Ending The Stigma Of Mental Illness ~ Not Calling It Mental Illness Might Be A Good Start

download (4)It is wonderful to see that there is an increased awareness of and drive to end the stigma associated with mental illness. Bell did a great job with their “Let’s Talk” Campaign, raising $6, 107, 538, 60 toward mental health initiatives! There is more dialogue happening than in the past, and I think that more than ever people are speaking out about their illness, and that even those without a mental illness are speaking out for those suffering. I think that it will continue to grow and through education and dialogue the stigma will become less of a threat to so many suffering.

images (42)If I am totally honest though, I still feel as though I live under the shadow of stigmatization and fear the consequences of sharing my illness with others. I recently wrote a post about a couple of incidents that made it very clear to me that there is a misconception about what mental illness looks like. You can check out the story here.

I have been living with Bipolar 1 for as long as I can remember, although I have only been living with medically treated Bipolar 1 since my diagnosis about 10 years ago. I have come to terms with my illness. Although I have to admit that despite knowing now that my manic and depressive episodes had a medical explanation, and that my condition is stable with proper medical care and medication, I still am not willing to be completely open about my illness. I am very careful about sharing that part of myself.

images (39)The illness has caused me an incredible number of challenges, missed opportunities, loss, has lead to self-destructive behaviour and I have hurt many people that I love. Fortunately, I have had the privilege of working with medical professionals to monitor my medications, I have psychiatric treatment/counselling and I’m learning to recognize symptoms and to make positive lifestyle changes. Thanks to this I live a fairly normal and functional life. Proper treatment allows me to maintain balance and some stability, reducing the number and the intensity of episodes I experience.

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I have to ask myself though, why are we still differentiating between physical and mental illness? Mental illnesses are a result of brain functioning, and I’m pretty sure the brain is a part of the body. Is it not? Not to mention the fact that symptoms respond to medication, which can in turn allow a person to lead a relatively stable and balanced life.

Maybe we need to rethink the divide. If what is considered to be physical illness is usually diagnosed by definitive tests, is often visible, and is viewed as a legitimate affliction, then mental illness must be something else.

images (49)Unfortunately, differentiating between physical and mental illness gives the impression that mental illness is something different, that it is not an illness of the body and therefore must be a problem of the “mind”. The mind is associated with behaviour, personality, and amongst other things, the ability of one to change or choose their disposition. Maybe the very distinction is perpetuating the stigma. Perhaps the decision to no longer label one type of illness physical and one mental is a necessary beginning step in ending the stigma.

Why do we differentiate between mental and physical illness? Where does this come from? Why does it matter?

There is much debate over the definition of Mental Illness. It is generally accepted that it exists and that it can have serious and an often detrimental impact of the lives of those suffering.

While there is debate over how to define mental illness, it is generally accepted that mental illnesses are real and involve disturbances of thought, experience, and emotion serious enough to cause functional impairment in people, making it more difficult for them to sustain interpersonal relationships and carry on their jobs, and sometimes leading to self-destructive behaviour and even suicide. The most serious mental illnesses, such as schizophrenia, bipolar disorder, major depression, and schizo-affective disorder are often chronic and can cause serious disability.~ SEP

download (2)The mainstream Western view of mental illness has changed with increased knowledge and conceptual sophistication. We have moved past the  less sophisticated, ignorance based view that what we now call mental illness was demon possession, or the result of some other supernatural phenomenon. Could the archaic diagnosis of a spiritual or supernatural cause of mental illness  still be lingering in today’s perception?  What do we mean when we differentiate mental and physical illness? To me that would imply that a mental illness is somehow an illness or disruption in some part of a person that is external to the physical body wouldn’t it? Which in turn would have to mean that we are more than our physical body, and that our mind is something outside of our physical selves.

At this point some of you reading might be thinking “who cares”? Well, being diagnosed with what is called a mental illness as opposed to a physical illness can have serious, life altering consequences. Including employment, issues with insurance and discrimination, to name a few.

There are limitations and difficulty surrounding medical insurance, being qualified to receive care and benefits that someone with a physical illness would receive even though the mental illness is causing comparable limitations. There is fear of informing employers because of concern about jeopardizing a career, even though it would be beneficial for an employer to understand the illness so that he would understand that the employee might need a to step out for a moments or whatever the case may be, rather than not understanding and chalking it up to laziness or incompetence. For example it might be important for a diabetic to inform his or her employer so that there is an understanding and accommodation for certain behaviours and needs related to the illness. It does not feel safe, however, in the case of mental illness.

