Visions BC’s MentalHealthandAddictionsJournal S T I G Addictions Information Mental Healthand BC Partnersfor M A D i s c a r n im d Vol. 2No.6|Summer2005 in a
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photo: Naomi Liu experiences background perspectives& 3 Editor’s Message Christina Martens 17 I Want a Little Respect Patrick Schnerch 4 Sticks and Stones, Policies and Words . . . 18 Does a Person Have to Look Sick to be Sarah Hamid-Balma and Corrine Arthur Sick? Kate 5 Letters to the Editor 19 Today, I Choose Life! K.C. Younker 6 Stigma and Discrimination in Canada 20 Navigating the Stigma of Mental Illness and Senator Michael Kirby Addiction Debbie Suian 7 Mental Illness and Human Rights 21 Stigma and Suicide: History, Real or Terri Kennedy and Susan O’Donnell Perceived? P. Bonny Ball 10 Demystifying the Role of the DSM 22 Living with Prejudice: An MtF Perspective Sarah Hamid-Balma and Joe Solanto Theresa Collinge 12 On the Borderline Carmen Lenihan 23 Mental Disorders: The Result of Sin? 13 The Stigma of Addiction Project Marja Bergen Margaret Kittel Canale and Ellie Munn 24 Breakdown at Work Max Danvers 14 Seniors, Alcohol and Stigma 25 And the Cement Cracked and Crumbled Charmaine Spencer Away Rosalyn 15 Not in My Backyard Mykle Ludvigsen 26 A Place to Call Their Own Donna Murphy 27 Stigmas Surrounding Eating Disorders: Interview Elizabeth Thornton Cronin and Anne 28 Adjusting Our Dreams Karen
bc partners visions
Seven provincial mental health and addictions agencies are Published quarterly, Visions is a nationally award-winning working together in a collective known as the BC Partners for journal which provides a forum for the voices of people Mental Health and Addictions Information. We represent the living with a mental disorder or substance use problem, Anxiety Disorders Association of BC, Awareness and Net- their family and friends, and service providers in BC. Visions working around Disordered Eating, British Columbia Schizo- is written by and for people who have used mental health phrenia Society, Canadian Mental Health Association’s BC or addictions services (also known as consumers), family Division, Centre for Addictions Research of BC, FORCE So- and friends, mental health and addictions service provid- ciety for Kids’ Mental Health Care, and the Mood Disorders ers, providers from various other sectors, and leaders and Association of BC. Our reason for coming together is that we decision-makers in the fi eld. It creates a place where many recognize that a number of groups need to have access to perspectives on mental health and addictions issues can accurate, standard and timely information on mental health, be heard. To that end, we invite readers’ comments and mental disorders and addictions, including information on concerns regarding the articles and opinions expressed evidence-based services, supports and self-management. in this journal.
The BC Partners are grateful to the Provincial Health Services Authority for providing fi nancial support for the production of Visions
2 Visions Journal | Vol. 2 No. 6 | 2005 editor’s message
t’s been over 40 years since Erving Goffman wrote the pre-eminent re- source, Stigma and the Management of Spoiled Identity. And while some inroads have been made for some diagnoses, it seems that others have alternatives ifi lled the void. A mother of a son with schizophrenia once told me that border- approaches& line personality disorder is “the new schizophrenia.” This she saw as a result of better understanding of schizophrenia. This is not, however, to say that people with schizophrenia do not still experience stigma. 29 Looking Into the Cultural Mirror R. Dan Small In a recent conversation with a colleague, the issue of stigma versus dis- 30 Genetic Counselling and Mental Illness: crimination came up. It is interesting to note that talk of stigma seems re- Helping Families and Fighting Stigma stricted now to issues of mental illness and addictions. In other social and Jehannine Austin health movements, discrimination is the word that is used. The difference here 32 Canadian Anti-Stigma Campaigns. A Review is that protection against discrimination is enshrined in the Canadian Charter Naomi Liu of Rights and Freedoms. Stigma is not. The articles in this edition of Visions talk of the many forms stigma take— societal, interpersonal, internal. And in some sense, this is preaching to the choir. As readers of this issue, we are already likely aware of the negative, often destructive impact of stigma on the lives of persons with mental illness and/or addictions. What we need to do is to share this issue with our communities, regional both familial and extended. As one article acknowledges, it is direct contact programs with a person with any of these diagnoses that makes the biggest difference. There is a very interesting structural issue that I want to acknowledge. In 34 Bad Endings Bruce Saunders putting together this issue, we had an abundance of personal and familial sto- 35 Mental Illness in Film: A Director’s Take ries, stories from service providers and ‘professionals’ about what stigma looks David Dawson like. Where there is a lack, and this may be our problem in defeating stigma, is 36 Partnership Education Program Nicole Chovil in programs and services created specifi cally to address stigma. Stigma will only cease to exist when people are valued for who they are, 37 Opening Minds Ron Plecas when they have educated and understanding social relations, and when we all 38 Changing Attitudes at VIHA begin to understand that self-stigma allows other-stigma to run rampant. If we Michael Reece and Sara Bristow think, “I’m glad that I have this diagnosis and not that one,” then we are just reproducing the same problem. To battle this, we need to look deep inside and challenge our beliefs about what mental health, mental illness and addiction 39 The Stigma of Mental Illness: Practical Strategies are. Let’s hope we don’t have to do another issue in 40 years to talk about the for Research and Social Change [book review] impact of stigma. Mailis Valenius Christina Martens 40 Resources Christina is Executive Director of the Canadian Mental Health Association’s Mid-Island Branch. She has an MEd in Community Rehabilitation and Disability Studies and is working towards her doctorate in Policy and Practice in the Faculty of Human and Social Development at the University of Victoria
subscriptions and contact us Tel: 1-800-661-2121 or 604-669-7600 advertising Mail: Visions Editor Fax: 604-688-3236 c/o 1200 - 1111 Melville Street Email: [email protected] If you have personal experience with mental health or sub- Vancouver, BC V6E 3V6 Web: www.heretohelp.bc.ca stance use problems as a consumer of services or as a fam- ily member, or provide mental health or addictions services editorial board | Nan Dickie, Dr. Raymond Lam, The opinions expressed in in the public or voluntary sector, and you reside in BC, you Victoria Schuckel, plus representatives from each this journal are those of are entitled to receive Visions free of charge (one free copy BC Partners member agency the writers and do not per agency address). You may also be receiving Visions as a necessarily reflect the member of one of the seven provincial agencies that make policy/issues editor | Christina Martens views of the member up the BC Partners. For all others, subscriptions are $25 structural editor | Vicki McCullough agencies of the BC (Cdn.) for four issues. Back issues are $7 for hard copies, editorial assistant | Cynthia Row or are freely available from our website at www.heretohelp. Partners for Mental bc.ca/publications. Contact us to inquire about receiving, production editor | Sarah Hamid-Balma Health and Addictions writing for, or advertising in the journal. Advertising rates and design/layout | Naomi Liu Information or any of deadlines are also online. printing | Advantage Graphix their branch offices.
Visions Journal | Vol. 2 No. 5 | 2005 3 guest editorial
Sticks and Stones, Policies and Words… A look at prejudice and discrimination in the field of mental illness and addictions
Sarah Hamid-Balma n many human rights circles, the last 50 years has seen as sins, crimes, behavioural problems, diseases, and Corrine Arthur been an era of increasing (albeit imperfect) toler- or some combination of these. Despite the changing ance. Those of us working in the field of mental frame, the perception has basically remained the same: ihealth and addictions have seen change—from mys- the person is, at worst, irreparable; at best, only capa- ticizing, warehousing and criminalizing to medicaliz- ble of temporary recovery through strict adherence to ing and psychologizing. We have moved people out of “the program,” “the steps,” “the medication”... mental hospitals and into assisted living units; we have People with mental illnesses and/or addictions found that a range of treatment options and social sup- are among the most devalued of all people with dis- Sarah is Director of ports help people recover like never before; we have abilities—and by extension, friends, family and pro- Public Education and spoken of addiction as an illness, not a moral issue. fessional care providers also face a kind of ‘stigma by Communications at the But there’s still the language—addict, mentally ill, association.’ A major US nationwide survey of mental Canadian Mental Health schizophrenic, psycho, junkie—personless, labelling health consumers found that almost 80% of survey Association’s BC Division, language that, even today, is so hard to shake off. respondents had overheard people making hurtful or and Visions Production And why? A person cannot choose their race or offensive comments, with more than a quarter often 2 Editor. She has been gender, or reverse a physical disability; behaviour, how- being told to lower their expectations in life. involved in anti-stigma ever, is different. There is an expectation that a person But the effects of discrimination go far beyond campaigns at CMHA and should be in control of their behaviour, thoughts and dirty looks and name-calling. Users of mental health or in 2002 wrote a report on feelings. And though the experts have argued for, and addictions services are denied basic rights of citizen- stigma and discrimination proclaimed victory in, having mental illness and addic- ship, encountering both subtle and blatant discrimina- for the BC Minister’s tion viewed as health issues, for many people it remains tion when accessing housing, employment, income as- Advisory Council on Mental an issue of poor self-control and character flaw. sistance, higher education, insurance, parenting rights, Health. She is also a “What if he falls off the wagon?” “What if he acts immigration status and even recreational opportunities. consumer of mental strangely?” “What if she becomes violent?” These are They are often viewed as second-class citizens by the health services not health concerns; they are judgements based on ste- communities and neighbours they wish to live among reotypes, media depictions, and lay assumptions of cau- and befriend, by the physical health care and criminal sality that are embedded in our culture. “Come on, pull justice systems, media, mental health and addictions up your socks.” “Stop trying to get attention.” “Just say professionals, other service users, and even their own no.” “If you just got a job and got off the system…” friends. Rejection from social supports, resources and institutions has a significant impact on a person’s self- What it is and what it does sufficiency, recovery and overall quality of life. The mental health and addictions movements have The case has been made3 that, due to discrimi- Corrine is board President historically always talked of stigma. According to the nation, mental health and addictions systems are of From Grief to Action father of stigma theory, Erving Goffman, stigma is the chronically under-funded—particularly when mea- (FGTA). As a relative of situation of an individual being excluded from full so- sured against the toll these conditions take on fami- an amazingly resilient cial acceptance because of a trait that marks them as lies, workplaces, and the health care and criminal recovering substance different from the so-called ‘normal’ majority. This dif- justice systems. user and mental health ference then elicits some form of discrimination from consumer, she regularly the community, such as punishment, restriction of Why prejudice is so hard to give up… receives lessons in rights, ridicule and/or social rejection.1 There are three main theories4 as to why stigma proc- humility, compassion and For the ancient Greeks, stigma referred to visible esses develop against any minority group. Each of the need for increased marks on the body that were branded on ‘undesir- these is at work against people with mental illnesses or public awareness. Through ables’—slaves, criminals and traitors. Although nowa- addictions: FGTA, Corrine promotes days people with mental illness and/or addictions are • stigmas justify current social injustices (e.g., the belief addiction as a public not tattooed upon diagnosis, the feeling is not altogeth- that people with mental illness were inferior justified health issue to assist er different; the brand is just invisible. sterilizing them) in breaking through Throughout their history and up to the present day, • stigmas meet basic self-serving psychological needs prevailing stigmas mental health and substance use problems have been (e.g., ‘I feel better about myself when I compare
4 Visions Journal | Vol. 2 No. 6 | 2005 letters
myself to addicts or the mentally ill’) I just finished reading my first issue of Visions. It was such a good and • stigmas are efficient mental shortcuts that allow peo- interesting thing to read and had so many perspectives and details to ple to quickly generate impressions and expectations learn about. Being a 16 year-old boy who’s experienced a lot, I really of someone based on their membership in a stere- believe Visions would help a lot of my peers with violence and drug otyped group (e.g., ‘If I encounter someone with men- issues. I think teenagehood is a lot more violent and dangerous than tal illness or an addiction, I’ll know what to expect’) it was for my father’s generation. I’ve seen so much teen violence and drug abuse and overdosings that this journal really did spit the truth on The public wants to conceive of sickness or unusual be- this matter. This journal really did impress me, and—let’s face it—not haviour as occurring with reason; otherwise, life is re- much does impress a 16-year-old guy. Keep it up. duced to a game of chance. Therefore, people are viewed —Dustin White as extensions of their conditions, so we can separate Vancouver, BC ‘them’ from ‘us.’ Though the stereotypes attached to di- agnoses and substances may differ, the myths driving the stereotypes are the same: people with mental illness Although the last two issues of Visions focused on gender—first Women, and addictions are violent, unpredictable with poor so- then Men—after twenty-five years of clinical observations in my practice, cial skills, incapable of recovery, and to blame for their I don’t see a lot of differences between men and women, in general. In conditions.5 They should be hospitalized or locked up; fact, it’s unusual for me to see differences rather than similarities. And they are worthy of help, but the public shouldn’t have the truth is that men and women are each such heterogenous groups. to see them. We have to remember that. I see more differences when you introduce On the index of fear and stigma, mental illness and socioeconomic status. When it comes to certain kinds of behaviours, up- addiction cluster with sexually-transmitted diseases, per class men and upper class women are more similar than, say, upper epilepsy and leprosy:6 three conditions that have his- class men and working class men. And that’s certainly true when you torically induced great fear in people. These are not the introduce a third variable like ethnicity. So the gender distinctions are diseases modern-day telethons are made of. As Susan probably much less apparent compared to other variables. Visions might Sontag wrote, “It seems that societies need to have one do well to explore class and ethnicity as themes of future volumes. illness, which becomes identified with evil, and attaches —Marty Klein, PhD blame to its ‘victims’… any disease that is treated as a Licensed Marriage and Family Counselor and Sex Therapist mystery and acutely enough feared...”7 Though she was Palo Alto, California writing about AIDS, the concept easily applies to mental illness and addictions. But there is also hope found in Sontag’s words. Over we want your feedback! time, stigmas are malleable. They can be created (drink- If you have a comment about something you’ve read in Visions that you’d ing and driving, smoking) and reduced (cancer, AIDS). like to share, please email us at [email protected] with ‘Visions By learning from other campaigns against ignorance, Letter’ in the subject line. Or fax us at 604-688-3236. Or mail your letter there will hopefully come a time for mental health and to the address on page 3. Letters should be no longer than 300 words and addictions when searching for the right language will be may be edited for length and/or clarity. Please include your name and city irrelevant—when the people will have superseded their of residence. All letters are read. Your likelihood of being published will labels and symptoms and behaviours. depend on the number of submissions we receive. Researchers have argued that people with physical disabilities have not found stigma a useful concept because stigma puts the focus on the ‘branded’ person, while prejudice and discrimination put the onus where it belongs: on the individuals and institutions that footnotes practise it. Why should our movement be any different 1. Goffman, E. (1963). Stigma: The management of spoiled identity. Harmondsworth, UK: Penguin. from other human rights movements? As researcher Liz 2. Wahl, O.F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467-478. Sayce says, “It’s not as if we talk about the ‘stigma of being black’—no, we talk of racism.”8 The adoption of a 3. Gross, C.P., Anderson, G.F., and Powe, N.R. (1999). The relation between funding by the National Institutes of Health and the burden of disease. New England Journal of Medicine, 340(24), 1914-15. social approach that links disability, human/civil rights, mental illness and addictions with empowerment, 4. Crocker, J. & Lutsky, N. (1986). Stigma and the dynamics of social cognition. In S.C. Ainlay, G. Beck- participation and human dignity is key. er & L.M. Coleman (eds.), The dilemma of difference: A multidisciplinary view of stigma (pp. 95-122). NY: Plenum. And yet, there is hope. Cultures vary in their 5. Hayward, P. & Bright, J.A. (1997). Stigma and mental illness: A review and critique. Journal of Mental levels of prejudice toward mental illness. For example, Health, 6(4), 345-54. schizophrenia has a better outcome in developing 6. Neaman, J.S. (1975). Suggestion of the devil: The origins of madness. Garden City, NY: Anchor Press. nations because of greater community acceptance.9 So 7. Sontag, S. (1988). AIDS and its metaphors. London: Penguin Books. we need to be open to doing innovative research and learning the lessons from people’s experiences. Some 8. Sayce, L. (1999). From psychiatric patient to citizen: Overcoming discrimination and social exclusion. NY: St. Martin’s. of the articles in this issue of Visions may be a step 9. Jablensky, A., Satorius, N., Emberg, G. et al. (1992). Schizophrenia: Manifestations, incidence and toward that end. course in different cultures. A WHO ten-country study. Psychological Medicine, 20(Suppl.), 1-97.
