mental functioning is declining could result from actual processes( i. e., caused by side effects of medications or symptoms of disease) and / or mirror long-term anxieties about the future. Wilma, in her eighties, still worked in her lab, and was horrified at the prospect of colleagues viewing her as physically disabled. However, her fear partly suggested her own projection, her terror of possible cognitive slippage.
I hate being seen in a state of cognitive disability— having to use two canes or a walker, more for safety, so that I don’ t fall. I have to admit: there must be a certain element of depression. I am tired. It’ s hard to go to work, and I really am not getting things done as I should. I don’ t like to be seen using a cane and a walker. They might think the brain might not be working, an unconscious association in their minds.
Wilma intimated, too, an element of distancing— referring to‘‘ the brain’’ rather than‘‘ my brain.’’ Still, the fact that sick doctors’ fears of discrimination may reflect projected feelings about themselves does not lessen the very real instances of discrimination that can surface.
Physicians’ beliefs in their own invulnerability can increase the shame they feel if they do in fact become sick. Especially with diseases to which their own behavior may have contributed, physicians often thought they‘‘ should have known better’’ than to become ill at all. Stuart, the internist with HIV now teaching at the university, criticized himself:
Being a doc, you’ re not supposed to get sick. You’ re supposed to know better. It would be like coming down with lung cancer from smoking:‘‘ I should have stopped.’’ I think back to the two episodes when I could have been infected. I should not have taken those chances.