My Experience Only. YMMV.

Posts tagged ‘stigma’

Mental Illness and Gun Violence

photo by Thomas Hawk

There’s been a lot of talk lately that not allowing the mentally ill to own guns would curb the trend of gun violence in the U.S. There are just a few things wrong with that theory.

Are background checks the answer? They aren’t. Such checks at certified gun dealers screen out only the very few who have been hospitalized for mental illness – involuntarily committed, that is, not just referred for a 72-hour hold for observation or self-referred. That’s only a very small portion of those with mental illnesses. Most people with mental disorders are never hospitalized and some never receive any diagnosis or treatment from a psychiatrist, psychologist, or another counselor, which means that background checks would never turn them up. And there are loopholes in many states’ versions of background checks that, for example, allow private sales of guns without them.

To take this to the next level of absurdity, it would be a severe breach of confidentiality if therapists had to report every client to a database somewhere, just in case, and would lead to fewer people being treated for mental health issues, for fear of being put on a registry that might be used for any purpose eventually, even employment. Gun owners don’t want to be on a nebulous registry “somewhere,” and neither do the mentally ill.

Can psychiatrists and other counselors report to the authorities clients they fear may become violent? Again, laws differ from state to state. Usually, the question comes up only when a client makes specific threats against a specific person or a government official. The therapist must make a judgment about whether the client is a danger to self and others, which could result in a 72-hour hold, and may of course be correct or incorrect. A client with generalized anger issues is probably not mandated to be reported.

And to whom and for what purpose would the person be reported? To the police, when no crime has been committed? Is a therapist’s report of a client’s report of feeling angry enough to shoot “someone” sufficient to justify a search warrant of the person’s house for a legally owned firearm?

Are mentally ill people more likely to be violent than other people? No. In fact, mentally ill people are much more likely to be the victims of violence than they are to be perpetrators. But no matter how many times we say that, few listen or believe it. Some mentally ill people turn violence – and guns –against themselves. Some are killed by police officers with no training in handling confrontations with differently abled people, including the mentally disordered.

Not only are mentally ill people more likely to be accused of violence, violent people are more likely to be accused of being mentally ill. That’s practically the first thing anyone says after a mass shooting – “Oh, he must be crazy” (or on psychotropic medications). Of course, with one in four adults being likely to experience some form of mental distress in their lifetimes, it is possible that a shooter is one of those people.

But newscasters and politicians and people on the street are, by and large, not psychiatrists or psychologists. They are no more able to diagnose mental illness than burger-flippers, dairy farmers, lawyers, or business executives. Not that that stops them. Mental diagnoses are flung about indiscriminately nowadays, from people who call themselves OCD because they straighten pictures to psychiatrists who claim to diagnose public figures without having spoken to them once, much less having developed a therapeutic relationship with them.

But can’t potential violence be predicted? No. It can’t. The prison system can’t do it, or there wouldn’t be so many parolees and probationers and those who have served their time who go right back to crime and violence. Mandatory sentencing laws and the political climate have reduced the problem in some areas, but there are still plenty of cases in which the system fails. At trials and parole hearings and sentencing hearings, there is always someone – doctor or lawyer or family member – to say that the offender will not offend again.

But the only known predictor of violence is past violence. That’s why some people think it’s more sensible to restrict the gun ownership rights of domestic abusers rather than someone mentally ill who has no record of violence.

Can’t mentally ill people who’ve proven to be violent be required not to own guns? Theoretically yes, but we know how well it works to tell people on probation who have no record of mental illness that they can’t own guns, drink liquor, or associate with known criminals. The probation system is too understaffed to enforce these requirements already. Who would be willing – or should have the responsibility – to check up on everyone, even the small proportion of the mentally ill who have been involuntarily committed or convicted and then released, and make sure they don’t acquire any guns? If the parole and probation people can’t handle the caseload they already have, why would we think that mental health professionals have any more time, capacity, training, or know-how to do it?

