Stigma is the Difference

STIGMA is the DIFFERENCE

Years ago, people could enter a dark place and stare at other people who were deliberately caged in or locked up.  These unfortunate individuals would be ridiculed and abused by on-lookers who considered this a spectacle by non-humans, deranged monsters, completely abnormal behaviours.  There are many accounts of people who were 'misunderstood' or 'psychotic,' who could be made a public event, where those who assumed they were 'normal,' could observe in amazement at other people. This was quite confusing for these on-lookers, the individuals they were watching seemed to be composed of the same body parts as themselves, but how could this person act so differently?  One case I have read about lately, in absolutely disgust, is the Bedlam Institute in the 18th century, London, England where it was similar to a Sunday routine of attending church.  Residents and visitors only had to pay one copper penny to gawk with judgement at mentally ill patients.  Sure, psychiatric facilities have come a long way since these acts of evading personal dignity and privacy of real human beings, however, in some ways, this is still the case, just less public and more humane.

Although, I do not have an extensive resume of the human services career, and I am only approximately three years deep in working in Mental Illness and Community Health, however, I am saddened, no less than I was the first time I heard this explanation to a struggling individual who has been diagnosed with the poor prognosis of an ongoing, non-curable mental illness.  This person will now be ordered to follow a strict medication regime that will ultimately change their overall functioning and personality, leaving them numb, tired, and unknown to themselves.  On top of that, they will now be told that if they take this medication they will be able to be employed, have a job, and possibly a family.  Although this is a true hope for someone with these circumstances and it is definitely not impossible for this to happen, but there are implications.  The most significant of this, they have not escaped the STIGMA of being mentally ill, now running the risk of acquiring a secondary diagnosis of depression or anxiety.  They have most likely been to a hospital, have difficulty holding down responsibility of holding a job, or maintaining their daily lives in a way that would consider them a functioning adult. Their thoughts are preoccupied and they are unable to stay focussed on small simple goals.  What I hear while sitting with a team of allied health professionals or in a Psychiatrists office at a client appointment, I am hurt and angered by, and to be in that client's shoes would make me feel very misunderstood.

I hear this, time after time:  "You have to take your medication."  "Treat it as if it were a terminal illness, such as, Cancer or DIabetes."  Does this bother you? I ask, how do these illnesses compare?  So I don't work with individuals who have been diagnosed with cancer per se, but I have had individuals in my life touched by cancer, and there are people who battle blood sugar levels at my witness.  The physical repercussions of going through a cancer treatment can only be imagined as complete and utter discomfort, fear, pain, the list could go on.  In the following thoughts, I am going to use cancer as the comparison, simply because it is commonly a disease that has presented in most people's lives. 

Each time I hear a person who is being convinced to take medications for their delusions or hallucinations, and treat it the same as if they had to treat cancer or diabetes, I am left unsettled.  First of all, these medications leave them feeling disoriented from who they know themselves to be with ongoing uncomfortable and undesirable side effects.  Then it is followed by telling them they can go get a job and are thrown the resources.  Down the road the typical situation is that the side effects are so undesirable that they give up and stop taking meds, land in hospital or are reported in some way to authorities for demonstrating overt and possibly dangerous behaviour. Over time, hospitals run out of room and psychiatry becomes a "one-stop shop" for patients.  Here is the problem: there is a lack of understanding and support in hospitals for these patients.  Stigma is their enemy at this point in their illness.

Comparing the diagnosis of schizophrenia with cancer seems to me, very irrational.  

Here is the scenario: a woman is diagnosed with devastating news that she has cancer and will undergo a series of treatments that will make her sick, and her family will go through a lot.  Family, friends, acquaintances, community members will come to her bed side and support her in her fight against cancer.  The family will experience that people are so giving and caring in these situations and they will feel love and a sense of community throughout this unknown path she is on.  

Now compare this scenario:  A young woman ends up in the hospital after the police had been called on her for acting out in the street, perhaps she was seen talking with herself, perhaps she was speaking with disorganized thoughts that seemed absurd.  She is in the hospital for a few days while an assessment of her mental stability is is completed and she is discharged, a referral to an agency might have been made, depending on the hospitals psychiatric team and she is given a prescription for an anti-psychotic.  This woman is known to have a first onset of psychosis and is quickly diagnosed after one assessment and a few months later she is admitted again and kept for less time than before. This woman is known to be mentally ill, has no one bringing her to hospital, people are calling the police on her, it is unknown where she lives, works, etc etc.  This woman is now on the record and will be known each time she enters the hospital as a "crazy person".  This is a general overview, however, I am referred these chronic cases of individuals who have repeated hospitalizations all the time.  

The difference is obvious, right?

The person who is diagnosed with cancer is examined extensively, the family is brought in, they gain more family, friends, and community support.  People in their lives tend to increase, people flock to someone who has been diagnosed with cancer.  What happens with the person who received a diagnosis of Schizophrenia over the course of a day, and has been apprehended repeatedly and shows up at hospital, when this person may not even know why and is all alone and then is discharged after a dose of medication and a prescription?  Well rarely do I see people flocking to this individual and I certainly do not feel it is fair to compare this person to a person who has cancer.  

The physical and mental struggles are different.  The cancer patient can still mentally feel like the same person they were the day before, and the day before that, physically, of course, they may feel different.  The individual with Schizophrenia can feel detached, disoriented and medication is not always going to fix this.  Even with complete compliance, they don't have people supporting them, and less people coming to encourage their fight.  I am not saying those with mental illness lose people, and many have very supportive family members.  The cancer patient out on the street receive sympathy.  The mentally ill out on the street might get started at or avoided.  This is a sad situation to me.  

If you ever encounter a health care professional comparing treatment of a person with a mental disorder to someone who has cancer or diabetes, and prescribe that this person has to take medication to treat their symptoms in the same way, evaluate what comparison is being made.  I am angry at this comparison.  A mental disorder such as Schizophrenia is not going away, but the people around them are.  Lets move toward their battle instead of moving away.  To reiterate, I do believe cancer is serious and it is amazing the support and encouragement this person can receive.  Now imagine someone who has a mental illness reports this to you (which is quite unlikely, because of stigma), lets flock in support of their recovery or their battle.  Its not contagious and may even teach you a lot about what our society (especially health professionals) are not doing for these individuals and move you to act and lend the same support.  

I encourage you to spend some time analyzing this man's experience both as an advocate of psychiatric care and mental health and his personal experience of being diagnosed with cancer and the comparison in treatment he discovered.  http://www.mindfreedom.org/as/act-archives/inter/mfire/cancer-psychiatry.