STIGMA: When your lived reality in the mental health system clashes with their dreamworld 05/21/2013Posted by ALT in Activism, Mental Health News, Patient Rights and Advocacy.
Tags: anti-stigma, BringChange2Mind, Glenn Close, mental health stigma, stigma
In last year’s blog “How to INCREASE stigma in mental health — fight stigma the conventional way,” we covered a few key points:
1. The disease model/explanation for so-called “mental illness” actually INCREASES STIGMA, while a psychosocial model/explanation slightly DECREASES it (good, replicable science has demonstrated this repeatedly)
and films her standing in Grand Central Station proclaiming her “brain disease” for all to see, Glenn is actually demonstrating how BAD she is at fighting stigma. (couldn’t be worse, really)
Nevertheless, Glenn Close and her foundation (BringChange2Mind) are the media’s poster children for anti-stigma campaigns in mental health.
They’re in the news again today, releasing another PSA and (as always) keeping their stigma-fighting a careful blend of the specific and the vague.
The specific: Accept your diagnosis-for-life and TAKE YOUR DRUGS.
Jessie Close started showing signs of bipolar disorder in her early 20s… “I was given my first treatment in my late 40s and finally, the correct diagnosis — and medication — when I was 51. I’ll be 60 in July and I grieved for those lost years. There were careers I couldn’t handle because of it. I wish I was able to get help earlier.”
- Jessie Close, sister of Glenn Close, wearer of “bipolar” t-shirt
The vague: What, exactly, is stigma?
What are foundations like BringChange2Mind really fighting for? There’s a brief reference to “social inclusion,” and of course a non-specific call for “laws to protect the mentally ill” (I hope that’s not a veiled reference to forced outpatient commitment!) – but that sure doesn’t tell us much. BringChange2Mind’s greatest impact so far has been the release of a PSA whose main message appears to be “psychiatric labels are LEGITIMATE references to actual BRAIN DISEASE, and to PROVE IT TO YOU we’re having them printed on t-shirts.”
Later in the article we hear from stigma expert Bernice Pescosolido: ”There are two parts to mental literacy, one is knowledge and the other is what to do about it.” She keeps it nice and vague – what knowledge? The knowledge that a biological model/explanation for “mental illness” is, not only untrue, but also MORE likely to produce stigmatizing beliefs and behaviors?
Technically a sociologist, Pescosolido has been doing “research” on this important topic for years. I decided to consult her corpus of academic publications. Somewhere, anywhere, can ANYONE tell us exactly what they mean when they say “stigma?”
Stigma= when lived reality clashes with their theoretical dreamworld
In a study of adult stigma towards children who have received mental health treatment, Pesconsolido and co-authors devised a four-question instrument to measure what they refer to as “stigmatizing beliefs.” After hearing a vignette that described the “symptoms” of a child with either depression or ADHD, participants were asked if they agreed or disagreed with the following statements:
(1) a child receiving mental health treatment would be “an outsider at school,”
(2) a child receiving mental health treatment would “suffer as an adult if others learned he/she had received mental health treatment when young,”
(3) that the parents of the child in the vignette “would feel like a failure” if their child received mental health treatment, and
(4) that “regardless of laws protecting confidentiality, most people in the community still know which children have had mental health treatment.”
The more strongly you agree with the statements above, the more “stigmatizing” your beliefs about children’s mental health are – strongly agree with them all and you’ve got “high stigma.”
The authors assure us that “the reliability of this scale is .69”
So here’s what I’ve learned about stigma from Pesconsolido’s work:
Stigma is when you and your lived reality in the mental health system clash with the so-called anti-stigma activists’ dreamworld.
Because the truth is YES – to be falsely labeled as “brain diseased,” to be set apart from the rest of humanity for a unique program of dehumanization, the literal commercialization of your mental and emotional suffering, to have fundamental rights to bodily integrity, due process, freedom of association, etc. taken away – YES, this will make you an outsider.
