Lockup Doc

I used to have a more “normal” job.

Early in my career I worked in a large medical center and hospital and rotated through a call schedule. I got called into the ER regularly. I covered the inpatient unit and performed consultations on the medical and surgical units. I did all of the typical work tasks associated with a traditional practice.

Then I left it all.

I started working half-time in correctional psychiatry. I have worked in various other less traditional settings to fill the other half of my schedule over the years, but most of it has been spent working with people with developmental disabilities.

My work life is very, very different from what it was. I like many aspects of it now, and I’ll write more about that some other time. But, I have mixed feelings about having a job that is, well…weird.

Psychiatrists face a great deal of prejudice and stigma regardless of practice setting. Just go to a party and tell people you don’t know that you’re a psychiatrist, and you’ll understand what I mean.

Add to being a psychiatrist the fact that one practices in prisons, and the stigma and lack of respect issues intensify.

For example, in a 2008 survey by the American Correctional Association that was designed to identify the barriers to the recruitment and retention of educators and various health professions, 83% of respondents indicated that “lack of occupational prestige” was a top reason that retaining psychiatrists in corrections was difficult.

On the one hand, some people are quite curious about my field. I believe that this interest stems from a genuine curiosity that many have about prisons. They are forbidden places, extraterrestrial worlds into which most people never enter. In fact, wanting to give others a glimpse into this exciting yet disturbing domain was one of the original reasons that I started this blog.

Unfortunately, for every person interested in or fascinated by my unusual career choice, there are many more who have a negative reaction.

It’s not uncommonly a socially awkward pause followed by a forced smile and a disingenuous, “Oh, that must be interesting” comment. Simultaneously their body language screams, “Quick exit!”

I believe that more people assume that correctional psychiatrists either must be very strange for choosing such a line of work, or else they assume that we’re incompetent wannabe doctors not capable of having “real” practices.

I’ve been told several times over the years by nurses that I “seem so normal” compared to some of the other psychiatrists with whom they’ve worked. I guess I am supposed to feel flattered by such comments, but it is annoying always to be in an uphill battle against stigma and normalcy. The most recent comment I heard from a nurse, and I believe she’s said this to me at least twice, is that every time she hears the country song, “God is great, beer is good, people are crazy,” she thinks of me. Gee, thanks. Just how I want to be remembered!

I don’t dwell on these negative reactions about correctional psychiatry, and on most days they don’t bother me. I do what I do because I really do like it, and that’s what matters. I also do it by choice and am free to leave it at any time. There are even advantages to having a job that is less popular.

But, I’d be lying if I didn’t admit that, especially on a bad day, a part of me still finds it frustrating and somewhat depressing to have spent 9 years in medical school, residency, and fellowship so that I can have a position that I like and believe to be important yet is undervalued, stigmatized, and is thought of by many as, well…weird.

Photo: Tim Pearce, Los Gatos