When you have BPD, the perpetual mood fluctuations and intensity of emotions can feel like you’re riding on a roller coaster blindfolded. One minute you’re on the rise, then next minute you come crashing down, and you never know which way you’re going to be pulled next. And it’s scary and dangerous, because when you’re in the trough, you come this close to acting on the impulse to do something reckless and self-destructive. Then in the next moment when you seem to be trekking uphill again, you’re momentarily glad you didn’t do anything drastic after all and wonder why you were wanting to do so in the first place. Except for the times when you do, because even when you know that the roller coaster will climb uphill at some point, you don’t think you could bear another steep decline and you’re desperate to get off. Then you feel yourself start to dip, and it all happens all over again. And it’s frustrating, because you want to go on the carousel or Ferris wheel instead, something a bit more smooth riding, or if you’re going to be on the roller coaster, at least be in control of the car. But you don’t know how, so instead, you’re stuck on a ride that’s a bit too fast for you, with massive mountains and twists and turns.
Hello hello! Welcome to this month’s mental health blog carnival on the topic of Stigma & Discrimination. An issue that many of us are aware exists within the world of mental illness unfortunately, and have personal experience of. Some excellent blog posts have been written and submitted, time to showcase them all! Thanks to all those who have contributed.
Occasional Wallflower experienced stigma when she went to hospital for her mental health:
A few months ago, I went into hospital. It seems a world away now. I have been mad for a long time but this is when people really found out. I had to explain to my housemates why I was in hospital.
No, it’s not my appendix. No, there wasn’t an accident. No, my limbs are intact. It’s, um, my head.
They were great, they really were. They sent magazines, toiletries, brought me comforting things from home. My puppy had the best possible care. But there was something.
People started to treat me differently. They spoke to me as though I were fragile. I guess this isn’t such a big deal. If I had cancer, they would most likely speak to me in the same way. They kept their distance. I assure you, mental illness is not contagious. They were afraid to joke. This may be my insecurities but it was as if they thought I was weak.
I had some lovely nurses in the hospital, but there were also some right arseholes. There was one who would speak to me as though I was 12 and stare at my arms. She thought that I had cut them but they were burns from work. It isn’t so much that she stared, it was that look she gave me. You know, that look that lets you know someone is judging you.
You are a mental health nurse, for Christ’s sake! Get a grip.
TheUrbanWorrier compares the treatment she received for a physical illness vs. a mental illness;
Let’s just deal with the cancer bit first. I’m Australian. I’d kinda expected to get skin cancer. I’ve been taught to be aware of the signs, and to seek early treatment. It was a sign of my mental ill-health that I finally succumbed the cancer after so many years, and that I subsequently let it go unchecked for a year and a half. But when I did, a(nother) lovely Dr C (a locum GP) treated me with respect; pointing out (nicely) that I was wrong that moles on my head were cancerous, but that the one on my chest was. He referred me to the dermatologist. I was seen within 2 weeks. The dermatologist was a consultant, and he paid enough attention to what I was saying, and respected my insight into the condition and its prognosis that he felt safe in challenging one of the medical students to give (what was her first diagnosis) of cancer. Was referred then for biopsy, then surgery, then a post-surgery checkup, all in quick order. It was all over within 3 months. I was listened to. Even when I turned up late for an appointment, they’d been waiting for me, and rushed me through to see the surgeon. To be honest, I wasn’t quite expecting the level of respect I got. Throughout, was treated as a person, with care, and concern.
Compare that to the mental health stuff. I waited 3 months for an assessment for CBT after referral. I waited another 3 months for treatment. Keep in mind this was a crippling illness which prevented me working, and therefore contributing to society, and that the delay has further reduced the prospects of success. None of this is new to anyone who has tried to access mental health services, of course.