Visions Journal | Vol. 2 No. 5 | 2005 5 background
Stigma and Discrimination in Canada What we have learned so far
Senator Michael Kirby n February 2003, the the phenomena of stigma phase, participants were label, not expected to have Standing Senate Com- and discrimination and able to provide specific basic personalities that mirror Senator Kirby is mittee on Social Af- what can be done to cur- advice to the committee those in the greater population, Chairman of the ifairs, Science and Technol- tail them. on how to help strengthen good and bad and everything Standing Senate ogy (SSCSAST) launched We also realized, how- mental health and addic- in between. A schizophrenic is a Committee on Social the first comprehensive ever, that we needed to tions services in Canada. schizophrenic, and every action Affairs, Science and review of the state of men- reach out even more wide- Morever, the SSCSAST is attributed to that disease Technology. The tal health and addiction ly. Therefore, following the has undertaken public and not to the underlying na- committee has been services in Canada. The release of the background hearings that will take it ture of the individual.” engaged in studying committee is in the proc- reports, we conducted the to every province and ter- People across Canada various aspects of ess of preparing its final first of two phases of Web- ritory. As well, a number have also highlighted the Canada’s health care report, which will contain based or ‘e’ consultation of special topic meetings, negative way in which system since 1999 a detailed set of recom- with Canadians. More than such as the Children’s mental illness and addic- mendations for restruc- 500 people replied to a Mental Health Roundtable tion are often portrayed turing and enhancing the questionnaire posted on that was held in May, have in the media, and have delivery of mental health the committee’s website, allowed the committee to insisted that the media and addiction services in almost all of whom had meet with advocates, con- could play an important this country. experienced, or knew of sumers, psychologists, psy- role in changing attitudes The committee is deep- someone who had expe- chiatrists and educators to about mental illness and ly committed to this study, rienced, some form of discuss in detail the issues addiction in our society. not only because reform is stigma or discrimination relating to specific areas. Many witnesses have essential, but also because because of mental illness We have learned an recommended that we the majority of us have had or addiction. enormous amount from need a national campaign firsthand experience of Respondents (official- the input we have received to help reduce the wide- the impact of these cond- ly referred to as witnesses) thus far. We now know spread occurrence of stig- tions. In fact, it was only told us of discrimination that it is possible for mil- ma and discrimination. once we had begun our re- in relation to employment, lions of Canadians who They have pointed to the view of the mental health education and the justice are living with a mental critical importance of ed- and addiction services in system, as well as from disorder or addiction to ucating people about men- Canada that we realized health professionals. They live meaningful and pro- tal illness and addiction in we had never talked with spoke of the difficulties ductive lives. But we also order to reduce stigma and each other about the im- they encountered in find- know that for this to be- discrimination and enable pact mental illness has had ing safe, affordable hous- come a reality, action is re- people to gain timely ac- on our own families. This ing, and in obtaining dis- quired to deal with stigma cess to needed services was in stark contrast to ability, life or medical insur- and discrimination. and supports. how open we had previ- ance. We were profoundly The stubborn persis- In concluding, let me ously been with each oth- moved by their candour tence of stigma and dis- insist on one thing that er about physical health and their insight. crimination is very discon- has become clear to us: problems. The second phase of certing. These phenomena in order for any of the The issue of stigma and e-consultation, which took are clearly deeply rooted recommendations we make discrimination has already place between April and and have a profound ef- in our final report to be featured prominently in the June, has allowed us to fect on people’s lives. One implemented, it will be three background reports gauge even further the ex- witness, Pat Capponi, an necessary for Canadians on mental health, mental periences that consumers, author, advocate and con- from coast to coast to coast illness and addiction in families, service providers sumer, put it this way: to hold governments’ feet Canada that the SSCSAST and concerned Canadians “A chronic mental patient to the fire. We believe that released last November. have had with mental ill- is just that in the eyes of many. together we can make a In those reports, we ex- ness and addiction serv- We are not entitled to be full difference. amined in some detail ices in Canada. During this human beings behind that
6 Visions Journal | Vol. 2 No. 6 | 2005 background
Mental Illness and Human Rights
wenty years has passed since the proclamation of proved and applied in many human rights jurisdic- Terri Kennedy and Section 15 of the Canadian Charter of Rights and tions.5 The test says that a mental condition should be Susan O’Donnell Freedoms,1 guaranteeing legal equality to all Cana- considered a disability for human rights protections tdians, including those with mental disabilities. While where it meets all the following criteria: 1) it prevents Terri is Communications society as a whole may still have a long way to go be- the person from performing significant functions that Coordinator and Susan fore people with mental illnesses are treated with the can be performed by most people; 2) it is ongoing is Executive Director of level of respect and dignity they deserve, our human in nature; and 3) it is beyond the person’s control. the BC Human Rights rights laws have helped us understand stigmas associ- The courts have determined that alcohol and drug Coalition. The coalition is a ated with mental illnesses and have helped set rules addiction constitute a mental disability for the purposes community based non-profit that restructure employment and service relationships of human rights legislation as well. A stress-related dis- organization that promotes with the ultimate goal of inclusivity. order may—but still will not necessarily—amount to a and strengthens the human disability. It is a factual question as to the impact on the rights of British Columbians Defining mental disability individual’s capacity to function. In many cases, stress through advocacy, education For people with psychiatric disabilities, it is important may signal—or even mask—a larger mental disorder. and law reform to know that all human rights decisions that apply to other protected groups, such as race, sex, and so on, Accommodations and standards also apply to them. In a case called Gibbs v. Battlefords The first step towards inclusivity was the development and District Co-operative (1996), the Supreme Court of of the concept of reasonable accommodation. As an Canada ruled that an insurance company’s policy of equality concept, accommodation seeks to build inclu- providing long-term disability benefits to the age of sive environments that respect differences and rights in 65 for those with physical disabilities, but for only two a diverse society. As a process, accommodation seeks years to those with mental disabilities unless they were to resolve conflicts by balancing rights and interests. institutionalized, constituted discrimination. The ruling The goal of accommodation is to enable the full and eq- specified that all groups protected in the human rights uitable participation of all members in society. Today, legislation must receive equal treatment.2 the concept of accommodation is better known by the Although mental disability is included as a protect- term ‘duty to accommodate’ which is the legal phrase ed ground in the BC Human Rights Code, it is not defined arising out of human rights legislation and case law in our legislation.3 Therefore, it is necessary to turn to in Canada. other jurisdictions and to the existing case law for defi- In the case of the University of British Columbia v. nitions. One of the most comprehensive statutory defi- Berg (1993), the Supreme Court of Canada upheld the nitions is that found in the Saskatchewan Human Rights right to accommodation when it found the university Code; Section 2(1) defines disability and specifically in- had discriminated against the complainant by provid- cludes reference to “mental disorder.”4 ing her with limited service because she had bipolar The following test, taken from The Law of Human disorder.6 Prior to the adoption of Section 15 of the Rights in Canada: Practice and Procedure, has been ap- Charter, employers were able to design occupational publicly funded human rights clinic
The BC Human Rights Coalition and the Community Legal Assistance Society jointly operate a publicly funded human rights clinic. The clinic provides initial and summary advice regarding human rights issues, as well as assistance in pursuing a complaint under the BC Human Rights Code. Full representation, provided by advocates and lawyers who specialize in human rights law, is available to those that have lodged a complaint with the BC Human Rights Tribunal. This clinic service is available province-wide at no cost to individuals. Whether you decide to file a human rights complaint or simply want some help or suggestions with issues related to your situation, you can call the BC Human Rights Coalition for information and assistance: (604) 689-8474 in Vancouver or toll-free at 1-877-689-8474
For specific information on the complaint and hearing process, please see our Guides and Information Sheets section of www.bchrt.bc.ca
Visions Journal | Vol. 2 No. 5 | 2005 7 background
requirements that effectively excluded people with dis- to accommodate an employee with a disability before abilities. it is appropriate to end the employment relationship.3 Balanced against the duty to accommodate is the notion of bona fide occupational requirement, or the Attitudes a step behind footnotes standard one needs to meet in order to reasonably While these concepts and definitions are moving 1. Constitution Act, 1982 [en. perform a job, or receive a service such as obtaining things forward on the road to equality, negative stereo- by the Canada Act 1982 a driver’s licence. The Supreme Court of Canada has types and attitudes continue to interfere with judgment (UK), c. 11, s. l], pt. 1 (Ca- nadian Charter of Rights ruled that standards in service and employment must around dealing with people with mental disabilities. and Freedoms). Retrieved meet a three-part test: the standard must have a con- A case we settled recently serves as a typical exam- June 23, 2005, from laws. nection to the work to be performed; the employer or ple of how lack of understanding and poor judgement justice.gc.ca/en/charter. service must have an honest belief that the standard is can manifest as discrimination in the workplace. Our necessary for the work to be performed; and the stan- client had re-entered the workforce after an extended 2. Gibbs v. Battlefords and District Co-opera- dard must be one of reasonableness: i.e. the employee absence due to bipolar disorder. He had an outstanding tive (1996), 24 CCEL 167 can do the work reasonably well. In addition, this court performance record and had no problems meeting job (SCC). has stated that an employer must show it is impossible requirements or standards in his new position. Unfor- tunately, his co-workers perceived some 3. British Columbia Human of his behavioural traits as ‘weird’ and ex- Rights Code, [RSBC 1996] Chapter 210. Retrieved pressed a collective fear to management June 23, 2005, from www. frequently asked questions that his illness would likely prevent him qp.gov.bc.ca/statreg/stat/ from meeting agreed-upon sales targets. H/96210_01.htm. What is Discrimination? Management, thinking they would boost Discrimination is when a person is treated unfairly, harassed the morale of others, fired our client. 4. Saskatchewan Human or denied something because of the group they belong to, or Rights Code, SS 1979, When the employers were asked at medi- because they have a certain characteristic. Under the BC Human c.S-24.1. Retrieved June 23, ation whether they allowed racist or sexist 2005, from www.qp.gov. Rights Code, it is against the law to discriminate against someone concerns to influence hiring or firing deci- sk.ca/documents/English/ because of any one or more of the following characteristics (these sions, they were quick to realize how their Statutes/Statutes/ characteristics are called protected grounds): judgement had been influenced by noth- S24-1.pdf. • race (including colour, ancestry or place of origin) ing more than negative stereotypes and • political or religious beliefs 5. Zinn, R. & Brethour, P. fears around mental illness. Management (1998). The Law of Human • marital or family status (including being married or single, being accepted responsibility for the discrimina- Rights in Canada: Practice and a parent, or simply who you’re related to) tion, and as part of the settlement, agreed Aurora, ON: Procedure. • physical or mental disability to educate themselves and their workforce Canada Law Book. • sex (being female, male or transgendered; pregnancy; breast- on working with people with disabilities.8 feeding in public) 6. University of British Columbia v. Berg (1993), 2 • sexual orientation (being lesbian, gay, heterosexual or bisexual) Accommodation balancing act SCR 353, 18 CHHR D/3. • age (where a person is between 19 and 65 years of age) Beyond settlements, numerous decisions • a criminal record unrelated to their employment from courts, tribunals and labour arbitra- 7. British Columbia (Public Service Employee Relations tors continue to send strong signals to em- When am I protected from discrimination and harassment? Commission) v. British ployers indicating that those with mental Columbia Government You are protected from discrimination and harassment when you’re: illnesses are to be accorded the same right and Service Employees’ • at work to an accommodation as those with physi- Union (BCGSEU) (1999), 35 • applying for a job cal disabilities. Recent cases are frequent- CHRR D/257 (SCC); British • attending school or some other educational institution Columbia (Superintend- ly about fine-tuning the balance between • looking for a place to live ent of Motor Vehicles) v. all parties’ rights and obligations with re- British Columbia (Council • renting or buying property gards to the accommodation process. Per- of Human Rights) (2000), 36 • wanting to access a service or buy a product that is available to haps the most controversial of these is the CHRR D/129 (SCC). the public Gordy v. Oak Bay Marina (2004) decision.9 8. This is an example of This case involved a situation where Under the Code, the BC Human Rights Tribunal is responsible for a typical case. It has been a fishing guide was terminated from his settled recently, and as part accepting, mediating, resolving and adjudicating complaints of dis- position at Oak Bay Marina after entering of the agreement, the par- crimination. Publicly funded clinic programs have been established a manic phase of his illness, bipolar disor- ties cannot be named. to provide assistance and representation to individuals involved in der. Oak Bay Marina argued that assuming complaints, and the Ministry of the Attorney General is responsible 9. Gordy v. Oak Bay Ma- the safety risk of continuing to employ the for developing and conducting education programs. rina, dba “Painter’s Lodge” guide would amount to undue hardship. (No. 2) (2004), BCHRT 225. The BC Human Rights Tribunal disagreed, (source for this sidebar item: Mahil, H. (2001). Mental Illness and Human Rights. noting that the employer had no accurate Visions: BC’s Mental Health Journal, 1(13), 44-45). information about bipolar disorder or the likelihood of a relapse.
8 Visions Journal | Vol. 2 No. 6 | 2005 Oak Bay Marina appealed the decision to the Supreme Court of BC, which set aside the tribunal’s decision, finding that the tribunal had erred when it failed to consider the per- sonal observations of two Marina managers. The BC Court of Appeal upheld this decision, agreeing that Oak Bay Marina was entitled to rely on the personal observations of its em- ployees with respect to the Mr. Gordy’s condition. The court referred the case back to the tribunal for reconsideration. After all this, the BC Human Rights Tribunal came back to its initial decision: it agreed that the company’s knowl- edge of Mr. Gordy’s condition “justified a concern” and could form part of a risk assessment, but that the duty to accommodate required Oak Bay Marina to undergo a full assessment, which included educating itself about bipolar disorder in general, and the risk of relapse in particular, before being able to properly assess the risk. Because accommodation is an individual right, it of- ten comes into conflict with management policies and pro- grams that are designed with a ‘one-size-fits-all’ approach. There is a lot of case law around attendance-management programs that adversely affect workers with mental illness- es, who may require more time away from work to attend to their disability. Equally challenging are labour arbitra- tions that seek to balance the rights of parties when disci- plinary measures appear unfair and inequitable given that conduct may be symptomatic of a specific mental health condition. Although the outcome of each claim rests on a unique set of facts, there is a growing recognition that a one-size- fits-all system and structure is not appropriate given the diversity of today’s workforce. There is also a growing rec- ognition and acceptance that accommodation is a multi- party process. To avoid pitfalls, it is important that employees keep their employers properly informed about their medical condition and accommodation requirements, and it is equally impor- tant that employers engage in individualized assessment in order to reach the most appropriate accommodation. A workplace rule or practice that conflicts with an indi- vidual’s right to be free from discrimination must be modi- fied or adjusted without affecting the employer’s right to a productive workforce. Where capabilities are restricted by a disability, increasing permitted time off or restruc- turing certain job components may be required to allow the disabled person to apply their skills and abilities on an even playing field while making a contribution to the workforce. One challenge for human rights law is to continue to move beyond the concept of “freedom from discrimination.” Today, many of the decisions coming from our courts and tribunals in relation to mental disabilities speak to a “right to equality”; a right that is positive, proactive and implies a high standard on our institutions, workplaces and services to design and deliver appropriate systems, rather than relying on the affected individuals to fight for equality case by case. A right to equality in 2005 should be an expectation, not a surprise.
Visions Journal | Vol. 2 No. 5 | 2005 9 background
Demystifying the Role of the DSM Diagnosis with dignity
nyone who’s ever been diag- years, Solanto has deliv- “We have to accept ing. In the end, it’s their a nosed with a mental illness, ered these courses on the that any system that tries clinical judgement that’s knows someone who has, DSM to more than 500 par- to categorize or classify is most important. But I’ve Sarah Hamid-Balma or has done the diagnosing ticipants throughout BC. going to be limited by a also encountered diagnos- themselves knows that the “The course content whole number of factors,” ticians who may not have Sarah is one of the Guest Diagnostic and Statistical tries to present the DSM says Solanto. “One of the same ability to estab- Editors for this issue of Manual of Mental Disor- system in a balanced way those factors is that people lish rapport, to have the Visions ders1 (known as the DSM, that not only increases un- just don’t appear in black- sensitivity or the cultural or the DSM-IV-TR to reflect derstanding, but also in- and-white form the way awareness, or to acknowl- Interviewed: the latest edition) can play creases the likelihood that that diagnoses appear; edge the social, political Joe Solanto, PhD an important part in shap- it won’t be misused,” says people are much more or legal contexts of the cli- ing a person’s illness iden- Solanto. After two inten- complex. And assessment ent’s life. When you con- Dr. Solanto is a therapist, tity. Since 1952, the DSM sive days of groundwork, doesn’t have the accuracy sider people outside of the consultant, and clinical has been the psychiatrist’s participants review case and specificity of x-rays contexts of their real lives, supervisor and educator bible for assessment guid- studies and use the DSM or lab study, so there’s it’s questionable how use- in private practice. For ance. It is a powerful tool system to come up with a lots of room for subjective ful that information is go- more than 30 years he that can both encourage multi-axis diagnosis.2 judgements and error. ing to be for them.” has trained educators and (through labelling) and dis- While mental health Inherent in the DSM sys- “The process, from mental health professionals courage (through normal- consumers are not the tem is forcing the clin- start to finish, is loaded in therapeutic responses izing) prejudice and dis- target audience for the ician to make choices. with potential pitfalls and to critical incidents and crimination. course, Solanto says that A diagnostic category it’s only with tremendous psychological trauma. In To learn more about in nearly every session, might emphasize some sensitivity, awareness and addition to training clinicians the complexities of the someone invariably volun- symptoms and under- caution that one can do in diagnostic assessment DSM, I interviewed Dr. Joe teers that they are partici- recognize others. So, in the least amount of harm,” and treatment-planning Solanto, a psychotherapist pating out of personal in- the effort to decide on a he says. This advice is par- processes for the Justice and educator in private terest because of a mental term, you’re often missing ticularly important with Institute of BC, Joe teaches practice, based in Victoria. health diagnosis. “They’ll as much as you’re addres- the more controversial or courses in workplace Dr. Solanto teaches clini- often express their feelings sing. Even an accurate problematic categories— wellness, restorative justice cian groups how to under- of what that’s done for or diagnosis is like a snapshot problematic in diagno- approaches, and adventure- stand and responsibly use against them. Sometimes of someone: true for that sis, treatment and, often, based counselling. Before the DSM system at the the learning for the group moment, but not the full community prejudices. moving to BC, he spent Justice Institute of BC. His is that the person was dis- picture of his or her life.” “There’ve always been 18 years as a school course offerings include advantaged by the system. The person using the a few diagnoses that have psychologist and seven as two levels of a workshop And sometimes people DSM tool is just as impor- had pejorative effects: in the director of a mental called Everything You Ever acknowledge that it was tant in the equation, says recent times, borderline health outpatient treatment Wanted to Know about helpful to them; that when Solanto. “It’s been my personality disorder is centre in New York. He the DSM-IV-TR. This, and they finally arrived at a di- experience that there are probably number one on currently lives in Victoria, BC a similar course for child agnosis, it helped put them some excellent clinicians that list. In many cases, it and youth assessments, on a path of healing that out there who have the still can be a kind of fatal are geared for profession- they may have not been necessary clinical and in- diagnosis,” notes Solanto. al gatekeepers, such as on otherwise.” terpersonal skills, a thor- “In my experience, the school personnel and vari- Solanto approaches the ough understanding of di- underlying probability of ous mental health practi- curriculum in a very sen- agnoses and the full range early childhood trauma tioner groups. Members of sitive, people-centred way of treatment options, as has not been fully appreci- these groups may not have and encourages partici- well as awareness of com- ated. When understood in clinical backgrounds in pants to appreciate the munity resources; the that light, it leads to a more the DSM, but often have potential helpfulness as DSM in their hands is real- sensitive understanding of to make provisional diag- well as the limitations of ly a guide to help them di- behaviours and, therefore, noses. During the last 13 the diagnostic system. rect their diagnostic think- the person.”
10 Visions Journal | Vol. 2 No. 6 | 2005 background
Naming and renam- “That’s another pitfall ing has been a historical of the diagnostic system: The DSM is 900 pages long and defines more than 300 mental feature of the DSM system. that so much of it is linked The term personality disor- to the biomedical model,” disorders. Sales of DSM-IV (1994) and DSM-IV-TR (2000) have ders is just one of a number says Solanto. “Clearly, I sold more than one and a half million copies to date.3 of recently appearing psy- have seen people’s lives chiatric names—and it has saved and transformed not always served people with the help of psycho- well. In Solanto’s view, sim- tropic medication. But I ply changing the term for think the strong influence a previously-stigmatizing of the biomedical/phar- impact of cultural differ- vision. All sorts of folks are condition does not mean maceutical model has ences between the diag- drawn to this work, and if that the old prejudice does conditioned mental health nostician and the client? you’re already inclined to not attach itself to the clinicians to be thinking “We have to remem- not be very engaged or new term. When Solanto down that track from the ber that it is a very cultur- compassionate, you’ll find worked in the New York outset. That has to colour ally bound system and the lots of ways in this field to school system, and mental how you think about the DSM itself emphasizes re- express all of that.” retardation was the term person, and whether you peatedly—more heavily in Despite all these cau- of the day, the kids were consider all the other pos- later editions—that it rep- tions, Solanto’s encounters called “retards” by their sible causes, or treatment resents a North American with practitioners around classmates. When the term options.” cultural world view. In this BC have been heartening. was reframed to devel- “Certainly, some peo- part of the world, when cli- He says, “Mostly though, I opmental disabilities, the ple have found freedom nicians are working within find the dominant attitude problem didn’t disappear; in announcing their men- very diverse communities, of the folks who take my peers just called the affect- tal health diagnosis, that if we are to use a cultur- course is that they come ed kids “DDs.” The tone of they’re on medication, that ally bound system like the very humbly to the task ridicule was the same. it’s changed their life. Rath- DSM, we have to think of of doing an assessment. Children in particular er than stigmatizing them, how to address the cultural I’ve been quite impressed have had to face the re- it has empowered them relevancies of it in some with the level of sensitiv- cent parade of newer di- and, paradoxically, has al- way that keeps a caution ity, caution and compas- agnoses, such as conduct lowed them to feel less ab- alive throughout.” sion that they convey in disorder, oppositional de- normal. However, it’s more Cultural assessments talking about their clients. fiant disorder, and atten- common that psychiatric are one way clinicians Even when we do the tion-deficit hyperactivity medications are associ- are encouraged to think more clinical case studies, disorder (ADHD). ated with ‘craziness’ and of their own assumptions the discussion most often “We have to ask our- disability. The medications and acknowledge their goes toward the human footnotes selves: are these diagno- come with the potential own prejudices and world side of the story and what 1. American Psychiatric ses real clinical entities benefits, but also with that views and how that in- would really be helpful for Association. (2000). Diag- or are they a by-product cloud over them.” forms and complicates the this client.” nostic and statistical manual of of many different factors: As attitudes—toward diagnostic process. And, clients are gain- mental disorders (4th ed., text social, political, familial, medication, other treat- “It all starts with self- ing power in therapeutic revision). Washington, DC: cultural, legal? ADHD is ments, or mental illness in examination,” says So- situations. This adds a Author. one of those that has more general—are culturally de- lanto. “Mental health clini- beneficial balance to the 2. A multi-axis diagnosis behind it than the indi- fined and reinforced, So- cians, all along the spec- DSM therapeutic equation looks at various factors vidual child’s neurological lanto’s course curriculum trum, can benefit from and to the potential stig- affecting symptoms. In the development,” says So- includes attention to Ap- a regular check on their matizing effects of a di- DSM there are five major lanto. ADHD is culturally pendix I of the DSM, which attitudes and beliefs, be- agnosis. “It is great these axes: 1) clinical disorders, localized, since European encourages clinicians to cause even if you didn’t days,” says Solanto, “that 2) personality disorders and developmental disability, 3) and other nations do not conduct a cultural assess- come into the work with the ordinary person is general medical condi- recognize ADHD as a prev- ment during diagnosis. negative ones, these may getting more knowledge- tions, 4) psychosocial and alent clinical condition. They are encouraged to develop over time. You able—talking to others, environmental problems, ADHD is one of many dis- ask questions such as: Are can become particularly reading the books, com- and 5) global assessment of functioning. orders in the DSM that has there any cultural factors cynical and distant as a ing to the meetings, and been heavily linked to a that might better explain self-protective measure. I getting on websites—and, 3. Spiegel, A. (2005, Western-based pharma- the person’s behaviour, or think it takes constant vig- as a result, asking more January 3). The dictionary ceutical influence and so that should be taken into ilance, a lot of peer-shar- questions. The empower- of disorder. The New Yorker, has been culturally rede- account in treatment plan- ing, ongoing professional ment that comes with that 56-63. fined through marketing. ning? What is the potential training, and good super- is half of the healing.”
