Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov “A bold but necessary move, self-disclosure is a first step toward successfully addressing the stigma associated with being mentally ill. Before we can reveal ourselves to others, we have to come out of our own dark closets.”

Steele and Berman, 2001 Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov Acknowledgments Numerous people contributed to the development of this document (see Appendix A, Participant List). This publication was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), by Iris Hyman under contract number 277-98-6010. Carole Schauer and Paolo del Vecchio served as the Government Project Officers.

Disclaimer The views, opinions, and content of this publication are those of the participants and garnered from the material examined and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), SAMHSA, or HHS.

Public Domain Notice All material appearing in this document is in the public domain and may be reproduced without permission from SAMHSA. Citation of the source is appreciated. This publication may not be reproduced or distributed for a fee without the specific written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication This publication can be accessed electronically on the Internet at www. samhsa.gov. For additional free copies of this publication, call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727).

Recommended Citation Hyman, I. Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services. HHS Pub. No. (SMA)-08-4337 Rockville, MD. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2008.

Originating Office Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 1 Choke Cherry Road, Rockville, MD 20857 HHS Publication No. (SMA)-08-4337 Printed 2008 CONTENTS

Executive Summary...... 7

Introduction...... 10

Purpose...... 11

Current Selected Literature...... 11

To Disclose or Not To Disclose?...... 13

Self-Disclosure in Employment ...... 17

Disclosure Among Mental Health Field Professionals...... 21

Other Disclosure Experiences...... 25

Disclosure of Other Illnesses and Situations ...... 29

Coming Out...... 33

Responses From Interviews ...... 34

Recommendations...... 35

Conclusion ...... 37

Appendixes

A. Participant List...... 38

B. References and Resources...... 39

C. Interview Questions on Disclosure...... 45 “The most important thing to remember is that you are in control of how much you tell; do not let anyone manipulate you into sharing more than you feel comfortable sharing.”

—Sean Bennick, Webmaster of Mental Health Matters Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services 5

Achieving Achieving identified discrimination discrimination identified

, the Promise: Transforming Mental Health Care in America in Care Health Mental Transforming Promise: the illnesses mental with individuals for torecovery obstacle central a being as stigma and 2003). Health, Mental on Commission (New Freedom problems persistent most the of one is illnesses mental with associated stigma The and employment, housing, in discrimination to fundamental is It face. individuals recovery. impedes it and treatment, prevents insurance. It attitudes individuals’ that shown has stigma and discrimination addressing on Research they illnesses, when mental with persons with direct contact have they when improve myths. and labels beyond people tocan know get personally— illnesses mental with people know to health getting is, mental received strategies—that have contact they For that identify or self-disclose to need individuals others work, to helping and hiding about worry to having not experiences, as such similar advantages has with Self-disclosure others services. finding illness, mental with experiences process. recovery own one’s promote even may which issues, health mental understand considerations of number a make must person A risks. have also may Self-disclosure such considerations personal include might These to disclose. whether deciding when or experience prior secret, a maintaining handle can she or he feels one well how as self- of sense one’s or experienced, have climate colleagues or discrimination an individual societal the and employers, actual or potential involving Considerations esteem. process. decision the into enter disclosure, might is considering one time the at Mental and Abuse Substance the of part (CMHS), Services Health Mental for Center The and Health of Department U.S. the (SAMHSA) within Administration Services Health literature current the examine to monograph this produced (HHS), Services Human of findingsseries a from includes monograph the In addition, to self-disclosure. related interviews. informant key to relates information available the of much that indicates literature the of review A an until wait to may disclose arena. The decision employment in the self-disclosure accommodation reasonable a until or workplace the in comfortable feels employee becomes necessary. Executive SummaryExecutive Health, Mental on Commission New Freedom The finalthe President’s of report

professional offered, “I’ve asked asked “I’ve offered, professional has it what patients my of many about know to them for meant one is there and history, my resounding and consistent feels person a If HOPE!” refrain: made has therapist the that own her his with or progress disclosure issues, health mental be may therapist the by consumers. the to beneficial not individuals of A number with professionally associated also have field health mental the

!” rofessional ealth P ental H M — he need become to educated about own condition one’s so that one can he recognition that one candecide share to less with those people who may he need pick to and choose when disclose to and under what circumstances he importance of feeling safe when one self-discloses he essential fact that each of us should be in control of how much tell; to do we not resounding refrain: HOPE refrain: resounding T educate others as needed The importance of first disclosingto someone one trusts T appear judgmental T T T let anyone manipulate us into sharing more than feel we comfortable sharing. there is one consistent and isthere one consistent ■ ■ ■ ■ ■ ■ know about my history, and history, my about know ■ ■ ■ ■ ■ ■ what it has meant for them to to them for has it what meant What else do we know about self-disclosure? self-disclosure? about know we do else What themselves have field health mental the in professionals are who individuals of number A strategies of variety a offered have professionals These services. health mental received such One work. they whom with consumers to disclosing and general in disclosing about written about their disclosure experiences. Much of the literature indicates that that indicates literature the of Much experiences. disclosure their about written difficult. although illness is positive, mental own one’s about todisclosing others self- about to decisions make also have life illnesses situations and other with People suggestions. useful provides issues these about literature the Examining disclosure. your child, your telling: are you person the fit to information your tailor example, the For for time take will it that remember to helps It friend. oldest your and neighbor, said. have you what tell to absorb you person situations personal or illnesses other or illnesses mental their disclosing find people Many that appears It others. to helpful overcome often to is and it recoveries, own their possible to more beneficial the gratifying, disclose, people more the and be can one open more the society. greater in stigma the discrimination and Factors that may facilitate self-disclosing include the following: the include self-disclosing facilitate may that Factors ’ve asked many of my patients patients my of many asked ’ve I “

sure and Its Impact on Individuals Who Receive Mental Health Services sclo Self-Di 6 Self-Disclosure and Its Impact on Individuals Who Receive Mental Health Services 7

be supported to further understand the significance of contact strategies on be supported to further understand to disclose in a way that is comfortable and beneficial within employment, to disclose in a way that is comfortable social, family, and other arenas. in developing strategies for individuals with mental illnesses to self-disclose. in developing strategies for individuals site information and training in disclosure. should offer Web vital information These dialogues will provide topic of self-disclosure. to individuals to self-disclose or preparing contemplating are mental health services who receiving thoseand support to who have already done so. he guidelines should help individuals learn The guidelines should help individuals cons of disclosure. how and when should be consumer ducational programs discrimination and stigma. E reducing teach individuals how and when to driven with the goal to encourage and disclose appropriately. to address self-disclosure in further examining the pros and cons to disclosure and cons to disclosure the pros in further examining self-disclosure to address and offering how and when individuals a dialogue for other consumers to hear have disclosed. inform that will self-disclosure and persons with mental illness about the pros ddress Discrimination and Stigma (Center) ADS ddress Center to A 5. SAMHSA/CMHS Resource dialogues on the should promote 6. Public and private mental health organizations rofessional and provider groups should join with consumers and family advocates should join with consumers and family advocates groups and provider 4. Professional nce these guidelines have been established, educational programs should educational programs 3. Once these guidelines have been established, S should support consumer workshops, meetings, and seminars workshops, meetings, and 1. SAMHSA/CMHS should support consumer 2. On the basis of these findings, SAMHSA/CMHS should develop guidelines on 2. On the basis of these findings, SAMHSA/CMHS Recommendations In fact, they saw self-disclosing as a mission to give others hope, increase public public increase hope, to others give a mission as self-disclosing with saw In they fact, experiences their reveal to others for easier it make help and awareness, illnesses. mental The findings from interviews of mental health consumers, some of whom are mental mental are whom of hiding some that consumers, health mental of The findings interviews from indicated politics, in another and clergy, the in others professionals, of health lot a consumes secrets one’s discover will someone that worrying and information stories. to tell their important was it felt individuals of A number energy. personal Achieving , defines stigma as a cluster of cluster as a stigma , defines Transforming Mental Health Care in America—The Federal Action Agenda: First First Agenda: Action Federal America—The in Care Health Mental Transforming identified discrimination and stigma as having a central impact on access to mental mental access to on impact a central as having stigma discrimination and identified

