Not a real doctor: how public impressions discourage medical students from considering psychiatry as a career – a commentary

Introduction

Mental health disorders are one of the global public health challenges, as they represent one of the world’s top 10 leading causes of disease burden. The COVID-19 pandemic and nationwide lockdowns have created a mental health crisis in society worldwide, including the Arab world¹. The Arab world comprises 22 countries, in which Arabic is the native language. According to the World Bank (2021), this region has a total population of 457 million, with the world’s highest percentage of youth. A recent systematic review conducted by Ibrahim (2021) showed that the Middle East has high rates of mental illnesses with a prevalence ranging from 15.6 to 35.5%, and the higher rates were recorded in fragile and conflict-affected settings². The demand for psychiatrists is increasing as mental illness is becoming more prevalent worldwide. Based on a systematic review and meta-analysis published in the Journal of Public Health in 2018, one in every five individuals is likely to experience a mental illness in the Arab world. However, there are insufficient professionals to meet this growing need. For instance, Eight Arab countries (Djibouti, Iraq, Libya, Morocco, Somalia, Sudan, Syria, and Yemen) have less than 0.5 psychiatrists per 100 000 population³ Figure 1.

Figure 1.

The number of psychiatrists per 100 000 population in the Arab world. source: Okasha et al. 2012³.

At the same time, the number of medical students who are interested in pursuing psychiatry is declining due to numerous factors, including the short clinical rotation of psychiatry during medical school with an average of 5.5 weeks, the fact that dealing with patients can be dangerous and emotionally overwhelming, and the fact that other specialties provide higher prestige and are better paid⁴. However, Stigma toward psychiatry plays a dominant role in medical students’ decisions to not choose psychiatry as a career. In the Arab world, there is a highly negative attitude among the general population toward psychiatrists and the psychiatry field. This is primarily due to three main factors: limited health literacy among the public, Arabic TV series, and films that draw a bad image of psychiatrists on screen, and stigma and discrimination against patients with mental illnesses, which reflect on people who work in the psychiatry field^5–7. In this commentary, we aim to address these factors in greater detail and provide some recommendations that may help overcome this issue. To identify and extract the three main concepts underlying our study, we employed a systematic approach. Firstly, we conducted an extensive literature review to gather relevant articles, studies, and reports related to public impressions of psychiatry as a career choice in the Arab world. This initial step allowed us to gain a comprehensive understanding of existing knowledge and identify potential themes or concepts

Limited health literacy

Poor health literacy can have a significant impact on the public’s perception of psychiatry, which may discourage medical students from considering further training in this specialty as a career path. Those with poor health literacy may struggle to understand and access psychiatric and mental health information. This can lead to misconceptions, stereotypes, and stigma in the field of mental health and psychiatry. Individuals with limited health literacy, for example, may believe that mental health issues are the result of personal weakness or character flaws, rather than legitimate medical conditions. They may also believe that seeking mental health treatment is a sign of weakness, irrationality, or shame. These misconceptions can lead to negative attitudes towards psychiatry and mental health professionals. Limited health literacy can lead to a lack of awareness of the role and importance of psychiatrists in healthcare. Without a clear understanding of the work that psychiatrists do and their impact on patients’ lives, medical students may not consider psychiatry as a viable career option^8,9.

Arabic TV series and films

While there are some Arabic TV series and films that accurately and positively portray psychiatrists and their work, many of them present a negative and inaccurate image of the profession. Some common misconceptions and stereotypes presented in these shows and films include portraying psychiatrists as cold human beings. In some Arabic TV series and films, psychiatrists are depicted as unemotional and detached from their patients. This could lead to the perception that psychiatrists are not empathetic or compassionate. Moreover, in some cases, psychiatrists are portrayed as manipulative, using their knowledge and power to control patients’ thoughts and behaviors. This may create mistrust among psychiatrists and a belief that they are not acting in their patients’ best interests. Additionally, some Arabic dramas perpetuate the stigma surrounding mental illness by depicting people with mental health conditions as being dangerous or unpredictable. This can lead to fear of seeking help and reluctance to engage with mental health professionals.