Visions Journal | Vol. 2 No. 5 | 2005 11 background
On the Borderline
Carmen Lenihan he Diagnostic and Statistical Manual of Mental Dis- orders (DSM-IV) lists a set of criteria used to diag- Carmen is Administrator of nose borderline personality disorder (BPD). These the Borderline Personality tcriteria include a frantic effort to avoid real or imag- Disorder Association in ined abandonment, patterns of intense and unstable Kelowna and a consultant relationships, unstable self-image, impulsivity, and a for non-profit organizations. chronic feeling of emptiness.1 She can be reached Once a diagnosis of BPD has been made, it brings at (250) 470-9586 or with it a set of consequences. Some may be good, [email protected]. some not so good. At the Borderline Personality Dis- The association would like order Association in Kelowna, we requested feedback the mental health system, resources focus on what are to thank the individuals who from individuals living with BPD and their family to categorized as ‘Axis I disorders’ in the DSM-IV, which have provided feedback better understand what it is like to have the disorder include schizophrenia, bipolar disorder, depression and shared of themselves or to care about someone who does. Below is what we and anxiety. Although many individuals with BPD may so freely as background for discovered. also have, for example, depression or an anxiety disor- this article der, treatment for the personality component is often In what way has the diagnosis been helpful? minimal. General consensus was that it can be a relief to know “there is a name for it.” Once something is identified, As someone living with BPD, what For more information it’s easier to get information and begin to get help. One would you most like people to understand? about BPD, please contact individual with BPD commented that not knowing what The societal fear around BPD and mental illness in the Borderline Personality was wrong was difficult, and from that perspective, the general needs to be addressed. It can be very isolating Disorder Association, 504 diagnosis was a relief. Sadly, that is pretty much where living with BPD because of misconceptions, a lack of Sutherland Avenue, Kelowna the positive comments ended. professional support, and because, by virtue of having BC V1Y 5X1, Phone: BPD, relationships are challenging. (250) 717-3562, or e-mail In what way has the diagnosis been hurtful? Living with BPD is a struggle that doesn’t need to us at [email protected] Using the word borderline in the name is itself stigma- be compounded by stigmatization and discrimination. tizing. One individual commented that the name im- People’s misunderstanding and false perceptions lead plies not knowing how to categorize someone to make to more hurt and de-humanization. As one person said, them fit societal norms, so they are on the borderline— “Please don’t treat us like you don’t know what to do but on the borderline of what? with us.” Another frustration is lack of understanding in the general community. One individual diagnosed with As a family member, what BPD was asked by a prospective landlord if she be- would you most like to share? comes violent. This individual feels it may actually be Family members indicated that educating themselves better to lie and make up a different disability when about the disorder was very important. As well, getting asked why she is on a fixed income. So, not only are a good support system in place can make a tremen- her options to find housing extremely limited, but she dous difference. Find a support group, or start one if now feels she has to lie in order to be accepted. This necessary. kind of stigma is often reinforced by the media, which portrays people with mental illness as violent or who What is needed? are to be feared. While there is a little less stigma and As previously mentioned, support for BPD seems lim- discrimination around some disorders that have re- ited. Additional research into BPD is necessary, and ceived more media attention in terms of education, footnote more therapists must be trained to meet all the needs public awareness of BPD is still in its infancy. presented by individuals diagnosed with this disorder. 1. American Psychiatric As- The lack of resources available for people with BPD Outside of the professional realm, educating the gener- sociation. (1994). Diagnostic and statistical manual of mental is also hurtful. As previously mentioned, it can be a al community is crucial. Stigma and discrimination will disorders (4th ed.). Washing- relief to get a diagnosis so that help can be sought. So not lessen if people continue to have no information, ton, DC: Author. often, however, there is not enough help. Even within are misinformed, or buy into fearful myths.
12 Visions Journal | Vol. 2 No. 6 | 2005 background
The Stigma of Addiction Project Turning voices into action
ociety tends to stigmatize behaviours that are • People who take methadone Margaret Kittel Canale, MEd, seen as different and less desirable than what • People who use any drug a lot and Ellie Munn, MSW is considered the acceptable norm. Substance • Women (especially if they are pregnant or have kids) suse, and moods and behaviours often associated with • People of lower socio-economic status Margaret works in Education mental illness, clearly fall into this category. The stigma • Older adults or younger people and Publishing at the Centre (prejudice and discrimination) associated with sub- • Aboriginal people for Addiction and Mental stance use and mental health problems creates barriers Health (CAMH) in Ontario. to accessing necessary care and support for individuals How does stigma affect people? She transfers research and their families. Stigma affects every aspect of a person’s life, in ways and clinical knowledge into that are impossible to measure. The following impacts practical print and Web Stigma refers to negative ways in which on life were mentioned most often: resources • Violation of human rights (e.g., being treated with society views people with addiction and mental less consideration and respect when seeking medical Ellie works in Education and health problems. But if we were talking about care and housing) Health Promotion at CAMH, racism, sexism, homophobia or ageism, we’d use • Lack of employment (losing jobs and difficulty get- conducting workshops in the the words prejudice and discrimination instead. ting jobs if substance use problems are known) community to raise • Negative feelings about themselves (internalizing the awareness of the impact negative beliefs of others) stigma has on individuals A few years ago, the Stigma of Addiction project of the • Avoiding services (e.g., fear of disrespectful treatment) with co-occurring substance Centre for Addiction and Mental Health (CAMH) set out • Continuing substance use (to cope with other peo- use and mental health to identify strategies for communicating anti-stigma ple’s negative attitudes and their own feelings) problems messages to various audiences. Literature reviews and the voices of people directly affected by stigma in- Suggestions for reducing stigma formed this process. Three themes emerged about ways to reduce stigma: Through interviews and focus groups, we heard Educate people (including students, health care and from people with past or current substance use prob-1other professionals, as well as the general public) lems, as well as from family members and service pro- Highlight the reasons people develop problems viders across Ontario. They talked to us about stigma with substance use and stereotypes, and suggested ways to reduce preju- Address media biases and inaccuracies dice and discrimination. Portray people with substance use problems as human beings Stigma and stereotypes Personalize substance use problems Here are some of the responses we heard when we2 Have people who have experienced substance use asked, “What does stigma mean to you?” problems and the related prejudice and discrimi- • Negative judgement nation speak about it • Judgement based on one aspect of a person’s life Use well-known spokespeople to raise awareness • Long-lasting labels that substance use problems can affect anyone • Disgrace Show that people with substance use problems • Embarrassment and shame come from a variety of backgrounds • Something you are not proud of and want to hide 3Tell positive stories • Being treated differently from the rest of society Show the positive face of people with substance • Hating yourself use problems rather than the negative (e.g., ways in which individuals contribute to society) Who is stigmatized most? When we asked which group of people with substance Taking what we learned into the community use problems are stigmatized the most, answers fell In the next phase of this project, we presented the re- into the following categories: sults of our research to the community. Examples of • People who use illegal drugs (especially injectable some of our awareness-raising events included presen- drugs; crack and heroin) tations at conferences, community coalitions, and to
Visions Journal | Vol. 2 No. 5 | 2005 13 background
addiction and mental health agencies; and a forum for attitudes and beliefs on people with concurrent mental the general public. health and substance use problems; highlight facts and As an immediate response to the suggestions for dispel myths; present positive stories and solution-fo- reducing stigma, we made an effort to have someone cused approaches; and support addiction and mental who has been affected by the stigma related to sub- health workers in their efforts to reduce stigma, preju- stance use problems participate as a co-presenter at dice and discrimination the events. These were golden opportunities to “edu- Beyond the Label focuses on hurtful language which cate,” “personalize” and “tell positive stories.” leads to prejudice and discrimination. How people are labelled can actually affect the way we feel about A toolkit for action them and how they feel about themselves. Negative The collective voice of the community led to another stereotypes often associated with terms like “junkie,” project, resulting in a practical resource to actively ad- “drunk” or “psycho” eclipse other stories of a person’s dress the stigma related to co-occurring substance use life—their strengths, successes and possibilities. and mental health problems. Beyond the Label: An Edu- cational Kit to Promote Awareness and Understanding of The last word the Impact of Stigma on People Living with Concurrent Stigma is not just about hurting someone’s feelings. Mental Health and Substance Use Problems is a free re- Stigma is about prejudice, discrimination and violating source, offering activities that emphasize the impact of a person’s human rights. · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · Seniors, Alcohol and Stigma Just imagine . . .
eeking Solutions: Consider the frustration of seniors in British Colum- Seniors point out that Canadian Commu- being told that you aren’t al- bia—and more than a stigmatization makes it nity Action on Sen- lowed to receive help in your quarter million seniors in unsafe for them to ac- siors and Alcohol Issues, apartment from special com- Canada—who experience knowledge personal alco- a national project funded munity services so that you alcohol use or prescrip- hol or prescription drug by Health Canada (2000- could handle your condition tion drug problems. Alco- abuse concerns. They are 2003), examined prom- better, and yet being told if hol use problems affect fearful of being judged ising practices emerging things don’t change, you will between 6% and 10% of by others, particularly by in prevention and treat- have to move. seniors who drink, a rate their peers. While having ment. As part of this Imagine being reluctant on par with other age an alcohol or prescription project, seniors and serv- to talk openly with your doc- groups. However, the is- drug problem is painful ice providers from across tor about your condition, and sue often remains hidden and isolating, stigma rein- Canada shared their per- your doctor being afraid to until a health care, hous- forces that pain and isola- Charmaine Spencer sonal experiences of stig- ask you. Or imagine know- ing or service delivery cri- tion many times over. matization associated with ing if that you did disclose, sis develops. And, because Even language com- Charmaine has worked at drinking problems. Here that you would be given a substance abuse is largely monly used by the public the Gerontology Research are a few excerpts from label that coloured the way invisible, the appropriate and service providers (like Centre at Simon Fraser the report:1 people saw you and every- community resources to alcoholic or addict) is often University since 1991. Imagine a place where thing you did. If you ended help are often lacking. highly stigmatizing. It often Working closely with you were unable to let any- up in hospital, you might be conjures up images of community agencies that one know about the per- arbitrarily denied access to Stigma and its effects those who are ‘down-and- serve seniors, she focuses sonal struggles and fears emergency care, treated as Ancient Greeks used the out,’ or who lie, manipulate on mental health, substance you faced in daily life. Imag- a ‘bed blocker.’ The pain you word stigma to refer to and fail to live up to their use and aging issues. ine taking the risk of being experienced from a broken body marks that identi- responsibilities. Charmaine was Project shunned by your few re- arm might not be treated. fied people others should Stereotyping overlooks Coordinator for the national maining friends if you dare Ageism and stigmatization avoid. Academics de- the diverse circumstances Seeking Solutions: Canadian to let them know about your can be a fatal combination. scribe stigma as having in which alcohol and drug Community Action on condition. These are a few of ‘master status,’ meaning it use problems may develop. Seniors and Alcohol Issues Imagine being denied af- the real effects of mis- eclipses all other aspects Older women may feel project fordable, appropriate housing conceptions, stereotypes of the person, including more social pressure and because of stereotypes about and stigmatization for an their strengths, talents stigmatization than older ‘people with your problem.’ estimated 21,900 older and abilities. men do. It’s somewhat
14 Visions Journal | Vol. 2 No. 6 | 2005 background
Not In My Backyard NIMBY alive and well in Vancouver
ur neighbourhood helps define us. Many of us are shared by many have put a great deal of thought into where we when it comes to treat- would like to live, and once we are there, we ing people with mental owork hard to create a living space that supports us. We illness and addictions. all take great care in ensuring that our communities Recently Vancouver stay healthy, livable, desirable places to live. has had two instances For people recovering from a mental illness, an ad- of proposed facilities ending up in storms of controver- Mykle Ludvigsen diction, or both, it is well-documented that a safe, sta- sy in their respective neighbourhoods. Each facility had ble and supportive housing environment is an essential been in advanced stages of planning and was seeking Mykle is Communications part of recovery. It could be argued that a strong com- Vancouver City Council approval. Officer at Canadian Mental munity setting is also an essential part of the recovery In the first case, the Vancouver-based Triage Emer- Health Association, BC Division process. By and large, most people with mental illness gency Services and Care Society proposed to build a 39- or an addiction can, with a lot of hard work, support, bed apartment building to house men and women who effective treatment and proper self-management, suc- have a mental illness but were also recovering from a cessfully reintegrate back into the community—some- street-drug addiction. The people housed in the facility, related resources times after years of disconnection from it. to be located in South Vancouver at Fraser and 39th • MacNeil, M. (2004). NIMBY: Sadly, these two ideals often clash when people re- Avenue, would be in the later stages of their recovery When Affordable Housing covering from mental illness and/or an addiction attempt with less risk of relapse. Over the course of several pub- Development Meets Community to reintegrate into a community. NIMBY, the ‘Not In My lic meetings, concerned members of the community Opposition. Calgary, AB: Backyard’ sentiment, often rears its head, making the showed up, outraged that this particular facility was be- Housing Strategies Inc. www.sharedlearnings.org/ reintegration process even more difficult and painful. ing located in their community. res.cfm NIMBY can be defined as the desire to keep a per- Fear regarding mental health and addiction can usu- • HomeComing Community ceived unpleasant thing out of a community. People will ally be put to rest with some simple knowledge. Those Choice Coalition. (2003). generally support the need for these unpleasant things of us personally connected with these issues need to en- Yes, In My Back Yard: A guide to exist, but want them located elsewhere. In most cas- sure that proper information is available. for Ontario’s supportive housing providers. www.onpha.org/ es, these same people will claim that their beliefs don’t It is also clear that both Triage and the City of Van- affordable_housing_ have anything to do with NIMBY attitudes, but every- couver needed a better plan for communicating with initiatives/nimby/ thing to do with the unsuitability of recovery and reinte- the community. According to a Vancouver Sun inves- • National Low Income gration services to that particular neighbourhood. tigation, only 277 flyers were sent out to this dense Housing Coalition. NIMBY Reports. Various newsletters In addition to NIMBY attitudes, there are people urban community to explain the project, and only in and reports (2000-2005) who hold the view that a particular thing should never English—neglecting that the neighbourhood is predom- at www.nlihc.org/nimby be built anywhere, ever. Unfortunately, these feelings inently Chinese and South Asian.1 Seniors, Alcohol and Stigma | cont’d acceptable for men to Hope for the future out-of-wedlock pregnancy Active efforts to normal- drink to excess, but not Seniors point out that were once considered ize these issues, as well as for women, and certainly during the past 40 years shocking.” And children changes in legal systems not older women. “You are many social and health is- with developmental dis- and social structures along supposed to be little ladies, sues that used to be highly abilities used to be hidden with positive role mod- prim and proper,” shared stigmatized have lost their or institutionalized, “but els, have helped to open one study participant. shaming effect. One ex- that changed a lot with the up discussion and break Another said, “I remember ample was cancer: “In Kennedy’s daughter [Rose- down stereotypes. Older my father saying to his five earlier generations, peo- mary] in the 1960s.” Sen- adults ask you to imagine daughters, ‘I don’t care ple did not mention the iors note that attitudes and a similar positive future for how much you drink, just ‘C’ word.” Another par- beliefs have improved sig- people experiencing alco- don’t show it.’” ticipant shared: “Family nificantly through public hol use problems—and to matters such as divorce or education and awareness. help make it happen.
Visions Journal | Vol. 2 No. 5 | 2005 15 background
footnotes The flyer sparked fear amongst community mem- Then, just as the Triage controversy was winding 1. McMartin, P. (2004, bers that this project was being imposed on them with down, Family Services of Greater Vancouver moved into October 20). Maybe the little debate, and that obviously someone must be try- the final stages of approval for a youth services centre NIMBY side has a point. ing to cover something up. A fundamental rule in con- to be built in Vancouver’s downtown, across from St. Vancouver Sun, B1. troversy communications: the less information put out Paul’s Hospital. The proposed facility would integrate to the public, the more suspicious the public becomes. services for at-risk youth, which were spread throughout 2. Ministry of Housing, Recreation and Consumer And instead of having a debate on the merits of the the Downtown and West End neighbourhoods, into one Services. (1996). Toward particular location for this facility, the ‘debate’ featured facility. The community has had serious problems with More Inclusive Neighbourhoods. accusations that the city knew the community didn’t street youth for some time, and the plan would move Retrieved June 10, 2004, want the facility and was trying to sneak it in the back services out of facilities in predominantly residential from www.mcaws. door. It also didn’t help that an unlicenced facility for areas to a more commercial area conveniently located gov.bc.ca/housing/ NEIGHBOUR. See the former sex trade workers recovering from addictions across from one of BC’s largest medical centres. section called “Property existed in the neighbourhood that people hadn’t previ- Despite what appeared to be an excellent oppor- values unaffected by ously known existed. The city quickly moved to shut tunity to situate these services on a centrally located, non-market housing.” that facility down. city-owned property, where they would be easier to ac- cess by at-risk youth and easier to monitor by police 3. Repper, J., Sayce, L., Strong, S. et al. (1997). Tall and other social service agencies, opposition in the sur- Stories from the Back Yard: A rounding area began to crop up. Notices were placed survey of opposition to community anti-NIMBY strategies in the lobbies of apartment buildings and slipped un- mental health facilities experi- der people’s doors, inviting them to attend the public enced by key service providers in “I was more frightened of the [neighbourhood] resi- meetings to oppose the project. In some cases, build- England and Wales (executive dents at the first public meeting than I have ever been ing managers and property owners were encouraging summary). London: MIND. with any of the patients I have worked with”3 tenants to turn out and oppose the project. 4. Sayce, L. & Willmot, These hearings also revealed a fundamental Best practices rooted in lessons learnt by 98 local J. (1997). Gaining Respect: need for information on mental disorders. Even non-profit, housing, trusts, and voluntary organizations A guide to preventing and though the facility was not just for people with men- tackling community opposition to include the following:4 mental health services. London: tal illness or addiction, mental illness was one of • supporting service users to be as involved as they MIND. the key points seized on by opponents to the project. want to be in planning how to prevent and deal In the end, the project was revised to include a man- 5. Reda, S. (1996). Public with community opposition agement plan, as well as the integrated youth services perceptions of former • providing a contact number that people can call if centre, and will go ahead. When completed, it will likely psychiatric patients in they have concerns England. Psychiatric Services, meet with the same response that greeted the Dusk to • having facts and figures ready 47, 1253-1255. Dawn youth drop-in centre that was established across • promoting partnerships between professionals, the street at St. Paul’s Hospital in the early 1990s: peo- media, consumers, neighbours, even neighbours ple who live nearby will hardly notice it’s there. from areas who no longer oppose a project In most cases, the neighbourhood concerns are • being prepared to listen to reasonable complaints unfounded. Research has proven that schools are no and make changes (e.g., about the size of a facil- less safe because of the nearby existence of a facility ity or parking arrangements) without compromis- for those with mental illness and addictions, and that ing key service issues (e.g., 24 hour access) property values in an area do not go down (in fact, • if the facility is user-run, selling the idea the province itself has done extensive studies on this • never making promises that would lead to dis- subject with some evidence suggesting that property criminatory exclusions (i.e., excluding people with values can even go up, not down).2 criminal records or substance use problems) While NIMBY reactions to projects that will benefit • if trouble persists, working with police, media, al- entire communities are difficult to deal with, and at lies and make use of criminal law if necessary times maddening to people who desperately need those • above all, not giving up or apologizing services, they do serve a valuable purpose. The debates • being proactive and not slipping facilities in side- about them propel society to learn about the particu- ways where you might avoid opposition initially lar disorders and afflictions, become familiar with the but also lose a pool of goodwill agencies that deliver services, and give those agencies a • in a UK survey, neighbours suggested the follow- chance to prove to skeptical members of the community ing be included in an education program: practi- that they are assets to the community. Debate provoked cal skills on dealing with problem behaviours, by NIMBY attitudes also helps agencies improve plans to understanding more about what mental illnesses mitigate fears and create effective communications and addictions actually are, available treatment strategies to combat those fears, including having ser- services, and the importance of accepting people vice users themselves talk to concerned neighbours. 5 with mental illness and/or addictions. As in everything, a little education and open communication go a long way.