The reason that the parity debate exists at all is because our institutions (governmental, legal, medical, insurance/financial, etc.) are and have been (for hundreds of years!) invested in the idea that mental disorders (such as depression, psychosis, and anorexia) are somehow fundamentally different (less real, more the fault of the victim/patient, and less deserving of support) than physical disorders. Though we know today that this view (that mental disorders are different and/or inferior to physical disorders) is false, the legacy of these older prejudiced beliefs still rules:

~Within any given health insurance plan, the coverage for mental disorders is inferior to that provided for physical health concerns.

~Many health insurance providers don’t even underwrite their own mental health coverage, but rather ‘carve it out’ (sub-contract it) to other specialized companies.

~Mental and physical disorders are actually diagnosed using separate diagnostic books. In no other field of medicine (that I’m aware of) is this done! Mental disorders are diagnosed using the “Diagnostic and Statistical Manual of Mental Disorders (the DSM)”, and physical disorders are diagnosed using the “International Statistical Classification of Diseases and Related Health Problems (the ICD)”. Last I understood, the DSM is also considered a ‘carve-out’ of the ICD in that the DSM (published separately) is considered a code-compatible sub-section of the larger ICD which covers physical disorders.

~While there is stigma involved with all illness, you get stigmatized (discriminated against) by employers and society at large more when you have a mental illness as compared to when you have a physical illness. No one thinks less of you for consulting a physician for diabetes, but they generally will if you consult a psychiatrist for depression.

~ Mark Dombeck, PhDBlurring The Boundary Between Mental and Physical.

download (3)Clearly there are serious consequences in differentiating between physical and mental illness. Sure, there are differences, but there are also differences between illnesses that are both considered physical. Could it be possible that the distinction itself between physical and mental illness is adding to the problem of stigma?

I have been wondering about this for a while, so I thought I would ask the question. I have no training in medicine or psychology but I think it would be safe to say that most medical professionals treat patients based on the assumption that they are physical beings. Where would a “mental illness” originate if not in the brain? The brain is an organ. Why then, is an illness that is the result of improper brain functioning not physical? Hypothyroidism has been associated with Bipolar like symptoms, behavioural symptoms. The malfunction is in the thyroid gland, but is causing “mental/emotional” symptoms. Why is it not a mental illness? How about damage to the brain causing behavioural changes, or any other disorder that is considered a physical illness (like epilepsy, stroke, etc.) that is a result of activity in the brain? Why are those physical illnesses and not mental illnesses?

images (4)In my opinion, I don’t see how any illness that causes symptoms that are shared by millions of people, responds to some variation of the same category of treatments, and that originates in an organ in the body can be anything other than a certain type of physical illness. Illness is illness, and illness occurs in the body. Unless we want to get into arguments about the mind being something outside of or separate from the body, something supernatural, I’m pretty sure most of us would agree that what we call our mind is our brain in action. The mind is the state when the brain is alive and at work. A living functioning brain produces the mind, so mental illness by that definition of mind would be caused by a malfunctioning of the brain, causing symptoms in the mind.

download (22)It is a big question to ask, but I do think that the stigma surrounding mental illness is perpetuated by our continuing to treat mental illness as something different from physical illness. It is all physical illness. They may represent symptomatically different, but they all originate in a part of the (physical) body.

Sources:

Bell Canada (Bell “Let’s talk” campaign)

Seven Counties Services Inc., Blurring The Boundary Between Mental and Physical. By: Mark Dombeck, Ph.D.

American Psychological Association: The roots of mental illness: How much of mental illness can the biology of the brain explain? By Kirsten Weir

Stanford Encyclopaedia of Philosophy: Mental Illness.

 

Smile? Not for 8 bucks an hour I won’t!

It was happening, it was one of those days, one of those moods. I began to get hot, things were ringing up as wrong prices, people were waiting while I tried to get things worked out, waiting for managers to fix the system. Customers getting impatient in line, staring at me work. I started to sweat, I was seething inside. I was not blatantly rude to anybody, but I certainly was not overly friendly, and I most definitely couldn’t muster up a smile. It was taking all my energy not to flip the cash machine over, walk away and say “to hell with it!”.

Little did I know, a similar scene was soon to unfold…

A Story About An Un-medicated, Undiagnosed Bipolar Cashier

I have been on mood stabilizing medication for several years now. Sometimes I think I am fine and wonder why I need any medication at all. Then I remember back to when I was not medicated. I remember the unbearable irritability, the profound anger and rage of a volatile and explosive mind. I was so irritable that I couldn’t even stand myself, I was literally getting in my own way and on my own nerves. I thank god often that I didn’t actually murder someone in a fit of rage. This kind of irritability and anger could result from just dropping a pencil or stubbing a toe. I’m not even going to talk about driving… Well… maybe just a little. The only way I could manage to not rip off my own head to relieve the anger was to imagine my car having undetectable go-go-gadget weapons that would just disintegrate any driver that would send me into a fit of road rage, which was almost any driver. I can’t even go into the things I imagined doing to people who honked their horns at me. Needless to say, after thinking back at how unstable my moods were I remember why I am on my medication and all is well with the world (for the most part anyway).