3. Institutional support for contact 4. High levels of intimacy the stereotype.” differ from mental illness does not greatly 5. The person with severe 1. Equal status among participants 2. Cooperative tasks define the interaction

the Promise: Transforming Mental Health Care in America in Care Health Mental Transforming Promise: the and avoid, reject, to fear, public general the motivate that beliefs and attitudes negative on Commission illnesses (New Freedom discriminate mental with against individuals 2003). Health, Mental face. people problems persistent prevents It most the of insurance. one is illness health mental and with associated stigma The employment, housing, in discrimination to fundamental is It recovery. impedes it and treatment, and stigma in reducing plays self-disclosure CMHS role the examines In this monograph, illness. mental with discrimination associated have people when illness improve mental about attitudes public that Research shown has challenges community the of have who individuals illnesses. Meeting mental with people with members interactions, or contact, productive are who and services health mental received to work, strategies contact these For 2001). Lundin, and (Corrigan attitudes stigmatizing services. health mental received have they that identify or self-disclose must individuals as a of contact benefits the on information extensive begun compiling have Researchers stigma. discrimination and to reduce way the between “contact that states this topic, on a researcher Corrigan, Psy.D., Patrick to regard with results greatest the illnesses produces mental have who people and public the illnesses and mental with people between interaction more the Hence change. positive of stigma the will stigma because Thistorn be more down. a challenge poses the public, People hidden. is largely lesbians, and men gay by experienced illness, like that mental the to benefits the against out coming of costs real the toweigh need illnesses mental with (Corrigan, 2003). themselves” as large well as at community Although out. comes person average the when occur effects greatest the that churchgoers shows Research fellow and coworkers, mental from of recovery stories neighbors, their tell notoriety with people when when benefit is some there challenged most are attitudes public illness, 2003). (Spikol, illness stigma mental beaten and with struggled too, have they, that admit elements following the when improve should effects “contact Corrigan that (2003) states are present: Introduction Center (SAMHSA’s) Services Administration’s Health Mental and Abuse The Substance health mental to improve leadership Services Federal (CMHS) Health provides Mental for services.(U.S. illnesses mental with individuals for Steps life of quality the on and services, health Services Human [HHS], and Health 2005). of Department Health, Mental on Commission New Freedom The finalthe President’s of report

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 8 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 9 s there a safe way disclose? to What impact does self-disclosure have personally and systemically? Why should a person disclose that he or she has received mental health services? What are the advantages and risks of disclosure? What factors facilitate disclosure? I ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Current Selected Literature books, from references of a compilation include in this cited monograph The selections disclosure of addressing sites Web various and research articles, projects, magazine the of much Although Resources). and B, References Appendix illnesses (see mental working consumers arena, employment inthe disclosure on focuses reviewed literature self-disclosure. about significantof statements number a made field health mental in the In addition, the monograph also examines techniques used by other individuals and and individuals other by used techniques examines also monograph the addition, In HIV/ with instance, individuals For to others. issues private disclosed have who groups lesbian and gay are who thisin AIDS significantarea. experience had Individuals have sexual their about others tell they when to define out” “coming phrase the coined have issues disclosure face illness mental than other disabilities with Individuals orientation. self-disclosure? address they do How well. as Purpose This examines monograph current literature related to self-disclosure and provides that factors examine the to interviews informant key of findingsseries a the from or promote hinder self-disclosure. Books, articles, sites andwere analyzed Web in toorder glean findingskey and regardingimplications the disclosureofmental illness in various arenas. following: the included examined questions the of Some “One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still that: dishonest.”

—Kay Redfield Jamison Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 11

Don’t Call Me Me Call Don’t , by Patrick Corrigan, Psy.D., and and Corrigan, Psy.D., Patrick , by ot havingot worry to about hiding experiences with mental illnessand being more aving increased anxiety due perceptions to that people are thinking about you romoting a sense of personal power and acting as living testimony against stigma xperiencing anger from family members and others because you self-disclosed. ncountering disapproval of your mental illness or your disclosure, including the risks inding others who express approval, including those with similar experiences inding someone who can provide assistance in the future hinking that future relapses may be more stressful because others will be “watching” P and discrimination. E of social ostracism and gossip Being discriminated against in employment, housing, and other opportunities H or pitying you T E N open about day-to-day affairs F F ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Corrigan and Lundin discuss two levels of disclosure: selective and what they call they what and selective disclosure: of Corrigan Lundin levels and discuss two specifically to who to choosing disclosure refers indiscriminate Selective disclosure. to tell. Indiscriminate authors disclosure, the when illness and mental one’s tell about a mental conceals longer no who person the by attitude requires of a change suggest, about attitude your changed successfully have “you that suggest They general. in illness or hesitancy of a sense evokes longer illness no mental talking about disclosure when is able an individual whether to determine questions sample offers The book shame.” indiscriminate with to cope disclosure. Some costs discussed costs include Some page of a chapter titled “To Disclose or Not To Disclose” in the book, book, in Disclose” the To “To Not or Disclose titled a chapter of page Illness Mental Stigma of the With Coping Nuts!: To Disclose or Not To Disclose? Disclose or Not To To experience. illness is a complex Mental choice. white and a black “Disclosure is not opening the states to disclose,” parts thisexperience of which to decide need People Robert Lundin (2001). Robert Lundin (2001). discuss list and include authors the that of disclosure benefits Some

done spontaneously.

t just felt natural to disclose at the moment. 3. It just felt natural to 1. The first time they disclosed was in a place where they felt safe or comfortable. they disclosed was in a place where 1. The first time they others said that it was ahead what they would tell, whereas 2. Some planned

First-time disclosure took place in a range of settings: from in front of a group for for group a of front in from settings: of range a in place took disclosure First-time consumer for one-on-one friend good a telling to Kennedy J. Patrick Congressman the or group the trusting of aspect the case, Ineach Pierce. Russell advocate disclosure. the of aspect individual an important was illness is a very mental one’s Disclosing to all be nothing. or have not does Disclosure mental about feelings own your at to look is important It decision. subjective personal, to needs everyone Not others. to information personal your disclosing before illness garner may diagnosis illness mental your sharing but struggles, person’s a about know from responses negative possible for yourself brace to important also is It support. the educate to try can you or disagree, to agree can You disclose. do you when people (Albert, you to 2005). assist are materials available educational Many person. said, group, advocacy consumer director a statewide S. Finkle, of Michael executive one-on-one, disclose don’t life, I usually my consumes “While movement consumer the I tell I do, what ask If to they disclose strangers. I don’t is a purpose to it. there unless judgment a make I then questions, more ask and interested, seem they if and them, so.” doing comfortable and beneficial be would it unless disclose to not tend I call. 2005.) (Finkle, communication, personal The authors view disclosure as a process. They conclude that there is no clear answer about about answer clear no is there that conclude They process. a as disclosure view authors The Lundin, (Corrigan and 2001). issue is a personal it to disclose; not to or disclose whether the of a majority thismonograph, for interviewed informants key the Among that indicated respondents

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 12 “It freed me from the burden of having to hide a part of me, and it freed me from the shame that comes from feeling as though you have to hide and keep secret the illness.”

—Interviewee Response “Another benefit of disclosure is that it promotes one’s recovery process by allowing one to form or join a self-help group and begin the relationships and conversations needed to reconstruct one’s self-image in a positive light. The more open one can be, the more possible it is to overcome stigma and discrimination in the greater society.”

