Wednesday, November 12, 2008

Stigma and Discrimination

I'm going to disappoint Lola at "Marine Snow", because I won't solve world peace, or the existential crisis problem in this post... I promise I will discuss my ongoing existential crisis and how it affects my wellness and resilience maybe tomorrow or the next day.

This post is a public apology to a fellow blogger, whose anononimity I would like to protect, but also whose situation is so similar to others I hear from that the story is an important one to write. The post is also a post about my feelings about how the mentally ill (vs. the physically ill) are treated. Yesterday, I sent a ranting e-mail yesterday to a blogger I very much admire and I am sorry if it was too forward, or preachy.

I sent it while I was in the throes of feeling passionately angry about both your situation, and my own experiences and fears. I did not mean to place the injustices of our mental health systems onto your shoulders. If I were brave I would take it on myself, but, like you, I am afraid.

The premise for the e-mail I sent was inspired by someone else, and I honestly cannot remember who. I thought it was another blogger, but now I think it was someone from the Art Clubhouse. If you are the dear reader are the person who first broached the "Stigma" vs. "Discrimination" differentiation observation thank you for the idea for this post.

This person had mentioned that when we see people being turned down for jobs, or promotions because of physical health issues, or illnesses that are physical we call it "discrimination". However, when we, as people with mental illnesses are being discriminated against we call it "stigma".

I thought about my old job and how they also made it clear that concessions would be made, not only for physical health problem, but also for religious purposes. For example, if a person was Jewish and needed to not work Saturdays for Shabbat, or a Christian person felt strongly about not working on Sunday, due to it being their Sabbath.

At my place of employment I saw concessions made for women who had children to take care of: single moms, new moms, all kinds of moms. I also saw the workplace dramatically altered to assist people who had physical disabilities. For example, flexible work weeks were easily obtained by new moms. Ramps, and handicapped washrooms and elevators were built for a person in a wheelchair. I saw extremely expensive software purchased for an employee who was blind, so they could "read" the computer screen with a voice, rather than their eyes. I saw bells that signalled incoming work replaced by lights for some hearing impaired people.

I also heard the derision in people's voices when someone went off on "stress leave"; a passive aggressive code word for "mental health leave". I heard the snickers, and the jokes about theses peoples' "inability to cope", about their "weak characters", and how they "were bucking the system". I watched as people ridiculed a person who obviously was having a mental breakdown. I tried to speak up, but I was one voice among many and no one listened. The person was blackballed in the workplace for the rest of their career.

I listened in manager's meetings as the managers discussed "problem employees". Many of these employees I knew personally and knew had mental health issues. I listened as the managers tried to find convenient ways to let these people go, to fire them. They did not believe depression was incapacitating, and even if it was there were medicines to make them better. These "depressed" people were simply finding a way to work less and get time off.

I did all this while at the same time listening to the vice president and managers ask me to create and run workshops to help inform managers and employees about how well the organization managed to create a welcoming environment, an environment without barriers, for employees with disabilities. My duty was to rah, rah the troops, to make them aware of how concessions were to be made, all barriers removed, when it came to hiring and retaining people with disabilities.

I watched as they requested I remove "schizophrenia" as a disability in the workshop, because "it might scare people". Anyways, someone with schizophrenia, or bipolar disorder couldn't work in a place like this. It wasn't a suitable workplace for those kinds of people.

I cringed at the words "those kinds of people". I knew I was one of them. I told a few people I trusted, but I never managed to fight the good fight and "out myself" to all in the workplace who challenged mental illness as an illness.

I should have, and I should now. I have a powerful voice and as a person with a mental illness I should let my voice be heard loud and clear...but I am scared.

I am scared of the "stigma", the discrimination. I am afraid to be labelled, laughed at, and punished. I am afraid if I bring too much of my power to the forefront, the powers that exist, the insurance companies, my company, the government; all who support me financially in some way, will begin spying on me, watching my every move, finding any way they can to shut me up.

I am afraid old friends will hear my voice and know it is me, that old coworkers will finally have the proof that what they suspected all along was true, that people who know me will feel I am a disgrace to my country, my employer, to myself.

I was walking in the mall one day a few years ago and I ran into an old co-worker. Her first words to me were, "it must be nice to have all this time off". Inside my head I felt like crying. I felt so misunderstood and so guilty. I realized people thought I was someone who "got a good deal" by being sick, that I was the person people were talking about, that people thought I was using the system. Inside my head I felt like saying, "yes, it is just wonderful wanting to kill myself everyday".

I didn't say that. Instead I said I have been sick. They walked away and I could tell, nothing about my being sick was a reality to them; to them I was a person who got a break and did not have to work, but still got paid to do nothing.

