Even mental health professionals can display stigmatising attitudes

Lots of people with mental illness experience stigma in their everyday lives. Perhaps your parents think you should be able to pull yourself together and think yourself out of your problem. Perhaps your friends believe that you have control over your illness and could do more to help yourself. If only you would join an exercise class or start eating blueberries or something, everything would get better for you.

I have come to expect these sorts of sentiments from people. Sometimes it comes from a good, albeit misinformed, place. Your loved ones are often just trying to help you with something they don’t understand. This doesn’t make it any easier to hear though when you know that you are trying your hardest and nothing seems to work.

I find myself trying to do the things that people want me to do just so that I can say to them: ‘look I have tried X and I'm doing all I can to try and get better’. Ultimately though, I know that these things won’t magically cure my mental illness. It’s more complex than that. My body has shut down and my behaviours have become strange. A switch has turned off in my brain and it is going to take a lot more than going on a jog to fix things.

Hearing these kinds of things from friends and family is to be expected. Hearing them from professionals though is quite shocking.

I once went to the GP to ask for some diazepam for my anxiety problem. I had been prescribed it by my psychiatrist but I wasn’t seeing him for a while. The GP’s response? ‘You just need to WORK through your anxiety. You shouldn’t rely on medication.’ (tone was very dismissive). I felt like I was being blamed for my illness. If only I would work a little harder, all would be fixed. I was made to feel like I was taking the easy road by taking medication. Of course, if medication is the easy road so be it. I would rather take the easy road and fix the problem than struggle down the path of yoga and raw vegetables alone.*

Maybe you wouldn’t expect a GP to have an in-depth knowledge of mental health problems. However, I would expect that a mental health support worker would have this kind of expertise. I had a very bad experience with my support worker. She forced me to do things I wasn’t ready for, she made me pay for her parking that she claimed back anyway and she asked me to buy her presents on my holiday. What most distressed me though was that she knew that I had bipolar but she didn’t believe it. When she read through my DLA application she was really shocked by the description of some of my behaviours. Her attitude? ‘I have never SEEN you behave like that.’ (strongly accusing tone). Surely as a MH support worker she would be aware that people cover up their problems.

Another time I attended an anxiety and depression group. The woman that ran the group said to us right at the outset: ‘I don’t think that any of you are ill. Mental health problems are down to bad experiences, but you are NOT ill and do NOT need medication.’ Now I am not of the opinion that only medication should be used to treat mental illness. Tools such as relaxation, CBT and mindfulness are all things that may help some people with mental illness. But dismissing the idea that mental illness should be treated with medication is dangerous. Medication helps many people and has been shown to be effective in controlled clinical trials. It is not good practice for a psychologist to dismiss medication just as it is not good practice for a psychiatrist to dismiss psychological treatments. Ultimately  of course it is a patient’s choice what methods of treatment he or she uses.

When a mental health professional says these kinds of things it’s very distressing for the patient. Anyone who has experienced a mental illness knows that they cannot control the illness by will alone. It is not a problem with strength of mind or character. It is not an easy choice to take medication. We have all experienced the side effects and the feeling that you should have been able to control the situation yourself without intervention. The fact that so many professionals have these incorrect assumptions about mental illness is deeply concerning. However, they just reflect the deeply ingrained prejudice of society in general.

A mental health professional has an important relationship with the patient. It is one in which the power dynamic is unequal. The patient is deeply distressed and desperate for help. They are fully reliant on the mental health professional for help. Most professionals are aware of this power imbalance but do everything they can to listen to the patient and advise, not dictate to them possible treatments. However, a significant minority of professionals give poor advice and demonstrate the same prejudices that uninformed members of the public have. This is all the more damaging considering the power imbalance between patient and professional.

Over the past few decades we have come a long way in tackling mental health stigma. This is partly because many professionals have gone out of their way to educate people and remove some of the stigma. I do not wish to negate some of the wonderful work many professionals do. I would not be where I am today without some of the great help I have received. However we must still hold those in power to account. When a professional holds a prejudiced view they need to be challenged, because often it is all the more damaging coming from them than it is coming from your friends and family.

 

 

 

*This is not to dismiss lifestyle changes. My point is that there are many treatments available to us.

Review of 'Being Bipolar' the Channel 4 documentary

I didn’t have high hopes for ‘Being Bipolar’, the latest Channel 4 documentary. I worried that the footage would be upsetting. It is always difficult to see other people struggle with mental illness in such a similar way to yourself. What I was most concerned about was the way that the documentary might portray those with mental illness. The media often don’t portray mental illness in an accurate sensitive way. This documentary was no exception.

It started with the host of the show, a psychotherapist called Phillipa Perry, pointing out that the established belief is that bipolar disorder can be caused by a variety of factors including chemical imbalances, genetics and environment. However, for some reason she started out the programme with the assumption that bipolar is caused solely by life experiences. There is no evidence cited to back up this belief, but it is a belief she holds on to.

She interviewed three different people who have bipolar disorder. She displayed sympathy and kindness to those people but in approaching them with her dogmatic belief, she couldn’t help but undermine them.

