Stigmatizing mental illness

Graeme Bacque (gbacque@idirect.com)
Sat, 8 May 1999 20:10:09 -0400


 Stigmatizing mental illness

 It's easier to get a job if you're an ex-con than if you're an
 ex-psychiatric patient
 By SANDY NAIMAN -- Toronto Sun

   It never ceases to amaze me, though I don't know why it should after 38
 years, that when I mention my mental illness, conversation stops. As this
 year's National Mental Health Week draws to a close and the number of
people
 affected by mental illness during their lives is one in five, why does this
 stigma still envelop us? Why is the very mention of the term "mental
 illness" so repulsive to us?

  Other illnesses usually prompt questions, sympathy or concern, but mental
 illness is different. When you struggle with schizophrenia or manic
 depression, you are a schizophrenic or a manic depressive. You become those
 illnesses. They take over your life and define you, brand you, mark you.
You
 become your label. Not so with cancer and heart disease or chronic diseases
 like arthritis or colitis.

  Interesting, too, because mental illnesses, far from being "diseases," are
 really part of the human condition, though the stigma that surrounds them
 tends to dehumanize people.

  Does it surprise you that there rages quite a controversy over whether
  mental illness, is, indeed, an illness at all?

  Psychiatry is not yet an absolute science. Research into the
neurochemistry
 of the brain and the field of psychopharmacology are trying valiantly to
 prove people with psychiatric illnesses have certain physiological
 idiosyncrasies differentiating their brains from those of the so-called
 "normal" population.

  Much of this is still speculative. Most psychiatric illnesses have never
  been scientifically pathologized. What's far more deleterious is society's
  attitude towards people who are perceived to behave differently and
labelled
  as mentally ill.

  We're all biologically, emotionally, intellectually and spiritually
unique.
 Yet, diagnoses of mental illness - there are hundreds and they're on the
 rise - are subjectively ascribed to people by psychiatrists and other
 clinicians who judge behaviours using as a guide the Diagnostic and
 Statistical Manual of Mental Disorders IV. It is considered the psychiatric
 bible, detailing symptoms which are categorized as different disorders,
 hence psychiatric labels.

  This often misunderstood categorization of symptoms into diagnoses is
meant
 to help clinicians communicate with each other. But it was never intended
 for the insurance industry.

  Yet in order to get OHIP coverage for psychiatric treatment, you must have
 a diagnosis - a label. The DSM is constantly revised, but many people don't
 fit the labels they're given. Because of an increasing dependency on drug
 treatment and a trend away from psychotherapy, people are often seen not as
 complex individuals, but as their labels. They hear their label, and
believe
 it, feeling tainted and demeaned.

  Labels have a nasty habit of sticking. I still think of myself as mentally
 ill, though I no longer take prophylactic medication and it's been years
 since I've seen the inside of a mental ward.

  INVISIBLE ILLNESS

  In 1991, when diagnosed with endstage kidney failure, I was so relieved to
 have a real disease. People called, visited, sent cards. As a psychiatric
 in-patient, I was shunned and ignored. Mental illness is invisible. I felt
 as if it was my fault.

  "Because of the way mental patients are treated and come to see themselves
 ... they feel ashamed of themselves, afraid to let others know about their
 illness, so the stigma perpetuates itself," writes Sheryl Pedersen in
 Partners in Healing, Perspectives on the Experience of Psychiatry (McMaster
 University Press, 1999).

  Employment stigma is most insidious. Clinical depression, for instance,
 will rob more working people of more productive working years than cancer,
 heart disease, AIDS and the violence of war, according to Homewood CEO Dr.
 Edgardo Perez in Mindsets - Mental Health, the Ultimate Productivity
Weapon.

  "Many would rather tell prospective employers that they have committed a
 petty crime and were in jail than admit to having been in a psychiatric
 hospital," writes Pedersen, a counsellor who's experienced mental illness.

  "They've learned it is easier to get a job if you're an ex-con than if
 you're an ex-psychiatric patient."