—Daniel Fisher, M.D. Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 15

or a famous person ’Day, 2005)?’Day, A Beautiful Mind ther identity issues—including gender, race, culture, and age. ow competitiveow the employment position is competitiveow the profession stockbroker) is (e.g., muchow expertise you bring a particular to job if you are (e.g., the only person ow wellow you feel you can handle maintaining secret—and a sometimes having ow wellow you feel you can handle prejudice and discrimination as there been anything in the news or the media that might result in a period of as there been anything in the news or arts that might result in a period of rior experience or discrimination that you or colleagues experienced ype of business whether (e.g., prejudice is more or less likely) H increased prejudice? H decreased prejudice, for example, the movie disclosing a psychiatric disability (Goldberg, Killeen, and O other disabilities Whether staff or supervisors make positive or negative comments about people with disabilities, including those with psychiatric disabilities H H H in the metropolitan area who has this particular skill) Whether the particular accommodation request will be seen as problematic or as matter-of-fact request (e.g., for part-time hours may not be problematic since many employees work part-time) Whether staff and supervisors seem be to friendly one to another and you. to H lieto do to so Sense of disability pride or identity O T Size of employer large (e.g., company vs. small mom and pop business) Whether there are other persons with disabilities employed there Whether it appears the employer has adequately accommodated persons with H P senseYour of self employmentYour history ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ At the time you are considering disclosure are considering you time the At ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Several Web sites on the Internet that discuss when and how to disclose often focus on on focus often to disclose how and discusswhen that Internet the on sites Web Several developed illnesses, mental with individuals for site Web interactive One workplace. the and issues addresses Rehabilitation, Psychiatric for Center Boston University’s by C.Societal Issues B. Considerations Involving a Potential or Actual Employer A. Personal Considerations Self-Disclosure in Employment when services health mental receiving person a for important is analysis strategic A “Experiences presentation, her in Goldberg Susan states decision, disclosure a making ADA: the and Disclosure Employment Around Disabilities Psychiatric With People of of kinds three that suggests She Implications.” Their and Findings Research analysis: strategic the in useful be may considerations

Mental Mental

niversity Center for control and you are looking for a chance to work for a good good a for work to chance a for looking are you and control ehabilitation, 1998). . In his introduction, he pointed out that one of the most difficult most things the of one that out pointed he . In his introduction, sychiatric R share less with those people who may appear judgmental. You cannot avoidYou abandonment a judgmental by person, but you can decide to P Be very general: refer a medical to condition or an illness. Be a little more specific: indicate a biochemical imbalance, a neurological problem, a brain disorder, or difficulty with stress. Mention mental illness specifically: mental illness, a psychiatric disorder, or a mental disability. Give an exact diagnosis: clinical depression, panic disorder, obsessive- compulsive disorder, and other conditions (Boston U ■ ■ ■ ■ ■

■ ■ ■ ■ ■

Extensive information on the potential benefits and drawbacks of disclosure in the of the in disclosure drawbacks and benefits potential the on information Extensive Accommodations Reasonable on in an “Case Studies article, can found be workplace from results the offers It “Disclosure.” chapter in the Disabilities,” With Workers for not or whether about “decisions that disclosed, concluding have who people of surveys delicate most the be may to say, much how and to to disclose, whom, to when disclose, for Act (ADA) Disabilities implementation Americans With area the of complex and (HHS, disabilities” psychiatric 1993). with workers the Is That Not Work: To Not or “To inSusan Rogers, Work an titled article or truth tell the should you whether disagree experts about “even that says Question,” history gaps with a ‘Swiss-cheese resume’—a work about employer tolie a prospective can through.” drive a truck you controversial. still is resumes in gaps address to “how that states also Rogers to elicit designed to questions ask employers is illegal for it since However, can they first; job the get to consumers advise experts many illness, about information (Rogers, later” 1998). accommodations reasonable for ask and illness their disclose House Fountain services at director employment of Bilby, Ralph hand, other On the said He disorder. psychiatric a have they that themselves to admit to is do to have people through. going was he to him close what still to learning was tell others he how that following: the include makes he points Some in New York City, has long believed that people “should not cover up.” He offered that that offered He up.” cover not “should people that believed long has City, York in New so I am refreshing, not is rare and approach an honest feel managers personnel “most for looking illness. What you’re to their disclose not individuals to a mind counsel of about front to is a chance up be ‘Swiss-cheese resume’ your and yourself in presenting doing been have you life, but a tough had you’ve an illness, that have you that fact the have you that and working, for yourself preparing in of terms are positive things that under illness well your 1998). (Rogers, do” can you what prove and employer of Sean an from by Bennick, article Webmaster can gleaned be tips Important Matters Health reasonable accommodations related to work and school and other employment and and employment other and school and to work related accommodations reasonable to an Disability an “Disclosing article, This Your features site issues. education illness to an employer. a mental disclosing before considerations outlines which Employer,” specific be to how determine should to an disclose, individual decides one If when and accordingly: information additional provide should and disability the about

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 16 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 17 ) . g

, Judith Leibrich, Leibrich, Judith , www.stampoutstigma.or t’s an entirely t’s different perspective, opened and it’s I ee, personalee, communication,2005; see also ost people think are we courageous and that gives us a lot of self-esteem. eopleask questions, know. to want he most important thing remember to is that you are in control of how much you tell; P up life my (L a lot. M Just doing this is liberating; speaking I love now. You shouldYou educate yourself about your condition so that you can educate others as needed. T do not let anyone manipulate you into sharingmore than you feel comfortablesharing (Bennick, 2003). ■ ■ ■ ■ ■ 6. Monitor the media. (Mayo Clinic, 2005). 7. Join an advocacy group 1. Get appropriate treatment. 1. Get appropriate with supportive people. yourself 2. Surround 3. Make your expectations known. 4. Don’t equate yourself with your illness. your own experiences. 5. Share ■ ■ ■ ■ ■ Corrigan encourages professional and provider groups to join with consumers and family and consumers with to join groups provider and professional Corrigan encourages out” illness to “come mental with people for ways best the to about strategize advocates (Corrigan, 2003). The examples offered above do tend to suggest that individuals gain confidence by gain confidence individuals that to suggest tend do above offered The examples combat and with to cope also ability often gain illnesses. They the mental their disclosing Clinic illness. staff An Mayo written article by mental with associated stigma the following: the include stigma. They end help and with to cope ways specific suggests the editor, says that the “act of telling stories can restore people (re-store). The telling of (re-store). telling people can of restore stories “act the that says editor, the through telling to the relates who and interested is genuinely who storyour to someone from stories of compilation a is book This thing.” special very a is experiences own their agreed have and illness mental a with diagnosed been have point some at who individuals (Leibrich, 1999). experiences to share their outreach educational and advocacy consumer-driven, the Lee, director of Carmen illnesses conduct mental with individuals (SOS), Stigma in which Out Stamp program, speakingout: of benefits the on this insight offers presentations, community Another article appearing online offers guidelines for disclosure. The intent of this site is thissite of intent The disclosure. for guidelines offers online appearing article Another with diagnosed people that symptoms of variety for the with tocope ideas toshare Guidelines article—“My The out. day and in day with contend disorders dissociative rules six disclosure Personalities?”—lists Multiple Have I People Tell I Should Disclosure: n.d.). (Emily Riversrages, and experiences own writer’s the on based is “self-disclosure that learned she class, in a communications find that to relates able The author be or know not likely would they that yourself about someone tell you something person reciprocal, meaning be listening other to the should Self-disclosure you. about out ourselves.” about disclose we information of amount to in us guide the that using and Illness Mental Deal With To Stories: Discovering How of A Gift book, In the “I would encourage people to self-disclose with caution. To self-disclose whenever possible, but not if it puts one at risk. I would say take the temperature of the person or the company that one is disclosing to and adapt the way you do it (self-disclose) to that temperature.”