Would banning guns prevent gun violence by the mentally ill? In a word, no. There are already too many guns in circulation in this country for that to be possible, and those guns are too easy to get. And again, there would still be the problems of determining who is mentally ill, by whose definition, and how such a gun ban could be enforced.

So, I hear you asking, you’ve told us all the things that won’t work. Is there anything that will?

Not if you think that the problem of gun violence and the problem of treating the mentally ill overlap. Gun violence is one topic and the mental health system is another. There is a lot that can be said about fixing one or the other, but nothing that would solve both at once.

Not that a lot is being done now, unless you count blaming, finger-pointing, and spreading stigma.

 

For more discussion on the topic, see http://www.amhca.org/blogs/joel-miller/2017/10/03/gun-violence-and-mental-illnessmyths-and-evidence-based-facts from the American Mental Health Counselors Association.

Do I Disclose or Don’t I?

As I’ve mentioned before (even on my other blog https://wp.me/p4e9wS-zY), I’m running low on money and clients in my freelancing business. Therefore, I’ve taken up searching job ads online for part-time, work-from-home gigs. (So far, Indeed is the only service that has presented me with reasonable options. I sometimes apply for as many as three a day.)

It’s filling out the applications that has me stumped. Oh, I’ve got a fine resume – one on Indeed and another file I can send to jobs not listed with Indeed. I can write a decent cover letter. If there are editing or writing tests, I can handle them too. I have way more education and experience than I need, but I explain in the cover letter that part-time, contract, or freelance work is what I really want at this time in my life.

Then come the other questions that many ask.

Am I a veteran? No.

Am I a U.S. citizen or do I have the necessary documents to work in the U.S.? Yes.

Is English my first language? Yes.

Am I male or female? Yes.

What race do I identify with? Yes.

(Those aren’t really yes/no questions and are usually marked as optional, but I answer them anyway.)

Then comes the real stumper. Am I disabled? Well, that depends.

Most of the application forms state that they abide by EEOC regulations. Some of them even have a handy list of what are considered disabling conditions – and bipolar is one.

So. Do I take them at their word and believe that they do abide by EEOC regulations, in which case I can reveal my bipolar condition without penalty. In fact, if the company is trying to prove to someone that they are abiding by those regulations, the answer is probably yes, I should.

But we all know that such questions, while well-meaning on the surface, may actually be used to screen out disabled candidates. So perhaps I should answer no.

The deal with the regulations is that employers must offer “reasonable accommodations” to let disabled employees do their jobs, unless the accommodations for that condition are not feasible because of expense or other reasons.

So, as a person with bipolar disorder, what actual accommodations would I need?

The main ones I would need are the ability to work remotely, from home, and to have flex time. Those cost an employer nothing, usually.

And those are precisely the kinds of jobs I am applying for – work-remotely jobs in which you can make your own hours, or at least partially.

So when it comes to “The Question,” I have been answering “yes.” For the purposes of work, I am at least partially disabled by my bipolar condition. I cannot work full time. I have trouble working in a bustling office with lots of people around. I need flex-time to work around my symptoms. (I can still meet deadlines, though.)

Funny, but the forms don’t have spaces or yes/no questions on those subjects.

I have considered the idea that I am doing this all wrong. That I should not disclose my bipolar disorder until I have the job (and for those who don’t ask the question, that’s what I’ll have to do). That after I have the job is when I should discuss accommodations.

But dammit, all evidence to the contrary, I am a cock-eyed optimist. Those EEOC rules are there for a reason and I am that reason. I know that when most employers think “disability,” they think “wheelchair” or “impaired hearing.” But there it is, listed right among the possible disabling conditions – bipolar.

So far I’ve gotten a few form rejection letters and mostly a resounding silence. And in the meantime I’ve been scrambling for other clients and other assignments.

But I hope the day will come when just one of my potential employers means what it says about disabilities.

The Question I Hate the Most

There are many things you shouldn’t say to a bipolar person: Cheer up. Smile. What have you got to worry about? We all have mood swings. Calm down. You’re overreacting. You don’t look depressed.