She’s also submitted a second post on the subject matter of everyday social stigma faced by those with mental health issues:
Even when you tell someone, the level of understanding is appalling. My out-laws know I’m mental, maybe not how much, but they know I’m ill. But they’d never ask – you simply don’t ask a mental how they’re doing. And because they don’t know, when my husband and I have spent lots of effort on making me look normal for a few hours for a family event, the ‘helpful suggestions’ start. ‘Oh, x, you should give her a job!’ As much as my former employers were arseholes who caused my illness and then refused the reasonable adjustments to get me back to work even before I was anywhere near as ill as I am now, they at least were correct in that I was not fit for work. And my uncle outlaw, whom my husband told about at least one suicide attempt, jumped straight in on the sympathy about my cancer, but hasn’t ever asked me how I am.
Tag has written a poem entitled Stigma of Mental Illness- One in Four:
Shhh keep it secret,
Shhh don’t ever tell,
If others find it out
They’ll make your life hell.
They do not understand,
How could they ever know,
The darkness in yourself,
The pain that hurts you so?
But madness is an illness
Just like a broken arm
And one in four of them
Will join the funny farm.
By keeping it all hidden
The stigma does increase,
So how will we ever get
The false rumours to cease?
Courage is required
to stand out amongst the crowd,
To say that mental health problems
Are something of which to be proud.
They show you are strong minded
Cos strength is what you need
To fight the battle in your head
Is very hard indeed.
The blackness of depression,
The voices you can hear,
The episodes of mania,
Sometimes suicide is near.
People are quite frightened,
They call you lots of names:
Crazy, mad and mental,
Psycho, sick, insane.
But twenty-five percent of them
Will go around the bend,
Yes, it really is this common,
This stigma now should end.
Mike shares his experiences of disclosing his mental health condition to his boss:
Anyhow, because I chose to disclose my condition and the fact that I am medicated, I have greatly altered my relationship to my boss. He has considerable power over me, even more so than he did before. He could use it against me if he wanted to.
So the question remains: Do I choose how people treat me based on what I disclose? The answer in my opinion is yes. Sure, there’s much more that goes into it than just that, but boundaries are a huge factor.
Most of the time I usually don’t disclose much of anything, and people think (at least in my opinion) that I’m distant, cold, boring, and that I perhaps don’t like them. In other cases, I disclose too much because I need emotional connection really, really bad. There is a happy/perfect medium which I haven’t exactly been able to find yet. Again, it’s something I’m working on, and, again, I believe one day I’ll get there.
It is now illegal to ask people about their medical history at interviews. This can only be a good thing. It goes some way towards preventing discrimination at the interview stage against people with disabilities.
However, imagine you’re a big boss type. You’ve received 50 applications for your new role and have one space left in your interview schedule. There are two halfway decent candidates left to choose from. Both have no/equal relevant experience and both are equally well qualified academically. Candidate A has a consistent work history and up to date work related references. Candidate B has a work history and references similar to mine.
It’s pretty obvious which one you’re going to interview. Unfortunately, I don’t need to declare ‘I have a mental health problem’ all over my CV, my history does it all for me.
Golden Psych is reluctant to be be too open about her struggles with mental illness as a student social worker:
I say that in being a student in Social Work I should probably be more open. You know, fighting for acceptance etc of mental health. But in reality, I know there is massive stigma and discrimination of people with MH problems. There are all these campaigns out there such as Time to Change which promote the acceptance of people with MH problems and encourage people to speak out about it. I am a big believer in this. I believe that people should be able to openly discuss that they have problems. I mean, if someone had a physical illness such as diabetes they wouldn’t be chastised for talking about that. So why with MH? Yet, even though I am a believer in this, I can’t find it in myself to be open with people I know or meet about it.
I want to be a MH Social Worker. I eventually want to do my AMHP’s training. Surly as someone who wants to do this I should feel that I could be more open about the issues I have faced? But no, it’s because I fear discrimination and stigma.
Astrid questions why suicide brings so much stigma with it:
Back in late 2007, I dealt with suicidal thoughts. I have never actually made a serious attempt, but one day, I made a serious enough suicidal threat. This not only led to voluntary hospitalization, but it also led to a lot of stigma. People said that suicide is selfish, and that being suicidal, or at least being open about it, is simple attention-seeking, as if it is a bad thing to need attention really.