—Interviewee Lydia Lewis, 2004 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 19 Perspectives: A Professional Journal of the Renfrew Renfrew the of Journal A Professional Perspectives: (2000). Center Foundation Foundation Center whether than rather how, and when more is question the self-disclosure, to regard “With formula, pat no “I psychiatrist. have Ph.D., McGilley, Beth states patients,” I tell my to not sense makes only It sharing history. rules this for hard fast part my and no of as I conceive relationship, therapeutic the because rigid guidelines, any into myself lock occur the as exchanges in which connection intimate and is a dynamic, unique, it, demands.” and allows relationship outweighed then colleagues professional to my out “coming that further states She patients.…I’ve my with considerations same the with dealing had I’ve experience any and history, my about to know them for has meant it what patients my of many asked refrain: resounding HOPE!” and consistent is one there Disclosure Among Mental Health Field Professionals writes, “A Disclosure,” Gradual Psychiatrist’s in his “A M.D., article, Fisher, Daniel residency. his completed he and status, until power, individual’s the upon to is alsodisclose contingent freedom person’s hospitalization or illness his tolerant, disclose is not who did He trust—someone can position.” you someone “Pick disclosure. in prudence advises He often,this will More who a peer be experiences. the about fearless and understanding, Tryto discuss recovery. of process is in the and a similar through experience has been Try received. to you treatment the and episodes past about feelings and thoughts your for a strategy develop can then you that objectivity and understanding gain enough 1994). further disclosure” (Fisher, process recovery one’s promotes it that is and disclosure of benefit relationships another the that begin and notes group Fisher self-help a join or form to one allowing by open The more light. in a positive self-image to one’s reconstruct needed conversations discrimination in and the stigma is to overcome it possible more can the be, one society. greater states, Fisher community, health mental the in working also of issues the addressing In can provider, than the rather client the of needs is geared to the it “Disclosure, when of questions The relationship. the to dimension human valuable a add and hope nourish peers.” with discussions through are disclosures addressed best to such make when and how to a led community health mental in the working consumers about comment Fisher’s on focusing article The following topic. that on literature of further examination in a appeared disorders eating of histories personal with therapists of self-disclosure publication, the of special edition

for her clients. She says, “I am says, She clients. her for that possibility to the open information sharing some disorder eating my about helpful, be might experience to err on still prefer would but general, In caution. of side the important extremely seems it sharing whether consider to personal disclosing or will attuned be information needs.…Since client’s the to I don’t believe there is a clear a clear is there believe don’t I to self- guide decision-tree those disclosure, I use me helped who’ve therapists in my a model as most the the For work. therapeutic . “Overall,” she said that “the “the that said . “Overall,” she

h.D. , Andrea Bloomgarden, Ph.D., states that she was was she that states Ph.D., , Andrea Bloomgarden, arion Bilich, P M — Perspectives have kept in kept s long as I have good that has resulted has resulted good that has far outweighed any outweighedhas far any A harmful consequences.” “ my personal revelations in personalmy revelations mind possible the pitfalls of the media, the therapeutic therapeutic the media, the

In the same issue of of issue same In the initially afraid that if she disclosed with her clients, it would get back to her colleagues, colleagues, her to back get would it clients, her with disclosed she if that afraid initially becoming Since past. her about heard if they her respect not would they that and is best free what to really think feels about Bloomgarden colleagues, her with outspoken most part, I’ve chosen to self-disclose in response to a specific question and after and I’ve to a specific inquestion response to self-disclose part, chosen most I’ve 2000). (Bloomgarden, question” the of answering ramifications the client the with explored Thomas states intuitive an this patient,” him to help position is ingives a unique “The therapist recovering eating-disordered be to like it’s what knowing “His M.D. Holbrook, a trust early establishing of a chance has He his with patient. on going what’s of sense caution.…Self-disclosure of a word calls it for is a useful tool, but on…self-disclosure The patient’s. the than for recovery therapist’s the for more used be unwittingly could will disclosed what’s of The choice is also important. critically timing self-disclosure of an ‘I’ve just been not and offering, a meaningful helpful and it’s whether determine too’ story” 2000).there (Holbrook, 20 years some that states in article this publication, in another Marion Bilich, Ph.D., News Daily in the disorder eating her disclosed she ago, to with deal prepared be always must media the through self-discloses who therapist disclosing by that out also points She disclosure.” that of arise out may that issues the appearances—we television books, articles, media—newspaper the through “publicly in the mind kept I have as long “as that further says She timing.” over control lose has good that therapeutic the media, in the revelations personal my of pitfalls possible (Bilich, harmful any 2000). consequences” has far outweighed resulted of growing number but a “small that Fred in notes Frese, an online discussion, Ph.D., who professionals health mental other and social workers, psychologists, psychiatrists, such. as themselves identify toopenly decided have illness mental from areinrecovery of those experiences, their about open begin to could more be professionals If these

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 20 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 21

In An Unquiet Mind: A A Mind: An Unquiet In , which is a first-person account of manic-depression, manic-depression, of account is a first-person , which I have had many concerns about writing a book that so explicitly describes describes soexplicitly writing that a book about concerns many had I have problems my as well as psychosis, and mania, of depression, attacks own my obvious for been, have Clinicians medications. ongoing for need the acknowledging psychiatric to their make reluctant privileges, hospital and licensing of reasons no warranted. I have are well often concerns These to others. known problems will my on be so openly issues discussing of such effects long-term the what idea to are bound they consequences, the whatever life, but, professional and personal and I am tired tired misspent hiding, of of to silent. be than continuing better be I have though tired as acting and of hypocrisy, tired the of energies, knotted a hiding of behind dishonesty the is, and one is what One to hide. something dishonest. is still that: words, of collection and manner any or a title, or degree, illness; manic-depressive have you that people to tell other way easy is no There told I have that people most that fact the So despite it. found is, I haven’t if there those so—I by haunted remain remarkably understanding—some very been have a lacking in even or unkind, was condescending, response the when occasions empathy. of semblance Memoir of Moods of Madness and Memoir states: (1997) Jamison further relates: She their family members and consumer advocates could better realize that mental health health realize mental better that could advocates consumer and family members their consumer from in isolation much as made being are not research decisions and policy Vogel-Scibilia, 2001). appear” Kress, and (Frese,may Stanley, it as influence has Jamison,Ph.D., Redfield Kay professionals, health mental among Notable illness. mental her disclosing books of a number published

“Self-disclosure had a most positive impact on my life. Through self-disclosure, I have accepted that something had changed and that I was different. It was too difficult and painful to deny what was happening to me.”

—Interviewee Response Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 23

. , New New , notes , notes aving ndrew Solomon A — , relates his , relates New York City Voices City York New ’d recommend coming out coming out recommend ’d , by Andrew Solomon, discusses disclosure Andrew Solomon, , by I about depression. H about secrets is burdensome and secrets exhausting, and deciding the convey when to exactly in kept have information you is readilycheck troublesome.” “ Darkness Visible: A Memoir of Madness of A Memoir Visible: Darkness