Each of these remarks contains a hidden assumption, from simple – you can choose your moods; to dismissive – your anxiety is not as severe (or as important) as mine; to possible gaslighting (see https://wp.me/p4e9Hv-pm, https://wp.me/p4e9Hv-C2, https://wp.me/p4e9Hv-Cu).

I’ve gotten all of those and more. Once I revealed my disorder to a coworker and she’d ask me, “How are you?” with a concerned look several times a day, taking my emotional temperature. But the question I hate most is a simple one.

Are you off your meds?

Let’s unpack this, shall we?

First, the underlying message is that, to the speaker, you are acting in a strange, inappropriate, frightening, incomprehensible, or otherwise “off” manner.

The second assumption is that you must be on medication in order to appear “normal” at times.

Third, that since you do not appear “normal” to the speaker, the only explanation is that you must not be medicated at the moment.

Fourth, that the speaker has the right to give you advice on how medicated you need to be in order to appear “normal.”

And, finally, that “meds” are the answer to all your problems. If you want to fit into society you must be on your guard at all times and medicate until you are acceptable to them.

There is a slightly less offensive version of the question: Have you taken your meds today?

This might be marginally acceptable from a loved one, who knows that you take medication for your disorder and also knows that you are sometimes forgetful.

But really. Most psychotropic medications build up in a person’s system over time and leave the body over a long time as well. Missing a single dose is not likely to have an appreciable effect on a person’s moods or actions.

There are some anti-anxiety medications that have short-term effects, and a bipolar person might have forgotten a dose or two.

But unless the speaker is the bipolar person’s caregiver, official or unofficial, it’s still rather parental and demeaning – suggesting that we aren’t competent to handle something as vital as our own medications.

Of course, sometimes it may be necessary to help a loved one remember to take medication, whether that person is bipolar or not. On a vacation, for instance, when one’s normal routine is disrupted, a gentle reminder may not be amiss. When one has just started treatment and the routine is still unfamiliar. Or if the person actually is a child.

You wouldn’t ask an adult with the flu “Have you taken your antibiotics today?” You wouldn’t say to a blind person “Now, don’t go out without your service dog.” Most people, most of the time, are deemed competent to know their needs and take care of those needs themselves.

But bipolar disorder and other psychiatric conditions, being largely “invisible illnesses,” seem to invite meddling. Everyone else knows what’s best for us, from a different drug to herbal medicine to a walk in the park to prayer.

They know a little bit about the disorders, perhaps, largely through television and celebrities. But they don’t know your particular version of the disorder (bipolar 1 or 2, rapid cycling, dysthymia, hypomania, anxiety, etc.)

So if I snap at you, or seem anxious, or don’t want to go out, don’t assume. I have regular “normal” moods too, even when I’m on medication. Sometimes I get annoyed if my husband has lost his cell phone for the third time this month. Sometimes I feel sad if my picnic is rained out. Not every mood is pathological.

So don’t assume you know what’s going on inside my head. Unless I ask for help, refrain from putting in your oar.

And don’t ask me, “Are you off your meds?” It’s an insult, not a question.

Are Political Extremists Mentally Ill?

Yes.

Well, some of them are. Given that one in four of Americans experiences a mental or emotional disorder at some time during their lives, 25% of any given group either are, have been, or will be affected by mental problems. Politicians. Girl Scout leaders. Chefs. Whoever.

Of late, though, it seems that political extremists – and politicians, of course – are being singled out for accusations of mental illness. And as for terrorists, they are in common understanding all mentally ill, so anyone you label as a terrorist is automatically insane. But we’re far from agreeing who is and is not a terrorist. (Antifa? Greenpeace? The NRA? The DAR?)

Admittedly, some of the extremists’ actions and statements seem “crazy,” but let’s stick to the more technically correct “mentally ill.”

Except it isn’t technically correct in most cases.