In reality, suicide as something selfish, criminal even in some countries until not too long ago, is hugely discriminatory. Most people who are suicidal are severely mentally ill and it is their illness that makes them want to die. Stigmatizing suicidality in such a harsh way stigmatizes the people it affects – already vulnerable, stigmatized people -, in an equally harsh way. Besides, it presumes that suicidal people are capable of making a calculation in which their families and others left behind will be valued and purposefully disregarded. In reality, most often either someone who is suicidal cannot think of their family at that point, or believes they will be better of without them. These are irrational thoughts often fueled by the mental illness. I am not against accountability, but only insofar as a person can actually be held accountable, and it is my belief that mentally ill people who attempt suicide, do not do this out of disragard or immorality.
Seeking Myself discusses the discrimination in the workplace faced by her partner after an episode of depression:
A few years ago, she had an episode of severe depression and took several months off work. She returned to the job with a clear idea of what she needed: more flexible hours and better support and training in her responsibilities managing another staff member. Her employer was not receptive and unwilling to make any changes. At a meeting between her boss, HR and occupational health it was eventually decided that a pay cut might be a way forwards. If my partner relinquished the line management part of her role and dropped a pay grade, she would also be entitled to flexitime. It was agreed that she would meet with her boss at a later date to work out the details of her new responsibilities and salary.
This did not happen. Instead, my partner’s boss and HR held meetings behind her back while lying to her face. Two weeks after returning to work, she was offered an ultimatum: she could either keep her current job with no adjustments made, under very close supervision, and be sacked if they felt she wasn’t coping, or she could swap jobs with her admin assistant, several pay grades below her. There was no possibility of the one-grade-lower version of her current job – oh, except that, due to his lesser experience, that was precisely what they offered my partner’s assistant.
Pandora talks about the taboo of sexual abuse in society and the stigma and ignorance of many on the issue of mental illness:
In this stigmatic sense, mental health problems are today’s cancer – but then again, these forms of illness have always been regarded in demeaning or horrific fashions. From ignorant cunts claiming that mental illness doesn’t exist, to things like enforced electro-convulsive therapy – mentalists amongst us are still under attack with little hope that I can discern of ceasefire. True; no one really fully understands the mind and its parent organ, the brain – but nonetheless, mental health problems are still subjected to a complete Cinderella of a service in terms of accessing meaningful treatment.
Why? What is it that this stupid fucking planet is so scared of? It fears the unknown, certainly, but it has overcome its prejudice in that regard on a multitude of previous occasions. Various organisations are trying to help it overcome this one, but I really wonder sometimes to what extent they are succeeding.
In this little corner of teh interwebs in which people like me write – the little part of the blogosphere that has become known as the Madosphere – there is no stigma, no horrified and urgent backing away, when you discuss the finer (or even the general) points of your illness. But, if you ran into an old friend today (that had not studied Psychology, Medicine, Nursing or some allied professional) and said to them, “I have borderline personality disorder,” do you think they would even know what you meant? If you said, “I have schizophrenia,” would they automatically assume that you have 17 different personalities and/or are, by your very nature, violent and deeply dangerous?
My Polar Opposite has posted about a very topical issue; Amy Winehouse’s death and society’s views on addiction and mental illness:
Yesterday, Amy Winehouse died. Her death was probably drug related since the singer suffered a long-term addiction to various substances – heroin, crack/cocaine, crystal meth and alcohol if I remember correctly. But I’m too sad to Google it. Not because I knew Amy and feel the grief of a lost loved one. Rather, I’m sad about how our society views addiction and, similarly, mental illness.
It’s very easy to criticize people from the comfort of your right mind. Winehouse‘s death reminds us of her arrests, her bedraggled appearance, her inappropriate public behavior, and we unilaterally judge all of those things as though they’re purposeful. American culture doesn’t accept anything other than Manifest Destiny, that people are sometimes powerless to control themselves in extenuating circumstances. So, “it was the drugs”, or “addiction is a terrible disease” don’t really sit well with our bootstraps society. Similarly, we don’t really understand or accept the trauma or pain that often drive people to drug use in the first place.
Jill was firmly advised not to reveal mental health issues to potential employers and it’s emphasised how present stigma is:
Back in 1987 when I was in college, I told one of my professors about my panic disorder and she said how brave I was. She was a professor of psychiatric nursing. We had become close over the semester and she felt safe to me, which is why I let her in on my secret.
