The Silent Suffering of Jane Doe: Negligence of Mental Health Problems in Daily Practice

Julius Kremling1

doi: http://dx.doi.org/10.5195/ijms.2014.104

Volume 2, Number 3: 138-139
Received 09 05 2014: Accepted 28 06 2014

The Experience

In a vast number of different specialities and in primary care during placements, I have encountered many different diseases, patients and doctors. But one seems to be a constant visitor: Jane Doe. Jane Doe is no real patient but a synthesis of many I have seen in this form very often and who shows some distinct features that distinguishes her from other patients. It might be her first visit to this service or a review appointment, however, whatever it is, lots of investigations have been done or will be undertaken. When she enters the room the doctor focuses on her (physical) symptoms and signs, takes her history and examines her. While doing so, she usually breaks into tears repeatedly and mentions troubles in college or at her workplace, anorexia, insomnia, financial difficulties. The list seems to be endless. The attending doctor, however, only offers a few kind words and ignores the emotional and mental breakdown of the patient. Later, when the consultant reviews the patient, the whole lot repeats itself and again the mental status of the patient is ignored. She is reassured that she will be well looked after and receives a review appointment and maybe even a specialist consult. Her urgent need for psychotherapy or any kind of psycho-social support, however, is once again ignored.

I have chosen her name deliberately since we all know the unknown corpse that appears frequently on television. A corpse, not a human being, missed by nobody that only gets the attention it deserves once dead. Though this patient showed several features of depression, her presenting complaint was reduced to a pure physical problem while her chief complaint was ignored. Considering that, according to the Global Burden of Disease 2010 study, depressive disorders are a leading cause of global burden of disease, such behaviour on the part of doctors shows ignorance of patients’ needs and negligence of medical duties.1 But it is not only failure of the attending physicians but failure of the medical profession itself. The junior doctor who took the history and examined the patient first, the consultant who reviewed the patient, the nurses who took her vitals and showed her to the examination room and last but not least myself as a medical student who failed to bring up her obvious worries.

Psychiatric diseases often go untreated, not to speak of all those little ailments that have not made it into the latest Diagnostic and Statistical Manual of Mental Disorders which, however, still bother many of us.25 Taking a psychiatric history outside a psychiatric ward or clinic feels to be much more intrusive than any physical examination. It is something people want to speak about only behind closed doors. We - that includes both already practising doctors and medical students - often feel embarrassed by the mere thought of asking our patients about some “strange” thoughts, ticks and emotions. Are we trying to conceal our own inner turmoil?

In our society crazy is not cool. It is stupid. It is antisocial. It is dangerous. It is something we laugh about and something we definitely do not want to be.6, 7 When I wander through the corridors of any hospital I usually pick up easily many anecdotes, rumours and jokes made at the expense of everybody with a mental health problem. I frequently catch myself drifting into the same discriminatory pattern of thinking many doctors and fellow students have. Stigmatisation seems to be omnipresent and contagious. I often sense that making some negative comments on people with mental health problems is thought to be good form on the wards. However, such behaviour of medical staff can only discourage patients with mental health problems to seek professional help and we have to ask ourselves if denying help to some of society's most fragile members is what we want.7, 8 I only wrote about Jane, but beware that John is her brother and though mental disorders are still commonly regarded as a “women's thing”, he might also be troubled.9



Conflict of Interest Statement & Funding

The author has no funding, financial relationships or conflicts of interest to disclose.

Author Contributions

Write the manuscript: JK


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2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington (VA): American Psychiatric Publishing; 2013.

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8. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ,. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007 Sep 8;370(9590):841–50.

9. World Health Organization. Department of Mental Health and Substance Dependence. Women's Mental Health: An Evidence Based Review. Geneva: World Health Organization; 2000.

Julius Kremling, 1 Medical student, Ruhr-University Bochum, Germany. National University of Ireland, Galway, Ireland.

About the Author: Julius Kremling is a fourth year medical student who has studied in Germany, Ireland and Belgium.

Correspondence: Julius Kremling, Address: Groenenborgerlaan 149, Antwerpen, Belgium Email: julius.kremling@rub.de

Cite as: Kremling J. The Silent Suffering of Jane Doe: Negligence of Mental Health Problems in Daily Practice. Int J Med Students. 2014 Jul-Oct;2(3):138-9.

Copyright © 2014 Julius Kremling

International Journal of Medical Students, VOLUME 2, NUMBER 3, October 2014