(En español) Armando Rodriguez, M.D., is an internist for a multi-specialty medical group in Miami, Florida. He was born in the United States in 1961—two weeks after his parents arrived from Cuba. His main patient base is Medicare and Medicaid recipients of color. Below he discusses his personal experience with depression, mental illness stigma in Latino communities, and how he screens primary care patients for mental illness.
What has been your history with depression?
Since I was a child, I have had depression, generalized anxiety, and OCD (obsessive compulsive disorder). But I didn’t start psychiatric treatment until about four or five years ago. Before then, there were moments when I was better and moments when I was worse. I remember having performance anxiety when I was going to grade school. I would panic from feeling uncomfortable in a classroom with so many people. They would have to call my parents to come pick me up from school. I’m 49 now and it’s amazing that I’ve been able to cope despite the stressors not just from my career, but also from family and life itself.
What made you want to become a doctor?
My pediatrician was my main role model. He made house calls, came over to see me when I was sick at any time of the day or night. In Cuba, he was a well renowned pediatrician, but he was seeing patients here, without a medical license, after he exiled himself from Cuba. Even though seeing patients without a license was illegal, he helped a lot of Cuban kids and parents that had recently arrived to the U.S.
Is there a stigma surrounding mental illness in Latino communities?
The stigma is very high. There’s a lot of machismo in the culture, so a man with depression is looked at as weak. If a female acknowledges her depression, it’s looked at as a sin, anti-Catholic.
How did your family deal with your depression?
There are no problems with my wife and kids. My parents have accepted it, but, deep down, they see it as a fault in their parenting. On the surface, there’s a little bit of denial, “Oh, it’s no big deal. You’ll get over it.” I have to explain that it’s a condition. They also suffer from mental illnesses that they have been reluctant to accept. They haven’t wanted to see a psychiatrist or take antidepressants. Their excuse is, “We don’t want to get hooked on these meds.” There’s a lot of denial on their side.
Do you screen for depression in your practice?
We do. We basically use a clinical eye—observing how the patient looks. We ask questions like, “How is your mood? Have you lost interest in things that previously interested you? Have you had any changes in sleep patterns or appetite?” What’s amazing is how many people will answer, “Yes, my energy is low. My mood is low. I’ve stopped doing things that I liked to do.” Many patients with chronic illnesses are depressed. Asking these questions helps us to diagnose it. Of course, we look for secondary reasons. Could this be caused by a medication? A beta-blocker? A diuretic? Do they have hyperthyroidism? We are always looking for possible causes instead of just saying, “You’re depressed. Here’s a prescription for an antidepressant. See you later.” We also try to find out if they are grieving over a recent loss or if their depression is otherwise situational. In that case, they may not need an antidepressant; they may just need to follow-up with a psychologist or counselor. We should be screening with a Hamilton questionnaire, but we don’t have time for it.
Why are your patients more likely to open up to you instead of directly seeking a mental health clinician?
Since I am their primary care physician, they are likely to see me first. It is also due to the stigma around mental illnesses. Some people think, “If I have to see a psychiatrist, that means I’m nuts.” I have to push them. I like for them to see a psychiatrist—especially if it’s a patient who already has a diagnosis of mental illness and is on medication. I also push them if I see that three or four months have gone by, we’ve tried a few different regiments, and we’re not getting anywhere. I need the help of a psychiatrist.
Have any of your patients had problems with access to mental health care?
Not really. The problem with our Medicare and Medicaid patients is that they don’t comply. They won’t follow through and make the appointments. I’ll give them a list and phone numbers of three to five psychiatrists whom I like. When they come back to see me again, I’ll ask, “Did you see any of the psychiatrists?” They’ll say no.
What advice would you give to people who do have trouble getting access?
NAMI (the National Alliance for Mental Illness) is an excellent resource and that can help people find services in their areas. Your Depression and Bipolar Wellness guides in Spanish are helpful for families as well. You can also talk to your family and friends, those who won’t be judgmental, or a member of the clergy. Talking about how you feel can provide a great source of comfort, reassurance, and emotional support. Clergy members might even be able to help you find doctors, psychiatrists, psychologists, or counselors in the congregation. Other resources might be local medical societies or, on the state level, departments of metal health. You can call and tell them, “Hey, I live in the boondocks. My next-door neighbor is one hundred miles from here. I’m having all of these feelings—what do I do? Who can I see?” It’s their job to help out. The number one thing is admitting you have a problem. Once you get over that hurdle, everything else becomes better.