. Styron (1990) states: . Styron (1990) I had described. It is the only only is the It described. I had it felt life I have in my time my invaded to have worthwhile that to make and privacy, own And I thought public. privacy momentum, such given that, in experience my with and of example detailed a as Paris occurs during depression, what useful be to try to would it own my of some chronicle and illness the with experiences establish perhaps process the in of out reference of a frame valuable more or one which drawn. be might conclusions The overwhelming reaction made me feel that inadvertently I had helped unlock a helped I had inadvertently that feel me made reaction The overwhelming too, they, proclaim that and out to come eager were souls many which from closet feelings the experienced had Other DisclosureExperiences field health mental the with professionally associated not individuals of A number are individuals the of Some experiences. disclosure their written about also have to disclosing that to indicate seems literature Overall, are the not. some and famous, difficult. although illness is positive, mental own one’s about others William Styron, in hisAuthor book, The An Demon: Atlas Depression of Noonday that in 1987 he was so annoyed about the press coverage of the suicide of Primo of Levi, suicide the of coverage press the about so annoyed was he in 1987 that the of page op-ed the for article wrote a short he that Italian writer, a famous Times York however, to say, have “I would states, Solomon “Politics.” titled in chapter a stigma and to easier illness to and bear the easier it made has depression my talkingthat about is secrets Having depression. about out coming recommend return. I’d its forestall you information the to convey when exactly deciding and exhausting, and burdensome 2001). (Solomon, is really troublesome” in check kept have and editor and advocate health a mental was Steele Ken his of death, time the Until Advocacy Health Mental for Journal A Consumer Voices: City York New of publisher Madness Hope and of A Memoir Stopped: His The book, Voices Day the “Most striking about recovery. illness story and of personal illness,” mental with people by stories personal of inclusion the been has however,

hospitalized hospitalized be in which consumers consumers which in presentations make Along the lines of lines of Along the York New Steele’s program, NAMI the as known (formerly Alliance for National has a Illness) Mental “Inprogram titled Our offers that Own Voice” for opportunities speak to consumers community. the to offers site The Web this on information program outreach the program works works program the

, found herself speaking in public at at speaking in public herself , found —Ken Steele Steele —Ken of our darkof own closets.” bold but necessary move, A bold necessarybut move, “ Before we can reveal ourselves ourselves reveal can we Before to others, we have to come out out come to have we others, to

self-disclosure is a first step toward toward step first a is self-disclosure

associated with ill. being mentally associated successfully addressing stigma the successfully to various audiences. It also presents an explanation of how how of an explanation also presents It audiences. various to says, and experience discusses the she In an in article Newsweek, anas adolescent. prodigal my this of privilege and unlikelihood at ecstasy surreal a by “I am overcome will go questions my of will many this and day pass, that know also I But return. to reparations make in so and doing, All story, unanswered. is tell I can my do myself” (Lewis, 2003). a about article in a Maine newspaper is chronicled self-disclosure of The power paper. local a in mentioned been had illness mental His Shumate. Tom man, 46-year-old to share his experiences decided Shumate After “outed,” to his being initial reaction his conceal neither would he that concluded had He shop. a local coffee at others with for is important it that emphasized Shumate them. for apologize nor experiences best the can get they so that to tell someone are symptoms having who individuals gets it try it, to hide you is—when it as hard enough “It’s commented, He treatment. a whether out disclosure comes sometimes that This out points article harder.” even good and can turn something disclosure into one the but not, or it for is ready person 2004). (Nemitz, others for an example set consumers to gain self-confidence, self-esteem, and income while serving as role role as serving andwhile testimonials income of the and NAMIprogram. for “it is also an opportunity that notes self-esteem, self-confidence, gain to consumers community.” the for models Inside: A Memoir Life of Lewis,Mindy author Steele states, “written in our own words and under our own bylines (often accompanied accompanied (often bylines own our under and words own our in “written states, Steele is a first self-disclosure necessary move, but A bold contributor). the of photograph a by ill. mentally being with associated stigma the addressing successfully toward step closets” dark own our of out to come have we to others, ourselves canreveal we Before Berman, and 2001). (Steele grand rounds to more than 100 mental health professionals at a hospital where she she where a hospital at professionals health mental than 100 to more grand rounds like to was it what to talk invited was about to She 18. 15 age from lived

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 24 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 25

. In an accompanying accompanying an In . Washington Post article, Widom describes how he tries to educate friends and colleagues about attention attention about colleagues and friends educate to tries he how describes Widom article, For comic. standup a being by (ADHD)depression disorder and hyperactivity deficit skills the coping like practicing as well as helped, has therapy him, findingright the “Take to society: the tosses a challenge He stage. on uses he humor self-deprecating 2004). (Guzy, me” with a laugh have and through, going I’m what hi ask and to say time gives Mine,” Have You Now Labels. Need People Well: as “Mad article, her in Spikol Liz which in newspaper Philadelphia in a writing a column about account first-person her She received. she reactions the describes illness and mental her about out” “comes she contended specificShe diagnosis. her inquiries about of a number were there that said 2003). (Spikol, labels with comfortable more were people that and stigma was, once taboo it as as illness is not mental of subject the Although have either who individuals brave the But discrimination are still prevalent. highly seem stories, to tell their volunteered have or to self-disclose, pushed or forced been recovery. part their of an important and it liberating to find Jeffrey Widom smiles in a picture featured in the in the featured in a picture smiles Widom Jeffrey “The brave individuals who have either been forced or pushed to self-disclose or have volunteered to tell their stories, seem to find it liberating and an important part of their recovery.”

—Quote From the Monograph Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 27 —Because timing—Because is critical, telling every , a magazine about multiple sclerosis, discusses whether to discusses whether sclerosis, multiple about , a magazine —The emotional climate of the workplace is different from from is different workplace the of climate emotional —The How to tell? Blurting out “I have multiple sclerosis” communicates poorly, possibly possibly poorly, communicates sclerosis” multiple “Ihave Blurting to out tell? How provokes that a label not information, tell needs you The person falsely. even person the to fit will information to your tailor need . . .You frightening images. friend. oldest your are neighbor, telling: child, your you your and disclosure romance of Issues progresses relationship the telling when not but a bore, be could date you person too to as soon be not Tell this thumb: rule of suggest is unfair We persons. to both it that to remember to helps to as too trust. a threat be It late not unnecessary, Think said. have how you what tell to absorb you person the will for time take illness. your to accept you has taken it long work at Disclosure telling your family and friends. There you confront the question of disclosure in of question the confront you There friends. telling family and your future livelihood. and present your about concern of context the you you, for limitations any created If MS not has your job? the toWhen tell on against disclosure will you, used be feel not if you But nothing. to say decide may you for better and relieving is more coworkers your and telling boss your that and is threatened performance tell. If job your should you then than remaining silent, accommodation seek to order in tell to need you then . . . symptoms your by ADA. the by provided need to know employer’s your on focused Stay nonapologetic. Be brief, and specific, what rehearse else, telling with as anyone But job. your to do ability your about speak Then world. business the from someone with Role-play to are say. going you It job. your desiredo to and experience, ability, your of positively and confidently not does that a disclosure statement rehearsed to have important is extremely disability. the disease or the overembellish tell or not to tell about MS, and these topics again are similar to issues that individuals individuals that issues to similar are again topics these and MS, about tell to not or tell Abel, 1994): Van and Siegel, (Donoghue, illnesses face mental with convey to want you what down writing recommends further disclosure on article MS The trust: you someone with role-playing some doing and Disclosure of Other Illnesses and Situations to how and what on also decisions make situations illnesses and other with People appeared “Disclosure: Facts,” The Basic titled article, such One information. disclose of many The covers article site. (MS) Sclerosis Web Society’s Multiple National the on Multiple (National illnesses address mental with individuals concerns same the 2004). Society, Sclerosis A similar in article Inside MS tell you technical before to get advice is essential it that The MS suggests magazine kinds of the about advice and ADA provisions the about facts the employer—get your people: other for worked have that accommodations article further further article suggests not disclosing MS in a job interview. “You are not required to do it legally. legally. it do to required not are “You interview. job a in MS disclosing not suggests are. you who and do can you what know yet not does interviewer your Moreover, can that guilt irrational feel MS with people Many established. been not has Trust has job a for interviewing everyone nearly But disclosure. premature prompt habits, drinking their pressure, blood their tell: to not prefer would they something family problems.” their health mental in us the of those for only not concern of is a matter Self-disclosure jails from and community are the re-entering who those also for but community, want we that us about something is there that presupposes Self-disclosure prisons. in us a will put it known or us hurt unknown—because if or made private to keep made if us to done be will something that presupposes also Self-disclosure light. bad we when with grapple us of many is what issue “this suspects latter He known. known will make if us from we taken self-disclosure—that something be consider us—our about dignity self-respect.” or something What to tell in a job interview? Unless you are visibly disabled, the the disabled, are visibly you Unless What to interview? tell in a job

Thomas Arthur, in his article, “Issues in Culturally Competent Mental Health Health Mental Competent Culturally in “Issues article, his in Arthur, Thomas privacy about to attitudes barriers relating discusses the Color,” of People for Services The issues. health mental and to emotional reference with color of people among those address should system health mental the ways on suggestions offers article the that implies it se, disclosure per examine not his does article Although barriers. to services be is an seek issue privately to cultures even other of attitudes and privacy disclosure 2000). (Arthur, before addressed was who 2004), a consumer May early (personal Pierce communication, Russell out: points this monograph, for interviewed in people how on focuses series 2004 toRecovery SAMHSA’s Road hand, other the On recovery successful their recount and testimonials provide can addictions from recovery and myths also addresses It still and respectful be 12-step traditions. of journeys to courage the and hope others give could that voices the silence that misconceptions Services, Human 2004). and Health of (U.S.recover Department

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 28 “Contact between the public and people who have mental illnesses produces the greatest results with regard to positive change. Hence the more interaction between people with mental illnesses and the public, the more stigma will be torn down.”

