Tuesday, March 31, 2015

Stigma, Mental Health and Others, In All Its Ugliness

Stigma is a hot button topic right now because of the GermanWings crash where the co-pilot is suspected of having had a mental disorder of some type for which he received treatment and also had had suicidal ideation. But stigma isn't something new and its been around for as long as we have been on this Earth.

Mental health professionals have had to contend with this unseen stain on someone's reputation and standing in a community or workplace forever. We've had to try to help people resolve it in as many creative ways as we could and there have been media stories devoted to its eradication, but it's still here. There was even a major book by Erving Goffman, "Stigma: Notes on the Management of Spoiled Identify" which is worthwhile reading for anyone interested in the subject.

After having worked in mental health for over a decade, I was emotionally confronted by a woman, who was the president of a national organization devoted to anxiety research. She told me that I didn't know what stigma was. She knew because she suffered from Panic Disorder and quickly related her erstwhile symptoms to anyone who would listen. It was a frightening experience for her, indeed, but she now displayed what Goffman said was an certain exclusion from stigma once she stepped into the limelight of professional (paid) advocate in an organization. Read about this in his book.

I was, I must admit, quite shocked because I had seen stigma up close and personal in the hundreds of patients with mental disorders who crossed my path, but she turned a deaf ear to any of that. I had seen the fear stigma engendered and the terrible price people paid to hide their illnesses. Some even resorted to suicide to free themselves and I knew it. What price had she personally paid, I wondered, to lash out so when the word stigma came up?

She preferred to see me as simply someone who had been hired by a firm to assist in her organization's high profile status. It had gone to her head IMHO, to put it in the vernacular.

It was useless trying to tell her that I already had a doctorate in psychology and plenty of clinical experience because she couldn't hear it through the heady cloud in which she lived and which had been created by her new position. Yes, the position and the organization had been created by a major pharmaceutical firm that failed to see she hadn't written a single article or book or participated in any research and was a mid-level professional in the field.

Still, she was the boss here. Was she still fighting her own sense of stigma? I remained quiet when she expounded on her personal, terrible experiences with panic attacks. Remember the old adage about, "He who fights and runs away lives to fight another day?" I was well aware of it. I kept my own counsel on stigma and its many forms and torments.

The case of the GermanWings co-pilot has, once again, uncovered the ugly presence of stigma in our society, much of it job related. Should a worker tell an employer of their mental disorders? Should they reveal that they take any type of psychotropic medication and, how could they handle those all-important drug screenings if they hid their disorder?

While managing an Internet board for a major corporation in healthcare, I can't recall how many panic-stricken messages I received about medications. The one that stands out is that people wanted to know how long medications could be detected in blood or urine samples. Others wanted to know either how to quickly eliminate the metabolites from their body or how best to maintain their jobs when their employers found out they may not have been entirely truthful on their job applications regarding mental disorders. You can imagine the panic that ensued at times. Some even wondered if it would affect their application to college or graduate school or even medical school.

Placed against this background of lack of understanding, inadequate knowledge about mental health/illness (some still believe anyone with a mental illness is extremely powerful and dangerous), it is understandable that the co-pilot might have seen suicide as his only way out. He may have felt he would lose the one thing he loved (flying) and he was having vision problems. Who helped him to understand that neither might have been true? I don't think anyone really did an adequate job in either. Someone had a duty to protect here and that will come out in further investigation.

Stigma is all around us. It works in ways that keep it under the radar in too many instances and this prevents its being addressed for the benefit of those who are the targets of it. First Lady Betty Ford understood stigma when she came forward and admitted she had a drinking problem. New York City's Mayor de Blasio's family understands it as their daughter talked about her depression. Certainly, the deaf have suffered stigma and even those with cancer are victims of it. Watch the Ken Burns special on PBS, "Cancer: The Emperor of Maladies" and you'll hear how people with cancer were, and maybe still are, pariahs in our culture.

Persons with disabilities suffer from it as do patients with Multiple Sclerosis, alcoholism, HIV and any physical or mental disturbance we consider abnormal. Should we be doing this? Obviously not, but ignorance foments fear and fear is the very nexus of stigma.

http://www.drfarrell.net