It’s always interesting when the same idea starts popping up in a number of places. Over the past two weeks I have been noticing a lot of interesting stuff on the subject of mental health and self-stigma. The current issue of One in Four magazine has a useful introduction to the general concept of stigma in mental health, but what particularly interests me is when we as sufferers of mental health conditions find ourselves buying into society’s negative and shaming views of us. The concepts of internalised racism and internalised homophobia have been well explored in the fields of psychology, health studies and sociology. The idea is that when people find themselves in a marginalised minority, even when this is through no fault of their own, they will unconsciously take on board the negative massages continuously given out about the group by majority culture. This makes it difficult for them to be accepting of and loving towards themselves and their differences from those who stigmatise them.
As service users, we live surrounded by ideas that people who are mentally unwell are “different”, maybe even visibly so. We are seen as both so out of control as to be “dangerous” and “benefit scroungers” or “attention seekers” whose illnesses are not genuine. We are both “malingering” at a cost to the state, and seen as less worthy of being given a job than other applicants. We are both trying to “seem cool” in having “celebrity illnesses” and the kind of people to whom others do not want to live next door. We cannot win.
In an environment where these stereotypes are so frequently reinforced by the media and by uninformed friends, family or colleagues, it’s very hard not to end up taking some of these negative messages to heart. While I was thinking about this issue, I came across an article from PsychCentral entitled “Mental Illness, Shame and Self-Stigma”. It points out that self-stigma can take a number of forms, including hiding our illness from people who might actually be supportive; considering ourselves as different from other (real, scary, crazy) mental people; and considering ourselves less worthy of help and understanding because we have a mental, rather than a physical, illness. This week too, a Twitter friend blogged about feeling unworthy of taking up a JobCentre Plus suggestion of applying for disability, rather than jobseeking, benefits. Despite all that it has cost her (and that is a lot), she does not feel her illness is worthy of being seen as a disability.
What about me? I would love to be able say that all the positive things I do to try to break down mental health stigma start at home, with my own attitude towards my illness. And perhaps I am open about sharing my diagnosis and information about my treatment plan with others in a matter of fact way. But self-stigma still has me well and truly in its grip. In a way, the fluctuating nature of my condition makes it easier for me to believe that even its worst excesses were “made up” or “just my imagination”, because whatever I feel disappears again weeks or months later. I can be in the utter depths of depression one week, exhibiting a host of textbook symptoms (some of which are very clearly observable to others, like over-sleeping, constant crying, unwillingness to engage in activities I normally enjoy), in absolutely no doubt that I am depressed, and terrified that it might never recede. Then as soon as the cloud begins to lift I start to think, “oh, it couldn’t have been all that bad, surely. I must be exaggerating. How self-indulgent!”
While I am depressed, of course, my thoughts tend to run around in a riot of self-stigma. I brand myself stupid, lazy, an idiot, and many other harsher, more Anglo-Saxon terms. I stare at myself in the mirror and snarl at myself to snap out of it. I start to believe that my friends are bored by me, my partner will leave me, I will never ever get back into gainful employment. Hyperbole and a Half’s excellent Adventures in Depression, which was another thing that popped onto my radar this week, has a fantastic part written/part drawn account of how the self-hatred-depression loop works. In my worst depths earlier this year, I start to externalise that self-hatred. I began to “see things”, as if my real life was a film and someone had embedded a frame or two of shocking imagery every so oftem, designed both to get my attention and make me say, “wait, what, did I just see what I thought I saw?” The “things” I saw were all incredibly graphic, horrifically violent flashes of me harming myself in extreme ways that I would never have consciously imagined. Like watching scenes from a war zone or torture session, they left me very shaky and frightened.
What about hypomania? Surely that shows I am really ill? I mean, that’s the bit that got me the bipolar diagnosis in the first place. And I couldn’t be doing it on purpose to play a “bipolar role”, because until I the diagnosis this year, I had no idea that the symptoms I was experiencing were those of a bipolar high. I am talking about bizarre stuff, stuff about which I think at the time: wow, I really could not make this shit up. Stuff like:
- Compulsively exercising for twice as long as I could when I am well, and yet still having to force myself to stop;
- When I am finally able to get some sleep, waking up from glorious, hilarious, beyond-technicolor dreams, laughing out loud;
- Eating something quite normal and feeling like my head is going to explode from the intensity of the flavour, or having to avert my eyes because a cushion is so purple it hurts, or finding the volume of my own footsteps unbearable;
- Being on public transport and suddenly realising that every single person is shockingly beautiful in their own way, like a host of TfL angels; or unaccountably hot and hard to stop staring at; or strangely hostile and staring at me.
Experiencing these symptoms, I know for certain I can’t be inventing them. It’s like some sort of special filter has been applied to my senses, causing me to genuinely see, hear and taste things differently. It’s been a while since my last hypomania, however, and now I find myself starting to think – but did I really think that, feel that, hear that? Surely I could have reined myself in, got a grip, stopped being so ridiculous? If anything, I’m probably harder on myself about my hypomanias than my depressions. After all, who would want to be depressed,? Whereas, like many bipolar people, I actually being hypomanic (as long as it’s not at its worst excesses) and I can’t be truly ill if I am enjoying myself, right? On an intellectual level, I know that hypomania gains its own momentum, and that it becomes hard to motivate yourself to do things that might pull you back from a high, so I shouldn’t beat myself up if I don’t do every single thing possible to bring myself down. But guess what? I still do.
Then there are the “normal” phases. There haven’t been that many of them in 2011 and they don’t last long (a week, or a fortnight – I think three weeks is my record since Christmas). Which of course is why I haven’t been able to go back to work yet; both my employer and I need to be reasonably confident that I will be able to attend consistently, without either bursting into tears because someone says good morning to me, or deciding that I am the finest that has ever graced my profession and that I will become annoyed if I am not permitted to work 12 hour days without breaks. But those normal times, the times when I actually feel like the “me” that I was before this episode, are the times when I feel most guilty. It is then that I start to brand myself a malingerer, and feel that I not deserve the sick pay or the understanding. When I feel well, I go out and do things which are supposed to help my recovery. I take long walks; I make sure I meet people and don’t isolate myself; I do yoga; I meditate; I volunteer; I read; I blog. Yet even though I know these things are helpful, and my psychiatrist approves of them all as part of getting better, I feel guilty – again because I enjoy them. I don’t feel that someone on long term sick leave should be enjoying themselves; I worry about a colleague on a lunch break or a leave day seeing me, and thinking, “hmm, she doesn’t look very sick.”
The interesting question for me is: would I feel this way about myself if I had a chronic, fluctuating physical condition? I have no way of telling.