I am telling you this because I was thinking of an incident from back in the days of my unmedicated madness and thought I would share. At the time I am surprised that I did not spontaneously erupt into a ball of flame and combust from the heat of my own rage. It took place in a store where I worked customer service, which is quite possibly the worst job I could have in my unmedicated days, heck, even medicated.

It was around Christmas time…

I was working at a store that I would describe as a small version of Ikea. It wasn’t all that bad for the most part. I mostly worked organizing shelves and stocking merchandise, things I enjoy doing anyway. It is not that I am not a people person, but I do not do well with a large number of small, superficial interactions, especially if I am in the middle of doing something and am focused on it. I also hate being interrupted and having to drop what I am doing just because someone needs to ask me a question. If I am in the mood for it, I am great at it, but if not (and I am usually not) I loathe it. I’m pretty sure I did a terrible job hiding my complete and utter irritation with the customers. Especially when they were asking me how much something was when the price was plainly posted no more than 2 millimetres below the item on a bright yellow tag. Just like on every single other item in the store. Either way, I was completely out of line. It was never the customers fault, I just quite simply was not cut out for dealing with people and had a bad attitude and an un-medicated mood disorder. Some days I was fine but others, when my mood was off, I could be pretty bitchy. Typically I wasn’t put on as a cashier and worked as much as possible on the floor, left alone to organize and arrange just as I liked it. Besides, that was what I was really good at anyway. I didn’t mind just filling in on cash for someone to break or something like that, but I hated being assigned there for my shift. I would rather eat glass.

I will just give a little background note here: Around the time of the incident myself and some of the staff who had been there for years had recently found out that a girl who barely graduated high school, had no education, hadn’t worked in four years and had no experience was hired as a cashier for 75 cents more per hour than the rest of us. More than people with university degrees who ran their own sections, and had worked there for years. So there was a little bit on animosity brewing anyway…

So, on a busy day during the Christmas rush my manager decides I should spend my shift on cash. I requested that I please work the floor, but it wasn’t happening. A bitterness seed sprouts open in my gut, uh oh, that familiar feeling is brewing. So, swallowing my contempt I slowly moped to the cash. I kept up appearances but inside I knew I wasn’t going to be able to hide my absolute disdain for the hundreds of meaningless interactions I was about to endure. People started to enter, the store became more and more busy. It was the Christmas rush. I wasn’t even that experienced on the cash anyway so I’m not sure why he would put me there at the busiest time of the year. It was happening, it was one of those days, one of those moods. I began to get hot, things were ringing up as wrong prices, people were waiting while I tried to get things worked out, waiting for managers to fix the system. Customers getting impatient in line, staring at me work. I started to sweat, I was seething inside. I was not blatantly rude to anybody, but I certainly was not overly friendly, and I certainly couldn’t muster up a smile. It was taking all my energy not to flip the cash machine over, walk away and say “to hell with it!”.

Little did I know, a similar scene was soon to unfold.

I was barely holding myself together, but I was managing to keep things civil, ringing up the items and saying “have a nice day!”. You know, the basics at least. Then they came. The curtain guys. I will never forget those damn curtains. The first gentleman said hello, I responded the same and took the package of curtains to scan them. I didn’t engage in conversation and certainly didn’t give them a friendly smile, full of Christmas cheer, but I wasn’t directly rude to them either. Not good enough. The second man, with his smug face, his half smirk and is condescending attitude snidely remarked,”Uh, you could smile you know.”

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I’m not sure where it came from, but before I knew what was happening my mouth was moving and I could hear my voice say, “Not for 8 bucks an hour I won’t.”. (Maybe some lingering bitterness about the 8.75 the unskilled labour was getting at the cash next to me?)

 Oh shit, oops.

He glared at me and snottily said, “You’re a little bitch.” “I want to see your manager!”


 

Silence

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Much of what happened next is a blur. I froze. It was as though every negative emotion hit me at once not allowing any of them to break through. The silence was palpable. There was a line up extending to the back wall of the store and only two cashiers.  I glared at the men for a moment, then without a word I slid their curtains back to them without completing the transaction, left the cashier station, walked to the managers office and calmly said, “I need to speak with you right now.”

imagesI was regaining my voice, emotions were starting to emerge.

My poor, clueless manager.

Trying not to lose it completely I informed him , my voice quivering from restrained rage, “They are pissed and want to speak to my manager, I really pissd them off.” Then it burst through and I snarled “But you can tell them that you are not my manager any more and I’ll be waiting for them outside of the store!”