Back to my original apology. I have no right to ask anyone to rally against an unfair system, because I myself have not done the same. I actually really and truly believe that there should be no distinction between a "mental", and a "physical" illness.

Mental illnesses are physical events; chemical mix-ups in the brain, neurons firing the wrong way, neural pathways developing a certain way because of abuse, or neglect, or an environment that did not nurture healthy neural pathways.

I wish we would just call "mental illnesses", an illness, like heart disease in an illness, or diabetes, or gall stones, or cancer. Environment and genetics play a part in mental illnesses, yet they also do in heart disease and diabetes, even gall stones and definitely cancer.

Why then do we differentiate mental illnesses from the above physical illnesses? Genetics plays a part, as does environment, along with physical changes in the brain. Is it because society somehow finds us, the mentally ill, complicit in our becoming ill? Do we, more than the person who has heart disease, somehow cause our illnesses?

Stigma does not begin to describe how differently many people view and treat a person with a mental illness; and I include many doctors, psychiatrists and other mental health staff amongst those people who are inclined to see the mentally ill as an "other". Discrimination is a more apt term. The mentally ill are not simply stigmatized, we are discriminated against; in the workplace, on the streets, in terms of finding available and affordable housing, in terms of being treated as equal human beings with an illness that while different than heart disease and diabetes, is no less an illness.

I feel blessed to have a pdoc who respects me as a person, who recognizes it is the illness and not me that causes me to behave and feel the way I do. Many people are not so lucky. Many are so ill they should not be working, but their needs to remove the level of stress from their lives are not supported by either their employers, or the their mental health professionals, or the governments in terms of offering both moral and financial support for an ill person.

It makes me sad to see people talk of being on the verge of killing themselves because they cannot manage the stress and responsibility of work, and to see that it is sometimes doctors these people are afraid to approach for help, for fear of being discriminated against.

My dear blogging friend, I did not mean to sound like you should take matters into your hands and make the world change its approach to people with mental illnesses. I am very worried for you and was feeling very frustrated by your situation. With my frustration my contempt for those not helping you, those blocking your path towards taking care of yourself, grew. I may have been too quick to rant in my e-mail to you. I pray you will become well, and everything will work out for you.


Annie said...

Aqua, What a thought provoking post. I must say that I remained "in the closet" all of my 3o some yrs of work. I was afraid to tell anyone for fear of rejection or worse. Good post. Peace Annie

Crystal said...

I totally agree with everything that you have posted about, just started reading your blog and i wanted to say thanks for sharing your thoughts with us..

jcat said...

Good post, A. I look at it as 'should I help some future person to avoid the stigma by bearing it myself' - if we don't say anything, it will never change. Most of the time people don't realise that mental illness can be the 'normal' person nect to you as well as the guy on the street yelling about aliens...

My compromise is to talk openly to some people, and if anyone else approaches me with questions, to be completely open with them. Quite a lot of those start off with 'my family member has just been diagnosed as MDD/BP/whatever, and someone said you might be able to tell me more about how to help them' or similar. When other people realise that you can help because you have the illness yourself, it starts to be seen as something that happens to everyday people too.

sara said...

Hi, I wasn't offended at all, I agree with everything you said.

And don't think I don't suffer tremendous guilt at the hypocrisy of telling others they have nothing to be ashamed of, yet refusing to do anything to fight the stigma by exposing myself. You're right, 100%. And anyone is free to be as ranting or preachy as they want (not that you were). That's what this writing is about. Honesty.

sara said...

Oh yeah, in my field as well, physical illness doesn't have to be disclosed (except for TB) but mental does.

Lola Snow said...

It's so sad that so many people have been in that situation. It's worse that it can only go in one direction, stimga breeds stigma.

I am hypocritical in a way by my obvious dislike for labels (80% of the time), it doesn't send a good message that they are nothing to be ashamed of.

Given me food for thought Aqua (as always!)

Lola x

PS- I thought I'd be disappointed if the world peace topic didn't show up, but actually I wasn't :)

Aqua said...

I am going to try really hard to fight the discrimination I see around me in terms of people with mental health disabilities. I am out of the closet to many people, but I might come out to more and let my voice be heard. Sara....I believe, but have a really hard time believing how arcane the medical system still is. There is no dichotomy between mental and physical health. Mental illnesses are illnesses of the brain...I do not know why so many supposedly intelligent people don't get that.

I remember answering some mental health questionairre at the hospital and it asked me to rate my physical health...I said awful, because my mental illness IS a physical health problem.

sara said...

Oh yes! I hate those ones that mention "mental health" and "physical health" as separate. No one puts, "Rate your liver health" and "Rate your cardiac health" on those kinds of questionnaires.

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