16 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives
I Want a Little Respect
ental illness is on our own. These actions illness. They treated me as son who has treated me Patrick Schnerch mvery common. It’s are an automatic response if I was mentally incompe- as a normal human be- a quiet disease, however. to our own mental pain. tent. I was given useless ing. I have been ridiculed, Patrick’s first 12 years Physically, the disability There is no thought or plan- tasks of no importance. belittled and abandoned of life were normal and often remains unseen. It’s ning; our minds no longer Even though I previously by friends and family. I happy; then his world came an affliction within one’s have control. We can usu- had a career in the army, have been accused of be- crashing down. He lives in heart, mind and soul. ally remember our ac- where I used equipment ing lazy and of being a Victoria, with a diagnosis of You must not stereo- tions, but are certainly not worth hundreds of thou- useless bum who should manic depression type us as ‘crazy people’; in control of them. We are sands of dollars, they be- get off his butt and work. you must understand that also usually unable to ex- lieved I wasn’t capable of The public needs more we have an illness. We plain our actions, because the simplest tasks, such education to help prevent must learn more about we really don’t understand as gardening—I most cer- the stereotyping of us as these devastating condi- them ourselves. Many tainly can pick up a shovel. useless and lazy people. tions. Let’s not forget, people with mental illness They talked slowly to me, With the proper support mental illness plagues mil- are substance abusers—in- and I was never left unsu- and medical intervention, lions of people throughout cluding me. We try to clear pervised. This treatment we are capable of taking the world. We don’t de- or remove the anguish by made me feel inept and care of our families, run- serve to be frowned upon any means possible. The belittled. ning households, working or considered unimport- most common substanc- I have met an incredi- in the public sector and ant members of society. es, in descending order, ble man, however, who has accomplishing our dreams Many of us who are are coffee, cigarettes, alco- the power and authority and goals just like ’nor- afflicted with mental ill- hol, and prescription and to inform the public of life mal’ people. We can do all ness try very hard to hide illicit drugs. Unfortunately, with mental illness. Vern of that and still have time ourselves from the general many of these substances Faulkner is the editor of the to be tortured by an illness public, so that we are not can greatly interfere with a Esquimalt News. He listened on top of it all! recognized as having a solid treatment program. to my story and felt that the Although my illness disability. We don’t want I have respect for peo- topic of mental illness was has caused severe chal- other people to know that ple with multiple sclerosis, important enough to do a lenges, my wife and her we’re not ‘normal.’ We AIDS and other medical two-part series. He exam- family are also incredible. have worn masks through- ailments. Why should I ined the political, structural They have stood by me, out our lives, and know not be respected for my and emotional aspects of never wavering for a single which face to put on in medical ailment? Attitude mental illness. He then ran minute. My wife has had which circumstances. We towards the mentally ill the stories,1 which were many reasons to leave me, are so clever that our de- must change—not just for later picked up by other sis- but her love and support ception is usually never our sake, but for the sake ter papers. He made a sub- has made me survive. Her detected. Our illness and of all those who come into stantial effort on the behalf incredible courage to with- struggle is kept secret. contact with us. Society of the mentally ill to inform stand some terrible situa- Fighting the ailment must learn to accept the and educate the public tions and to still stand by footnote can leave one confused mentally ill for who they about this ailment, and has my side is remarkable. 1. For his series on mental and exhausted. Physical ail- are. Education is a key to recently been nominated All I want is to live a health, Vern Faulkner of ments arise from the con- becoming a better person for a journalism award happy normal life, free the Esquimalt News won the tinual battle within one’s and to learning about oth- for his efforts. He made a from prejudice. People Best Feature Series award (4,000 to 12,449 circulation self. The battle becomes un- ers. A little understand- weighty contribution to- with mental illness want division) in the Canadian bearable, and the ‘combat- ing will go a long way to ward removing the stigma the respect that many Community Newspapers ant’ can become too weak removing the stigmas and of mental illness. I have the ‘normal’ people take for Association’s Best News- to continue the fight. fears associated with men- deepest respect for him, granted. Everyone has papers Competition on Subconsciously, we cry tal illness. and he also treated me their own ‘bottom line.’ June 6, 2005. He was also first runner-up in the Best for help through our ac- I once volunteered my with respect. I ask that you respect Feature Photo category for tions, because often we services to a local charity. In my entire life, Vern mine. a photo used in this same are unable to ask for help They knew I had a mental Faulkner is the only per- series.
Visions Journal | Vol. 2 No. 5 | 2005 17 experiences and perspectives
Does a Person Have to Look Sick to be Considered Sick? Personal reflections
Kate hen people, including professionals, think times—I have a post-secondary education with plans of mental illness, their perception may be to further it, have a professional career in a health care Kate is a Mood Disorders of a person who is not taking care of them- field, and have experienced other successes as well Association of BC member wselves and their responsibilities, and whose behaviour as challenges. Many professionals, it seems, have the and has been a recipient is out of control. As true as this is for some individuals, same prejudicial ideas that I used to have about what of care from the mental there are also people affected by mental health condi- mental illness ‘looks like.’ Even though I may appear health care system since tions who do not present in that way. This does not okay on the outside to others, I can be significantly 2004. She lives in negate the fact that there are times when treatment challenged internally and experiencing changes in the Lower Mainland. You and intervention are clearly needed to prevent further my normal pattern of functioning and energy level. I can contact her at decline in a person’s functioning, regardless of how can appear strong and confident, but feel unwell. Those its_your_healthcare they appear externally. who know me have the proper insight to understand @yahoo.ca How have I come to understand the difference be- this change. This is why, in my opinion, a person must tween looking healthy and actually being unwell? My be viewed individually and not placed into a defined perception of mental illness has changed because of category where assumptions are made solely on the my own experience of it. I used to have the stereotypi- category itself. cal idea that people with mental illness appear ‘out of Prejudice and stigma in our society about the ap- it,’ and were identifiable by their erratic behaviour and pearance and behaviour of the mentally ill may stem messy appearance. I realize now that I also believed from the fact that people do not receive adequate treat- mental illness was a character weakness. My percep- ment until their condition and functioning deteriorates tions were due in part to my family’s attitude towards significantly past the point where they ought to receive mental illness. Several relatives have experienced intervention. The prejudice can be that of the person depression, but within my family mental illness was who is ill, their family, friends and co-workers, or that considered a weakness and was treated with a ‘hush- of health care professionals. hush’ attitude. Thankfully, their attitude, and mine, has The experiences I’ve had make me wonder if one changed as a result of my experience. has to be totally ‘out of control’ before intervention can During the past two years my mental health has occur. Do we have to look or act a certain way even if been challenged, and it’s only recently that I’ve been we are not quite at that point clinically, but instinctively properly diagnosed. Know- know we will soon end up there without the proper ing that I needed medical treatment? Does a person have to arrive at a hospi- attention for what was oc- tal emergency room (ER) with very little or no ability curring was not something to function before they are taken seriously? What ever I was pleased about, given happened to the basic premise of listening to the pa- my independent nature. tient and gathering the proper information before mak- But deep down I knew ing an overall objective and subjective conclusion? Does treatment was necessary, the health care system want to prevent/limit repeated including the need for med- ER visits and hospital or facility stays? If so, where does ication. Were it not for my proactive medical care fit into the picture? general practitioner (GP) These questions may be difficult to answer in a and associate and staff, I quick and easy way, especially with all the constraints don’t know where I’d be the health care system is facing. But not taking the today. The treatment, un- time to listen or over-medicating a person and sending derstanding and proactive care I receive from these them home from the ER, on their own because there individuals is supportive beyond words. Sadly, some of are no inpatient or community facility beds available my other experiences have not been as positive. on that day, is not the answer. I believe these questions I believe that my education and external presenta- deserve close consideration by mental health care pro- tion has had a bearing on some professionals’ misper- fessionals and governments. Policy makers should also ceptions of the intervention I have needed at certain seek input from individuals who use mental health care
18 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives services, regardless of their background. My condition is improving, and I’m very satisfi ed with As a result of recent experiences at my local ER, the medical professionals involved in my immediate I now have a written “Crisis Health Plan” to help me care and treatment. I also benefi t from a high-quality to receive consistent and unconfused treatment when group therapy program. I feel I have to go to the hospital. I created this plan I hope that sharing my experience will help each with my GP, and it includes contact information for my and every one of us to take the time to refl ect upon our physicians and details about my diagnosis, symptoms, own situation (personally or professionally) and what coping skills and tolerance of medications and dosages. we can do to help all people with mental health condi- The plan is on fi le at a large community hospital where tions receive the best of care—regardless of their exter- I was able to receive what I feel was appropriate care. nal appearance. · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · ·
Today, I Choose Life! On HIV, addiction and being a mom
Wow, you’re really nourished myself through easy, nor will it be later. K.C. Younker “ healthy for someone two pregnancies in the With good management years since testing positive (diet, lifestyle and medi- K.C. is a 28-year-old mom who’s had HIV for six for HIV and hepatitis C. cation when needed), how- who loves to play and to years. Women with I do volunteer work with ever, HIV positive people eat wild food. She lives in that die a lot faster addicts going through with- today can plan for a Saanich and the photo than the men do. drawal, treating them with real future—beyond the on this page is an actual ” detoxifi cation acupuncture, standard seven years! photograph of K.C. which I learned to do after When I look back on I experienced how much it my journey, one of the oming from a update their knowledge, so helped me. My two young issues that really stands man who has a it’s no surprise that many boys are beautiful, healthy out is the deadly idea that lot of contact with other people still base their and normal, and I am just once a woman becomes crecovering addicts, this ideas about HIV/AIDS on as frazzled and content as pregnant, being a mother ‘declaration’ took me by information taken from a any other mother I know. will automatically replace surprise. All hope of a 1970s news release. I have challenges, of being an addict. I know casual conversation lost, I I know that when I was course. I have adopted a fi rsthand how the fear tried to present him with diagnosed as HIV positive ‘high raw’ whole foods of having one’s children some actual facts about in 1999, I believed even diet and am doing a liver apprehended can keep living with HIV—but to no then that I had no more cleanse to detoxify myself mothers from reaching out avail. Though I try not to than the expected seven from a 15-year nicotine for the help they need. My let ignorance affect me, years to live. However, at habit kicked on March 1 fi rstborn was taken from me I found myself feeling the time, I was an IV drug of this year. I’m still on when he was six months insulted. addict and wouldn’t have a methadone program, old. I took the opportunity One of the challenges in lived another year the way though my dose is low and to attend a day treatment educating people about this I was going. I am tapering off. (From program, and began to virus is that our knowledge HIV woke me up experience I strongly learn what recovery was is changing and expanding enough to save my life. I suggest that the process of really about. Six months on a daily basis. Something have accepted this path. tapering be done slowly, later, after heartbreak I learned two months ago I am not in need of pity; with patience and lots of and hard work, my son may no longer be the current I don’t want anyone to support—and not before was placed back into my understanding, let alone be ‘sorry’ for me. I’m a you are ready!) I feel I’ve custody. This wasn’t the something learned fi ve strong woman who has built a solid foundation on end of my struggle though. years ago. I’ve met doctors begun walking the lifelong which to live the rest of One of my hopes is who haven’t bothered to road to recovery. I have my life, but it has not been to help open a drop-in
Visions Journal | Vol. 2 No. 5 | 2005 19 experiences and perspectives
centre, where pregnant or taken one step backwards. when people are hurting give thanks for the support mothering addicts can One thing that has helped and dying all the time. I from my acupuncturist come access services such me immensely has been get very lonely at times. and my immediate family. as peer counselling and going into a sweat lodge. Some days I think a lot No one’s path is an easy detoxification acupuncture It has been necessary for about my old street family one; no one knows what in a non-judgemental, non- me to connect with others and how we were before will happen tomorrow. We invasive setting, regardless in my community who everyone got messed up are all here to learn, and of their amount of clean are familiar with the cycle on drugs and spread out my children have been, time. I read about a of addiction and loss, and over the continent. I know and will continue to be, similar program at a New the process of healing. A that few of us survived my greatest teachers. York hospital which saw descendant of European to adulthood. Through a Whenever I start to feel a significant reduction in ancestry, I have always group of people who come affected by someone the number of babies born felt out of place, especially together to pray in the else’s judgements, I try to addicted as a result. in ‘normal’ working class sweat lodge, I have found remember my own tiny Sometimes recovery is circles. I have seen and quiet support and role glimpse of the big picture. all about believing that you experienced too much to models of great strength I have been blessed, and I deserve to take those two pretend that my own well- and wisdom. I give thanks know who I am and where steps forward, after having being is all that matters, for having met them. I also I stand. · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · Navigating the Stigma of Mental Illness and Addiction A service provider’s perspective
Debbie Suian, MA, RCC hese are the words of the war against stigma, a person in recovery “We need to educate people, even the what has been overlooked Debbie has been a from mental illness addict, so there isn’t the shame. It’s so is the inability of resourc- therapist for over 20 years, tand addiction. Poignant es to meet the ever-grow- and currently works as and insightful, they are ingrained in me that it’s bad to be what I ing demand for services. a concurrent disorders words that speak to the Discussion of these dif- therapist. She is an power of stigma. am that when you don’t get mad at me, ficulties is beyond my instructor at the Justice For many people in I struggle with that. I don’t know how scope here but important Institute of BC and the recovery, stigma is a con- to note because they take editor of Step Softly, a stant companion. Mental many other addicts feel that way, but I a toll on potential clients publication of the Tri-Cities and physical illness, pov- who find themselves ‘de- Mental Health Centre erty, trauma and isola- bet it’s lots—and their families too.” flected’ elsewhere, on tion can make fitting into –Person recovering from concurrent disorders service providers who are mainstream society dif- seen as ‘passing the buck,’ ficult. Alcohol and drug and on the resource that use is frequently seen as an effective way to deal with becomes the object of the deflection. In this context, problems that might otherwise feel overwhelming. stigma flourishes. From time to time, people ask for help. Sometimes Stigma and discrimination do not begin with the the assistance provided is helpful, other times it is not. request for help. Too often, discrimination is perpetu- At any given time, there are enough people asking for ated by the help that is offered or is unavailable. At the help that those who slip away can easily go unnoticed, systems level, there are simply not enough services to returning to lives of despair, where alcohol and drugs meet the needs of the people who require them. While can be counted upon to numb feelings that never seem this is not news to health care professionals, it can be to go away. Sometimes, those people die. It can be said distressing. Where services do exist, admission crite- that stigma kills. ria are sometimes so strict they almost guarantee that In recent years, public awareness campaigns have those who most require help will be least likely to re- been launched with the aim of encouraging people to ceive it. Discovering that treatment is unavailable—or reach out for help. Although an important initiative in even worse, inaccessible—can be devastating for peo-
20 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives ple who have finally come to terms with the idea that change is needed, and that help is required to make that change happen. As an addictions therapist working in an outpatient clinic, I have frequently heard stories of the unremitting shame people feel at having to come to such a place Stigma and Suicide and ask for help. As a concurrent disorders therapist, I hear similar stories of shame as people disclose the Historical, Real fear they feel that someone might see them entering or leaving a mental health centre. These are issues or Perceived? that professionals coming to work through those same health centre doors every day can easily forget. After all, “asking for help is a sign of strength,” we tell our cli- vividly remember the ents, and for the most part, we act as if we believe that weeks immediately af- statement. But the twists and turns inherent in concur- ter our treasured son’s rent disorders treatment can wear down even the most isuicide. I remember being welcoming, empathetic and hopeful of therapists when wrapped in a cozy blanket prevailing attitudes suggest that people bring the mis- of non-judgemental caring ery of addiction and mental illness upon themselves. by friends, family, church, In spite of scientific advances into the study of mental co-workers and the agen- meaning comments often P. Bonny Ball illness and addiction, many people living with these cies working with us. I re- inadvertently perpetuate conditions are stigmatized by the system, by service member the compassion stigma. The funeral home Bonny is a survivor1 of her providers and, at times, by one another. For example, of RCMP Victim Services would not let us say in 21-year-old son’s suicide 11 within addictions, it is one thing to smoke, snort, or in North Vancouver as they the obituary that Reed years ago. She is now Acting to swallow, but it’s quite another to inject. Within the told us of Reed’s suicide in had died by suicide, and Vice-President and Chair mental health system, it’s one thing to be depressed or Calgary. I remember those they only very reluctantly of the Survivors Division, anxious; it is quite another to be psychotic. first long-distance phone included “donations to the Canadian Association for The power of stigma reaches a whole new level calls to tell friends and Reed J. Ball Memorial Fund Suicide Prevention. She is when people living with mental illness also abuse or family that Reed had died for Suicide Prevention.” also Project Manager of become dependent upon substances. The treatment by suicide—and realizing Also, every book I read Vancouver Suicide Survivors of co-occurring disorders is neither short term, nor that I needed to care for while struggling with ‘why’ Coalition, a project of the straightforward. Recovery is frequently a journey into them as much they need- seemed to focus on the Consumer Initiative Fund a ‘no man’s land’ of confusion, despair and isolation. ed to care for me. I appre- family as the problem. of Vancouver Community It takes an incredible amount of courage on the part of ciated the Calgary police This was stigma as Mental Health Services an already demoralized and suffering person to travel and the Alberta medical originally defined.2 I felt a path laden with the possibility of further rejection examiner for their gentle like Hester in Nathaniel and disappointment. Along the way, even the most questioning and patience Hawthorne’s novel The compassionate and caring of therapists can forget the with my tears. Scarlet Letter, set in Puritan power of stigma until reminded firsthand of its sting. Not everything was per- New England. In the book Historically, the addiction and mental health sys- fect. Unlike other deaths, Hester is forced to wear tems have had strong feelings about one another. Not survivors1 quickly discover a large scarlet ‘A’ on her uncommonly, these feelings have been negative. We that talking about a suicide clothing to announce her are, it seems, very good at identifying each other’s brings dinner conversations adultery. I felt like I walked shortcomings and failures. In this context, stigma to a screeching halt. But around with a large ‘S’ on also flourishes. If we wish to be effective in the war the true impact of stigma my forehead. Eleven years against stigma, we must set aside our differences and is that it keeps survivors later, I still fight this sense join together in the service of helping people heal. from connecting with each of imposed guilt. footnotes In making the decision to work with people whom other, robbing us of both A recent study rep- 1. in the suicide prevention others do not value, we must guard against devaluing “like me” support and orted: “incidents were re- field, “survivor” or “survivor one another. In the same way that we loan our clients the opportunity to band counted of children who of suicide” are terms used hope, we must find a way to nurture, encourage and had lost a sibling or a in reference to people who together with professionals have been affected by the support one another, regardless of the system from to “make a difference.” parent, returning to the suicide death of a family within which we work. Only by putting clients first, and Sadly, it’s often the school environment and member, friend, colleague, working together to create a truly integrated system professionals working the being subjected to harsh or client/patient of care, can we make an impact on the stigmatizing closest to new survivors— treatment by both teachers events that define the daily realities of far too many of 2. stigma originally meant funeral home staff, grief and fellow students. Res- a brand, tattoo or physical the people we serve. therapists, and other ser- ponses ranged from that marker on individuals, a vice providers whose well- of a teacher informing a visible mark of shame
Visions Journal | Vol. 2 No. 5 | 2005 21 experiences and perspectives
student that her father could see how the impact spared the secondary trauma tackle stigma. And we would be going to hell of stigma and silence had of stigma and allowed to learned that the stigma footnotes because ‘suicide is a sin,’ rippled down into the grieve appropriately. Other we feel, that perceived ‘S,’ 3. Davis, C. & Hinger, B. to students ostracizing third generation. Our being survivors who are open is sometimes just that— (2005). Assessing the needs of a student who lost her open about Reed’s suicide about their loss report expe- perceived, and not real. the survivors of suicide: A needs sibling by saying ‘stay might, she suggested, riences similar to ours. The language of sui- assessment in the Calgary Health away from her, she has help these folks in their But even with little cide is changing from Region (Region #3), Alberta. Re- 3 trieved June 9, 2005, from suicide germs.’” healing. At the memorial overt stigma, members “committed” suicide, with www.calgaryhealthregion. For our family, the service everyone knew of our Vancouver Suicide its connotations of sin ca/hecomm/mental/ worst impact of stigma that Reed’s death had been Survivors Coalition often and/or crime, as well as SuicidePostvention.htm was not when our son a suicide. The minister still internally feel his- “completed” or “success- 4. Ezzel, C. (2003, Febru- died, but after his first spoke tenderly about torical stigma—that per- ful” suicide, to the more ary). Why? The neurosci- suicide attempt. Stigma Reed, giving the assurance ceived ‘S’ on our fore- non-blameful, non-judge- ence of suicide. Scientific meant that we told no one. that “God would take his heads. For last year’s mental “died by suicide,” American, 288(2), 44-51. Stigma thus isolated us hurting child home.” World Suicide Prevention which finally provides ap- from the very support and This gift of non- Day, we decided to ask propriate and acceptable information that might judgemental support con- libraries and bookstores language for obituaries. have made a difference tinued as my husband to build a book and Other change is hap- then. and I returned to work. brochure display around pening. Researchers are Following Reed’s death, Our co-workers, a typical our poster, but we were beginning to untangle the the minister of our new Vancouver jumble of eth- nervous to ask. However, science underlying this church offered sympathy nicities and faiths, com- we found the librarians complex issue; for exam- and guidance, and encour- passionately supported us were enthusiastic, and ple, positron emission aged us to be open about no matter what their par- several shared stories of tomography (PET) tests his suicide. She said there ticular background taught suicide in their families being researched might had been two or three about suicide. and among co-workers. one day help doctors de- suicides over the years in In short, in the midst of Just making our request termine who among their that congregation and she trauma, we were blessed, to the libraries helped to depressed patients have the most unusual serot- onin-related brain activ- ity—a feature that has been linked to high risk of Living with Prejudice An MtF perspective suicide.4 And the media is im- Theresa Collinge here are many forms of discrimination faced by the proving as an ally, tack- tmale-to-female (MtF) transsexual, from all areas of ling stigma with well- Theresa was raised as a male, society. There are some people who will use religion as researched, informative but always knew she was a girl a reason to hate us and to discriminate against us.... and compassionate back- inside. Theresa eventually reached Most in the field still treat it as a mental condition. ground articles, exploring a point where she could no longer Transsexualism (renamed recently as gender identity suicide as tragedy rather live her life for everyone else, and disorder) is listed in the DSM-IV-TR, the manual that cat- than as a sin or a crime to began transitioning to female in egorizes mental conditions, but I don’t feel it is a men- be sensationalized. 2003. She is a member of the tal condition. New research is starting to look more at Thus fortified, many Phoenix Centre Clubhouse in the biological roots of it, particularly the neurological survivors choose to stand Nanaimo and endocrinological (hormonal) influences. But inclu- up to stigma. We take sion among the list of mental illnesses adds prejudice advantage of ‘educational to my life. Because that’s not how it feels; it feels very moments’ to talk about much that it is a condition that occurs in our bodies be- the suicide that has im- fore we are born. This is not a choice we make, to live pacted us. More and more this way. And for some of us, the choice becomes dire: survivors are choosing either to change or to take our lives.... to be open and are met A lot of the stigma and discrimination would stop with compassion and un- to read Theresa’s full article, if people could just open up their minds, use their derstanding, empowering mouths and ask us why we do this. My partner and I others to also be open. go to www.heretohelp.bc.ca/ have found that educating others about this does help. As often as not, people articles We talk to students and anyone else who shows an in- respond with stories of terest. So, I ask: please open your minds and try to suicide in their own circle. learn about us. The silence is breaking.