By now I was livid, all the anger about the unfair wages amongst other issues I had with the staffing, hours and all the bullshit at the job bubbled up and as I gathered my things I proceeded to inform him that we all know about the new girl’s wage and all the other things that pissed me off about the store. Finally I said, “I told you not to put me on cash today.” and I stormed out the back door in a blaze of glory. Then, as promised, I awaited the men outside of the store. I watched them walk to their car. They looked back several times in fear.

“What are you doing?” “Are you following us?” “We are going to call the police!” they shouted in worried voices.

“And tell them what?”, I yelled. “That a 20 year old girl is going to attack two 40 year old men?”

I’m really not sure what I was planning to do, but I finally backed off and watched them until they were out of site. I’m pretty sure they were terrified.

Needless to say, I never returned to that store again. I hated working customer service anyway and it was worth giving up 8 measly bucks an hour to steal any ounce of pleasure they would have had complaining to my manager. It mustn’t have been very satisfying complaining to a manager about an employee who no longer works at the store.

Long story short, I no longer work customer service and I continue to take my medication regularly.

I am not proud of my behavior, but at the same time the emotions were so strong and so unbearable and overwhelming I couldn’t control them. If only I had known that I had a mental illness that was causing these powerful episodes. It was so difficult to live with.

Since being diagnosed and treated I live a relatively normal life. Of course I have up and down episodes but I know how to recognize them in time and I understand what is happening and what to do about it. I am so grateful to haver been diagnosed and been given a chance at a more balanced life.

It has been so long since I have been in such an unstable state that I sometimes forget what it feels like and how detrimental it is to myself and those around me. That is why, when I start to wonder if I really need my mood stabilizing medications, I think back and remind myself of the alternative, then swallow the pills.

I think he’s like, bipolar or something…

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I wanted to write this evening about something that has stuck in my mind for a long time. There were two incidences, several years apart, but they are very similar. They are both examples of stigma and how uninformed many people are about mental illness. Both occurred where I was working at the time, and both involved a discussion between co-workers (myself included). In each scenario several of my co-workers were talking about a regular customer, an acquaintance (more of mine than anyone’s). Each customer was a regular at each place I worked. Most of us had close to daily interactions with them, mind you they were the typical superficial interactions that a coffee shop regular would have with a seasoned barista. The customers were regular enough that we had plenty of time to observe each of them, their mannerisms and their perceived characteristics.

"He was different, very quiet. He kept to himself a lot."
“He was different, very quiet. He kept to himself a lot.”

In the first workplace, I actually had a chance to sit and chat several times with the gentleman and I happened to really like him. I could see how he could come across different or even a little strange, but he was actually quite interesting and very nice. He was just really quiet and kept to himself. He always walked to and from the shop and dressed like someone who might live a simple, natural life in a cottage by a lake. I could see why they found him to appear out of place.

In the second workplace, I had never personally met the individual, but I was listening to the conversation of a couple of my co-workers and immediately got the impression that he was not a nice guy. He clearly had some issues and they seemed to find it quite acceptable to make it clear that he was screwed up and most certainly not a good person. He had major issues, in their opinions.

In both situations, the conversations drifted to an end with exactly the same conclusion. Not one that was based on any previous training or understanding of the “diagnosis”, mind you. Nevertheless, it wawomen-gossip-at-work-e1359396952867s clear to them. The first pair, about a man that they had never actually spoken to, agreed that “Yeah, he’s bipolar. He creeps me out so much.” The second pair, the two that I was considering sharing that I have bipolar, quite simply stated, “I’m pretty sure he is like, bipolar or something.”

“I’m pretty sure he’s like, bipolar or something.”

This sentence has silenced me for far too long. Those conversations still paralyse me.

These people had no idea what qualifies as bipolar disorder. They didn’t know that I was bipolar. I am quite certain that neither of those men were bipolar. Those two scenarios pop into my mind often. I have not come out about my bipolar disorder to many people, and it is situations like that that keep me silent. It is my impression that bipolar disorder is perceived to be an illness whose sufferers are plagued with unsavoury characters, that they are selfish, dangerous or miserable. They are strange and not to be trusted. That is my experience of how those who do not know anybody personally (that they know of) who has bipolar disorder perceive a person with bipolar disorder to be. It scares me frankly. It makes me worry that suddenly those who I have been close to will immediately question every moment that we have spent together, that they will suddenly see me as something else. Someone that is not safe, that needs to be kept at a distance. This is stigma. This is what it does and how it feels.

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Sometimes I imagine what would happen if all of us with bipolar disorder were to come out and tell the world at the same time. At least there would be an accurate representation of what bipolar disorder looks like, acts like, is. They are people that they like, love and have known as friends for many years. That is what bipolar looks like. Just like the person they are sitting next to, sharing another story about the strange guy who just came in for coffee again.