Later when I was applying for a position at local hospital I asked her if I should divulge to the interviewer about my panic attacks (me thinking it was a positive character trait since she said I was brave and all). So imagine what a mixed message I was sent when she said firmly, do NOT tell a prospective employer about this. I know it was over 20 years ago but it’s stuck with me all these years.
The stigma was huge back then and this experience only served to reinforce the tremendous shame I felt at the time and to hide my anxious feelings at all costs. As much as it hurt me to hear her words, this professor was right. I have always held a respectable job with a title, and I have seen how people who do reveal psychiatric issues with their employers get looked down upon. Because of this I have never revealed my anxiety issues with work people.
Null Future asks us how tolerant we are of people with mental illness:
So, if you’re reading this it’s a safe bet that you know someone with mental health problems. How intimately you know them is not really the point for this… but I digress.
My question to you is, how tolerant are you of them?
Everyone has their own little quirks and foibles and we put up with quite a few of them otherwise we wouldn’t get along with anyone. However, when someone has mental health things going on as well, these quirks and foibles can be… amplified/worse/down right weird (delete as applicable). It’s part and parcel of mentalism otherwise it wouldn’t be mentalism. That doesn’t mean it’s a bad thing in itself but it can be annoying to those who know us.
Ok, you encounter someone who annoys you with a habit or mannerism. Obviously, for most people, this is what you will see and you will then label that person as annoying. Now what if someone says that the person has bipolar, borderline personality disorder, schit… bugger that, I always spell it wrong. But you get the point. How do you view them now? Are you more tolerant of their behaviours? Does it matter what that habit is or is it an across the board judgement?
Amy has written a post on labels and healing in relation to PTSD:
It’s a tricky thing — this method of healing. Because I don’t doubt my courage. I was, like so many others, forced to be tough. That stays with us as we grow — blossoming and mutating in ways at the same time. But hey, who says the mutations can’t be beautiful? Just different. Different perspectives. I find myself not even having to muster up the courage because it’s within arms reach, as it always had to be. The problem is how to use it? These are times I may realize I need to just BE and FEEL. But again, there are good times, and bad, horrible times. And moments of pure bliss — small, yet ever more than enough, more than I can wrap my heart around.
I have chronic, severe PTSD and the episodes (flashbacks) and anxiety and dissociation quite consume me at certain times. I was armed and ready and fighting — and then I realized I wasn’t going to win. There’s no way. And I think that’s because I’m not just being — I spend so much energy on the fight when I really need to learn to sit and feel, accept it and just be.
Lothlórien explains what dissociation is:
Dissociation is something that we all do from time to time. In its most functional forms it’s like daydreaming or being engrossed in a video game. It’s a time when our mind either drifts from our surroundings to a far off place or attends to one thing so intensely we block out the rest of our environment. Dissociation itself is a normal human experience. When a person dissociates, even in this way, time can often be distorted. You may find yourself looking at the time and think, “It’s 3:00 already???!” Another experience you may have is that you may have little or no memory of the last few minutes. This is sort of what happens in highway hypnosis. Your conscious thoughts wander away, while some other part of your brain is still attending to the road in front of you, and when you get where you’re going, you literally have no memory of the drive there. I mean, you know you were driving, but it’s as if you were on auto pilot and really don’t remember any of it. Dissociation is also used by people to minimize pain, and they most likely have no idea that’s what they are doing. Have you ever had to have blood drawn or anything else that you really didn’t want to do but knew you had to??? Of course you have. What do you do??? You try to look the other way. You try to think about something else, anything else, you try to mentally separate from the physical sensations of your body. You are practicing dissociation. These are all examples of normal dissociation under normal circumstances.
