Hektoen International

A Journal of Medical Humanities

Conquering the stigma of mental illness

Eric Levy
New York, New York, United States

 

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You have an illness, you let your boss know, and he fires you. There are many first-hand accounts of people who have had such an experience. Moreover, not only can mental illness be a cause for dismissal, it is also a taboo subject.  Not just to your boss, but your coworkers too.

I am one of many who suffer from bipolar disorder, and I am what is known as a “functioning” person with bipolar disorder. It often does not feel that way, but I have held jobs for thirty years (with several disruptions along the way).

I worry about the costs of disclosing my bipolar disorder, particularly at work. So for now I devote much energy to keeping it hidden. I have never told anyone about this at work, with the exception of one former coworker with whom I formed a friendship. Maybe some suspect it, but I doubt it, because I have learned to cover it well, whether I am on the manic or depressive end. When I am somewhat manic at my workplace, people flock to me, wanting to be the beneficiaries of my off-the-edge humor and irreverent remarks. When I am down, interactions are more formal and less interesting. That is why I have become such a good actor, able to perform as if I am up when I am down. I also take a cocktail of bipolar and antidepressant medications which keep me somewhat stable. I no longer have long bouts of mania, nor of depression. They come and go, and last a relatively short period of time.

Why it is that mental illness is such a stigma? Simple: people are terrified of it happening to them. We are our minds. To lose one’s mind is to lose oneself, the most critical part of being human.

This is why we hide our disorder with the impenetrable masks we have taken so long to create. Those who come out of the closet, as Sifu Casey Blood writes in his book Science, Sense and Soul, are “so tired from faking it.” Then there are many who have selected to stay in the closet, writes Helen Schucman, PhD, in her book, A Course in Miracles, because their “greatest fear is being discovered.”

Gary Zukav, author of The Heart of the Soul: Emotional Awareness, writes about what I particularly fear, about having people, especially at work, find out about my disorder: “You make a good impression at first and assume people won’t like you once they get to know you better, so you push people away, anticipating inevitable rejection…Intimacy paralyzes you because it [reveals] the truth of who you are.” In my case, and I suspect in many others, that truth is often seen as a defect, a limitation that we pretend not to have in our social interactions.

The misinformation and stigma surrounding mental illness was widely broadcast on March 26, 2015, when Andreas Lubitz, a copilot on a Germanwings Lufthansa flight, intentionally crashed a commercial plane in the French Alps, killing himself, 144 passengers, and six crew members. In a frantic search for an explanation, the media quickly began to blame Lubitz’s treatment for depression and speculate about “suicidal tendencies.” According to some media outlets Lubitz was reported to have bipolar disorder. One TV reporter described Lubitz as “a troubled man who became a mass murderer.”

According to news reports, Lublitz did not disclose his mental illness to his supervisors. If he had, the logic goes, management wouldn’t have allowed him to copilot the plane and it wouldn’t have crashed, avoiding the deaths of so many innocent people. The message seems to be: those of us who have mental illness are capable of mass murder. Watch Out!

The issue of whether to disclose or not disclose plagues many people. In their book, Don’t Call me Nuts: The Stigma of Mental Illness, Patrick Corrigan and Robert Lundin write that disclosure can be considered successful if it changed one’s attitude when talking about mental illness, which no longer evokes a sense of hesitancy or shame. Most people, they write:

are coping with some kind of personal trial or tribulation, even if it is not mental illness. They may be fascinated by your ability to cope and respect you for it. You may be pleasantly surprised to find out that others have similar problems. Frequently, people discover that when they admit to their psychiatric problems, others respond “me too.” Given that more than twenty percent of the population are struggling with some kind of mental illness at any one time…it is likely that you will have “me too” experiences when you tell your story.

The website Workingwelltogether.com outlines the three levels of disclosure: low, medium, and high. Low disclosure is providing facts to people, not too personal, and easy to share. The medium level provides biographical facts, opinions, and is sometimes risky to share. High level of disclosure is very personal, risky to share, to be used only if you trust the other person, and if the other person is willing to listen.

The Working Well Together staff outlines the benefits of disclosure:

  • Not having to worry about hiding one’s mental illness and being more open about it in day-to-day affairs.
  • Finding others who express approval, including those with similar experiences.
  • Finding someone who can provide assistance in the future.
  • Promoting a sense of personal power and acting as living testimony against stigma and discrimination.

David J. Miklowitz, in his book, The Bipolar Disorder Survival Guide, addresses an advantage to disclosing your mental illness at work. “Disclosing to your boss early on may set the stage for later changes in the structure or demands of your job…If your employer knows ahead of time, you can problem solve with him or her about what accommodations seem reasonable during your period of illness.” He writes that there may be instances when you feel you must disclose your disorder to your boss, such as when you have had multiple absences or a clear deterioration in your work productivity. Some people, he notes, decide to wait to see if their performance actually does slip, and then disclose the disorder to his boss when asking for time off or other work adjustments. This can be a sensible plan, but timing is important. Your boss may feel annoyed if this disclosure occurs in the midst of trying to meet an important deadline. Also, when you are in an active period of your illness, you may not be able to tell if your work performance has changed or if you need accommodations.

The costs of disclosure, as outlined by Working Well Together, include:

  • Encountering disapproval, social ostracism, and gossip.
  • Being discriminated against in employment, housing, and other opportunities.
  • Experiencing anger from family members and others because you self-disclosed.
  • Having increased anxiety due to perceptions that people are thinking about you or pitying you.
  • Thinking that future relapses may be more stressful because others will be watching.
  • Worry that people you tell will assume that your child’s mental illness is due to bad parenting.

Miklowitz points out that once you disclose your mental illness at work, “coworkers may become distant and overly cautious in their interactions.” He also notes that coworkers may “frequently ask if you want to talk about your problems, repeatedly reminding you that ‘I’m there for you.’ ” Although these responses may likely seem unhelpful, Miklowitz suggests viewing them in context that coworkers, along with family members, “are often struggling to figure out how best to respond to your disorder.”

If someone says something stupid, the worst thing you can do is react defensively. A defensive response empowers the other person’s words. It presumes you are threatened by the response, which suggests there is some truth in it. And the more defensive you get, the more confident the other person becomes. If you were raised in a dysfunctional home, you know this dynamic well.

Even when a situation seems so personal, even if others insult you directly, it has nothing to do with you. What they say, what they do, and the opinions they give is simply ignorance regarding mental illness. Remain strong. I have. We can all, whether afflicted or not, fight the stigma of mental illness.

 


 

ERIC LEVY has been a writer-editor for 25 years, working on the publication staff at Columbia University Medical Center and magazines. For the past 10 years, he has held the position of employment specialist for individuals who have faced great life challenges, including mental disorders.

 

Summer 2016  |  Sections  |  Psychiatry & Psychology

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