To be so marked as a child WILL have serious consequences, even into adulthood, as many psychiatric survivors will testify.*
And NO, your confidentiality will NOT be maintained, not when the buying and selling of data about prescription medications is “commercial free speech,” not when there are EVER-SO-MANY dollars to be made from your compliance with a system that demands you accept your diagnosis-for-life and take your pills.
If recognizing these and other harsh realities means I have “stigmatizing beliefs” – so be it.
What kind of world are we fighting for?
Anti-stigma activists like Glenn Close & Co. seem to be fighting for a world extremely similar to our own, with only one key difference: nobody has to recognize the truths listed above, everyone has the literacy, the “awareness” to pretend, fully and convincingly, that the Emperor is indeed wearing the finest suit ever made.
If we all say it’s so, then it’s so… right?
There’s also the option of fighting for a different world entirely. A world where mental and emotional suffering still exist (part of the human experience, you see), but where the response to them is grounded in a fundamental respect for the humanity and free will of the individual so suffering. (more on that HERE)
Dreamworlds — and their naked emperors — be damned.
* Here’s how Laura Delano’s lived experience of the mental health system clashed with the “anti-stigma” dreamworld:
When Psychiatry had first attempted to indoctrinate me as a young teenager, I was not yet vulnerable or hopeless enough. When I eventually reached such a state, I surrendered myself immediately to a psychiatrist at America’s most prestigious private psychiatric institution, and became a full-blooded patient, passive and dependent and convinced of her brokenness, in a matter of weeks. I believed him when he said I’d need “meds” for the rest of my life, and would have to learn how to “manage my symptoms” and “set realistic expectations” for myself. I was sure that the “Bipolar” diagnosis was the explanation for all my problems, and that the prescribed “treatment” would be my solution. I needed to be “Bipolar”, and I needed to want the antipsychotic, antidepressant, and sleeping pill prescriptions that were written for me at the end of that first session, because they gave me hope that something could, and would, change. For, that’s what I wanted so desperately: a shift, some sort of momentum forward and out of the mire I was in. With his MD and PhD from Harvard, my psychiatrist emanated this powerful promise for change.
Just what does it mean to say that I was indoctrinated into Psychiatry?
-It meant letting Psychiatry tell me who I was, and forgetting how to define myself.
-It meant surrendering my humanness and replacing it with the narrative of a “chemical imbalance”, of an abnormal “condition” that made me different from everyone around me.
-It meant that I never questioned anything I was told by a psychiatrist, psychologist, or social worker, because I believed that “mental health professionals” had science on their side, and expertise about me that I could never have. After all, who would ever be so presumptuous as to question a doctor?!
-It meant sacrificing my agency, my sense of self, and my sense of responsibility and accountability to the DSM, to any proclamation made by a “mental health professional”, and to my “meds”.
-It meant that I stopped trusting my gut, following my instincts, or having faith in myself and my ability to feel big feelings or think intense thoughts, and that my psychiatrist was always on speed dial in case I needed an upped dosage or an extra therapy session when I sensed another “episode” coming on.
-It meant that I was fragile, “couldn’t handle” too much stress, was emotionally unpredictable (“labile” was a favorite word of mine), was “hypersensitive”, and was at the whim of my “disease”; indeed “being Bipolar” became my justifiable excuse for impulsive behaviors, fights with family or friends, and shirked responsibilities.
-It meant that most of my decisions began with, “My psychiatrist says that…”.
-It meant that I was Bipolar.
-It meant that I forgot how to stand up for myself and for my rightful place in the world.
-It meant that I no longer believed I should have full rights, as my “disease” made me less than human.
-It meant that I lowered my eyes in subservience before the shiny, gray-silver DSM-IV-TR, the Psychiatric Bible, my life’s definer.
-It meant that I worshiped at the altars of worn leather armchairs, praying to the Gods of DSM, Harvard Medical School, and Lexapro.
-It meant that I became convinced only Psychiatry could save my life and any scrap of sanity I may have had left; that if left to myself, I would surely perish.
(from Laura Delano’s brilliant essay: “Reflections on a Psychiatric Indoctrination, or, How I Began to Free Myself from the Cult of Psychiatry“)