—Patrick Corrigan, Ph.D.

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 31 , g www.hrc.or to be aware of and work work and of to aware be different people, and expect it it expect and people, different which includes information available on “coming out” in a separate section noting noting section in a separate out” “coming on available information includes which remember to others, out to come really need you whether “Ifthat, are questioning you is also a powerful It yourself. for can do things you powerful most the of is one it that someone know who people that shows opinion public as others, for can do thing you in step one be may Coming out equality. for quest our to support likely are more gay future.” in the and today all GLBT for people, to a giant leap contributes it life but your director which HRC’s executive the from within a letter This emphasized also was transgender or bisexual, lesbian, gay, an openly being that “Letstated, assure you me than gratifying more much so is disclosure But easy. always not is society this in person will your discover someone worrying and that Hiding information closet. in the being life.” your of quality the from also detracts It energy. personal of a lot consumes secret face color of people Many project. Out Coming National a supports HRC the addition, In National the issues, these address To GLBT. as out come they when challenges American unique African the in out coming on resources new developed has project Out Coming Asian the Pacific community. and American Latina/Latino the community, community, an and “Coming article, Out features Kingdom United the from site Web Another This a step-by-step gives article Bisexual Men.” and Gay for Information Out: Staying clear is a very It in England. to out” resources “coming and suggestions and analysis offers, it example, For to make. considerations what to and proceed how of example Bear in to immense. be “This is likely time—the rejection racking of fear is a nerve 2004). Health, Men’s (Gay to tell someone” ways are many there that mind process. out coming the for model basic good a calls it what offers site Web another Still know minority.’ others lets “Coming out states, it “The ComingIn Out,” of an titled article Stages ‘invisible an extent large a to are we them; around exist lesbians and gays that chance the others gives and visible, us makes Coming out these consider to and world, the in else discrimination the see to someone biases, by own else their through somewhere them with confronted being before own their on issues 2005). (Niolon, fashion” understanding less a in disclosing are who individuals by considered be might also that words includes article This is crucial to that process is a normal “Overall, illnesses: out’ ‘coming mental their in some ‘out’ can more be You yourself. good about are feeling and you who accepting to ways in different out’ ‘come than insettings others; of process the of part significant a is It badly. go to sometimes and well go to sometimes ones.” loved and friends to your closer becoming and identifying Coming Out AIDS Day discusses Kingdom World United the from site Web informative Another disclosure regarding of HIV/AIDSstories personal individuals’ a as well as offers and 2004). (worldaidsday.org, stigma discrimination and of discussion closet” the of out “coming and illness mental a disclosing in similarities many are There kinds of the (GLBT). of In a review transgendered or bisexual, lesbian, is gay, if one self- of in consideration and lesbian or is gay who to someone available information material. of is a plethora disclosure, there (HRC) site, Campaign Rights Human Of particular Web is the note

Responses From Interviews From Responses interviews The self-disclosure. with mental received have or receive who people of experiences number a with interviews informant Key their about conducted were services health Disclosure). on Questions C, Interview Appendix (see telephone by conducted were Three men approval. and editing for responses their sent each were The interviewees for were who individuals included The interviews interviewed. were women four and as or professionally either now issues health mental on working part actively most the disclosure. with experiences their allabout candid were They volunteers. One freeing. very self-disclosing of experience the found individuals some In response, it and a part me, to having of hide of burden “It the from freed me offered, respondent keep and to hide have you though as feeling from comes that shame the from freed me illness.” the secret life. Through self- my on impact positive a most “Self-disclosure had stated, Another It different. I was that and changed had something that accepted disclosure, I have to chose I me. Therefore, to happening was toowhat difficultwas painful and deny to I think through. going self- I was what about myself and others with honest very be I have that I believe Honestly, comfortable. feel people other story helps my disclosing in life again.” I can participate where to a point least at recovered, under to and disclose when choose and still pick selectively disclosed have who Others “Self-disclosure has to an offered, be individual’s individual circumstances. One what was Mine cons. and pros the at look to have You everyone. for different is It choice. something through are going who to tell people responsible I feel spiritual. more has it and survived self-disclosure, I have that through been I have similar to what you when safe feel sure to you be make would suggestion My me. healing for been self-disclose.” expressed, Alliance, Support Bipolar and Depression the of president former Lewis, Lydia To caution. with to self-disclose people encourage I would “I but think is wonderful, it the take say risk. would I at one puts if it not but possible, whenever self-disclose way the adapt to is disclosing and one that company the or person the of temperature temperature.” to that (self-disclose) it do you disclose I functioning. high as me see to people want I time the of “Most said, person One more a little me take may it that know them to let people for helpful be may it when or consumers are not who friends personal any have not I do things to done. get time friends personal my of Most any. need to seem don’t I because It’s consumers. to related challenges.” my know already

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 32 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 33 disclosure. One person had an experience when being treated in the emergency room and another another and room emergency in the treated being when an experience had person One professional the case, In died. each relative after a close a grief counselor seeing when inappropriately. acted mission their was it felt They stories. to tell their important it felt individuals Several hope. to to others disclose give compelled felt and is the gained things I have the “One of offered, Kennedy J. Patrick Congressman front so out being for me thanked have who met I have that people the from response more them forward gives coming public, so being of I think profile my personally. before long be won’t I think it it. that written about a lot was there because comfort I illness. this to guilt much carried we so that foolish think and how back look we is to it to as how to others to an be example way in own our think works us of if each lives.” own in their support to get others help may illness, it the with live after site disclosing Web started an educational Veierstahler AnnSister Catherine of stories features site The Web interview. illness in a local newspaper mental her on impact well. servicesare an and doing health mental received have have who individuals to opportunity an others, to hope offers “disclosing that says Veierstahler illnesses mental about others educate to opportunity an and stigma, and that discrimination states further She progress.” making are who people of experiences positive the and youngest I try tothe to get help. without I did as long as to live people any want don’t “we to hope give site they Web our on stories of things thousands tothe have all love I would have away. well right so people doing are who those is, trouble The others. to healing and others.” significant special as or help lives to their see even not do so they well to get needed also professor, psychology Holyoke Mt. a but interviewee, an not Ph.D., Hornstein, Gail of a bibliography compiled has She experiences. consumers’ in studying value sees says, Hornstein than 500 titles. more lists which madness,” of narratives “first-person Another perspective came from an individual who said, “Persons can self-disclose when when self-disclose can “Persons said, who individual an from mentally came being perspective of Another designation the than other something accomplished have they feel they of a multitude have People a good artist, be ill. a good friend. or cook, may . . . I other of support of ourselves—balance organizing among I resent characteristics. a part being of pull the resist shouldn’t People can limiting. be is good, but consumers community.” larger the of including community, professional health the that commented individuals A few to in responding compassionate least to the be seemed care providers, health of the person. person. the of I don’t think you can say if it is right for one person to disclose or not. How do you you do How not. or disclose to person one for right is it if say can you think don’t I person— right the it’s know they do married, gets how a person like when It’s know? a correct having not . . . Timing thing. I hated personal a very is important. it’s tell could and better and much I was that worked, that about a treatment I had once open diagnosis, but very was I before. years seven cancer When stomach had level. I comfort story. my individual’s the on depends It me. for pray to everyone told to share. opportunity the I have will so glad I’m they disclose. are ready, people Would you encourage others to self-disclose? others encourage you Would values. their with is consistent it as so long I do, So liberating. to tell others. release and relief is a great It is so healing to me. It because choice, It has be to an individual like butterflies. feels it Sometimes are different. self-disclosure for reasons the and is different everyone others. can help they how of in terms people for it encourage I would Absolutely, and society change disclose—you are if helping you it about better can feel You lives. people’s to save helping personality the on depends sharing of a lot and levels areThere many

