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Coming Out

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Recently there has been an explosion of profile pictures appearing on my feed – all of them friends of friends so far – which use some combination of these ‘badges’.  They seem to resemble rather low-stakes bingo cards.  Personally, I’m pretty sceptical about how far posting a list of diagnoses on facebook does anything to ‘end stigma’.

There is something of a pervasive idea that saying “I have this thing” will cause stigma around mental ill health – and more specifically the behaviours and symptoms associated with mental ill health – to evaporate.

These mental health bingo cards seem to aim to show how ‘normal’ or ‘just like you’ people with mental health issues are; ‘surprise! we’re hiding in plain sight’.  But why should we have to make this argument or disclosure? Why should that huge responsibility fall to any of us as individuals? Indeed, will it do anything to change how these conditions and their symptoms are viewed in general? I think this tactic might be a backwards way of thinking about stigma.

Some time ago now, I wrote about what I think are good questions to ask yourself if you are deciding whether to disclose your mental health problems. That was focused on how coming out can produce identifiable, specific changes in your professional life or friendships.  The idea that ‘coming out’ to all of your facebook friends (and their friends) will alter the overall perception of mental ill health is, by contrast, a vague and massive aim.  Without context, without further information, how much can a list of conditions, some of them rare or relatively unknown, alter perceptions?

Let me put it another way: my brother has schizophrenia.  He has been sectioned numerous times, has been very unwell and exhibited all the classic symptoms including psychosis – with its delusions, hallucinations and disordered thinking and speech.  He was and has been immediately and unequivocally altered and recognisably mad.

I understand what schizophrenia means. I understand that my brother would never harm me or anyone else and I know the stats on people with mental health illnesses being more likely to be victims of violent crime than perpetrators. I know that the causes of schizophrenia are genetic and environmental.  I know my brother’s schizophrenia was hastened by use of illegal drugs.  I know his brain has been irrevocably altered by the severity of his illness.

Given all of the above, I’d class myself as not holding any particular stigma or fear of people with schizophrenia.  But I’m not any more enthusiastic to go and speak with the mad person on the bus who is talking to invisible friends or foe.  I’m not going to sit next to the person who looks terrified or angry or manic on the train. I’m not going to enjoy spending time with anyone, including my brother, who is in the grips of schizophrenia.

Knowledge of the normalness, of the ‘just like me’ nature of people who have schizophrenia does not lessen my disinclination to get up close and personal with some erratic, occasionally frightening, and often confusing behaviours.  Stigma around mental ill health is about more than knowing, it’s about something much deeper, and perhaps something which cannot actually be ‘defeated’ or ‘ended’.

Rather than trying to kick start some sort of ‘mad-pride’, isn’t it better to target misinformation about mental ill health (depression isn’t laziness, anxiety isn’t being too coddled, schizophrenia doesn’t make a murderer, etc etc) and encourage people to understand mental illness in the context of wider physical health?  ‘Stigma’ is amorphous and complex and to do with a lot more than lack of knowledge.  It relates to distaste, social norms of behaviour, comfort, the ability to actually have an inter-personal relationships.

From knowledge though, we might move towards compassion, empathy.  Even if that empathy can’t and won’t translate into spontaneous interactions with the person raving at the invisible people on the street corner, it will make things better in other ways.  It will allow people space, and perhaps alert people to the need for properly funded and resourced mental health services. It will help people realise that symptoms are just that – symptoms of an illness which can be managed or controlled.  Symptoms – source of stigma – are not the people – the ones cheerfully shouting ‘bingo!’ on facebook this week.

Most importantly, the work to address misinformation on mental illnesses can be done by anyone. Anyone can share links to websites like Mind and the NHS.  Anyone can look up information on these conditions and advocate for better understanding. It takes the weight of responsibility off us to turn ourselves into one-man-ambassadors and asks everyone to join together to better understand a range of illnesses facing many, many people.

We are not our illnesses.  Listing all of the diagnoses we have won’t change how people feel about the expression of the symptoms of those illnesses.  Explaining what those illnesses mean, can help change how people connected to those symptoms are understood.  But it won’t change more general, gut reactions to visual and social signs of mental ill health any more than a badge saying you have had food poisoning would make people feel warmer about vomiting and diarrhea.

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1 Comment

January 8, 2017 · 9:18 pm