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?
Before posting, please read our blog moderation guidelines. The comments below begin with the oldest comments first. Click on the last comments page to jump to the most recent comments.
Before posting, please read our blog moderation guidelines.
Post a Comment:
Copyright © 1995-2013 Psych Central. All rights reserved.
Site last updated: 23 May 2013
|
Good article. I would only add that the most insidious way mental health practitioners discriminate against clients is through lack of counter-transference awareness, as well as lack of support from management to address it in an ethical manner.
Dr. Grohol
I want to start by thanking you for your pioneering work on the internet. Your site helped me back when I was experiencing the worst of my illness, back in the 1990s.
I think that the stigma generated by professionals is partially connected to the scientific mindset. If you’re scientific, you get rigorous and focused. You need to dominate the variables and control conditions. It’s easy to develop “person blindness.”
“Capacity blindness” has another source, I think. If all you do is serve the poor, and people who have high levels of disease burden, it’s easy to start thinking of sad experiences as “normal for them.”
Even the recovery movement fails at building hopeful futures. People of Judy Chamberlin’s era were so focused on liberation from coercive treatment systems. They took recovery as far as they could given their experiences. The recovery process model was left incomplete. It is as though we climb out of our hole, just to hang around the hole’s edges staring at what we barely escaped, contemplating the bits and pieces of the climbing process.
To get beyond recovery you have to be willing to set a goal beyond the hole, and walk away from the hole, doing whatever you must to maintain your footing.
I think all of this is simpler than our mental health system has made it. Yes, we need treatment, but kindness, friendship and family life deliver meaning and hope. You must look for strengths, with due regard for risks and limits.
Thank you for the opportunity to comment.
–Paul Komarek
What is stigma?
Problem of knowledge = ignorance
Problem of attitudes = prejudice
Problem of behavior = discrimination
It is interesting that you call it “stigma,” it is more aptly prejudice and discrimination.
History has shown us vey clearly it was not the “stigma” of Jews. It is also not the stigma of mental illnesses.
If it is indeed the lack of knowledge, first responsibility has to be higher education, and its graduates.
Harold A. Maio, retired Mental Health Editor
We were talking about this today at a Recovery coaching course I’m running. As a student occupational therapist years ago I was taught not to ‘set people up to fail’ by taking on goals ‘beyond their capabilities’ They had to be persuaded to be ‘realistic’.I have come to see how wrong this is. Who are professionals to know what a person’s capabilities are? What damage is caused by encouraging a person to set limits on their hopes and dreams? As I moved into coaching I discovered the power of belief and expectation, and practical, evidenced -based ways to help a person live their hopes, not bury them.
Exactly. Time and time again, resilient and inspiring individuals have shown the world that the human spirit can’t be pigeon-holed into simple, neat categories.
All too often, I find professionals who look at the statistics or what they were taught about mental disorders from a textbook (or even in talking with other professionals), instead of looking at the person sitting right in front of them. People are not labels — they are capabilities waiting to be transformed.
It’s a professional’s job to help in that transformation. Sadly, too many of them don’t see it that way, and act as a weight on their clients instead of being aspirational and energizing.
Was inspired by what you posted! It helps me start to have more faith in some of the professionals within the Mental Health system after a few years of falling in the cracks with just the same type of training that you voiced in your post. To me, it took courage to be able to write what you posted because oftentimes I have seen it with some of the medical professionals I have come in contact, who talk to those of us with mental health issues, as if we are children and try to refrain from encouraging a person when they believe they can handle things.
I’m doing alot better now with my new counselor and am on very, very small amounts of medication. I haven’t been able to be on medication much since 2006 when the doctors decided that I was experiencing too many allergic reactions to different ones they tried me on. I even tried volunteering for a research program; but my body wouldn’t accept the meds offered so I couldn’t finish the last two weeks due to not being able to take medication.
Anyway, I am glad on joined this forum and will continue to read others’ inputs because you have helped me to have faith in humanity again! Thank you!
As someone who was severely abused as a child, and as someone who has been speaking publicly and conducting research on sexual violence, I have encountered nasty attitudes from therapists/social workers, etc on many occasions. I agree they are the worst, but there are also a few good ones.
It took me decades to recover a life for myself, but I never have and never will identify myself as someone with a mental illness. The ones who abused me are ill, and unfairly I have paid a hefty price which included many struggles that kept me from having a decent life. But I have a good life now, and my first novel *Nickels: A Tale of Dissociation* was published a year ago (and was a Lambda Literary Finalist). Among other other issues, the storyline includes the protagonist having both good and bad interactions with therapists, etc. Keep up the good work!