22 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives
Mental Disorders The Result of Sin?
few months ago, an in a daze. She had to be com- feels an absence of acquaintance told mitted to hospital against hope and faith when ame about her moth- her will. To this day, she is emotionally ill still in denial, feeling guilt • The belief that being a er-in-law, Cynthia*, who had been found to have and shame. Christian means you’re bipolar disorder. In her Hearing this story sad- emotionally healthy late 50s, and always hav- dened me deeply. Being • The mistrust of modern ing been a competent a Christian with bipolar medical findings person, Cynthia had a disorder, I know how im- • Misinterpretation of the about my problems, he Marja Bergen great deal of trouble com- portant my faith is to my Bible expressed a desire to learn ing to terms with this. well-being and how much • The biblical concept of about my disorder. Marja is a writer and She refused to accept I need the support of a demonic possession I haven’t always been photographer living in the diagnosis or to take church family. I am not • Fear because of mis- a Christian. I know what it Burnaby. She has written the medications prescribed alone in this. And medical understanding and not is to be ill with, and with- newspaper and magazine by her doctor. She was professionals are becom- knowing how to help out, God in my life. But articles about mental health hospitalized several times. ing increasingly aware of now, during crises, I’m issues. Her book, Riding the Failing to cope, her life— the importance of spiritu- At the same time, it’s no longer alone when it Roller Coaster: Living with and her family’s life—was ality to mental health. clear to me that not all becomes difficult to hang Mood Disorders, describes in turmoil. Some Christian writers Christians stigmatize those on. I now have a spiritual her life with bipolar disorder The evangelical faith have revealed that a large with emotional problems. lifeline—a loving God—in and the coping skills she she followed did not en- segment of those identify- At the United Church I whom I can trust. My faith has found helpful courage her in her battle. ing themselves as Chris- belonged to for 14 years, means everything to me. The general opinion she tians does indeed cling I was open about my This is why Cynthia’s story had grown up with was to faulty ideas and judge- disorder, having decided disturbs me. Those who * pseudonym that emotional problems mental thinking, and lacks long ago that if I wanted are in the best position to were an indication of not compassion towards those to help end the stigma, encourage her are causing “being right with God”— with mental illness. In I myself would have to more suffering. the result of sin. In her spite of overwhelming ev- stop hiding my condition. All of society needs to mind, and in the minds of idence of biochemical fac- My church friends read become better informed many others in her church, tors in mental illnesses, the book and articles I about mental disorders. her illness was not a medi- many well-known, respect- wrote and became familiar Yet, for members of faith cal issue. They believed, ed writers and evangelists with my story. In spite of communities, this is es- as one author wrote, “If a still believe these illness- this—or perhaps because pecially so because of the person has ‘the peace of es are caused by sin and of it—I was loved and important part they play God which passeth all un- weakness of character— accepted. I became an in the emotional care of derstanding’ (Philippians that is, by something that active member of the their members. Pastors 4:7) in his life he cannot is under our control.2 congregation, taking on a and other church leaders have emotional conflict. The very church that number of leadership roles. desperately need educa- Ultimately…symptoms preaches Christ’s uncon- Only occasionally did I tion about mental health footnotes 1 are spiritual problems.” ditional love and compas- sense some awkwardness issues, so they can encour- 1. Solomon, C.R. Cynthia’s friend from sion, in some instances, with people who were age—not reject or judge— (1971). Handbook of church told her that tak- hurts its most needy mem- aware of my background those with emotional dif- Happiness (p.48). Denver: ing medications demon- bers. Some of the dynamics but didn’t know me very ficulties. Grace Fellowship Press. strated a lack of faith. The contributing to this irony well. And, they need to 2. Carlson, D.L. (1994). friend advised her to throw include: More recently, I began know when it’s time to Why do Christians shoot away her pills. Not long • The fuzzy line between attending an evangelical help members of their their wounded? Helping (not after, Cynthia was found the psychological and church and here, too, I’ve pastoral community seek hurting) those with emotional wandering the streets of the spiritual found support. When I medical care. difficulties. Downers Grove, IL: InterVarsity Press. another city, confused and • The fact that one often let my new pastor know
Visions Journal | Vol. 2 No. 5 | 2005 23 experiences and perspectives
Breakdown at Work How I was treated when I needed long-term disability coverage
Max Danvers* was working for a It’s interesting to me insurer. Frankly, I didn’t the house, just to pay the large chemical waste how there can be people think that there would be bills and cover the rent. Max lives in Delta. company as a plant who are so well educated any question as far as be- I had three children and The following is adapted iforeman and an on-site and yet just can’t com- ing covered. I had been di- I’d always been the sup- from a transcript of union representative. I prehend the devastation agnosed a decade or two porter. A month before I a live interview with had worked there for that depression causes. before, and they had ac- went off of work, we had Max about difficulties about seven years and had There’s a serious lack of tually denied me group been pre-approved for a accessing workplace climbed the ladder well. It understanding out there. life insurance through the mortgage, we had a down disability insurance. He was the kind of job that To this day, it’s a thing that company because of my payment, my credit rat- was interviewed for a everyone considers, these I don’t share with people illness. And yet, when I ing was good, bills were documentary made by the days, very secure. It paid except for close friends; had to go off of work, the always paid in advance. Canadian Mental Health well, I was a senior man even some of my family same company denied my And through all of this, I Association’s BC Division. and I had security, ben- doesn’t understand. Well- claim saying that I didn’t lost everything. I honestly The documentary was efits, pension—the whole meaning people would have an illness; that it was thought we were going to released in February 2005 bit—but in the end, none like to, but they just don’t just work-related stress. end up on the streets. as an adjunct to a 2004 of it helped. have a full appreciation. So it’s ironic that the same It’s like if somebody report on the same topic. To I was diagnosed with The company itself company is telling me two has a cold, you don’t stick access the report and the depression in my early was self-insured for short- different things. them in a refrigeration documentary online, and to 20s, but at work I had the term disability, and that What angers me the unit and tell them to get see other people’s stories as ability to hide it well and I was for three months, most about it is that I just better. I was down. I was well as recommendations held on for a long time. Ev- then you applied for long- wanted to get back to down as far as you could for employees, employers ery day I would go to work term disability through the work. That’s all I wanted go, and I couldn’t get back and the insurance industry, and hang on, and then I’d private insurer. When I to do. I wasn’t trying to up—and it wasn’t for lack see www.cmha-bc.org/ pretty much just go home was off on short-term, I scam anybody. All I want- of trying. I did everything research and sleep. I had no energy was told by the company ed was help to get back on I could, but antidepres- left. As time went on, it to apply for long-term and my feet. sants alone aren’t enough. * pseudonym got worse and worse. The to do it right away. I said It was about three The last thing anybody politics and stress at the no; that I wanted to come years after I applied and needs when they’re down company didn’t help. back to work. the court date was ap- like that is more finan- I kept trying to battle When I did return to proaching that they finally cial trouble and creditors my symptoms by working work, I was just thrown had a psychiatrist come phoning. night and day. One day I into the melting pot. It and interview me. Their A stable income is had a meltdown. I broke was basically like nothing own psychiatrist admitted important to everybody. down in tears and just had happened; nobody that, had the insurer just To this day, I don’t want to couldn’t cope with it at all wants to talk about these paid the benefits to keep be rich; it doesn’t matter to anymore. They had one of things so I just went right my family afloat while I re- me to be rich whatsoever. the Health and Safety guys back to assume my regular covered, I would have been All I want to do is pay take me to the doctor. duties. Half a day later, I back to work long before. my bills and support my Some of my co-work- was shaking and sweating In the end, there was family—and when that’s ers were somewhat stand- and in tears again. When a settlement, but the dam- disrupted, you feel like offish, some were suppor- I was taken, again, to the age was done. Basically, it a failure as a father, and tive, others looked at me hospital, I realized that I was far too little too late. others view you as such. and thought that it was just had to apply for long-term To this day, I’m still trying All you want to do is get a scam; that I was just try- coverage. That’s when the to recover from it. I lost better. You don’t need a ing to get time off—ironic whole dilemma started. my marriage and had to fight when that’s going on. since who wants to be la- I had never before sell everything I owned It’s the last thing anybody belled with mental illness? submitted a claim to the just to keep my family in needs.
24 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives
And the Cement Cracked and Crumbled Away
There is a crack in everything. That’s how the light gets in. —Leonard Cohen
t was April: the season myself out of bed and go Rosalyn of rebirth. I stepped to class. I would be wiped out of the hospital and out long before the end of Rosalyn is a fourth-year iinto the sunlight, suddenly the day. Insomnia haunted interdisciplinary arts aware that I was no longer me. Though it was clear student in Ethnic and wearing a puke-coloured to me that it was getting Intercultural Studies at gown and disposable slip- increasingly hard to live, I the University of British pers. I was wearing the managed to stay on top of Columbia. An aspiring clothes I wore when I was school and complete four writer and social activist, admitted. I was a normal co-op work terms. she writes about life and person wearing normal I thought that if I could mental health at clothes and walking nor- just give the appearance www.back-space.ca/lite mally down the street. of a happy, high-function- Given the unexpected and ing student, whom people Rosalyn would like to give devastating storm that was my hospital stay, I clung to thought was well-liked, intelligent and talented, my in- special thanks to her high anything that reassured me life after hospitalization ner hell would eventually shrink away. But it didn’t. It school teacher Joanne for would be normal again. grew tall and large, ferocious and insistent. recognizing and nurturing The years leading up to April 2004 were marked The more depressed I grew, the less I saw my psy- the seed in her, and for by fear, anxiety and a drowning darkness. I began to chologist. I began missing work. Due to escalating prob- encouraging Rosalyn to have trouble in 1996 at the age of 14. For three years, lems at home, I fell into a suicidal crisis and was accom- tell her story my weight swung high and low; my eating habits were panied to the emergency ward at Vancouver General disgusting; and I ate inordinate amounts of junk food Hospital (VGH) by co-op program staff. There, I saw a along with regular meals. I ballooned to a size 16. I had psychiatrist, then a social worker who connected me to gripping anxiety attacks in the middle of the night; I the Domestic Violence Program (DVP). I had a history of flirted with suicide. physical and psychological violence at home. At age 17, I had so little will to live that I didn’t Seeing a DVP social worker was helpful. After a few apply to any universities, even though I knew that my months of seeing this social worker regularly and my Chinese parents expected no less. At home, I had built psychologist intermittently, I got marginally better. I a strong and sunny exterior that belied the war raging landed a coveted, challenging summer job. Outwardly, inside me. My sister was shocked to find that I hadn’t I was doing so well. Inwardly, I continued to struggle for submitted any applications, and subsequently helped years with sleep and eating and mood disturbances. me with my application to the University of BC. Finally, a crisis counsellor encouraged me to get an The next three years were marked by many new ex- assessment for depression at Student Health Services. periences, challenges and decisions. I sought help for my Within days I was diagnosed with major depression and problems and I began to develop a sense of self-worth generalized anxiety disorder. I was put on medication. and empowerment. I switched from Commerce to Arts, Easy as pie, as if they had treated many other students which felt right in my heart. I joined the co-operative ed- for the same reasons. Then why do I feel so alone? ucation program and was introduced to the professional The diagnoses didn’t surprise me, but they were working world. I was learning and thriving. unsettling. I was ambivalent about antidepressants. I At the same time, I struggled with a mind-weak- was a bad patient because I didn’t take them as pre- ening and soul-crushing depression that went undiag- scribed. I noticed improvement after about four weeks nosed. I had no appetite. The world was tasteless, co- of taking medication, and was starting to feel normal lourless, ‘feel-less.’ I was numb. I couldn’t cry. I felt ex- again—whatever that meant. But when six months lat- ceedingly guilty and reeked of self-loathing. Each morn- er they ceased to bring relief, I stopped taking the little ing I had to muster every ounce of willpower to pry white pills. And paid a heavy price.
Visions Journal | Vol. 2 No. 5 | 2005 25 experiences and perspectives
In the fall of 2003, I left home and moved into a seed took root and a tiny green leaf lifted its face to campus residence, then began another rapid and debil- the sky, and the more I nourished it, the more leaves itating descent into darkness. I thought the medication grew. I did that by taking care of myself, managing my was supposed to drive this away for good! stress, eating well and exercising regularly, and making Again, I worked hard and studied hard despite my a commitment to get better through weekly therapy diminishing appetite, severe lack of sleep, and heavy sessions with my psychiatrist. Being really sick gave heart. Over three months, I lost a quarter of my weight. me a new appreciation and gratitude for being well. I went weeks without going to classes. I was so disen- Recovery is also about grief and sadness. The most gaged and withdrawn that my roommates, classmates painful part of my recovery has been the aloneness, and professors hardly saw me. I barely cared. I wanted the silence, and the internalized stigma—cultural and to die. But I didn’t even have the energy to do that. social—of having a mental illness. Recovery has been Then I had strange out-of-body and out-of-reality a lonely experience for me. If depression is so common, experiences that rattled my consciousness. I sensed especially among students, why do I feel so alone? Aside something was going wrong with me, that I needed from the people who assisted me with getting help, help. I reached out to a trusted colleague, who accom- and my employer who graciously arranged accommo- footnote panied me to see my psychologist. The psychologist re- dations, no one else knew about my illness, my family 1. Susan Rook is a ferred me to psychiatric services. The next day I found the least. former CNN Anchor myself in an ambulance being wheeled to the Psychiat- The greatest stigma did not come from others, but and current advocate ric Assessment Unit at VGH. This was in March 2004. from within myself. I befriended silence for a long time for addiction recovery. Words like psychosis and depression possessed me for fear I would be cast aside once people knew I was This quote is from her at the hospital. It was simultaneously comforting and not ‘normal.’ But as Susan Rook1 once said, “What is nor- presentation “Report- ing from the Front frightening. I knew I was depressed, but I didn’t know I mal, anyway, but a cycle on your washing machine?” Lines of Addiction was also psychotic. I was given medication, and for the I then realized that to stay silent was to feed the and Recovery” at the first time in months I slept through the night. stigma growing inside of me, and eventually it would February 2005 Bottom Colleagues and co-workers visited; no friends came, swallow me up. I had to break it, so that others, too, Line Conference on because they didn’t know I was hospitalized—and I may know that they are not alone in the storm, and Workplace Mental Ill- ness and Addictions by didn’t want them to know. When my mother came, I that help is available. the Canadian Mental was cloaked in shame and guilt. I willed myself to get Help was not readily available to me, but when I Health Association’s better as quickly as possible, even though the last thing had the energy, I persisted and found the courage to BC Division I wanted to do was breathe. ask others to help me persist. When you have help, you April came and I was still alive. I was well enough to have hope. Hope comes with knowing that no matter be released. Recovery is like cultivating a seed covered the outcome, life is blessed with meaning even in mis- in cement. It needs extra nourishment, loving support ery, and is therefore worth living. and tender care. It needs sunshine, water, and rooted- April 2005 marked a year since I left the hospital. ness to the earth. Even though covered in cement, the I am eating, exercising, writing, volunteering and en- seed can grow under the cement and will break through gaging in life. Some days are good, some bad. The bad it in time. The key is having faith that it will. days help me to fully enjoy the good days. My recovery began in April of 2004, when I took I know that if I just keep going, keep believing that immense pleasure in the pink and white cherry blos- I will get better and that my life is important and mean- soms I could see from my window. My long wait for ingful, I will see more and more flowers growing, until regular appointments with a psychiatrist ended, and I one day, the cement that is depression will crack and dutifully took the proper medications. Soon after, the crumble away.