“All of us need to have a more humble, appreciative, and respectful attitude toward toward attitude respectful and appreciative, humble, more a to have need us of “All the toward especially and can in general make patients contributions the illness” their of agony the from to make able been they’ve accomplishments a teach Edwards Lee professor Massachusetts of (Hornstein, 2005). University and She first “the course believes, she “It Illness.” is,” Mental of Narratives “Patient seminar, patients.” writings mental of the of entirely texts consist whose anywhere informants: key posed the to question arethe to specific responses The following Some to this question. replies in their differences greatest the had Respondents cautions. issued others to disclose; individuals encouraged comments: the of are a few Below

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 34 Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 35

Center) should offer Web site information and training in the topic of disclosure. disclosure. of training and topic in the information site Web offer should Center) and self-disclosure on information of repository centralized a of The establishment service. a much-needed provide and self-disclosure promote trainingin disclosure would health mental receiving of topic people the on to dialogues promote should information organizations health vital mental private offer and Public could dialogues Such self-disclosure. those support as well as to self-disclose preparing or can are contemplating services who groups support “Mutual said, interviewees the of one As so. done already have who have who talk and to groups others support Go to mutual issues. these of a lot with help can.” people Other dialogue. you give can’t paper A it. did they how them Ask disclosed. SAMHSA’s CMHS should support consumer workshops, meetings, and seminars to further Recommendations further to seminars and meetings, workshops, consumer support should disclosure, of CMHS disclosing. benefits SAMHSA’s and costs the experiences examining include that individuals’ issues self-disclosure documenting as address well as approaches, strategic discussing discussed. is substantially this topic that to indicate seem not does The literature their discuss individuals which in accounts first-person of is a plethora there Although promoting on resource centralized no or little appears there experiences, and illnesses can point starting a as thisreport of Use disclosure. about consumers educating and the offer may report The subject. the of examination comprehensive a about bring screen. radar the on impact its and self-disclosure of topic the to put opportunity to family advocates and consumers with join should groups provider and Professional illnesses to self-disclose. mental with professionals for ways best the about strategize are from in recovery who professionals to those available made be should Information in many experiences, Their themselves. identify to openly how illnesses on mental families. their and serve they people to the promise and hope offer could cases, SAMHSA/CMHS self- meetings, on guidelines suggested From the develop should discrimination and stigma countering of of cons and pros the illness about way mental will with disclosure that a person inform effective most the that known is It disclosure. when and learn how people to help important is it therefore, contact; is interpersonal is comfortable that services in a way health mental received have they to that disclose development the with done be could This step disclosing. person the for beneficial and others with toconnect individuals for chance a offering self-disclosure, on guidelines of purposeful and way. illnesses in a nonthreatening mental about teaching them and SAMHSA/CMHS in place, suggestions and are public guidelines there Once other and educational the Such to programs further understand educational stigma. establish should and organizations private and discrimination reducing on strategies contact of significance to share individuals encourage to goal the with driven consumer be should programs illnesses. mental surrounding stigma and discrimination reduce thus and stories their The SAMHSA (ADS Stigma to Discrimination and Address Resource Center

Self-DiScloSure anD itS impact on inDiviDualS Who receive mental health ServiceS 37

next next

ften, telling your story is especially rewarding and liberating. iming has be to right, and only you can determine when it feels right self- to nitially, it is a good idea tell to someone you trust, who is tolerant and understanding. f you are disclosing your to employer, the decision disclose to may wait until t is important remember to that you are in control of how much you disclose; don’t t is also important remember to that sharing your own experiences may offer t is helpful educate to yourself about your mental illness and be to ready for someone else hope that they too can recover. have the conversation, and know how you will refute any negative responses. I you feel comfortable in the workplace or until a reasonable accommodation becomes necessary. I let anyone manipulate you into sharing more than you feel comfortable sharing. O Self-disclosure can promote confidence and a discoveryyourself of while acting as living testimony against stigma and discrimination. I I T disclose. I questions and concerns from those you tell. may practice want You to role-playing by what you will before you say, actually ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Overall, the literature seems to indicate that disclosing to others about one’s own own one’s about to disclosing others that to indicate seems literature Overall, the for importance utmost the of difficult.it is although Thus, illness is positive, mental issues, health mental with to cope how only not other to learn each from individuals is that in a way to others problems had have or have they to that disclose how but of topic the on openness and contact The more rewarding. and helpful, liberating, services will health mental receive who people more the in society, our health mental discrimination. and stigma the to avoid able be in discussions by tackled been taboo to discuss have once were that issues Sensitive the be services should health receiving mental about to disclosing others public; “open forum.” forum.” “open Conclusion a addressing discussion to is begin much-needed a thisThe monograph purpose of most the that is known illnesses. It mental with people of lives in the crucial issue experiences, their If contact. discrimination is interpersonal and share stigma countering of to way effective encouraged are services health mental receive who individuals that suggests The literature self-disclosure? facilitate would that factors are the what health mental one’s particularly oneself, about people many or person telling one done have others that knowing But dilemma. a “lump-in-the-throat” is always issues, can experiences, consumers’ circumstances, learning of and so in other a myriad from are about who those for easier so much road can the and make helpful enormously be employer. or colleague, friend, neighbor, to tell a relative, monograph; the throughout themselves repeat to seem ideas simple seemingly of number A personal and complex a is self-disclosing that be to seems theme recurring the however, so. to do ready and strong feel they when only address must individuals that issue those for considerations following the offers paper the this with theme, In keeping self-disclosure: contemplating v v v s

Yokote Sharon P. Patient Hospital State Hawaii Committee Protection [email protected]/o Federal Representatives: Substance Abuse and Mental Health Services Administration/ Center for Mental Health Services Vecchio del Paolo SAMHSA/CMHS Cherry Road 1 Choke Rockville, MD 20857 [email protected] Schauer Carole SAMHSA/CMHS Cherry Road 1 Choke Rockville, MD 20857 [email protected] Chris Marshall SAMHSA/CMHS Cherry Road 1 Choke Rockville, MD 20857 [email protected] s

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Sister Ann Catherine Veierstahler AnnSister Catherine Honorable Patrick J. Kennedy J. Patrick Honorable [email protected] Key InformantsKey Director S. Finkle, Michael Executive On Our Own Maryland of C Suite Street, Edgewood 1521 MDBaltimore, 21277-1139 [email protected] Representatives of House U.S. DC 20515 Washington, [email protected] c/o President Lewis,Lydia Former Alliance Support Bipolar and Depression Franklin730 North 501 Suite Street, ILChicago, 60610-7224 http://www.dbsalliance.or Affairs Family and Manager County Stanislaus Recovery Services and Health Behavioral [email protected] Inc. Homes, Pathway Fairfax 200 Suite Boulevard, 10201 22030Fairfax, VA Antida Charity Joan St. of of Sisters to Healing Hope APPENDIX A APPENDIX Participant List Consumer Maria Maceira-Lessley, Box 270728 P.O. Allis,West WI 53277 Russell Pierce, Regional Pierce, Coordinator Russell Services Inclusion Recovery and of [email protected]

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. (pp. 199– (pp.