Great article! In my opinion, however, lack of knowledge (ignorance) is still a problem. While there is a lot of information on the Internet, etc, this information is often misunderstood and the general public still has many misconceptions about those with mental illness (as in they are all dangerous, etc). We still have so much work to do to increase knowledge, and change attitudes and behavior.
Great article overall. What you did not touch upon is how the use of pharmaceuticals contributes to the stigma. The metamessage of taking a psychotropic medication is that the human is organically inept and that by taking a medication his/her functionality will be improved or corrected. I understand that there is not a single piece of research that confirms that any human has organic chemical imbalance and that the use of psychotropics or other self-medication efforts actually causes the chemical imbalances. Psychotropics in many forms provide a tranquilization effect that limits a person’s emotions and functionality.
Thanks John for bringing up such an important topic that is sadly routinely in shadow.
I’ve written rather extensively about this topic. My own experience as both (now – ex) patient and a mental health professional allows for some interesting and sometimes uncomfortable insights into the mental health system in the United States. I find that there is often deep denial among professionals that this goes on. That bias and prejudice exists among the very people who purport to be the helpers.
This bias and prejudice starting kind of hitting me over the head as I started interacting with professionals online. I could change my hat at will…either speak as a “patient” or a “professional.” I found that I was well-respected and engaged as an equal when I put my “professional” hat on. I also found that I could say exactly the same thing with my “patient” hat on and be immediately dismissed…I started experimenting with changing hats…what I discovered wasn’t pretty.
If anyone is interested this is the most comprehensive piece I’ve written on the subject: Bridging Patient-Professional Divide http://beyondmeds.com/bridging/
I don’t think this topic can be covered enough.
My shrink told me I couldn’t have a baby because I have agoraphobia, GAD (Generalized Anxiety Disorder) and panic attacks.
I mean really, who do these people think they are?
If that were the rule, very few of us would have ever been born.
How does my right to pursuit of happiness differ from someone undiagnosed with such problems?
There is nothing wrong with me physically that would prevent me from having children. Luckily, I am very skeptical and do not take the words of “authority” as the last word. In fact, I was offended.
Clearly, some doctors are wrong.
Of course, I can have a baby. Many, with far worse diagnoses than myself, have babies.
Yet I get this attitude often, from more than one psychologist and psychiatrists as well.
We need to trust ourselves and our OWN opinions sometimes. This is certainly one of those times.
Hi Cate:
Well… I agree with your perspective. Anxiety disorders should not prevent you from having a family at all, unless medication or a history of extreme panic attacks could render you and the baby helpless. Some medications can cause conditions in the baby and extreme anxiety can lead to a stressful pregnancy.
In cases of extreme psychosis or hallucinations, it is recommended that these individuals reframe from having children. This is not simply because of the mental illness, but because individuals with chronic, severe, and untreated psychosis or mood swings have trouble caring for themselves and sometimes end up homeless. The baby born into this situation can be terribly neglected. Because we therapists are also advocates in many ways, we sometimes recommend that families and individuals consider how a baby will impact their life and struggle with mental illness.
Mental illness does not stop you from living life in many cases, but there are those few cases that require an altered lifestyle. This is simply for the protection of the person struggling with the mental illness and those attached to the person, including a baby.
I hope this makes sense. It can be hard to wrap your mind around and even accept. If you have been born with the genes that make you vulnerable to severe schizophrenia, you do not want to hear that you should not have a baby or a family. But sometimes due to medication, lack of treatment, and the severity of the illness, this is best. Consider John Forbes Nash, Jr. He was a great genius, but his family life was often stopped by his mental illness. Google him.
Welcome to the outcome that managed care and the pharmaceutical industries have forced on the system.
Chip away at what clinicians can treat, and then what interventions they can use, and voila, you have the mess we are in now. Now that Obama will be in office for another 4 years and PPACA can be entrenched for the country, let me remind you all that psychiatry will be basically extinct by 2016, that non psychiatrists providers with prescription pads will be the primary treatment providers for more than 75% of mental health care needs, and therapists will have Treatment Plans that will limit therapy visits to less than 10 visits a year.
Welcome to the demise of effective care by the next presidential election. Oh, that is if society lasts to then to appreciate any opportunity for real hope and change. Hey, you who voted for Obama, thank you for your choice! Not that Romney was a real alternative anyway!
And to all of you who laid silent while managed care decimated mental health care interventions, thank you for your silence and lack of advocacy. Sorry I can’t type this in the most overtly sarcastic font one could use!!!
