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Thursday, March 22, 2012

Mental Illness and Me: Adventures In a Stigma Nation

"Recovery from mental illness

is not about complete relief from symptoms,
but about regaining a sense of control over life,
rather than feeling defined by the illness.
It is understood in a personal way
by each individual, often as a journey
toward self-determination, choice, and empowerment.

Although there may be setbacks
along the way,
the path is moving forward."

-Dr. Taylor Alexander, Chief Executive Officer
Canadian Mental Health Association

This is a subject I feel uncomfortable writing about since the audience seems to be fairly split on their opinions concerning the reality and the significance of these illnesses. Even a mention of the term mental illness puts many in mind of a condition that evidences itself in deplorable, tragically flawed lunatics.

The truth is I have been a victim of metal illness for decades, and I began receiving treatment for my clinical depression and obsessive-compulsive disorder in 1984. Since that time, I have been treated by a number of psychiatrists who have prescribed me a combination of various medications that help me live with certain brain abnormalities. Now, I am committed to a lifetime of taking drugs to control my illnesses.

I had to leave my teaching career in 2001. Since that time, this premature departure has represented extreme embarrassment and disappointment in my life. For years after receiving disability retirement, I felt a combination of guilt and inadequacy. After all, I had witnessed my students and my fellow staff, fully aware of my defects, engaging in hushed conversations as my condition surfaced and revealed itself more aggressively in the form of my disturbed mind.

Let me say, I completely understand why people act as they do around mentally or physically handicapped people. The foreign nature of the manifestations that result from a handicap run so contrary to normal that many don't know how to approach someone so atypical and so impaired.

In my case, some people began to treat me "differently" in very subtle, barely distinguishable ways. And, I believe their behavior was very legitimate considering their uninformed point of view about mental illnesses.

I know my illness pretty well now. I have fallen off the ledge of sanity into the deep chasm of depression, and I know how major depressive disorder can completely cripple a life. Once I experienced the first fall, other bouts with depression and OCD followed -- each more devastating than the previous one. No one with depression wants to experience the crushing feelings of hopelessness, sadness, and guilt generated by the disorder. People like me learn to maintain wellness thanks to medication, counseling, and avoiding stessors that trigger complications.

Most of the time, my medication balances the chemical imbalance in my brain, and I can function well. But, sometimes as I struggle to maintain a happy, normal existence, I occasionally find myself unintentionally slipping into mentally incompetent behaviors that befit a crazy man. These episodes can happen within the framework of a normal, functional day, and they are seemingly never ending irrationalities. In truth, the improprieties are mistakes, but I do not blame the actions on my disease. I just have to apologize to those I offend and pray to God for His forgiveness. I have become a person who accepts his condition and finds solace in grace -- I try to make up for my imperfections.

Dealing With Stigma and Being Mentally Ill

The ancient Greeks originated the term stigma to refer to bodily signs designed
to expose something unusual and bad
about the moral status of the signifier.

Stigma is a social phenomenon that has strong influence on eligibility, funding, and access to treatment of mental illness. At the community level stigma may affect how organizations including social service agencies, employers, health care providers, or schools respond to individuals with a mental illness and to their families. And at the individual level, stigma prohibits people from seeking the treatment they need, creates profound changes in identity and changes they way in which they are perceived by others.

"Nearly two-thirds of all people
with diagnosable mental disorders
do not seek treatment."

(Regier, D.A., Narrow W. E., Rae D.S., Manderscheid, R.W., Locke BZ & Goodwin F.K. The De Facto US Mental and Addictive Disorders Service System. Epidemiologic Catchment Area Prospective 1 Year Prevalence Dates of Disorders and Services, Archives of General Psychiatry,       1993)

Stigma surrounding the receipt of mental health treatment is among the many barriers that discourage people from seeking treatment . The stigmatization of mental illness and the lack of information on the symptoms of mental illness are seen as the main barriers to seeking help for mental health problems. 

Research confirms that public perception of mental illness has changed significantly -- and for the good -- in the last 15 years. That doesn't mean, however, that people feel comfortable working or living near or being friends with someone with mental illness, according to a major new survey.

The study in 1996 and 2006 compared people's responses to vignettes involving mental illness to gauge public understanding of the ailments. The idea was to assess whether major efforts to improve the treatment of mental conditions and eliminate stigma in the United States is working. Several sweeping efforts have been made in the past two decades to educate Americans about mental illness. A major theme of these campaigns was that mental illnesses are biological, brain-based, sometimes-genetic illnesses that are each "a disease like any other."

