Stigma & Mental Illness

Because it is both timely and still (unfortunately) relevant, here is something I wrote about a friend of mine.

I have a friend with a mental illness. Let’s call him Darren. Darren was a psychologist and he worked at a hospital in the city. He enjoyed his work and he was good at it. A practicing Buddhist, Darren was very widely read and would often join our household for dinner, entertaining and enlightening us with his knowledge and expertise. He talked about spirituality and history, about art and life and people. He lived a rich, full life and had many friends, a comfortable flat in the inner west and creative, fulfilling work. But in 2007, Darren had a breakdown.

In a series of heartbreaking phone calls, Darren wove the story of his illness and the devastating impact it had on himself and his family. He lost his job, his home, his health and many of his friends. When I caught up with Darren he would drive me to the beach and talk about the voices which had become his intermittent (and unwelcome) companions. At the same time, Darren’s skin was ravaged by eczema and he often wanted nothing more than to hide away from the prying eyes of an unsympathetic world. It was, in many ways a spiritual downfall, a coruscating encounter with the hostile forces of his own mind as it succumbed to an illness which seemed like an attack on his soul.

Darren’s experience is by no means uncommon. According to the 2007 National Survey of Mental Health and Wellbeing around 7.3 million Australians will experience mental health problems in their lifetime and almost 64,000 will be diagnosed with a psychotic illness. For many sufferers, the stigma which accompanies their illness can be just as debilitating as the illness itself.

It would be socially risible to blame a cancer sufferer for their illness, to exclude them on the basis of their affliction, or to make assumptions about their personalities, lives and social worth based on their illness. But this is what happens with mental illness. Being labeled as a schizophrenic can change a person’s social identity – the experiences often degrading and dehumanising.Many people with mental illness also suffer from “self-stigma,” internalizing the prejudice they see around them.The fear and shame of being labeled like this can stop people from seeking help.

People with psychotic illnesses like Darren often suffer from social isolation alongside their illness. According to SANE Australia one in eight people with psychotic illness had periods of being homeless in the previous year, “nearly a quarter reported feeling socially isolated and lonely. One in eight (13.3%) had no friends at all and a similar proportion (15.4%) had never known someone they could confide in.” (p.9) The illness itself brings its own problems, but the social consequences of the illness can make life with schizophrenia bleak. It doesn't have to be that way. Rather than seeing this as more bad news, or confirmation of our worst fears, we could look at it as a call to action – if social isolation is a consequence of having a psychotic illness, then we need to do what we can to ameliorate it.

The recent Work Wanted report on mental health and workforce participation focuses on the social isolation and stigmatization suffered by those with mental ill-health. It acknowledges the impact of stigma as a barrier to social participation amongst those with a mental illness and emphasises the lack of progress that has been made in de-stigmatizing psychotic illness.

Work Wanted addresses the potential for those with mental ill-health to gain employment, recognising the importance of supporting entry into the workforce and more precisely targeted help for job-seekers. The report recommends education and awareness campaigns for employers to increase understanding and create more flexible workplaces where disclosure of mental illness doesn't lead to job loss. But its not just bosses who are the problem – we all are.

As the report points out, the images of mental illness that stay in our public consciousness seem to be characterized by violence, dangerousness and despair. Success stories are rare – we don't see people with schizophrenia gaining employment, moving into their own flat, getting married or being active in the community. In the absence of more varied or realistic information about people with psychotic illness, relying on the mass media seems fraught with opportunities to have our prejudices confirmed. Isn’t it time we created some new ideas about mental illness?

My friend Darren was one of the lucky ones – he has a supportive family, somewhere safe to live, and has been able to re-enter the workforce, getting a job where he gets to use his skills and his experience of illness. Although he still has periods of illness, Darren has far longer periods of wellness, and he also has flexible, supportive employers understanding enough to appreciate and value his unique perspective and expertise.

Although the SANE statistics speak of the reality of living with psychotic illness in contemporary Australia, they don't tell the whole story. Many, like Darren, lead productive and fulfilling lives – many more could be helped with access to resources such as secure housing, employment and social support. If we want to make a difference in the lives of people who suffer from this illness we need to start in our own neighbourhood by refusing to give in to the ease of stereotyping and assumptions about mental illness and those who suffer from it. We can make a difference in the lives of those whose illness makes them one of the most vulnerable groups in our society, simply by reaching out our hand in friendship and support.

In the past, having psychotic illness often meant being locked up. Asylums were places where those who threatened social norms were locked away – snake pits and funny farms where inmates were subjected to invasive and coercive treatment of dubious clinical value. With the closure of the asylums, they have returned to the community. Isn’t it time we welcomed them back?