A lot of people seem paranoid these days. Everyone on the “other” side is out to get them, destroy America, or at least scare the pants off us. Conspiracy theories abound. And nearly all of them are crazy. (I wrote about this a short while ago: http://wp.me/p4e9wS-AH).

But “paranoid” is a clinical term in psychology, and it has a specific meaning: Paranoid Personality Disorder is a psychiatric condition, manifested by, among other things, “generally unfounded beliefs, as well as … habits of blame and distrust, [which] might interfere with their ability to form close relationships,” as WebMD says.

Those traits your political or social opponents may have, but most of them don’t also:

  • Read hidden meanings in the innocent remarks or casual looks of others
  • Perceive attacks on their character that are not apparent to others; they generally react with anger and are quick to retaliate
  • Have recurrent suspicions, without reason, that their spouses or lovers are being unfaithful

Diagnosis at a distance is dangerous, as well as bogus. The fact is that none of us (except perhaps psychiatrists) can diagnose a person as paranoid or any other variety of mentally ill without having met the person and performing detailed interviews and tests (I’ve written about this too: http://wp.me/p4e9Hv-6F).

This is also true of public figures. We can say that Donald Trump, to choose an example not entirely at random, has narcissistic traits; or is a narcissist in the garden-variety, non-technical meaning of the word; but we cannot say that he has Narcissistic Personality Disorder, an actual clinical diagnosis. We may think he’s crazy, but we can’t say whether he’s mentally ill.

Public readiness to label people, both acquaintances and public figures, with loose pseudo-psychiatric terms raises a number of problems, particularly stigma.

Labeling is a convenient way to dismiss a person who disagrees with you without listening to what he or she has to say, or considering the possible validity of an argument or even a statement of fact. If we apply a label, we make an assumption about a person that may or may not be true.

Stigma comes with the label mentally ill. People with diagnosed mental disorders are too often assumed to be violent, out-of-control, homicidal (or suicidal) maniacs – and therefore not worth listening to. In fact, many people with mental illnesses have no impairment in their cognitive function. It profoundly devalues them to dismiss them from political and social topics of conversation.

So, bottom line. “Those” people may be crazies, may act crazy, talk crazy, believe crazy things, but it is not accurate or helpful to call them crazies. Neither is it helpful to label someone who has never been diagnosed or has never been open about a diagnosis as mentally ill.

I just think that how we talk about people affects how we treat them. And that matters.

Discrimination: Mental Illness and Disability

A while back I wrote a post called “Another Word for Stigma” (http://wp.me/p4e9Hv-oz), which was about the new-to-me term “sanism” and how it set up a dichotomy between the sane and the insane. While sanism may have been intended to reframe the discussion about mental health issues, I said, “We already know that stigma exists surrounding mental illness. We don’t really need the word ‘sanism’ to redefine it. Or to pit us against one another.”

When applied to mental illness, “ableism” is another word that subtly reinforces stigma. It implies that, unlike the neurotypical population, those of us with mental disorders are differently abled, mentally challenged, or – dare I say it – disabled.

Many of us – including me – have applied for disability and many – including me – have been turned down. Despite that, many of us live with varying levels of ability and disability, which are nearly impossible to see and therefore to prove.

When I applied for disability, I was in the depths of what would once have been called a nervous breakdown. I had mental deficits, emotional instability, trouble performing the skills of daily life, inability to hold a job – certainly at the level that I formerly had, or possibly not at all. My thoughts were disordered. My life was disordered. I got by only with the help of a caregiver – my husband. If that’s not at least partial disability, I don’t know what is.

By the time my claim was denied and my disability lawyer was prepping me for a hearing, however, I was, if not well, at least better. I had found part-time work that I could do at home, which provided as much income as disability would have. At his suggestion, I dropped my claim. Perhaps I shouldn’t have, because the lack of medical benefits has been a constant difficulty.

So, am I disabled? I would have to say, partly. I still cannot hold a full-time job – certainly not without accommodations – and my caregiver (still my husband) has to help me with many of the tasks of daily living.