The survey found the public has embraced that concept, but only to a point. The percentage of people who attributed depression to neurobiological causes increased from 54% of those surveyed in 1996 to 67% in 2006. And, those who endorsed psychiatrists to help treat alcoholism increased from 61% to 79% in the 10-year period.

"However, the willingness to associate with people
with these disorders did not change much.
For example, the percentage of people
who said they are unwilling to work closely
with someone with major depression was
46% in 1996 and 47% in 2006.
The percentage of people who considered people
with schizophrenia to be a danger to others
was 54% in 1996 and 60% in 2006."

(Bernice A. Pescosolido, Ph.D.; Jack K. Martin, Ph.D.; J. Scott Long, Ph.D.; Tait R. Medina, M.A.; Jo C. Phelan, Ph.D.; Bruce G. Link, Ph.D. "A Disease Like Any Other? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence." The American Journal of Psychiatry. Vol. 167, 2010)

The U.S. Surgeon General, in his 1999 report
on mental health, identified stigma
as a key barrier not only to adequate treatment
but also to the breadth of life opportunities
for people with mental illness.

Key to this body of research have been first-person studies—that is, obtaining the perspective of people who have been labeled as mentally ill about their experiences with stigma.
These surveys and qualitative interviews with persons who have mental illness have yielded several findings. The results suggest that a majority of these persons perceive themselves as being stigmatized by others, expect to be treated poorly by the public because of this stigma, and suffer demoralization and low self-esteem due to internalization of the stigma.

(Patrick Corrigan, Psy.D.; Vetta Thompson, Ph.D.; David Lambert, Ph.D.; Yvette Sangster; Jeffrey G. Noel, Ph.D.; Jean Campbell, Ph.D. "Perceptions of Discrimination Among Persons With Serious Mental Illness." Psychiatric Services. 2003.)

Other research attempted to evaluate the relationship of mental illness and violence by asking three questions:

(1) Are the mentally ill violent?
(2) Are the mentally ill at increased risk of violence?
(3) Are the public at risk?
Findings showed that mental disorders
are neither necessary
nor sufficient causes of violence.

Major determinants of violence continue to be socio-demographic and economic factors. Substance abuse is a major determinant of violence and this is true whether it occurs in the context of a concurrent mental illness or not.

Therefore, early identification and treatment of substance abuse problems, and greater attention to the diagnosis and management of concurrent substance abuse disorders among seriously mentally ill, may be potential violence prevention strategies.

Members of the public exaggerate both the strength of the association between mental illness and violence and their own personal risk. The researchers found that too little is known about the social contextual determinants of violence, but the study supported the view the mentally ill are more often victims than perpetrators of violence.

(Heather Stuart. "Violence and Mental Illness: An Overview." World Psychiatry. 2. June 2003)

I have grown accustomed to the stigma of being mentally ill. It is true that some of these feelings of being stigmatized by others probably stem from own my active, crazy imagination. I do not hide the fact that I suffer from mental illnesses as I once did. However, I still feel frustration when others see my "difference" to be grounds for distrust and for alienation.

Often, when associates do not question me about my illness, I feel especially suspect that they see only the fractured part of me. I do not want to be judged as irreparable refuse nor as an object in need of pity. I simply want to be myself -- a person who, much like a diabetic, has primary medical concerns that must be carefully managed.

The very biggest disappointment of my life since 2001 is that I am unable to have any actual association with my profession. Once Ohio (STRS) judges a person is disabled, he cannot engage in ANY work related to his profession. I was educated and trained to be a high school teacher. I have over 27 years of practice as a teacher. I was president of my class my freshman through senior high school years.

I actually started working with youth in 1970, just one year after my own high school graduation, as a counselor and a tutoring project director. I know what caused me to burn out and, believe me, it was not instructing students or leading activities. My eventual disability resulted after a long battle with chronic depression.

The one thing I can do well is teach -- now, I am forbidden to take part in any remotely related field or venture. Why? Because I am mentally ill. And, if you think like many, I am defective. Unfortunately, my chronic disease does not reside in the kidneys, the liver, the lungs, the stomach, or the heart. My illness is in my brain; therefore, Frank was "once a normal ol' boy" but now "he's one crazy old shit." Both the reality of the effects of the disease and the stigma against it are inescapable.

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