. New York: Scribner. Scribner. York: . New . New York: Random House. House. Random York: . New Dialectical to approaches (accessed April 2008)/ (accessed 3 . New York: McGraw-Hill. York: . New Don’t call me nuts!: Coping with the stigma of of stigma the with Coping me nuts!: call Don’t he day the voices stopped: A memoir of madness of A memoir voices stopped: he the day Fear is no longer my reality: How I overcame panic panic I overcame How reality: my is noFear longer . Mahwah, NJ: Erlbaum. Erlbaum. NJ: . Mahwah, The An depression atlas noonday demon: of A gift of stories: Discovering how to deal with mental illness mental to Discovering how stories: A gift deal with of On the stigma of mental illness: Practical strategies for research and and Practical research strategies for illness: mental of On stigma the (pp. 121–175). Tinely Park, IL: Park, Recovery Press. Tinely 121–175). (pp. Washington, DC: American Psychological Association. American DC: Psychological Washington, . In B.M. Montgomery and L.A. and . In B.M. Baxter Montgomery (Eds.), . New York: Basic Books. Basic York: . New (chap. 13), Self-disclosure and openness section [Online book]. [Online book]. section openness and Self-disclosure 13), (chap. Angell, B., Cooke, A., and Kovac, K. (2004). First person accounts of stigma. In P. In stigma. P. of K.Angell, A., accounts First Kovac, (2004). and B., Cooke, person Corrigan (Ed.), social change. (2004). J. Glatzer, and J., Blyth, too can you and socialand anxiety disorder APPENDIX B APPENDIX References and Resources* Books Corrigan, P., and Lundin, R. (2001). Lundin, and R. (2001). Corrigan, P., illness mental The dialectics stigma of closet: the of out coming Going and Dindia, into K. (1998). disclosure *This list is as is provided by SAMHSA. It not endorsement a resource. exhaustive, and does it not imply Dunedin, New Zealand: Otago University Press. Zealand: Dunedin, Otago University New A. (2001). Solomon, studying personal relationships personal studying moods of madness and A memoir K.R.Jamison, mind: An unquiet (1997). Knopf. York: New 209). (1999). J. Leibrich, Darkness visible: A memoir of madness of A memoir visible: Darkness (1990). Styron, W. skills. In Psychological C.E. (1996–2005). developing Tucker-Ladd, for Methods self-help www.psychologicalselfhelp.org/Chapter1 and hope and Steele, K., and Berman, C. (2001). T K., Berman, and (2001). C. Steele,

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Psychiatric Services Psychiatric http://my.webmd.com/content/ , 54(9), 765–776. , 54(9), , 9(1), 35–53., 9(1), , 4(3), 426–447., 4(3), www.bu.edu/cpr/jobschool/disclosing.ht (accessed April 2008) (accessed FAQS.html , 18(1), 3–13. , 18(1), Rehabilitation Vocational of Journal / (accessed April 2008)2 (accessed (accessed April 2008)m (accessed , 24(1), 113. , 24(1), Psychiatric Rehabilitation Skills Rehabilitation Psychiatric , 22(1), 133–145. , 22(1), Perspectives: A Professional Journal of the Renfrew Center Foundation Center Renfrew the of Journal Professional A Perspectives:

Donoghue, P., Siegel, M., and Van Abel, M. (1994). To tell or not to tell. not tell or To Abel, M. (1994). Van M., and Siegel, P., Donoghue, Eakin, P.J. (2001). Breaking rules: The consequences of self-narration [Digital]. self-narration of BreakingThe consequences rules: (2001). Eakin, P.J. Biography K.L., A. Patterns (2003). Lyass, Ellison, Z., and M.L., MacDonald-Wilson, Russinova with managers and professionals disclosure among workplace of correlates and conditions. psychiatric personalities? multiple I have Emily and Riversrages. (n.d.). My guidelines for disclosure: Should I tell people I tell people Should disclosure: for guidelines My (n.d.). Riversrages. and Emily 54(10), 1313. discrediting on Lessons social from psychology (1999). D. Penn, and Corrigan, P., American stigma. Psychologist psychiatric www.dbsapages.org Corrigan, P., and Watson, A.C. (2002). The paradox of self-stigma and mental illness. mental and self-stigma of The (2002). paradox A.C. Watson, and Corrigan, P., Science Practice and Psychology: Clinical questions. Alliance. asked Support (2005). Frequently Bipolar and Depression Bennick, S. (2003). Incremental disclosure: Talking about your mental illness. mental your Talking disclosure: about Bennick, S. Incremental (2003). www.mental-health-matters.com/articles/article.php?artID=26 April 2008)(accessed the through Self-disclosure to kill father?: reallyBilich, want M. (2000). your you Did media. April 2008) with Persons policy: in public consequences Unintended (1994). J. Campbell, Act. Americans Disabilities with the and disabilities psychiatric Journal of An examination gamblers: problem Online for assistance (2001). G. Cooper, Ontario Doctoral stigma. of dissertation, role the and characteristics participant Toronto. of in Education/University Studies for Institute ca/Results.ht closet. the of out Come stigma: the Beat (2003). Corrigan, P. Articles illness. mental Albert, about S. (2005). Coming out people services for health mental in (2000). competent culturally Issues T.E. Arthur, color. of Article/98/10469 Bloomgarden, A. (2000). Self-disclosure: Is it worth the risk? the worth it Is Self-disclosure: A.(2000). Bloomgarden, 8–9., 5(2), Foundation Center Renfrew the of Journal Professional your Disclosing (1998). Rehabilitation. Psychiatric for Center Boston University to andisability employer.

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xplain why. or example: family, to an you explain why you did not disclose? ave youave been in a situation in which you wanted disclose to receiving mental youave been in a situation in which you debated internally about disclosing? as self-disclosure had a positive or negative impact on your life? E ooking back on what it, was the response/result? it Was a positive or f self-disclosure was on the job, when was it and done, what why, was the result? friends—why? it Was your choice? What led disclosure? to first time? H health services and did not? C Would you do it differently if you had the chance do to it again, that is, the first time? H What were the pros and cons? Would you encourage others self-disclose? to What factors make it more comfortable self-disclose? to What suggestions do you have on when, and what how, say to when you self-disclose? services? it Was a particularly significant moment? Do you remember where you were? What was the setting? L negative experience? Disclosing is not a one-time occurrence, so can you recall some different circumstances when youdisclosed and whom? to F I What words did you use? Would you do it differently if you had the chance do to it again, that is, the H What do you think you have risked and what do you think you have gained disclosing?by whomTo did you first disclose? Why? What ledyouto self-disclose? Didyou prepare disclose, to ordid it just happen? When did you decide disclose to others to about your receiving mental health ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ More specifically, More The author spoke to a number of people who receive or have received mental health health mental received have or receive who people of to a number spoke The author posed: were questions The following self-disclosing. experiences their services about APPENDIX C APPENDIX Interview Questions on Disclosure

CONTENTS

Executive Summary...... 7

Introduction...... 10

Purpose...... 11

Current Selected Literature...... 11

To Disclose or Not To Disclose?...... 13

Self-Disclosure in Employment ...... 17

Disclosure Among Mental Health Field Professionals...... 21

Other Disclosure Experiences...... 25

Disclosure of Other Illnesses and Situations ...... 29

Coming Out...... 33

Responses From Interviews ...... 34

Recommendations...... 37

Conclusion ...... 39

Appendixes

A. Participant List...... 40

B. References and Resources...... 41

C. Interview Questions on Disclosure...... 46 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov HHS Publication No. (SMA)-08-4337 Printed in 2008