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By JOHN M. GROHOL, PSYD
Founder & Editor-in-Chief
While attending the 28th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center last week, it occurred to me that mental health professionals are some of the worst when it comes to discriminating against people with mental illness.
They do this in insidious and subtle ways, suggesting a patient can’t do the things others without mental illness can do. Like hold down a job, get into independent housing, interact in social situations or even just go back to school and get a degree.
They also do this in more direct ways, by suggesting to their patients applying for a job or going back to school that, “If they don’t ask about mental illness, don’t volunteer that information.” Why not?
Why are mental health professionals helping to contribute to discrimination and stigma about mental illness by making these suggestions?
I had this insight while Graham Thornicroft, Ph.D., a professor of Community Psychiatry at King’s College London, was giving his keynote. He put up a slide that questioned what we mean when we talk about stigma:
What is stigma?
- Problem of knowledge = ignorance
- Problem of attitudes = prejudice
- Problem of behavior = discrimination
Item 1 is really lot less of a problem nowadays than it was 20 years ago. With the advent and widespread use of the Internet, everyone has access to so much information about these concerns.
Items 2 and 3 are what we are really dealing with today when we talk about the “stigma” of mental illness. It’s really a problem of attitudes and behavior, of prejudice and discrimination.
The last place in the world you would expect to find such problems in attitude and behavior are with the very professionals tasked with treatment of mental illness. And yet such prejudice and discrimination is rampant amongst the profession.
Time and time again, I hear stories of therapists and psychiatrists treating people with things like bipolar disorder and schizophreniatelling their patients all the things they can’t do. Instead of being an encouraging support, they are a wet blanket on an individual’s hopes and dreams (yes, people with bipolar disorder and schizophrenia have hopes and dreams just like the rest of us).
Many Professionals Contribute to the Prejudice and Discrimination of Mental Illness
Both healthcare and mental health professionals regularly contribute to reinforcing the prejudice and discrimination that exists for people with mental illness. Perhaps they do so in a paternalistic manner, hoping to spare their patient the pain of rejection or some people’s attitudes in the real world. But patients don’t want paternalism and don’t need to be coddled. They want support, hope and encouragement.
Perhaps the professional honestly believes the patient is simply “too sick” to participate fully in society. But since there’s no objective measure of what this statement is being measured against, it boils down to this — one person’s opinion.
Here’s some of the statements patients have heard uttered from their therapists’ and psychiatrists’ mouths, and my response:
You can’t hold down a job, it requires a regular commitment.While many people in acute psychiatric distress may indeed have troubles going to a job, usually such features are episodic (and less of an issue when a person is stabilized with a treatment regimen that works for them) — not a permanent character trait of that individual. Many employers are more than happy to make allowances for people with mental illness, if only they’re told ahead of time.
You can’t go back to school and get a degree, it’s too stressful.While people with a mental illness should work to avoid stress, the same could be said of everyone. Once a person finds a treatment that works for them, they should have and be encouraged to experience all that the world has to offer — including an education of their choosing.
You can’t live on your own. While some people make benefit from the routine and familiarity of a group home or living at home with their parents, most people with mental illness don’t need the rigid structure and supervision of such places. Virtually anyone can live independently, as long as they are given the support and encouragement to do so.
You can’t become a therapist or doctor. This is the most frustrating form of discrimination I hear from graduate schools. I’m not sure it’s based on reality, but consider this scenario. A graduate school has two equal candidates vying for one slot. One has disclosed a history of mental illness and successful treatment, while the other has not. Which do you believe the graduate program is going to choose?
Anyone with mental illness can do anything they want in life. The key is finding a successful treatment regimen that works for them, whether it’s medication or psychotherapy or some combination of the two.
Instead of encouraging people to not “bring it up if they don’t,” we should all be talking openly and honestly about mental illness. We are a long ways from the dark times when mental illness can’t be discussed. The people who are often holding us back from the light are sometimes the very mental health professionals who are supposed to be helping.
Encouraging people to hide or be ashamed of their mental illness does not help anyone.
This is the symbol for Psychology.
Does it look like a person shrugging their shoulders or is it just me?
Quote from Richard Handler, February 20 2012
“Most of us don’t identify in any real way with a cancerous tumour, should it take hold. But we do identify, intensely, with our minds, as representing something about the content of our character.
If our moods have grown poisonous, malignant, we can’t help taking it personally.
Just ask yourself if you can separate the personality of a depressed or highly anxious individual suffering from a mood disorder from the sense you have of that person.