A Place to Call Their Own
Donna Murphy y first impression of the psychiatric unit at our local hospital was much the m same as my 17-year-old son Kelly’s: we were terrified. I knew that Kelly Donna is chair of the FORCE needed to be hospitalized—he was feeling very despondent and suicidal, and had Society for Kid’s Mental Health been admitted as a voluntary patient—but I wasn’t so sure that this was a place for his mental well-being. “How ironic this is,” I thought. “When my son is so ill, I’m afraid that the hospital may just make him worse.” ... To read Donna’s full story, go to www.heretohelp.bc.ca/articles
26 Visions Journal | Vol. 2 No. 6 | 2005 experiences and perspectives
Stigmas Surrounding Eating Disorders: Interview
Elizabeth: In the past you’ve hesitated about sharing E: After the stigmas she went through, does your your story. This time, you agreed right away. Why? mother better understand your stigma? Anne: I feel I’ve been ‘in the closet.’ I know this analogy A: My mother is elderly now. She cannot comprehend doesn’t have anything to do with mental health, but I the concept of purging. The less she knows, the better. feel I suffer the same stigma as gays did in the past. We hide our ‘true lives.’ We have come a long way in E: You have shared with me what you believe to be the understanding gender differences. I want to help us to Elizabeth Thornton triggers that contributed to your eating disorders. When Cronin and Anne come out of the closet and for the public to understand you’ve shared this with your friends and family, have the bulimics and anorexics. they better understood your illness? Elizabeth Thornton Cronin is fomer Executive A: No. No one wants to take responsibility for my prob- E: Do you believe other mental illnesses are better un- Director of Awareness lems. They find it repulsive that I’m a bulimic. I’ve had derstood and more ‘accepted’ than eating disorders? and Networking Around a relative say that they can picture me vomiting in the Disordered Eating A: Yes. Absolutely. My personal experience has to do bathroom, and that I should be ashamed of myself. I (ANAD) with my mother who suffered from depression and think she sees it as a ‘spoiled kid’s rebellion.’ anxiety, when it was ‘not talked about.’ Many moons Anne, now a 33-year- ago, she was prescribed tranquillizers that were ‘not old high school teacher, E: You’ve met others with eating disorders. Do you talked about’ in our family. Later on she received thera- reflects on the stigmas of think they feel the same way about the stigma? py and took antidepressants. Today, as an older person, having bulimia. From age she can speak openly about her medication and her A: Yes, I meet people all the time who had disordered 8 to 16, she was bullied support systems. In fact, many of her friends have simi- eating and experimented with diets that went too far. by her male cousins; her lar treatments, and so she feels safe in speaking out. But they stopped. Eating disorders are something else. I scars were shown in her This has made her stronger and more confident, and felt like I was in an AA meeting when I went to my first bulimia. Anne has not we joke about the “old days” of her “secret” pills. I think support group about 18 months ago. It was the best purged for 30 months if I were to ask everyone I worked with over a week, thing I have done. We could be open with each other. and is confident in her there would be many who would come forth about suf- I think it was best put in context when one woman current support systems fering from depression. I think that they feel safe in in the support group—a high school teacher—said that talking about it. No one talks about eating disorders. she tried to document her need for a leave of absence due to her anorexia. When she honestly submitted her forms and supporting documents, she was urged to E: In your opinion, why are eating disorders—in your qualify her leave of absence as being for her ‘depres- words—still “in the closet”? sion,’ because her colleagues and the administration A: On most of my attempts to ‘come clean’ and speak would fully understand this due to classroom stress lev- to my friends and family about my eating disorder, els. She interpreted this as: if her colleagues knew she they turn it into me dieting. They talk about food and was anorexic, they would have seen her as being ‘irre- how I’m trying to be skinny. They don’t listen. They sponsible’ and ‘out of control.’ So she decided to stay in just don’t get it. It’s easier to hide in the closet and stop the closet and document her absence as depression. talking to them about it. None of my family members want to know why I have had this illness. E: How should we address these stigmas? Do you know what it’s like? I go to a family function, A: Time will take its course, like it did with gender is- and I get, “Oh, you are way too thin! You need meat on sues, depression and anxiety. I’ve decided to train with your bones.” And, “You look pale. I better show you ANAD for their community outreach presentations. Af- how to make a good meal.” Everyone watches what I ter completing their program, I will be able to deliver eat. No one asks about, or wants to listen to, the causes. positive body image presentations to schools, business- It would be easier for me to say that I lose weight be- es and others. By doing this, time and time again, we cause I am depressed. That they could understand. will break down the stigma wall.
Visions Journal | Vol. 2 No. 5 | 2005 27 experiences and perspectives
Adjusting Our Dreams
Karen wo years ago, when band Insane Clown Posse. Untreated, psychosis Wayne spent his days t my son Wayne* was It’s the same with his spir- continues to progress— during a heat wave run- Karen lives in Port Alberni 16, he was a handsome, ituality; he carries a Bible with frightening poten- ning awkwardly up and well-rounded young man, everywhere he goes and tial consequences. Not all down the side of the high- * pseudonym destined for a healthy and rejects or accepts ideas people with psychosis be- way. He could never make productive adulthood. He based on his interpreta- come violent, but many, up his mind where he was had great talent in his lit- tion of God’s word. Not in even the most placid and going; he just needed to be erary and communication a wholesome manner, but caring of individuals, do. on the road. He was 25 or abilities. He was a valued like a zealot. Psychosis co- Depression, too, visits peri- 30 pounds under weight employee at a part-time lours his life. odically. Many people with and his clothes were rum- job he had pursued—and Psychosis takes many long-term psychosis even- pled and smelly; he wore obtained—all on his own. months to develop to the tually commit suicide. layers of them. His face Wayne was a cheerful, point of the sufferer hav- was unshaven and his outgoing presence in our ing any clear, recognizable Terrible responsibility eyes like dirty gray rocks household, spent time with symptoms. To a parent it Last year, my son’s illness from the driveway. his friends (and a girlfriend can look like adolescent re- reached a level of severity But people—many, or two) and had an eye bellion or the result of teen- that allowed him to enter- complete strangers—just toward an acting career. age drug use. The illness is tain and then act upon a kept pulling up and drop- My son seemed to have hard for him to recognize. frightening idea. With a ping him off at our home. everything going for him. After all, it’s a disease of kitchen knife, Wayne at- They’d find him wander- the brain and the brain is tempted to cut off his ing or standing gazing into Things changed the organ that must recog- testicles. Fortunately, the their neighbours’ yards, or It’s hard to reconcile that nize the illness. pain and the blood—or maybe sitting motionless image with the gaunt 18- But the behaviours some semblance of san- for hours in the long grass year-old who now sits, are hard to ignore. I tell ity—caused him to abort near the highway, and day in and day out, in a him that it’s not appro- the operation before the they’d offer him rides in darkened living room, priate to lie down and do act was completed, and to their cars. “I’m so amazed motionless, with downcast “exercises” in the middle seek help. at the scope of human vacant eyes, no longer ca- of a crosswalk on 10th Av- The wound was closed kindness,” I told my hus- pable of, or interested in, enue. I tell him that nor- and healing within a few band. “He looks odd and any sort of sustained con- mal people don’t bend weeks, but Wayne failed scary. You wouldn’t think versation. This is mental and kiss the pavement to go for required follow- they’d pick him up.” I was illness. This is psychosis. every 30 seconds. I stop up care despite concerns surprised to discover how He is preoccupied with him from kneeling in his about complications. He’s many other families have vivid, puzzling and con- pajamas in the mud of chosen to reject this medi- been touched by mental flicting images and ideas. our driveway. Wayne un- cal treatment—along with illness. Thoughts start out clear derstandably resents my the mental health assess- “Everyone I talked to in his mind, but before constant reminders that ments and drug therapy. just wanted to help in some they’re fully processed, he is ‘crazy.’ But no per- way,” my husband remind- they collide with one an- son in this world cares On attitudes – ed me recently. When he other, shattering. Just sit- more for Wayne’s well- The community said that, it made my stom- ting quietly considering being than I. My voice is When I think back to last ach do a little flip-flop. these jumbled thoughts the one that has rattled in summer and how the can easily consume most his head, begging him to changes in Wayne’s de- of his time. accept treatment, point- meanor were reflected continued on page 30 The rest of the time, ing out symptoms that in the faces of our adult his interests become un- he cannot—will not—see, friends and neighbours, healthy obsessions such as in a desperate attempt to above all else, I recall their with the underground rap help him get well. concern and kind words.
28 Visions Journal | Vol. 2 No. 6 | 2005 alternatives and approaches
Looking Into the Cultural Mirror Addiction, secret lives and lost personhood
“…I, being poor, have only my dreams; I have spread my dreams beneath your feet; Tread softly because you tread on my dreams...” – William Butler Yeats or months, a woman sat outside a housing agency ceptions about the future, secrets, fantasies, hopes and R. Dan Small, PhD and repeatedly stabbed herself. “She’s just doing it dreams, as well as roles such as father, mother, brother, to get attention,” the staff said. One night, she killed sister, anthropologist, teacher or orphaned son.3 Dan works with the fherself. A man living with an active addiction went to a Personhood provides information about an indi- Portland Hotel Society, in hospital to treat an infec- vidual’s membership in Vancouver’s Downtown tion. A clinician told him to society. Membership in Eastside go home to his “box in the society brings with it a Downtown Eastside” until sense of personal value, he was “clean from drugs” belonging and inclusion and then he could return to as a part of the human footnotes have his infection treated. family. Socially compro- 1. Ortner, S.B. (1997). Both these stories illus- mising attributes such as Thick resistance: Death and trate the existence of “cul- having an addiction de- the cultural construction tural zones of friction.”1 grade an individual’s per- of agency in Himalayan Stigma is often found at sonhood to a tarnished, mountaineering [Special the centre of these zones, diminished state.4 People issue: The fate of “culture”: Geertz and beyond]. Repre- particularly the case for with diminished value are sentations, 59,135-158. addictions. This article ex- considered to be “not quite plores the process of stig- human” and their “life 2. Geertz, C. (1975). From matization at the heart of chances” are reduced.4 the Native’s point of view: our understandings of ad- While addiction im- On the nature of anthropo- logical understanding. Ameri- diction and its inevitable pacts all social classes, can Scientist, 63, 47-53. outcome: the production addicts are typically rel- of suffering for people who egated to a lower social 3. Cassel, E.J. (1982). are relegated to the cultural position and are often The nature of suffering and shadows of life. placed at a social distance the goals of medicine. New England Journal of Medicine, 306, Why do we fear and from others. This results in 639-645. loathe addiction so much? a kind of social death and Does it speak to our inner- is due to a number of dis- 4. Goffman, E. most fears as individuals tinct social blemishes that (1963/1986). Stigma: Notes and a society? Does it somehow take away that which impact the personhood of addicts. These social blem- on the Management of Spoiled Identity. New York: Simon we cherish most about our humanness? Do we fear ad- ishes result in the marginalization of people with addic- and Schuster. diction because of the loss of control over our selves tions and, as a result, create implicit or explicit barriers it brings? What greater fear exists for us all than to to health care and social services. 5. Giddens, A. lose such personal control? Perhaps addiction doubles People with addictions combined with other health (1991/1997). Modernity and this fear, since addicts appear unable to control them- and social challenges have acquired many labels, in- Self-identity: Self and Soci- ety in the Late Modern Age. selves—and we cannot control them either. cluding hard to house, hard to reach, multiple barriered Stanford, CA: Stanford People influence culture and are likewise influenced or multiply diagnosed. The various labels layered onto University Press. by culture. The notion of what it is to be a person, as this group often perpetuate the demonization of this opposed to a piece of sandstone, a rattlesnake or finger- vulnerable population by implicitly blaming them for 6. Cruikshank, J. (1998). nail clipping, is a broad-reaching and important concern failing to conform to various systems: health care ser- The Social Life of Narratives: Nar- rative and Knowledge in the Yukon 2 in most, if not all, cultures. A person comprises many vices such as hospitals, emergency wards and acute Territory. Lincoln, NE: Univer- parts: life experiences, a past, a family with obligations, care facilities; pre-trial centres, law enforcement and sity of Nebraska Press. work history, a culture, physical characteristics (how we other criminal justice services; and social housing. look to ourselves and others), relationships, emotions, Addicts are aware of threats to their personhood consciousness, sexuality, a political side, a body, per- brought by the stigma of addiction. In some situations,
Visions Journal | Vol. 2 No. 5 | 2005 29 alternatives and approaches
these threats are so great that people need to employ also their public and secret selves. dramatic strategies in order to survive. For example, Traditional anthropologists were fascinated by ‘far- Giddens describes the condition of anorexia as reflect- away’ cultures, which opened a secret window for an- ing a situation where the person does not feel safe, thropologists to compare these ‘exotic’ cultures to their even in their most personal sanctuary, their body. They own. The anthropologists were often disparaging in the therefore reject their own body as a home for their way they examined and classified other cultures as less self.5 Addiction, like anorexia, can be seen as a strategy developed and ‘civilized’ than their own (usually West- for creating control over the story of one’s own person- ern) culture. Similarly, the most marginal in our society, hood. For the anorexic, the body is alien, a place where drug addicts, are the focus of a kind of public anthro- the self does not have a home, while for the addict, so- pology and voyeuristic fascination. Each year a new ciety is the place where the addict’s self is homeless. demon drug (this year it’s crystal methamphetamine) Suffering is a challenge to personhood, and is not generates public panic and worry about moral decline. restricted to physical pain. Nowhere is this truer than In order to best develop accessible services for in addiction. Addicts suffer biologically, psychologically people with active addictions, we need to uncover the and socially. Suffering is a complex personal experience “cultural scaffolding” surrounding addiction that un- that can come about due to a number of things such derlies professional practice.6 The soundest and most as the anguish of a loved one, physical agony, power- ethical strategy for removing barriers to access begins lessness, hopelessness, homelessness, memory failure, with turning the analysis inward to ourselves as profes- loss of friends, lack of validation, lack of meaning, iso- sionals, to uncover the values we hold that hinder our lation, loss of a secret dream, an inability to work, or approaches to helping marginal populations. fear of the destruction of one’s self as a person.3 Maybe the most marginal and forgotten people A physician writing on the importance of address- in our community are not really evil ‘others,’ but are ing human suffering in treatment wrote that one of the instead a mirror of our own cultural anxieties. If we key elements of personhood is a secret life.3 This secret looked into this cultural mirror, what would we really life may be composed of secret passions, hopes, lovers, see? Would we see the personhood of people living ambitions and dreams. Addicts, too, have secret lives. with addiction in danger of being further wounded by But addiction damages not only people’s bodies, but our disapproving cultural images?
Adjusting Our Dreams | cont’d from page 28 trailer door. We watched know what he’ll do, do we? through the window as What made him hurt him- On attitudes – their travel trailer, Wayne Wayne stood there looking self that day? If that could Closer to home would sneak in to watch down at the crib. I imag- seem okay to him, what One sickening comment her sleep. A couple of ined Mikaela’s soft blonde else might?” will always colour the times he picked the baby curls, fat cheeks, her baby Sickened, I went with summer of 2004 for me. up. Joanne kept asking smell. Who wouldn’t want my sister to coax Wayne My sister Joanne and him not to, but whenever to watch her sleep? away from the baby. her husband brought their she turned her back, there “It’s just that she needs The comment I uttered beautiful baby girl, Mikaela, he’d be. to sleep and he keeps wak- in my kitchen that day— to visit. Wayne was en- She and I watched ing her up,” said Joanne. “If myself!—was the most tranced; he just watched from the kitchen window she doesn’t sleep now...” hurtful thing anyone has her. Every time Joanne put one afternoon as his lanky “No,” I said softly, “It’s said since psychosis came Mikaela down to bed in shape stepped up to the not just that, is it? We don’t to visit. · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · Genetic counselling is... Genetic Counselling People usually only think of genetic counselling as something that applies to pregnancies where there is a and Mental Illness chance the baby could have a condition such as Down syndrome. Genetic counselling is rarely thought about Helping Families and as something that might benefit people dealing with mental illnesses such as schizophrenia or bipolar dis- Fighting Stigma order. But it can be very useful for families affected by major mental illnesses—and can help fight against the stigmatization of mental illness.