Now there is another form of dissociation, and this occurs when a person has to deal with a stressor that is not of the normal human experience. In this way dissociation is thought to be a highly functional defense mechanism. The types of stressors I am referring to here are things such as child sexual abuse, rape, physical assault, any sudden tragic occurrence, being the victim of a crime, being the witness to a crime or some other tragic event. The list is truly endless, but I think you get it. In this sense, the dissociation is more intense. It is more severe. There is a more complete separation of thoughts and feelings and emotions, etc
She also explores what causes DID:
In Dissociative Identity Disorder the dissociation itself is at the highest level, where literally altered ego states are present to get through portions of a day or specific events. A small child who is being sexually abused dissociates and “leaves her body” during the abuse. What is left in her body is an altered ego state. It’s almost like that highway hypnosis thing I described where part of your mind is off in daydream whereas obviously another part of your mind is still driving. Here, part of the child’s self is gone, out of the body, safe from harm, while another part of her is still there. However in this example of dissociation, upon the child’s return, the level of dissociation can be so pronounced that she recalls none of the abuse that just happened. The memory of that abuse is still there, somewhere in her brain, but because of dissociation it is not accessible to her, or she may recall seeing the event as if it happened to someone else. She may recall the actual event, but have no feelings associated with the event, or just be confused by it, and just disregard it, tucking the entire event away inside and not looking back. Children developmentally don’t know what to do with this event. It’s like someone is dumping objects in your hands faster than you can “put them away”, and you run out of options, so what do you do? Children find these intense events, thoughts, and feelings overwhelming….literally spilling over. What do you do with all that? DID is like stuffing it all under the bed. It’s a mess, it’s too much, and the child doesn’t know what else to do with it.
Road To Recovery talks about conquering the stigma within ourselves and the difference between illness and being sick:
I contend that there is an even greater stigma that an individual with a mental illness must address, the stigma and limitations which he/she places on himself/herself as the result of this diagnosis. Many individuals, whether they are newly diagnosed or one who has battled mental illness for years, allow their mental illness to be the center of their identity. It is the “colored glasses” through which they look at the world and thus react or respond to it.
Let’s look a little closer at the statement that entitles this article, “I’m not sick, I have an illness.” When you hear someone say, “I’m sick”, what are they saying? I identify myself by my illness. My being “sick” is the defining characteristic of who I am.” “I’m sick”, so I can’t take care of myself or the house. “I’m sick”, so I can’t go to work today. “I am sick”, so I need someone to take care of me. In other words, because “I am sick”, I make judgments regarding what I am capable or not capable of doing without even attempting them. “I’m sick” implies that I am powerless and I am the victim of my situation. I have heard it said that when someone says “I’m sick” it is like giving up and not believing that treatment and recovery are possible.
“I’m sick; I have depression, so I can’t find and keep a job.”
“I’m Sick; I’m Bipolar, so I can’t control my spending and risk taking behavior.”
On the other hand, if “I have an Illness”. The illness is something that affects me, but is not something that identify as defining who I am, or what I am capable of doing. By acknowledging “I have an Illness”, I admit that I need treatment and I need help, but it does not mean that I am the stuck in this condition forever. “I have an illness” implies that with treatment recovery is possible. “I have an illness” means that the illness is simply a part of my current state; it is not the totality of who I am.
My own submission regarding the discrimination in healthcare people with mental illness may face, with the view some people hold that it’s ‘our fault’ for being ill:
As someone who has a mental illness, this also affects my opinion. I am all too aware that similar as to how an obese person may be blamed for their heart condition, we may also be blamed for our mental illness or the symptoms associated with it. Depression? It’s your own fault for not being strong or resilient enough to cope with life. Anorexia? It’s your own fault for denying yourself food and not eating enough. Cut yourself? It’s your own fault for taking the blade to your skin. Overdosed? It’s your own fault for taking handfuls of pills. Therefore none of you deserve to have your treatment paid for by the government/taxes.
Thousands of dollars has been spent by Medicare on my psychologist and psychiatrist appointments. Not to mention trips to the Emergency Department following ODs and a stint in a public psychiatric ward. There are times when I have felt guilty about the money spent, because it is ‘my own fault.’ Especially when I’ve had to obtain hospital treatment following an OD. Really though, people with a mental illness are just as deserving as people with a physical illness, whatever the origin.
August’s mental health blog carnival is being hosted by Occasional Wallflower on the topic of Personal Journey.