  At 18, Ian Chovil, a brilliant student, lost all ambition to succeed with
 the onset of his schizophrenia.

  "If people know you're schizophrenic, they don't think you can work," he
 says. Chovil lost 10 years to delusions, destitution, alcohol and
 homelessness. Even though he completed a university degree and started
 graduate school, his career has not kept pace.

  Today, at 45, and a 1998 Courage to Come Back Award recipient, he is paid
 minimum wage as a community education coordinator at Guelph's Homewood
 Health Centre.

  "I've never gotten a foothold in the workforce," he stresses, sounding
 frustrated. "I'd love to work with schizophrenics. I have experience few
 clinicians have. I've been there. Now I manage my illness with medication
 because I can recognize the symptoms. I've never had a relapse. But I have
a
 hard time explaining huge gaps in my resume. When I say I'm schizophrenic,
 the meaning of the word isn't what most people understand it to be. I'm not
 a psychopath ..."

  Statistically, though the media tend to feed into this mythology, people
 who are mentally ill tend to be less likely to commit acts of violence than
 the so-called normal population.

  Historically, age-old visions of violent, unpredictable behaviours of
 people labelled "mad" are so deep-rooted, fear fuels the vicious stigma
that
 perpetuates the taboo of mental illness.

  Years ago, those considered insane were locked away in attics, cellars or,
 later, asylums.

  Today, if not institutionalized, too many people on the street, an
  estimated 70%, have untreated problems with mental illness.
  For example, what comes first? Madness or homelessness?

  THEATRE COLLECTIVE

  "Homelessness can drive you mad," says playwright Ken Innes of the
Friendly
 Spike Theatre Band. For two weeks, beginning May 12, this theatre
collective
 comprised of ex-psychiatric patients is presenting Angels of 999, at the
 Theatre Centre, 1032 Queen St. W.

  This historical play is based on Geoffrey Reaume's PhD thesis, exploring
 patient life at the Toronto Hospital for The Insane, known as 999 Queen
 Street before it became Queen Street Mental Health Centre, Ontario's oldest
 mental hospital.

  "The homeless have nothing," says Innes. "No respect, no dignity, no
 identity, no voice, no welfare, no employment insurance. They're out of the
 system. It might not be madness, but one's behavior could appear to be mad.
 People think, 'Why aren't they in hospital? Why don't they have a job?' The
 so-called normals don't want to look at them or listen to them."

  In the early 1960s, French historian Michel Foucault wrote that the mad
 have become the new social lepers of our time. But there's nothing new
about
 this stigma. According to U of T's Reaume, who specializes in the history
of
 psychiatric patients, the stigma dates back to Biblical times.

  The Babylonian king Nebuchadnezzar, born in 605 B.C., was considered a
 lurid beast because he walked on all fours and ate grass, he notes. "Anyone
 who behaved differently or irrationally or who spoke in metaphors was
 considered mad and not worthy of being taken seriously."

  To be mad was considered a punishment by God in ancient times, notes Cyril
 Greenland, a retired McMaster University social work professor and
associate
 professor of psychiatry. "It was thought demons would enter your body if
you
 had lecherous thoughts. Hence, the saying, 'He's got the devil in him.'"
 (Under this definition, most adults could be labeled insane.)

  "Treatment was always more punitive than therapeutic - cutting, bleeding
to
  make your insides so uncomfortable that the devils wouldn't want to stay
in
  you," Greenland adds.

  Though treatments have improved, the stigma still rages.

  But we can change that, by learning more, understanding more and caring
   more.

  That begins with looking beyond the labels to the human beings behind
them,
   in our homes, on our streets and in our workplaces.
  There's only one label with which I'm comfortable.

  After all, first, before everything else, we're all human.
  ---------------------------------------
  Naiman, a Sun Lifestyle writer, was the recipient of the 1998 Celebrity
 Courage to Come Back Award from the Centre for Addiction and Mental Health