Good Article!
I always tend to look at things critically and consider what other sides of the coin might be useful to bring up. I was thinking more in depth about the statement: “You can’t become a therapist or doctor.”
I wonder if this statement is a bit too broad or black and white and doesn’t cover the gray. Unfortunately, I have seen quite a bit of colleagues and former graduate students enter the field of psychology having had a prior battle with mental illness, trauma, or extreme abuse. Were they the best therapists? No. But they are in the field! Were they capable of getting an education and utilizing their knowledge? Yes. But they couldn’t always offer compassion or true concern because of their experiences. The mere existence of a mental illness should not preclude one from pursuing the field of counseling and psychotherapy.
However, there is a dark side and we don’t talk much about this because we are focused on “anti-stigma.” Anti-stigma for me includes educating people to reality, not skewing the perspective. The dark side includes individuals who:
-Did not successfully complete any type of therapy
-entered therapy and “graduated” as having made progress because they achieved one or two goals
-does not respond well to psychotropic medications such as in the cases of resistant psychotic disorders
-does not believe therapy is required for their issue
In addition, chronic, long standing mental illnesses (like Schizophrenia or Bipolar disorder) or behavioral patterns (such as borderline personality disorder) is also an issue. I have heard of colleagues who do not like to be touched, hugged, or simply called “dear” or “sweetie.” One colleague responded negatively to an elderly woman who called her “dear” at the end of her therapy session. She stormed into my office and criticized the woman for 20min!
I suppose I am saying that realistically there are some issues that preclude some people from entering the field of counseling. EVERYONE is not called to be a therapist! Even if the person has a strong desire to help others, therapy may not be the avenue for them!
We ALL experience trauma, heartache, and psychiatric illnesses. We don’t want to stigmatize or discriminate, but we also want to be open to reality.
Should Jeffrey Dahmer have become a therapist?
Food for thought
Years ago when I was a young attractive college educated working mom in good shape who was in a very bad marriage, I know the PhD psychologist and Psychiatrist only had the best in mind for me when they worked together with my primary doctor to get me to apply for SSDI. But that was the single greatest harm they did to me. Not that they meant to, what they saw in front of them was a terrified young girl on the verge of disapearing. To the rest of the world I was maybe too thin but a bright leader with the world in front of her. Being consistinly told I could not work that I needed to go on SSDI because work was too much for me, I was too sick by professionals was devasating after working my entire life to combat discrimination against my deafness. Coupled with the abuse and memories I took it to heart. Many years later after fighting off multiple psych drugs, their side effects and finding that I can not tolerate anti-depressants in any form I found myself facing a set of far different “professionals”, ones who judged me before even seeing me, I was that middle-age self entitled non-working dependant who was non-compliant. As far as anti-depressants yes they were right(if they would ask past MDs and Pdocs they would have evidence not just my MI word), and yes I was middle age but I was free of work not by any choice of mine. I long ago used up all the “cushion” of trial work months and was pentilized each time I took a full time job and lost it. And lost it I did, mostly because my self esteem is gone. I’m nearing the age people think of retirerment and I’m still trying to get work. I know SSDI is a good thing, and it did help but it came with the statement I wasn’t good enough to work. Thats the part that disabled me, not the deafness, not the MI. They wanted to protect me, but it is not the job of doctors to protect the clients, their job is to support and listen and build a person up so that they can go on with their life, not insulate them form life.
What I needed was a safe place to figure out what to do, I needed to work for the core of myself being. If the message had been instead of “you can’t work,” “you are too sick” but, “you need a break” “You need some time for you”. If back then there had been a way to get out of that system once you were in, a way to get back to work instead of the almost instant discrimination I got from every ER, every doctor, and subsquent mental health workers from seeing the labels and SSDI compound prehaps I would have been able to be a more worthy member of socity today. It is somewhat better in someplaces, strangely, I’ve seen more improvements amoung the attitudes of those working in ER’s and other medical professions than I have amoung those in the mental health field that treats those who are most in need.
As for information/knowledge being out there, yes it is. But it is so intermeshed with mis-information and myths of the media that many people often have the wrong information. Once a prejudice is formed it is very hard to change even with facts, prejudice has more to do with feelings than ideas.
The greatest action/behavior that hurts is silence and inaction. Those who do nothing, see nothing and do not speak up while others are harmed and they know of it. While being abused in a hospital nurses and aids gave me their phone numbers and said if I could excape they would help hide me, but would say nothing to officials for fear of their jobs.
pls excuse the spelling tonight.