The notion of requiring accommodations leads us to the subject of discrimination. Employers are required by federal law to provide “reasonable accommodations” to persons with disabilities, according to the Americans with Disabilities Act (ADA), for conditions including “a physical or mental impairment that substantially limits one or more major life activities,” and also to “a person who has a history or record of such an impairment, or a person who is perceived by others as having such an impairment. The ADA does not specifically name all of the impairments that are covered.”

“Reasonable accommodations” are not defined for mental disabilities, but examples of accommodations for other conditions include modifying work schedules, as well as leave flexibility and unpaid leave. But just try telling a prospective employer (as you are entitled to do) that you will need flexible hours to accommodate appointments, panic attacks, or other phenomena; or asking someone you work for to give you unpaid leave for a hospitalization. I think you know the result as well as I do.

One problem is that these forms of discrimination – which is what they are – are damnably hard to prove, as onerous and unlikely as being classified disabled in the first place. Yet the protections against these forms of discrimination are defined by law. But how many of us have the wherewithal to challenge them, prove our cases, and get by while waiting for the results of a lawsuit?

Even the act of asking for an accommodation opens us to yet another instance of stigma, and the outcome depends on the individual knowledge and understanding of an employer, when it should follow the law. We approach employers and prospective employers hat in hand, asking for – but not expecting – to get the treatment that is legally, rightfully ours.

In these days of rampant discrimination against people of any number of races, religions, national or ethnic origins, sexual orientations, and disabling conditions, our voices may not be the first to be heard. But we, the neurodivergent, the mentally ill, the emotionally disabled, the psychiatric patients, and our caregivers and loved ones deserve to be free from the effects of ableism, discrimination, and stigma.

Let’s speak up, keep educating about our issues, and support each other in banishing stigma, ending discrimination, and putting ableists on notice that we will not shut up until our rights are acknowledged.

 

Another Word for Stigma

Stigma concept.Recently I was reading an article online and came across a word I had never encountered before: sanism.

I don’t like it.

Oh, I realize that it’s meant to go along with all the other “isms” – words that point out how the world decides who is worthy of respect, then campaigns for the rights/recognition/understanding of the disrespected. There are lots of “isms,” some familiar by now, and others that just never quite made it.

racism

sexism

nationalism

feminism

elitism

ethnocentrism

ableism

lookism (This one didn’t catch on. It means that pretty people are advantaged.)

colorism (Not quite the same as racism, it refers to the idea that lighter shades of brown skin are preferable to dark ones.)

Not all of these terms are equally adequate. Sexism, for example, refers to the divide between male and female, and implies (though does not call out) heterosexism in particular. It ignores the experience of people with other kinds of gender expression – genderfluid, pansexual, and trans, for example. It probably should be “cis-sexism,” but then everyone would spend an hour explaining that when they tried to use it.

Ableism is another term that has problems. In its basic form, it contrasts the able-bodied against the disabled, or rather points out that the rights and even the humanity of the disabled are discounted. I bet some of you are wincing at the phrase “the disabled.” Times change and terms change. Right now the preferred term is “person with disabilities,” though we have been through other versions – “differently abled,” “physically challenged,” etc.

The general rule in these situations is to call people what they prefer to be called. But how do you know which term that is? Negro, Black, black, non-white, colored person, person of color, and probably a few I’m missing have had their day. And if you use Black, do you also have to use White? Many people do not understand the word Caucasian anymore, and certainly can’t explain why it means the same as white. Nothing you can say will satisfy everyone. Perhaps the best solution is simply to call everyone “Chuck,” or “Emily,” or “Mariko,” or whatever.

So. Back to sanism. My first problem is how to pronounce it. San-ism? Sane-ism? And if the latter, shouldn’t it be spelled saneism? Do we need a hyphen (sane-ism) to keep it from being mistaken for an unfamiliar religion?

But the real problem goes deeper than that. Sanism implies that there are two categories: sane and insane. If you’re not one, you’re the other (and discriminated against, but let’s put that aside for now).