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Genetic counselling is often regarded warily. This illness, the counsellor will try to give this information. Jehannine Austin, is understandable, because unfortunately, it has an un- Counsellors will also help clients make decisions relat- PhD, CCGC pleasant past. Its origins are tied to the birth of eugen- ed to the counselling session by providing information ics (i.e., controlled breeding of human beings), which and support, and by connecting clients with support Jehannine holds a doctorate involved many horrific human rights violations. The groups. They also provide the opportunity to explore in neuropsychiatric genetics, forced sterilization of 2,800 people with mental and the impacts this new understanding might have. is a certified genetic physical disabilities in Alberta between 1928 and 1970 counsellor, and a clinical is just one example.1 How can genetic counselling help fight stigma? instructor in the UBC A desire to avoid repeating the mistakes of the Fear of mental illness is one of the most significant fac- Department of Psychiatry. past, however, has helped modern genetic counselling tors contributing to stigma, and uncertainty about what Through the South develop into a profession governed by “non-directive- causes mental illness is one of the things that makes Fraser Early Psychiatric ness.”2 This means that genetic counsellors will not people afraid. Intervention program, make decisions for their clients, or advise them not to Helping families to understand the causes of men- she works exclusively have children because they have a mental illness. Ge- tal illness will not only help to decrease guilt and anxi- with families affected by netic counsellors believe that when their clients have ety, but will also help to demystify mental illness and mental illness. Jehannine all the information and support they need, they are the increase the sense of personal control. We know that plans to set up Canada’s best people to make their own decisions. many people share their new knowledge of the causes first specialist genetic Genetic counselling is a communication process. It of mental illness with friends and family, which helps counselling service for deals with problems that involve an illness where ge- to demystify mental illness within the community. De- mental health concerns netics plays a role. Mental illnesses are “complex disor- mystifying mental illnesses should decrease fear, and ders,” which means that both genes and the environ- reduce avoidance and discrimination against people ment affect the development of the illness.3 with mental illness and their families.5 We know that genes play a significant role in schizo- Genetic counselling is usually only offered to fami- phrenia, bipolar disorder, schizoaffective disorder and lies affected by conditions that are caused entirely by OCD, and a slightly smaller role in alcoholism, panic genes (e.g., cystic fibrosis or Down syndrome). Or, it is disorder and major depression.4 Genetic counselling offered to families affected by diseases for which ge- for mental illness helps people understand the roles of netic tests are available (such as some kinds of breast both genes and environment in how the illness devel- and ovarian cancer). footnotes oped, and helps them make the best adjustment they Mental illnesses are not caused entirely by genes 1. CBC. (1999, November possibly can to the illness in their family. and there are no genetic tests for them. As a result, 9). Alberta apologizes for forced sterilization. CBC Women with mental illness who are pregnant or families affected by mental illness are not usually of- News Online. Retrieved who want to become pregnant, may find genetic coun- fered genetic counselling. April 29, 2005, from CBC selling useful. The prospective parents may want to If, having read this article you are interested in ge- News website at cbc.ca/ know the chances of the baby developing a mental ill- netic counselling, ask your doctor to make a referral for cgi-bin/templates/view. ness, or they may want to talk about how medications you at 604-875-2157. cgi?/news/1999/11/02/ sterilize991102 might affect a developing baby. The following individuals may also find genetic 2. Weil, J. (2003). Psycho- counselling for mental illness useful: social genetic counseling • People who have a mental illness and who want to in the post-nondirective know “why me?” era: A point of view. Journal of Genetic Counseling, 12(3), • Parents of individuals who have a mental illness, who 199-211. have felt guilty, wondering if they somehow caused the illness, or who were previously told that the ill- 3. Gottesman, I.I. (2001). ness was “their fault” Psychopathology through • Brothers, sisters or children of individuals with a a lifespan-genetic prism. American Psychologist, 56 11), mental illness, who are afraid they might also devel- ( 867-881. op it, or that they might ‘pass on’ the illness to their children 4. Merikankas, K.R. & Risch, N. (2003). Will Each genetic counselling session is unique. Usually, the the genomics revolution revolutionize psychiatry? counsellor starts by helping the client work out what American Journal of Psychiatry, they want to achieve or to learn in the session. This can 160, 625-635. be very different from person to person. The counsellor will ask the client about their experience of the illness, 5. Austin, J. & Honer, and what appeared to cause or trigger it. The counsellor W. (2005). The potential implications of genetic will ask about, and draw, the client’s family history. If counseling for mental ill- the client would like to know what the chances might be ness. Clinical Genetics, 67(2), for other family members to be affected with a mental 134-142.
Visions Journal | Vol. 2 No. 5 | 2005 31 alternatives and approaches
Canadian Anti-Stigma Campaigns A review
Naomi Liu he realities of discrimination and social exclu- footsteps of the landmark New Zealand campaign, Like sion have prompted the use of public relations Minds, Like Mine, which has used a similar long-run, Naomi is an undergraduate campaigns in an attempt to influence people’s celebrity-spokesperson approach. (For more about the Communications and T attitudes and behaviours toward those with a mental Like Minds campaign, see the article by Mykle Ludvig- Publishing co-op student illness. Most of these campaigns have used mass me- sen on Marketing to Men, an exclusive online Visions from Simon Fraser dia as a singular or secondary avenue of persuasion. article available at www.heretohelp.bc.ca/articles). University. She currently I’ve chosen to highlight a few examples of Canadian works in the Public campaigns. “Imagine...” campaign (2004) Education Department of In 2004, the Canadian Psychiatric Research Founda- Canadian Mental Health Transforming Lives campaign (2005) tion (CPRF) also launched an ad- Association, BC Division A quick look at history—and movies like A Beautiful Mind vertising campaign using print, or Shine—shows us that brilliance often walks hand in radio and television spots in hand with mental health problems. Sigmund Freud for hopes of addressing the public’s example, is thought to have misconception of mental illness. lived with some of the very The ads asked people to juxta- mental ailments that he diag- pose how they treat people with nosed his patients with.1 physical conditions or disabili- Celebrities are able to play ties with their treatment of peo- an important part in influencing ple with psychiatric disabilities. the public’s opinion on topics relating to mental health. In the select screen shots from the CPRF TV “Imagine if we last millennia, public figures ad (below) and sample poster (right) treated everyone like Marilyn Monroe, Abraham like we treat the CAMH posters Lincoln and Alanis Morissette mentally ill,” was featuring fought to keep their personal the tagline accom- celebrities like battles out of the critical eye of panying each mes- hockey player, the media for fear they would sage. A man hit by Ron Ellis (above), be wrongly judged and faced a car while crossing and Ontario TV with sinking careers. Many the street lies mo- personality, Dan others, however, such as Rafe tionless on the pave- Carter (below) Mair, Elizabeth Manley, Svend ment. “He’s not Robinson, Lorraine Bracco, bleeding, he prob- Mike Wallace, Brooke Shields ably just doesn’t and Alex Rodriguez, coura- want to go to geously share their stories of work,” a woman mental illness. proclaims, mimick- In April of 2005, the Cen- ing the comments tre for Addiction and Mental many employees Health (CAMH), based in Toron- overhear from co- to, launched the Transforming workers when returning to work after a mental health Lives awareness campaign. crisis. This two-year campaign fea- These public service announcements won nu- tures notable public figures merous awards and received worldwide recognition, such as hockey star Ron Ellis, including a United Nations Department of Public In- television host Dan Carter and formation award for producing a message that best re- former federal finance minister Michael Wilson discuss- flected the values and concerns of the United Nations. ing their personal journeys with mental illness through The campaign archives, including multimedia files, can print, radio and TV public service announcements be found online at www.cprf.org. (PSAs). The CAMH campaign follows in the successful
32 Visions Journal | Vol. 2 No. 6 | 2005 alternatives and approaches
BC Association of Broadcasters’ Humanity Award campaigns (2003–2004 and 1998–1999) two of the three Every year the BC Association of Broadcasters awards posters from more than $3 million in donated air time to a social the CMHA BC marketing cause. In the past several years, two men- campaign tal illness–themed campaigns—each with provocative and hard-hitting messages—were honoured with the Humanity Award. One of the award-winning campaigns was pre- sented by the Canadian Mental Health Association’s BC Division in 1998–1999. It featured three bus shel- ter posters showing a person’s face and life activities, with a diagnosis overprinted on the face and the cap- tion, “Don’t let your attitude be their disability.” The campaign also featured a series of radio ads with the tagline, “To some I’m a problem. To others, I’m a per- How effective are these campaigns? son. How do you treat mental illness?” There were two Research suggests that campaign efforts aimed at re- TV spots—the most famous one, known as the father- ducing discrimination towards those suffering from a and-baby ad, depicted a man cuddling his infant child, mental illness fall short of producing a measurable im- followed by the message “This man has a mental ill- pact.2 But this isn’t unique to mental illness campaigns; ness….But what’s really sick…is how your attitude of the vast majority of social marketing efforts—that is, him just changed.” marketing efforts aimed at advancing a social message related resource The more recent campaign has targeted stigma in or affecting attitudes and behaviours—are usually only to learn more about US a similarly provocative way in terms of schizophrenia. able to register, if measurement is done at all, a slight campaigns in this area, The BC Schizophrenia Society’s We’d Like to Change increase in awareness levels. go to www.nami.org and Your Mind campaign featured a well-aired TV spot of We live in a society that tends to disregard advertis- in the search box, type “national efforts.” Three a young man disclosing his schizophrenia diagnosis to ing the first few times it is viewed. To be effective, ad PowerPoint presentations friends in a diner. Written captions beneath the dialogue campaigns aimed at changing the mindset of the pub- on US anti-stigma pro- describe the highly negative fears and thoughts of the lic must be sustained, and combined with multiple ap- grams, from NAMI’s 2005 friends, in radical contrast to their outward ‘support- proaches. Advocacy at a systems level, to draw attention convention, should top the ive’ response to their friend’s disclosure. The campaign to policies and procedures in society that discriminate result list. paints a face of schizophrenia that counters stereotypes against people with mental illness, is one approach. and points out that prejudice is increasingly subtle and Grassroots interaction, to bring people with personal driven underground. experience of mental illness in direct and meaningful contact with those most likely to change their attitudes, is another approach. We also need to consider how we’re evaluating ‘success’ and measuring changes in prejudice levels.2 footnotes Do we survey potential members of the discriminating 1. Buchwald, A. (1999). public to test their attitude shifts (and can a Celebrity meltdown: Fa- research tool honestly tease out politically- mous, important people who incorrect attitudes?), or do we poll people have suffered depression. who have been stigmatized in the past to Psychology Today, 32(6), 46. gauge their sense of changes in community 2. Stuart, H & Arboleda- responses over time? Or do we look at Flôrez, J. (2001). Community behaviours themselves? All of these are attitudes toward people with difficult questions. schizophrenia. Canadian Journal There are critics who suggest that mon- of Psychiatry, 46, 245-252. ey and energy are better spent on recov- ery and treatment options for people with mental disorders, as they are the most like- ly avenue to effect change. Although there is a definite increase in awareness surrounding mental illnesses, we select screen shots from still have a long way to go in terms of social one of the BCSS TV ads acceptance. Mass media messages may be called ‘Sub Titles’ one tool in the arsenal, but are by no means a magic bullet.
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Bad Endings
Bruce Saunders We sat there riveted, watching the SWAT team taking positions. A ‘manic-depressive’ had taken a hostage, had taped a sawed-off shotgun to a terrified woman’s arm, aimed at her head. The SWAT sharpshooter finally dispatched his target. We breathed a sigh Bruce is the force behind of relief. At the same moment I was struck with the irony that we were all sitting there in our gowns after snacks in the Eric Martin Movie Monday and Pavilion (Victoria’s psychiatric hospital). It was a pivotal moment that led me to start my film series in the auditorium downstairs, in the Reel Madness Film the same building. I always look to that as an example of poor programming. It inspired me to do better than that in my series. Festival in Victoria. His bipolar condition has twice hospitalized him in ately I’ve become chiatric hospital, using Christopher Morahan for An Angel at My Table, the Eric Martin Pavilion very conscious of the opportunity to explore British television, stars Judy Janet Frame’s biography, at Royal Jubilee Hospital, L bleak endings in film depictions of mental Dench and her husband is a more realistic film, which houses the 100-seat movies about people with illness and recovery. as the parents of a young ending with the subject Movie Monday theatre. mental illness. It’s true that Movie Monday screen- man who fills his pockets living a humble writer’s Bruce is also a landscape too often we do have nasty ings like Ordinary People with stones (Virginia Woolf- lifestyle after a harrowing maintenance gardener endings. But in films that and Dead Poets Society style) and walks into a lake. early life of madness cou- are fiction, stories can be deal with suicide, as did Another bummer. We don’t pled with some positive told without the quick and Rollercoaster, Taste of Cher- need that! adventures. We’re impress- For more information on tidy jump off the bridge or ry, About a Boy, Mr. Jones, A recent release, See ed with her resilience. Bruce and Movie Monday, rooftop, the hanging, and and even The Full Monty. Grace Fly, sounded prom- During the discussion see islandnet.com/mm the overdose as convenient In fact, most films that ising. Not! The filmmakers with Dr. Dawson following plot devices. They happen approach mental illness tried to craft an ambiva- his film, My Name Is Walter often enough in real life. realistically demonstrate lent ending, but it seemed James Cross, I raised some- I was nearly one of those that suicide is an often- pretty clear to me: another thing I’ve learned from suicide fatalities. But hav- present threat. ‘jumper.’ Revolution #9, a various schizophrenia pres- ing survived, and finding But the implications choice in UBC’s Frames of entations: people with the my life turned around as of how movies handle Mind series, was equally illness as young adults I never imagined it could the topic of suicide struck dismal “leading to tragic often tend to experience when I was suicidal, I now me when filmmaker results” as the program significant recovery as seek out positive models and psychiatrist Dr. David read. Oh, no! Here we go (and if) they reach middle of success to support my Dawson recently gave us again... People around us age. He hadn’t heard that. recovery. a look at his new feature, —doctors, kids, parents, Dr. Dawson argues that I can see the power of Drummer Boy, a story of a neighbours, co-workers, we must realize how dan- movies in our society. They young man becoming ill friends—don’t need to gerous these illnesses are. are persuasive, and it’s with schizophrenia. The learn from popular enter- But I say, please, don’t do it important to realize what protagonist is on the run, tainment that suicide is by knocking off the person we are being taught. When paranoid, confused, and our inevitable outcome. we’ve spent the last hour screenwriters don’t choose unable to cope with the In contrast, in the film getting to care for. more positive endings for torment. It’s an engrossing Girl Interrupted, a se- I’ll continue to screen their protagonists, we, as journey, but Dr. Dawson condary character dies films like The Hours and people with disorders that sends him off the top of a by suicide, but the pro- even Dr. Dawson’s Manic. come with a fair dollop of building in the last frames, tagonist survives, writing But we’ll incorporate dis- related resource hopelessness, are encour- falling backward to his her story from middle age. cussions. It’s a challenge for more information aged to accept suicide as death. Damn! “True” stories about for people with mental on Vancouver’s Frames of an appropriate end. We’ve I was incensed that this brilliant people who have illness to build a hopeful Mind Series, see got to be careful about film revealed itself to be mental illness, such as outlook into their treat- www.psychiatry.ubc.ca/ what templates we put out yet another in the genre Shine, and A Beautiful Mind, ment plan, and in the con- cme/film or call (604) 822-7610 there for people balancing that I have dubbed “schi- are somewhat embellish- text of our presentations on the edge. zophrenia snuff films.” An ed, but they are break-out we can balance the ‘inevi- For 12 years now I’ve earlier film by Dr. Dawson, films that inspire many to table’ spectre of suicide in been showing films in my Manic, has a similar out- look at mental illness in a film with some hopeful al- weekly Movie Monday come. Can You Hear Me different way. ternatives. series in Victoria’s psy- Thinking?, a film made by
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Mental Illness in Film: A Director’s Take response to bruce saunders Hi Bruce, Your thoughtful comments have not alienated me. We ac- home. He is hospitalized. His illness is severe and his re- David Dawson, tually filmed an alternate ending for the film Drummer Boy: covery is minimal. So for years he resides in an Australian MD, FRCP the cop grabs the protagonist and the rest is left to the mental hospital, which is actually very picturesque with imagination. This alternate ending is sitting in the vault semi-tropical grounds and is located by a beautiful river. (All Dr. Dawson is a semi- waiting to see audience reactions. A veteran actor who Australian mental hospitals are found on rivers, by the way. retired psychiatrist and reviewed the script for me used a phrase similar to yours: They also all have pianos available for those who can play.) educator, and a past “You can’t have your audience live and breathe and like Times change. Now on some medication that improves his Chief of Psychiatry at this kid for two hours and then kill him off.” But as John illness somewhat, Helfgott is ‘integrated into the commu- Hamilton Psychiatric Travolta’s character in Get Shorty says: “Endings are hard.” nity.’ A woman takes Helfgott on as a project and falls in Hospital. He is an artist, I have wrestled with these considerations and agree with love with him and marries him, providing a rare protective owner of Gallery on the your comments. The other side of my head, however, family environment that allows him to live and thrive. She Bay in Hamilton, Ontario, uses another argument. also controls and monitors his medication regimen. Then, a published novelist, and Most American film today is an act of denial. We we come along and exploit him. a filmmaker, who uses don’t have to worry about the sorry state of the public I think, with both A Beautiful Mind (about the life of famed film to explore realistic school system because Meryl Streep will show up and mathematician John Nash, who has schizophrenia) and Shine, portrayals of teach all the kids violin. Or another prototypical American we are told Hollywood stories that subliminally suggest to the mental illness hero (free, independent, iconoclastic) will take charge of audience that it’s okay to be a weird-looking schizophrenic if the high school. Or save us from aliens. Or corruption. you also happen to be a genius. And don’t you worry about Or win the Vietnam War single-handedly. We don’t have them—if they have any kind of talent or willpower or initiative, to worry about 50 million uninsured Americans because they will pull themselves up on their own. This again is a form a true ‘American Hero’ can always get a heart transplant of societal denial. We are left entertained, even enthralled, for his kid if he shows a little initiative. Now, I enjoy being admiring, but certainly not worried, not guilty, not feeling re- manipulated as much as anybody. But I think we are do- sponsible or challenged in any way. ing ourselves an ultimate disservice here. We, as viewers, don’t like the ending of Drummer Boy. But Shine—the 1996 dramatization of the life of David that’s the point. Maybe if we worked or tried a little harder, Helfgott, a renowned pianist with schizophrenia, star- understood or paid attention a little more to the mentally ill, ring Geoffrey Rush in an Oscar-winning performance—is the ending would be different for the protagonist. a wonderfully crafted and acted movie. I enjoyed it im- I don’t know which is right. As pure drama, the death mensely. It was only on later reflection that some doubts of the protagonist (although it is not a high building and we crept into my mind. Here they are: The word schizophrenia simply see him floating away and some viewers have chosen is not used. (This hearkens back to the days when the to see this not as a death) is classic tragedy. As an affecting word cancer would not be used.) The young pianist is driv- experience for the audience I think the death brings tears, en ‘crazy’ by the passion of playing Rachmaninoff’s Third causes the story to linger in the mind, and may influence Piano Concerto—implying a last-century idea that lunacy perception and ultimately action. Whenever Drummer Boy is the product of a creative, sensitive mind in touch with has been shown, someone has come up to me with tears God. In the film, Helfgott’s father didn’t want to let his in their eyes, and talked about a brother or sister—often a son go to England to study music. The father is portrayed brother or sister who is living in an institution or supportive as brutal and controlling. (An alternate explanation could housing and kept out of mind as much as possible. Viewers be that his father was a reasonable man, and sensed that also tell me that after seeing the film they understand more his son was not well or strong enough to go travelling on about mental illness in general and schizophrenia in particu- his own. Subsequent events suggest that the father was lar. A different ending would show rescue, hope and new correct). Then, as portrayed in the film, after years of wal- possibilities. Would it be as effective? The words of Willy lowing in equally brutal mental hospitals, Helfgott finds a Loman’s wife in Death of a Salesman are the ones that should piano again, and a woman to take care of him, and lives ring in our ears: “Attention must be paid.” happily ever after. If we’d only just understood his needs and his passion in the first place! All the best, Here is the probable truth: Helfgott is a very good student pianist. He develops schizophrenia while far from David
Visions Journal | Vol. 2 No. 5 | 2005 35 regional programs
Partnership Education Program Increasing awareness, decreasing stigma and discrimination
