The general population is typically ignorant about mental illness. People believe myths such as a relationship between violence and mental illness, when statistics show again and again, that only 4% of violent crimes are committed by the mentally ill. In fact, “People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime” (Appleby, et al., 2001). In fact, the mentally ill are more likely to harm themselves than others. People with severe mental illnesses such as schizophrenia, bipolar disorder, and psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population (Hiday, et al.,1999).” Unfortunately, the news media selectively reports the very rare incidences when mentally ill people actually do commit violent crimes and the entertainment industry further perpetuates these misconceptions by depicting characters with mental illness as the most demographically dangerous.
As somebody living with bipolar disorder, such misconceptions frustrate me. It is insulting to know that there are people out there who fear that I could become violent towards them on the basis of my bipolar diagnosis. I am personally committed to teaching society the truth about mental illness. Stigma creates unnecessary barriers for people with mental illness, which often leads to discrimination. We can change peoples’ perceptions and the overall conversation of mental illness by telling our personal narratives.
Dr. Kay Redfield Jamison, a psychologist and leading expert on bipolar disorder, wrote about her personal experiences with manic depression in her memoir, An Unquiet Mind. Her memoir was written in the 1990s when the stigma associated with mental illness was even worse than it is today. Jamison’s bravery to speak so openly about her struggle with manic depression is one of the ways in which mental patients may respond to their stigmatizing status – through awareness and education. In understanding how labeling and stigma play a role in Jamison’s life, it is useful to look at Erving Goffman’s theory regarding “the moral career of the mental patient”. Jamison never explicitly mentioned any type of inpatient psychiatric hospitalization in her book nor have I ever heard her discuss of such an experience during one of her lectures, but her outpatient experiences are still relevant to the process of labeling and identity development. What’s interesting to note is that when Jamison speaks publicly about her illness, she never calls herself a mental patient, but rather a “mental health consumer.”
Jamison began experiencing bipolar symptoms at the age of 17. It first manifested as mania, in which she was highly energetic, creative, and extraordinarily passionate about the beauty of life. Her friends were the first to notice that something wasn’t right, but Jamison felt great and ignored her critics. However, like all people with bipolar disorder, Jamison crashed from her manic high and became severely depressed to the point where she had become suicidal. When she was in college, her symptoms began to significantly interfere with her ability to function. She continued to repeat this cycle of mania and depression and suffered in silence for several years. Finally during graduate school, one of her colleagues who she had been dating suspected that she had manic depressive illness. She began learning all she could about the illness and took the initiative to see a psychiatrist, who prescribed her Lithium. Her first encounter with the mental health system was the beginning of her career as a mental patient. As illustrated in her self-narrative, she frames a lot of aspects of her personality and things she’s done in the past as symptoms of the illness. For example, her compulsive spending, ability to work long hours on very little sleep, and paranoid delusions were a result of mania.
Similarly, I conceptualize a lot of my past experiences – feelings and behaviors – as part of my bipolar disorder. When I was first diagnosed in 2006, I too, began reading everything I could about the illness. Jamison’s memoir was one of the first books I read and I literally felt like I was reading my own story. I could suddenly explain why I was so hyper during my senior year of high school, e.g. the multiple instances of bringing stuffed animals to school, running around the halls singing broadway musicals, writing nonsense on teachers’ chalkboards, and hijacking class with jokes that usually only made sense to me. It wasn’t because I was an eccentric teenager; it was because I was in the midst of a manic episode. Before all of this madness, I was known as a quiet reserved student. My mania destroyed that reputation and now almost 10 years later, I have tremendous regrets for how out of control I was. I just wish someone would have forwarded me to the mental health system because it was obvious that there was something seriously wrong with me. Instead, I had to seek professional help on my own when I hit rock bottom in college and could no longer function or take care of myself.
It is empowering to take action and get help for your problems. Seeking mental health treatment can be life saving. It is also comforting to learn a name that describes your experiences and know that you aren’t alone in your struggle. Although it isn’t the mentally ill person’s fault that they have a mental illness, it is their responsibility to recover. Unfortunately, the stigma surrounding mental illness can thwart one’s willingness to get help because it creates a lot of barriers.
There was a point in Jamison’s life when she was hesitant to reveal her mental illness to her colleagues because of stigma. In the field, she observed many medical students, clinical psychology interns, and residents who had similar problems and were asked to discontinue their academic studies because of psychiatric illness. She said, “This happens far less often now – indeed, most graduate and medical schools encourage students who become ill to get treatment and, if at all possible, to return to their clinical work – but my early years on the faculty at UCLA were plagued by fears that my illness would be discovered, that I would be reported to one kind of hospital or licensing board or another, and that I would be required to give up my clinical practice and teaching” (p. 130-131). Although coming out as manic depressive was very difficult for her, it ultimately led to her status as a highly respected and world renowned expert on bipolar disorder. Not everyone she told was accepting of her illness. She said, “Despite the fact that most people that I have told have been very understanding – some remarkably so – I remain haunted by those occasions when the response was unkind, condescending, or lacking in even a semblance of empathy” (p. 199).
Like Jamison, I knew that seeking professional help would result in labeling, which had serious implications. At the time, I aspired to work in the field of national intelligence and I knew that being diagnosed with a mental illness would automatically disqualify me for any type of security clearance. However, I was so miserable that I had to get help or I was going to kill myself. Ultimately, I had to re-evaluate my career goal. Today, I am pursuing a career in clinical social work so I can help others with mental illness. It’s a field in which I can be somewhat open about my illness. I just need to prove to prospective employers that my experiences are an asset and not a liability. Although I’m protected under the American with Disabilities Act (ADA), employers are subject to their own prejudices and don’t always act ethically.
You would think that someone who works in the mental health system wouldn’t discriminate against the mentally ill, but stigma exists within the institution itself. This is especially true in an inpatient setting as Goffman points out. Generally, as a psychiatric patient, everything you say, think, or do is conceptualized as being a part of your symptomatology. You are essentially reduced to a diagnostic label. For example, one time when I was getting ready to be discharged from the hospital, I was legitimately excited to go home and the psychiatrist misinterpreted it as manic energy so I was kept on the unit for a few additional days. It is particularly worrisome that some mental health professionals possess this type of ignorance and are indirectly contributing to stigma. Like the Rosenhan experiment, On Being Sane in Insane Places, hospital staff make basic assumptions about a patient based on their particular diagnosis. The way they interact with a patient directly reflects their presuppositions.
It took me awhile to realize that not everything I say, think, or do is a part of my mental illness. The therapist I met with from 2007 to 2011 frequently pathologized my normal human experiences; she made me feel like I was crazy and that there was no hope for me. I finally got away from her and found a new therapist who views me as a person and not an illness. Learning how to differentiate between my personality and bipolar symptoms has been a tremendous part of my recovery. It is important that patients are treated as people, not illnesses.
Appleby, L., Mortensen, P. B., Dunn, G., & Hiroeh, U. (2001). Death by homicide, suicide, and other unnatural causes in people with mental illness: a population-based study. The Lancet, 358, 2110-2112.
Goffman, E. (1961). The Moral Career of the Mental Patient. Asylums; essays on the social situation of mental patients and other inmates.(1st ed.,). Garden City, N.Y.: Anchor Books.
Hiday, V. A. (2006). Putting Community Risk in Perspective: a Look at Correlations, Causes and Controls. International Journal of Law and Psychiatry, 29, 316-331. Institute of Medicine, Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington, DC: Institute of Medicine, 2006.
Jamison, K. R. (1995). An unquiet mind. New York: A.A. Knopf.