It might be unfair. But a person’s mood disorder is often seen as an intrinsic part of him or her.
In many cases, the only way you can admit to having a mood disorder or a mental illness is to proclaim that you have recovered from it, or that it is so well managed that it’s really not crippling.
This happens, most tellingly, at the very heart of the psychological and psychiatric establishment.
Worthy mental health institutions, like the Centre for Addiction and Mental Health in Toronto, enlist athletes and entertainers to announce that they, or a close family member, suffer from mood disorders.
But would the good doctors and administrators themselves admit to suffering from depression? I think that is highly unlikely.”
This is an article from Psychology Today that I really enjoyed!
I stopped reading PT for awhile because of their idiotic posting on the lack of attractiveness of Black women (http://www.huffingtonpost.com/2011/05/17/satoshi-kanazawa-black-women-less-attractive_n_863327.html) and a post I read that horribly stereotyped girls which included degrading comments related to mental illnesses (http://www.psychologytoday.com/blog/valley-girl-brain/201105/the-four-types-female-friends-avoid my comment is there under my name).
They seem to slowly be learning their lesson that if they want to be a credible scientific magazine they need to stop producing BULLSHIT!!!
I was very happy when I stumbled across this article looks at how being labeled with a mental illness can be both good and bad. This is something I have discussed with friends and colleagues and the points included in the article are ones that we have touched on!
Psychological Diagnosis: Dangerous, Desirable, or Both?
A client of mine, let’s call him Gary, once said something that struck me as startlingly insightful. Gary had had a recurrence of his soon-to-be-fatal cancer. Yet he was informing almost none of his friends of his regrettable medical reality.
“As soon as I tell anyone that I have cancer, all they see when they are with me is CANCER. They no longer see me, Gary, with all my foibles and virtues. All they see is CANCER.”
Gary understood that words have the power to define what we see, potentially blocking us from seeing aspects that differ from the label.
Calling yourself an anxious person, for instance, can put you at risk for ignoring the many times that you feel relaxed, playful, and loving. Label your friend a narcissist and you risk losing sight of the generosity, creativity, and insightfulness that used to draw you toward him.
In addition to screening non-confirmatory data from our view, using a label heightens our awareness of confirmatory data. Label yourself an anxious person and you will be more likely to notice the many times that you feel a flutter of nervousness that in the past you might have ignored.
Sometimes you don’t help.
Sometimes you are the reason people with mental health issues are stigmatized.
You create stigma when you label yourself as experts. Claiming that you know more about my life than I do. You are the reason every person who took a psychology course at one point in their life feels they can now diagnose everyone and understand what mental illness is. I hate it when random people play “expert” and tell me what my symptoms are and what treatments I should consider because “I took a psychology class once.” If you have not lived it you will never get it. When you don’t listen to me when I say that something isn’t working because you can’t trust the judgement of someone who is “crazy”. You create stigma by taking away my right to choose all because you are the “expert”.
When you withhold valuable information on side effects you are creating stigma. You are keeping all knowledge to yourself and not sharing it with those who deserve to hear it; those taking the medications and treatments you offer. You keep us in the dark so we need to look up to you and trust you because we don’t have access to this information ourselves. You have the power. We become powerless.
When you blame the disease and not the drug, you are creating stigma. It is a horrible feeling to think that you are so sick that not even the industries “wonder drugs” can help you. This leads to “common” knowledge being that these medications WILL help and if they do not then you are a lost cause. This also creates a fear for those who have mental health issues but are not on psychiatric medication, such as myself. “Rarer than corpses are the unmedicated Mad” (Terrence McKenna). We must be truly crazy and out of control since we are not on medication. Maybe this is because we’re thrown into an industry that can’t admit it’s flaws. Only patients fail. The Industry can only succeed. Stop spreading this lie.
“Experts”, when you don’t take us seriously you create stigma. I was talking to my Mother last night about my Prozac-induced suicide attempt at 16 years old and how I’m afraid to talk about it on national TV. She began telling me that the hospital just waved off my attempt. They had always waved me off claiming it wasn’t a big deal. I got worse. If those who are supposed to help us cannot take us seriously then who will? And why should they?
What, you may ask, should you do about this? “Experts”, stop being experts. Value our insight, value our knowledge, value our lives. See us as equals, see us as valid. We should be your partners, your answers to everything you want to know.
We cannot be helped, we cannot recover if those who help us are apart of the problem.