Nicole Chovil ducation about men- er in a climate of trust and the Partnership program benefits including the op- tal illness is critical respect, share their experi- has been used in commu- portunity to work as part Nicole Chovil is Director of to enhancing the ences to educate commu- nities throughout BC, and of a team which can also Education with the British elives of people with men- nity groups about serious the demand for presenta- enable panel members to Columbia Schizophrenia tal illness and their fami- mental illness. These team tions is ever increasing. learn of other perspectives Society lies. They often indicate members each talk about on mental illness. Panel that stigma is harder to mental illness from their Objectives members also report in- deal with than the disease own perspective. This pro- The program is an educa- creased self-esteem, pride itself. Uninformed atti- vides audience members tion vehicle designed to: and enjoyment in know- tudes compound the dif- with an opportunity to see • Dispel myths about ing that one is providing For further information ficulties experienced by the ‘whole picture’—not mental illness a valuable service. Skills about the Partnership those with the illness and just one perspective. • Inform the public and training for each team Education program, by their families who sup- The two main goals other agencies of the members allows them contact your nearest BCSS port them. Mental illness of Partnership presenta- facts about schizophre- to practice areas in com- regional coordinator or education humanizes and tions are 1) to present in- nia and other serious munication and presen- branch, or visit the BCSS demystifies the disorders. formation and facts about mental illness tation that are needed to website at www.bcss.org Understanding leads to schizophrenia and other • Humanize mental ill- effectively present their compassion and accept- serious mental illness in ness issues by focusing stories. This, combined ance. order to increase aware- on the people rather with planning, evaluat- The Partnership Edu- ness and understanding than the diagnosis ing and debriefing, allows cation program is offered in communities, and 2) • Reduce stigma and for feedback to make im- through the BC Schizophre- to achieve closer relation- discrimination provements. nia Society (BCSS). It uses ships between consumers, • Help build relationships One psychiatrist re- personal storytelling as a family members and pro- between professionals, marked about a client pan- basis for informing people fessionals. families and consumers el member: “She’s devel- about mental illness. A The model we use • Maintain ongoing com- oped significant confidence person with a mental ill- has proven to be a power- munication about the through the opportunity ness, a family member ful technique for educat- needs of families and to do public presentations and a mental health pro- ing the community about consumers from a patient’s perspec- fessional, brought togeth- mental illness. Since 1990 • Empower families and tive. She feels much more consumers by provid- adept socially... and this all ing training in skills gave her a much more solid necessary to work with sense of herself and from others and to speak out that evolved a new relation- sample audience responses • Improve the chances of ship with her illness.” “ “We need reminding that this matter of mental illness is complex timely intervention and and we should not stereotype it.” treatment by increasing Results “True” stories from real people. This is an excellent presentation, public awareness and • Increased confidence very informative and worthwhile. Everyone’s personal experiences recognition of mental and improved skills of helped me to understand how it actually affects people.” illness symptoms presenters “Excellent presentation! We admire your courage.” • Reduce the negative • An appreciation for the “The presentation personalized the issue and the information I impact of mental illness presenters by the audi- have learned will assist me in dealing with the mentally ill in my on the community ence members job and in everyday life.” • Increased public aware- “It was truly wonderful to learn about a subject that is usually kept Benefits for ness of the prevalence on the back page of the paper.” team members of mental illness (i.e., it Participants receive many can happen to anyone)
36 Visions Journal | Vol. 2 No. 6 | 2005 regional programs
• Better service quality for consumers and families Who can request a Partnership presentation? • Better understanding and increased knowledge of Everyone can benefit from education about mental ill- mental illness and its effects on individuals and ness. Partnership presentations have been made to their families and friends church groups, public transit drivers, police depart- • Increased ability of people with mental illness and ments, hospitals, mental health centres, home support their families to cope, adapt and initiate changes workers, financial aid workers, crisis lines, lay counsel- within the mental health system ling services, social workers, high schools, colleges, uni- • Increased support and improved communication versities, medical and professional associations, coun- amongst people with mental illness, family mem- selling centres, senior centres, and service clubs. bers and mental health professionals · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · · Opening Minds
pen Minds Open Windows (OMOW) is a mental formed by Beautiful Minds, a choir comprising 18 peo- Ron Plecas health services charity formed in Nanaimo in ple with mental health issues. The choir was conducted 2002. Its mission is to reduce the stigma and by a musician who had been so moved by the 2004 Ron is Chair of the oprejudice surrounding people with mental health is- concert that he volunteered to form this choir. Beautiful Nanaimo Mental Health sues. Its goal is to target two areas of stigma: the stigma Minds has since been invited to take part in an annual and Addictions Advisory that a person with a mental health issue holds and the fair held in Nanaimo’s south end and has two other gigs Committee, Director of stigma society holds. lined up as well. the Nanaimo branch of I created the Open Minds Open Windows concept Open Minds Open Windows also uses approaches BC Schizophrenia Society, of how to reduce stigma while I was providing care for other than the arts to fight stigma. The organization and the founder and my son as he struggled with a mental health issue. I was showcases people with mental health issues at a vari- Co-Chair of Open Minds already involved with one mental health organization. ety of community events. The Nanaimo mental health Open Windows. Ron is Then I developed a mental illness, which took me into a centre’s Day Program participants painted rocks and diagnosed as bipolar psychotic manic state, and my ideas about how to fight sold them during Nanaimo’s Bathtub Race festival. We against stigma became quite grandiose. When I came entered a float in the local Empire Day parade and won out of psychosis, I gathered together 11 hand-picked first prize in its category. We’ve played ball with the local people, not all known by me. This group talked me into RCMP and taken on local Junior ‘B’ BC hockey champi- reducing my grandiose ideas, and then began creating ons. People with mental health issues have taken part in ‘grandiose’ ideas of their own, which magically began two psychology forums organized by OMOW at the local to conform to my ideas and even expanded on some. campus. And, a 17-song CD was created with 16 profes- Mental illness touches almost every family in some sional musicians who donated their songs; Day Program manner, and not one of the 11 people I approached hes- participants wrote and recorded the 17th song. itated to become involved. They consist of two retired New initiatives include a special project with a lo- businessmen, four active business people, two people cal, renowned First Nations carver who is teaching not with knowledge of mental health issues, two musicians, only his carving skills, but also his holistic view of life, to and a still life artist. The 12 of us became the keystones four people with mental health issues. A contract with of the organization, and as directors we all have hands- GO Rowing and Paddling Association of Canada has on involvement in each of the OMOW projects. begun, with two one-and-a-half-hour paddling sessions Our idea was to use the arts and humanities as an held each week for the next four months. Each canoe, avenue of approach to deal with stigma. What has been capable of holding 24 people, will provide exercise and accomplished to date is the production of two annual socialization for those who do not wish to compete. For concerts in Nanaimo’s 800-seat theatre. Both received those who enjoy competition, a team will be created to standing ovations from full houses. take part in the Dragon Boat Festival in Nanaimo from The first concert, in 2004, presented six mental July 8 to 10. Other projects are in the works. health stories, using local professional actors to act out While there is much still to do, OMOW has made scenes while local professional dancers also interpreted significant strides in its short three-year history. We rec- the stories. The stories were interspersed among per- ognize that there are many people in our society who formances by professional musicians, which were in- are willing to assist with projects, and as each event is terpreted on canvas by a visual artist. held, more opportunities present themselves and more The concert in 2005 replaced dramatizations with people in the community respond. poetry readings, and closed with a two-song finale per-
Visions Journal | Vol. 2 No. 5 | 2005 37 regional programs
Changing Attitudes at VIHA “ A significant challenge in developing welcoming, effective services is the stigma that exists concerning addictions. Strong moral stances are prevalent among service providers and in the community. This orientation training was fantastic in addressing my own values and beliefs and helped me to begin thinking about how I can change my own practice and perhaps influence the practice of my team.” – MHAS Professional Development Day participant Michael Reece, RN, and he subject of mental illness and/or substance abuse cation on current mental health and addiction topics. Sara Bristow, MEd tcan generate considerable misunderstanding, prej- As part of MHAS’s Comprehensive, Continuous, In- udice, confusion and fear. Individuals known to have tegrated, System of Care (CCISC)2 initiative, a cadre of Michael is Clinical mental illness and/or addiction may find it more dif- trainers is developing a series of educational workshops Nurse Educator with the ficult to find employment, be approved for a loan, or focused on core competencies for understanding men- Vancouver Island Health rent an apartment, even if they are well at the time. tal health and addiction. One professional development Authority. He has worked To make matters worse, health care providers can workshop has already been developed in partnership in the mental health and sometimes poorly serve those with a mental illness and/ with the South Island MHAS Practice Resource Team. addictions field for several or substance addiction. Practitioners may be less will- This free training is offered one full day per month and years, with experience in ing to offer support and empathy if someone is suffer- is available for new MHAS employees, affiliated college emergency room psychiatric ing from a mental illness rather than a physical health and university students, and other health professionals care and inpatient care problem. Due to their complex presentation, those ex- wishing to build upon their skills and knowledge within periencing mental illness and/or substance addiction the field of mental health and addiction. Sara is a Comprehensive, tend to over-utilize scarce health care resources, and The morning session, facilitated by a CCISC train- Continuous, Integrated they rarely fit into traditional medical treatment mo- er, focuses on theoretical models of addiction, beliefs System of Care (CCISC) dalities. Individuals diagnosed with mental health or about addictions and mental health, stages of addic- trainer. A clinician and addiction concerns are often thought to have ‘done it tion, life areas affected by concurrent disorders, harm leader in the addictions field to themselves’ and do not usually respond to ‘quick fix’ reduction, stage model of change, and principles of for 15 years, she works with remedies. Inevitably, this population produces difficult- motivational interviewing. The afternoon session, facil- VIHA and the community, to-predict clinical outcomes and creates higher treat- itated by the Practice Resource Team, focuses on com- providing addiction ment costs for an already stretched health system. prehensive mental health and addiction assessment prevention services, Dr. Ken Minkoff, a psychiatrist and advocate, de- strategies, psychiatric emergencies, suicide and aggres- consultation, education scribes this population as “system misfits.”1 Why? sion. It includes abbreviated sessions on psychotic dis- and resources Because he has identified the social prejudices within orders, personality disorders, mood disorders, anxiety health care settings against this already marginalized disorders, eating disorders, and the Mental Health Act. group, and has a comprehensive understanding of how In addition, a plethora of teaching material is handed old mental health and addiction health care philoso- out to the participants. One of the most prominent re- phies have failed to meet the needs of this clientele. sources distributed is the BC Partners for Mental Health footnotes To help address these issues within the Vancouver and Addictions Information Primer.3 1. Minkoff, K. (2001). Dual Island Health Authority (VIHA), Mental Health and Since January 2005, over 100 service providers l. Diagnosis: An integrated mode Addictions Services (MHAS) has announced its com- have attended the Orientation to Mental Health and (Presentation). mitment to welcoming people who present with both Addictions training. Evaluations from participants and 2. Mindoff, K. (2004).The mental health and/or substance use concerns. MHAS program coordinators are extremely positive with out- Comprehensive, Continu- is committed to improving treatment outcomes by comes including increased awareness of personal bi- ous, Integrated System of creating empathetic and welcoming relationships within ases, of the importance of the stages of change when Care model. Visions: BC’s programs, and providing appropriate services matched supporting people, and of harm reduction strategies. Mental Health and Addictions Journal, (2)1, 45-46. to the needs of the individual, their stage of change and This new educational initiative of VIHA’s Mental phase of treatment. MHAS recognizes that meeting the Health and Addictions Service intrinsically encourages 3. BC Partners for Mental needs of people with mental health and substance use improved treatment outcomes by creating empathetic Health and Addiction Infor- issues requires an effective, integrated and coordinated and welcoming relationships, and by providing app- mation. (2003). The Primer: continuum of services that, collectively, will address a ropriate services matched to the needs of each ind- Fact sheets on mental health and addictions issues. See www. wide variety of consumer concerns. ividual, their stage of change and phase of treatment. heretohelp.bc.ca/ To further support this initiative, MHAS is providing We hope this article has led you to reflect on your own publications/factsheets its service providers with professional development edu- beliefs concerning social prejudice within our field.
38 Visions Journal | Vol. 2 No. 6 | 2005 book review
On the Stigma of Mental Illness Practical Strategies for Research and Social Change
Edited by Patrick W. Corrigan. Washington: American Psychological Association, 2005. 343 pp. Review by Mailis Valenius
ccording to the book, ignore the effects of public vides inspiring stories of cation may be limited, as apublic stigma is “the re- stigma altogether. recovery to counter some evidence from education sult of a naïve public endors- Stigmas are also not prevailing stereotypes. studies that target racial ing the stereotypes of men- the same across disorder In another chapter, the and other minority group Review writer: tal illness” (p. 12). Labels groups. For example, Chap- authors talk about disclo- stereotypes is mixed, ac- Mailis is a freelance and stereotypes lead to ter 10 outlines how sub- sure of one’s psychiatric cording to the book. Short- researcher and writer. She prejudice and discrimina- stance use disorders are history to others as being erm improvements may just completed a work tion, which can affect a per- even more stigmatized than a powerful tool for change. be seen; further research is practicum at CMHA from son’s opportunities, such mental illness, due to the Parallel lessons are drawn needed, however, to deter- Gastown Vocational Services as obtaining competitive public’s blaming of people from disclosure of sexual mine the long-term effects in Vancouver employment and living with addictions and percep- orientation which can be of such interventions. independently in a safe, tions of a lack of self-control, a normalizing, liberating The book holds the decent home. The impact as well as associations with strategy. Of course, public greatest hope for the Book editor: of stigma also affects fam- crime and violence. The au- disclosure of mental illness contact strategy to change Patrick Corrigan, associate ily members, friends and thors note that changes are is a decision left to the in- mental illness stigma. Stud- professor of psychiatry at mental health service pro- needed at the public policy dividual, who must weigh ies show that contact with a the University of Chicago viders. Self stigma is defined level emphasizing treat- the costs and benefits. person with mental illness and director of its Center as “the consequences of ment and de-emphasizing In Chapter 13, protest, improves attitudes better for Psychiatric Rehabilitation, people with mental illness punishment. education and contact are than either protest or edu- is an acknowledged leading applying stigma to them- The “practical strategies” presented as processes for cation interventions. expert in stigma and selves” (p. 12). By internal- promised in the book’s changing public stigma. I strongly recommend mental illness. Corrigan izing the stigma endorsed title include personal em- Protest strategies are di- this book as an up-to-date worked on this anthology by the ‘public,’ people with powerment, public dis- rected against specific primer into a very complex with contributors from mental illness believe they closure, protest, education, stigmas, using a moral field. The book’s contributors the Chicago Consortium are less valued because of contact, and the role of appeal to stop behaviours maintain a wide view of the for Stigma Research, a their psychiatric disorder. media and marketing. and influences. Education subject and its relevance multidisciplinary team of Self-stigma may result in In Chapter 11, Corri- attempts to challenge and to systems outside of the experts from psychology, lowered self-esteem and a gan and Calabrese discuss replace inaccurate stereo- traditional mental health psychiatry, social work, lack of confidence which, overcoming self-stigma by types with more factual field, such as criminal jus- law, sociology, and human again, can significantly in- increasing self-empower- information. Contact in- tice and addictions. The development terfere with life goals and ment. People with a strong volves interpersonal con- book would be of interest quality of life. sense of personal power tact between the public to academics, consumers, The book does point can have high self-esteem and members of the stig- family members, mental out that stigma’s effects and the confidence to be matized group. health and addictions pro- are not uniform. Many active decision-makers in The book states that fessionals, as well as law people with mental illness, their own care. Empower- protest may have limited enforcement or criminal for example, are aware of ment may be considered impact on changing over- justice personnel, human the negative stereotypes, one of the best ways to deal all public attitudes, but can rights and disability advo- but do not buy into them. with the adverse effects of change some behaviours cates, members of the legal Not everyone with a men- self-stigma and psychiatric significantly. For example, profession—and educated tal illness experiences low labels. It can be fostered organized protest may be lay readers. It’s academic in self-esteem. Some indi- by giving mental health useful to stop media out- its approach and therefore viduals become energized consumers greater control lets from running stigma- most accessible to those by prejudice, expressing over their treatment and tizing programs, advertise- with a college education— “righteous anger” (p. 26). their reintegration into the ments and articles. or who have interest and Others are indifferent and community. This also pro- The benefits of edu- appetite enough.
Visions Journal | Vol. 2 No. 5 | 2005 39 resources
Organizations, Groups, Campaigns dice and Discrimination Against People with Mental • Chicago Consortium for Stigma Research. Illness. Available in book form, CD-Rom and online www.stigmaresearch.org expanded HTML version. www.stigma.org • The Resource Center to Address Discrimination and • Sayce, L. (1999). From psychiatric patient to citizen: Stigma. www.adscenter.org Overcoming discrimination and social exclusion. St. • Stigmabuster alerts. National Alliance for the Mentally Ill, Martin’s Press. US. www.nami.org/Template.cfm?Section=Fight_Stigma • World Health Organization. (2005). WHO Resource • SANE stigma watch, Australia. www.sane.org Book on Mental Health, Human Rights and Legislation: • Like Minds, Like Mine anti-stigma/media campaign, Stop Exclusion, Dare to Care. www.who.int/mental_ New Zealand. www.likeminds.govt.nz health/policy/resource_book_MHLeg.pdf • Stamp out Stigma project, California. www.stampoutstigma.org Addictions and Concurrent Disorders • Anti-Stigma Project from On our Own of Maryland. • The Stigma of Substance Use and Attitudes of Profes- www.onourownmd.org sionals (2001) and Stigma of Substance Use: A Re- • Open the Doors project, World Psychiatric Associa- view of the Literature. (1999). Two reports by the Cen- this list is not tion. www.openthedoors.com tre for Addiction and Mental Health. At www.camh. comprehensive • Center for Psychiatric Rehabilitation. (2005). Stigma net/education/ed_projectsresources_intermed.html and does not imply Survey. Open to anyone in recovery from mental ill- • Meza, E.D., Cunningham, J.A., el-Guebaly, N. et al. endorsement of ness who has encountered stigma and discrimina- (2001). Alcoholism: Beliefs and attitudes among Ca- resources tion. www.bu.edu/cpr/stigmasurvey nadian alcoholism treatment practitioners. Canadian • Stigma of Addiction Project. Centre for Addiction and Journal of Psychiatry, 46, 167-172. don’t forget all the Mental Health, Canada. sano.camh.net/stigma.htm • Corrigan, P.W., Lurie, B.D, Goldman, H.H. et al. resources listed at (2005). How adolescents perceive the stigma of men- the end of Visions Books, Reports, Articles tal illness and alcohol abuse. Psychiatric Services, articles as well Mental Disorders 56(5), 544-550. • BC Minister’s Advisory Council on Mental Health. • Richmond, I.C. & Foster, J.H. (2003). Negative atti- (2002). Changing Attitudes, Opening Minds: Discrimi- tudes towards people with co-morbid mental health nation Against People with Mental Illness and Their and substance misuse problems: An investigation of Families. www.healthservices.gov.bc.ca/mhd/advisory/ mental health professionals. Journal of Mental Health, publications.html 12(4), 393-403. • Corrigan, P. & Lundin, R. (Eds). (2001). Don’t Call • Cape, G.S. (2003). Addiction, stigma and movies. Acta me Nuts: Coping with the Stigma of Mental Illness. Psychiatrica Scandinavica, 107(3), 163-169. Recovery Press. • Pinikahana, J., Happell, B. & Carta, B. (2002). Mental • Wahl, O. (1999). Telling is Risky Business: The Experi- health professionals' attitudes to drugs and substance ence of Mental Illness Stigma. Rutgers UP. abuse. Nursing and Health Sciences, 4(3), 57-62. • Angermeyer, M.C. & Matschinger, H. (2005). Labe- • Link, B.G., Struening, E.L., Rahav, M. et al. (1997). ling—stereotype—discrimination: An investigation of On stigma and its consequences: Evidence from a lon- the stigma process. Social Psychiatry and Psychiatric gitudinal study of men with dual diagnoses of mental Epidemiology, 40(5), 391-395. illness and substance abuse. Journal of Health and So- • Corrigan, P. (Ed). (2004). On the Stigma of Mental cial Behavior, 38(2), 177-190. Illness: Practical Strategies for Research and Social • Cunningham, J.A., Sobell, L.C. & Chow, V.M. (1993). Change. American Psychological Association. What's in a label? The effects of substance types and • Sartorius, N. & Schulze, H. (2005). Reducing the Stig- labels on treatment considerations and stigma. Jour- ma of Mental Illness. Cambridge UP. nal of Studies on Alcohol, 54(6), 693-699. • Stigma issue. (2003). Canadian Journal of Psychiatry. • BC Partners for Mental Health and Addictions Infor- 48(10). www.cpa-apc.org mation. (2003). Stigma and Discrimination Around • Royal Society of Medicine's Psychiatry Section. Mental Disorders and Addictions [fact sheet]. (2001). Every Family in the Land: Understanding Preju- www.heretohelp.bc.ca/publications/factsheets
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40 Visions Journal | Vol. 2 No. 6 | 2005