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 schizophrenia telling 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.