She repeatedly asked them if there had been any trauma in their life, to which the answer seemed to be a resounding no. Phillipa Perry saw any negative experience as a complete explanation of why someone developed bipolar disorder. At one point she cited how one of those people interviewed, Paul, had been an only child and then a successful business man later in life. As if this somehow explained away everything.

There are of course certain experiences that everyone has that have been traumatic and these people interviewed will have had these kinds of experiences too. This doesn’t instantly mean that these experiences have caused bipolar disorder to develop. If they have they are likely to be part of a complex picture that includes environmental, genetic and chemical factors. Stressful experiences may trigger episodes, but it seems that some people have a propensity towards the illness to begin with.

Phillipa Perry talked very negatively about medication used to treat bipolar. She declared that people with bipolar disorder were using medications to numb emotions and that this was only a temporary fix. In one fell swoop, she made thousands of people feel ashamed that they rely on medication. Of course, medical professionals generally agree that medication is important in the treatment of bipolar disorder. People take medication because they are desperate to get help and the effectiveness of certain medications are backed by clinical studies. This generally held expert belief didn’t seem to matter to the presenter who pushed psychotherapy as the appropriate treatment. This is not to say that psychotherapy can’t used to treat bipolar. It’s just that this isn’t the only option out there; a range of treatment options should be considered for bipolar disorder.*

I fear that people will watch this documentary and then think that they know everything there is to know about bipolar. I fear that people who don’t know better will judge me for being on medication. I fear that because they have seen people interviewed with the illness, they will think that my experience is exactly the same.

I know that these kinds of programmes are important in raising awareness, but that is not much good if the awareness they are raising is misguided awareness. I hope that people will come away from the documentary with sympathy for those interviewed but remain sceptical about some of the presenter’s opinions. 

*Of course, psychotherapy is barely available within the NHS, Medication is a lot cheaper to provide and so is often the go to for mental illness for this reason too. 

How will my friends react to my mental illness?

I wage a constant battle with myself. It all revolves around what my friends will think of me. Should I hide my mental illness from my friends to avoid embarrassment? Or do I drop the mask and allow friends to see me acting abnormally, knowing that some people will be scared and judge me harshly?

Having a mental illness is no fun, but it’s made all the worse by the stigma which surrounds it. We can’t help but be affected by society’s expectations. Everyone cares what other people think of them. The fact is that society judges those with mental illness negatively. 

Often people think that those with mental illness are responsible for their condition. The idea is that those with mental illness are somehow in control of the course of their illness and can choose whether or not to succumb to it. Often it is thought that those that have mental health problems are weak in some way. Perhaps other people suffer from the same problems in life but are of strong enough mind to overcome their difficulties. On this view, whether or not you suffer from a mental illness is all about choice.

Some people may go a step further and think that mental illness doesn’t even exist. You can’t see a mental illness, only observe behaviour. The behaviour can seem strange and scary. It is easier to believe that someone is just ‘crazy’ (a dehumanising word, setting someone apart from yourself and others) rather than imagine that person to be just like you or me but in intense mental pain. Some may just think that the person is behaving this way because they have let themselves go rather than actually suffering from a medical condition. 

These kinds of thoughts often lead people to the belief that those with mental health problems are a drain on the state. They read about ‘benefit scroungers’ in the newspapers and believe that someone with a mental illness is unworthy of help. At best, they are weak and lazy. At worst, they are faking it for monetary gain. Either way they see you as a drain on ‘the taxpayer’.

I worry that my friends will be thinking these kinds of things about me when I talk about my mental illness. I don’t think most of them will think I am making it up, but perhaps they think I am lazy and a drain on the state. I claim disability living allowance but I don’t tell many people that. I am sure they can guess though. Maybe they look at me buy new things or go on holiday and resent me for it. Who knows what kinds of things people are thinking when they look at me. I shouldn’t care. Mental illness is not about weakness or choice. I should just shrug it off. They are the ones with the problem with their ignorant views. I shouldn’t care, but I do.

I try to navigate the tricky path with how to behave around other people so as to minimise these kinds of negative judgements. I want to be open and show people what my mental illness really is all about. I want to tell people about the way that I feel and why I end up behaving as I do. Most of my friends know that I have a mental illness. However, I always end up trying to hide the behaviours associated with it to avoid people thinking I am scary or weird. If I am depressed, I act cheery. If I am anxious, I act much more calmly that I feel. If I am manic, I try exceptionally hard to quash down my desires to pace around and laugh wildly.

I have ended up in the strange situation of being open in what I say about my mental illness but acting as if nothing is wrong. Of course, in doing all this behaviour modification, people are going to have a hard time believing that I am really ill. I may have saved face but people are going to wonder why I can’t work when I seem capable enough in front of them. 

I know that other people with mental health problems must feel the same way. As well as coping with the illness, we have to deal with the stigma surrounding it. This makes it hard to be completely honest and open with people. However, how are people ever going to understand mental health problems if we all keep quiet about it? It is a tough dilemma because when we are open, we sometimes do get judged negatively by people we think of as friends. We can only hope that real friends will at least try and be compassionate, even if they don’t really understand mental illness.