A more accepting age? Why stigma is nowhere near a thing of the past

STIGMA

1. fig. A mark of disgrace or infamy; a sign of severe censure or condemnation, regarded as impressed on a person or thing; a ‘brand’.

Example: 1882   J. H. Blunt Reformation Church of Eng. II. 172   Branded with the stigma of illegitimacy.

Oxford English Dictionary

 

I’m particularly lucky where stigma is concerned. Despite having had bipolar since early adolescence, generally I have not experienced much stigma and discrimination. Some of it is to do with how open I am (it’s harder for someone to attack you if anything they could potentially use against you is already out in the open) but some of it must just be pure lucky because almost everyone I know who has a mental health condition has experienced much worse stigma. I know people who have been turned down at interview or hounded out of jobs, people who rejected by friends and family, people verbally abused within their communities, people who have had their fitness as parents questioned – all because they had a mental health diagnosis.

How baffling it was, then, to read Elizabeth Day’s Observer article “Robin Williams and the talk of the ‘stigma’ of mental illness” over the weekend. It is Day’s contention that the concept of stigma has been massively oversold in discussion of the death of Robin Williams. “Is there a stigma?” she asks. “The very fact that the internet was abuzz with people sharing their own stories of depression and encouraging others to do the same suggests that, thankfully, we live in a more accepting age. Most of us will know of close friends or family members who have dealt with depression. Some of us, myself included, will have experienced a form of it ourselves…. As a result, I don’t view mental illness as a scary, strange thing or as a form of weakness. Do you? I doubt it.”

Well, here’s one thing, Elizabeth: if you’re bringing up your own mental health but you don’t specify what your experience has been, I can draw two conclusions from this: either your experiences were quite mild, not necessitating a diagnosis or specialist treatment (I suspect this is the case, since further down the article you conflate depression with mental health in general, as if the experience of people with depression is the same as the experience of people with schizoaffective disorder or dissociative identity disorder, in which case you’ve fallen into the age old trap of thinking that because you are “on the spectrum” this gives you insight into the whole thing, just as did Giles Fraser last year). Or you do have a diagnosis, but you’re scared of sharing it in a national newspaper. And that would be – well, the effect of stigma, you see.

I do have a diagnosis and I am willing to talk about it. And although it’s a severe mental health problem, my diagnosis – bipolar mood disorder – is viewed relatively positively by the public. And yet. And yet stigma is a thing, you see. It is very much a thing. How do I know this? Well, despite my celebrity-friendly diagnosis and my relentless determination not to be ashamed of who I am, I have had so very many experiences where I felt marked, felt branded as worthy of less kindness, less respect, less understanding, where I was made to feel one of “them”.

Hooray for you Elizabeth Day if you have never experienced serious mental illness or stigma. But to assume that everyone else, all these people sharing their concerns on social media, must just be wrong because it’s not been your personal experience – that’s like me as a white British woman stating that racism doesn’t actually exist, just because I’ve very rarely experienced it.

 

If there were no stigma…

…in the 1990s, I would not have felt that sick, hot shame and horror at having a classmate spit at me, “YOU have got some kind of personality disorder.” If there were no stigma a decade later, I would not have so felt marked out by reluctant to share the diagnosis of borderline personality traits I held for many years. Depression, that was one thing. Anxiety, well, I could tell people about that. But disclose that a consultant psychiatrist thought I had something wrong with my personality? No thanks.

…my university GP would not have looked me in the eye and said solemnly, “Are you sure you want to see a psychiatrist? I think you should, but you must know this means a… psychiatric file will be opened up on you.”

…I would have got cards and flowers when I left my last job because I was poorly. No one, not even the team members I directly managed, was ever told that I had been diagnosed with bipolar, nor even that I would not be coming back. I was simply disappeared.

…I would never tense up when hearing of a brutal murder, as I wait for the inevitable opinion on social media and in the comments sections (ahead, of course. of any detail) that the perpetrator must be “psychotic” or a “psycho”.

…I wouldn’t have felt sick with shame and anxiety about having to disclose my past history to a complete stranger to attempt to get health insurance or life insurance, would not have been horrified to have to recount much needed treatment in an open plan office.

…I wouldn’t think twice about applying for an ESTA visa to visit the United States.

…it wouldn’t feel like an issue to answer the question, “Oh dear, have you got a headache?” with, “Oh, no, actually I just need to take my antipsychotics.” I do it, because that’s what I do, I challenge by being quite matter of fact about my life. But I am aware of having to make the conversation matter of fact, having to plaster on a smile and count on being met with a kind response.

…I wouldn’t feel like I was crossing an invisible line of acceptability once I start talking about my persecutory delusions. No matter how safe the space, no matter how committed I am to sharing my story, I have to screw my courage to the sticking place to do this. Every time I do it, I worry about people finally realising I am much more mental than they ever thought, that the respect they had for me will diminish, that I will no longer be able to exercise authority.

…I would never see reputable newspapers misuse the word “psychotic” to mean intensely angry or lacking in empathy. I would never see them use the word “schizophrenic” to describe a schism in the government or the economy. I would never have to cringe at hearing the weather or somebody’s fickleness being described as “so bipolar”. There would be no need for guidance from Time to Change or the Samaritans about how to report mental health issues appropriately (guidelines that were widely ignored in the reporting of Williams’ death).

…I wouldn’t have cringed in my tube seat recently upon hearing a discussion about a man who was such “a nightmare” because he was “a manic depressive”.

…I wouldn’t have to hesitate over every job application before I tick the box marked “disabled” and note my diagnosis. My first meeting with every new line manager would not inevitably involve having to have “the talk”.

…I wouldn’t hate having to ask for my prescribed drugs by name in the pharmacy in case I am overheard.

…I wouldn’t have been written off as ineligible for jury service a few years ago, despite informing the Ministry of Justice that my job at the time was to write reports to advise Crown Court Judges on sentencing (the law has thankfully been changed on this point, but it took a lot of campaigning from the big mental health charities).

…it would feel just as normal to walk into a community mental health clinic or mental health inpatient unit as it does to walk into a GP surgery or an acute hospital outpatient department. It really, really doesn’t. 

…I wouldn’t feel like I have to preempt judgment about why my children don’t live with me full time to prevent assumptions that I have had them taken away by social services.

…I wouldn’t have to read newspaper articles that deny my community’s experience because our voice is considered trustworthy on our own lives.

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