Finally, yet importantly, some Arabic shows tend to focus on extreme cases. In these reports, psychiatrists were only shown to treat patients with severe mental health conditions such as schizophrenia or multiple personality disorders. This can create the perception that all psychiatrists only work with these types of patients when, in reality, psychiatrists work with a wide range of mental health conditions. It is important to recognize that these negative portrayals by psychiatrists are not representative of the profession as a whole. While these TV series and films may be entertaining, they can also perpetuate harmful stereotypes and misconceptions about mental health and people who work in this field⁷.

Stigma against patients with mental illnesses which reflect on mental health workers

Many psychiatrists feel that their profession is stigma toward their profession. Psychiatry and psychiatrists are stigmatized indirectly due to discrimination toward people with mental illness, which is believed to be the actual reason behind the negative attitude toward psychiatry. In the last decade, attitudes toward those who suffer from schizophrenia and depression have remained unchanged, if not worsened. The improvement of young graduates’ training and raising awareness of stigmatizing attitudes should be top priorities for psychiatrists. If left unaddressed, the stigmatization of psychiatry may exacerbate psychiatrists’ intentions to leave the profession. Therefore, it is essential to provide reliable information on the mental health system and its services, as well as the effectiveness of diagnostic and therapeutic approaches to mental illnesses, to overcome stereotypes and prejudices towards people with mental diseases and mental healthcare workers due to mental health illiteracy¹⁰.

Recommendations

Thus, the need for psychiatrists is increasing. Therefore, there is an urgent need to enhance recruitment in psychiatry to meet the increasing demand. Qualitative studies could be conducted to explore the specific public impressions and attitudes towards psychiatry in different Arab countries. These studies would provide insights into cultural and religious beliefs, social stigmas, and misconceptions that contribute to the discouragement of medical students from pursuing psychiatry.

Alleviating the negative impact of the public’s attitude towards psychiatry starts with increasing public education and awareness of psychiatric diseases and the role of psychiatry in treating these conditions. This can be done using different methods, such as media coverage of mental health issues and public campaigns. These methods will increase public awareness and reduce the stigma¹¹.

Understanding that mental illness is treatable rather than mysterious would alleviate the stigma surrounding psychiatry and allow medical students to pursue psychiatry¹⁰. It is obvious that when patients view mental illness as untreatable, they may be hesitant to seek help. This is the case for the patients. What about the doctor? Therefore, by alleviating this misconception, medical students will begin considering psychiatry. Additionally, it is essential to understand the human as a whole rather than focusing on the fragmentation of the individual. In doing so, students will understand that mental health and well-being are closely linked to physical health. Whether it is cardiology or orthopedics, it will not make a great difference, as treating a broken bone is similar to treating a patient with bipolar disease. Both these methods contribute to making people feel better¹².

Another way to encourage medical students to consider psychiatry as a future specialty is to use innovative interactive methods when visiting psychiatric wards. For example, implementing a proper psychiatric course for students in the UK changed the perception of more than 42% of all students; none of them considered psychiatry at the beginning of the course¹³.

Conclusion

In conclusion, the shortage of mental health services in the Arab world is accentuated by many factors, including the public’s misconceptions, the negative portrayal of the profession by the media, and the stigma towards mental health disorders and professionals. These factors have direct implications for medical students career choices and decisions. National health workforce planning stakeholders in the Arab region should consider innovative approaches to uphold the training pipeline in psychiatry to meet the current and future demand for mental health services in the region.

Ethical approval

Ethical approval was not required for this letter.

Consent

Informed consent was not required for this letter.

Sources of funding

The authors declare no funding source.

Author contribution

B.E.: conceptualization and validation; A.A.M., A.R., K.A., and R.J.: writing the draft; B.E. and A. R.: writing review and editing.

Conflicts of interest disclosure

No conflicts of interest to declare.

Research registration unique identifying number (UIN)

None.

Guarantor

Bashaer Elawfi.

Data availability statement

Data sharing is not applicable to this article, as no new data were created or analyzed in this study.

Provenance and peer review

All the data is available by the authors.