Personally, I have a mental illness (bipolar 2), but I don’t think most people would classify me as insane. And there are many other people with OCD, PTSD, phobias, anxiety disorders, etc., who have difficulties because of them but are by no stretch of the imagination insane. Do we go back to the days when anyone with a neurosis was sane and anyone with a psychosis was insane? Does anyone still divide the world up that way, or has the DSM caught up with reality?

What, then, do we call ourselves? Non-sane? Not-sane? Mentally ill? Mentally challenged? Mentally unhealthy? Neurodivergent? Emotionally disordered? Nothing seems to encompass all of us. Nothing seems to work. But the “ism” suffix implies lining up two groups to make it easier to talk about the differences between them. It doesn’t always work perfectly – racism can be black/white, black/Asian, Hispanic/Anglo, etc. – and you sometimes have to define exactly what you mean.

Admittedly, the sane (able-minded? neurotypical?) have automatic, inherent advantages over whatever-we-decide-to-call-ourselves. Housing, jobs, even service in restaurants are weighted in favor of people with no psychiatric/psychological label or diagnosis.

But wait! We already have a word for that – stigmatized. Sanism sets up the contrast between those who consider themselves “normal” and those that the normal consider “abnormal.” In other words, stigmatized.

We already know that stigma exists surrounding mental illness. We don’t really need the word “sanism” to redefine it. Or to pit us against one another.

We have mental or emotional disorders. We are discriminated against – hated, feared, shunted aside, diminished, discounted, blamed, or avoided – because of that.

That’s stigma.

That’s what we have to fight.

Not “sanism.”

I’m Not Brave – I’m Stubborn

Don’t forget! March 30 is World Bipolar Day!

Kopf durch die Wand

One of my friends, who is overweight, recently told me that when she was at the gym on the treadmill, a stranger came over to her and told her she was “an inspiration.”

My friend felt insulted. She was working out for herself and for her health, not to inspire anyone else or to be taken as a symbol of I-don’t-know-what – perseverance? attitude? effort? hope?

I feel sort of the same way when people say that because I am open and public with my bipolar disorder that I am “brave.”

I’m not doing this because I’m brave. I’m doing it because I’m stubborn.

I am who and what I am, and I’m willing to reveal a lot of it because, frankly, I can’t hide it and don’t want to. I’m not average or typical. Not normal, mentally or emotionally.

I’ve always had a love-hate relationship with the concept of “normal.” Desperately wanting to appear normal, but knowing viscerally that I am not. Wondering what it’s like, but knowing that I’ll never know. Wondering what it even means, or what it means that I’m not. I haven’t found answers yet, and at this point I don’t think I’m going to. It’s probably a waste of my time to try.

So, if I’m outside the “norm,” which I am, I may as well admit it. And since writing is what I do, I write about it. I’m not doing this because I’m “brave,” I’m doing this because on some level I have to. I’m stubborn.

I’m stubborn enough these days to have made a sort of peace with the concept of “normal,” even though I still don’t understand it.

I’m stubborn enough to acknowledge my difference and give it its proper name – bipolar disorder.

I’m stubborn enough not to care when I say that and some people flinch or back away.

I’m stubborn enough to reveal things that embarrass me because they are part of me and part of what I’ve lived and lived through.

I’m stubborn enough to get tattoos proclaiming my status as “mentally ill” and using them to open conversations and educate others.

I have not come to embrace my stubbornness easily. I’ve tried to fake “normal” and hide my differences. I’ve gone to my shrink and just referred to “doctor appointments.” I’ve made Prozac jokes even though I was taking it at the time. (For this I am truly sorry, as I later learned that one of those jokes made another person afraid to admit that she took Prozac too.)

I’m not trying to be an “inspiration.” I’m not trying to prove anything to anyone else. I’m doing what I have to do for me. If someone else finds some good in it, that’s fine. But that’s not why I do it.

I am bipolar.

I am a writer.

I am stubborn.

Taken together, you get this blog.

Bipolar Me.

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