The Price of Stigma

It has been said that the fight against the generally felt stigma about those with mental illnesses is a vain fight. Particularly, there was an article I alluded to about a  month ago that comes to mind.

And this was one of the points that came to mind when considering Robert Enke, the German goalkeeper who had been suffering with depression since 2003 who died by walking in front of a train on Tuesday and was, according to his widow, scared of his mental health difficulties becoming public as he felt he might lose his adopted daughter, Leila, after the death of their own child, Lara.

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I wonder how much the pressure of firstly being a public figure and well-known sportsman and secondly trying to keep hidden a depression that is obviously profound, added to the distress. Obviously enough for him to be driven to act.

His wife gave a deeply moving interview with the media which brought to light some of the pain that he and his family had been suffering and had been hiding from the glare of the media spotlight.

Teresa Enke said: “I tried to be there for him, said that football is not everything. There are many beautiful things in life. It is not hopeless. We had Lara, we have Leila.

“I always wanted to help him to get through it. He didn’t want it to come out because of fear. He was scared of losing Leila.

“It is the fear of what people will think when you have a child and the father suffers from depression. I always said to him that that is not a problem.”

Stigma, shame and misunderstanding of mental illness possibly are particularly burdensome in a ‘sporting’ environment where pressure is so intense and everything revolves around supreme conditioning of mind and body.

As the Times reports,  suicide is the highest cause of death for men under 45 in the UK. I wonder how much the gender perceptions that women are more likely to want to talk through things than men play in the role of treatments. Sometimes depression can be perceived as a ‘women’s disease’ and men may be  more likely to downplay the symptoms in general conversation until crisis level is reached.

So the general perceptions of mental illness and attitudes and assumptions about those who may suffer is not just thinking of terms of ‘the other’   – it is more than sympathy and empathy – it is about regarding seeking help and treatment for mental health in the same way that we might be guided to for physical health – and while I accept that it more likely to happen if you work in a supportive environment and have a strong network to support through difficulties, it might be more difficult in competitive environments that exist in the professional sporting circles. That makes it more painful, I would expect. Moving towards a more open discussion about mental illness has to be done for the sake of the societies and communities that we live in and work among.

In the meantime and for what it’s worth, I definitely have some positive thoughts towards Enke and his family and the pain that they have suffered and continue to.

Schizophrenia – on film

Time to Change, the campaign being run by a partnership of mental health charity, which is working towards challenging stigma which is faced by people with mental illnesses, is today launching a couple of films which are intended to work on some of the prejudices and preconceptions held.

The videos can be seen on the Time to Change website and are also going to be available on various other websites to be, according to the BBC, played in cinemas later in the year.

image atomicjeep at Flickr

Challenging some of the preconceptions that surround mental illness is certainly a positive as the preconceptions are invariably negative. I doubt there will be much measured effect but if it makes it easier for people to speak about mental illness and for the distress to be recognised, that can only be a good thing.

The BBC quotes a Yougov survey that indicates a third of people questioned thought that people suffering from schizophrenia were violent. It’s unsurprising and in some ways, I’m surprised it isn’t a higher figure.

The films will help I imagine, but the real stigma needs to be fought in some of the media reporting which tends to define people by their mental illnesses because it is an ‘easier’ explanation rather than display any kind of sensitivities or understanding of other factors that might come into play.

The actor in the films, Stuart Baker-Brow, has himself been diagnosed with schizophrenia and is quoted as saying he wanted to be involved in the filming in order to allay some of the assumptions and stigma that he faces, as he says to the BBC

“Helping to make the film has been part of a journey to take control of my life,” he said.

“Rather than giving up I made a decision to change my life, which was borne out of a necessity to prove not only to myself and to all those around me, that a good level of both physical and mental recovery from schizophrenia is possible.”

I don’t doubt that having these films is better than not having them. I hope they will make some difference, but there is probably a deeper level of understanding that needs to be reached for a difference truly to be made.

Stigma through the Ages

This morning, I read an article on the Telegraph’s website which asks, I thought a really pertinent question – namely, would leading historical figures, such as Florence Nightingale, Winston Churchill and Abraham Lincoln be able to reach the heights of influence that they did today – given that they were all affected by mental illness. The article reflects on a report written as a part of the ‘Think to Think’ campaign which is running to combat the ills of stigma relating to mental illness.

A young Florence Nightingale
Image via Wikipedia

The Telegraph writes

The report warns that achievements including the theory of evolution, the creation of modern nursing, developments in cancer treatment and the abolition of slavery may never have happened under modern ideas about mental health.

As well as Churchill, Curie and Lincoln both suffered from depression, while Darwin had extreme bouts of anxiety and agoraphobia and experts believe that Florence Nightingale suffered from bipolar disorder, also known as manic depression.

The report speculates that without Churchill, Britain could have made a compromise peace agreement in 1940, allowing a Nazi-dominated Europe and the loss of freedom and democracy.

It also warns that the “next Churchill” could be missed because of the modern demands on politicians.

Are we more demanding of today’s public figures and workforce in general and thus cutting off an enormously talented group of people who have been successful historically, from joining the workforce or, perhaps more tellingly, public life?

I wouldn’t imagine the perceptions of mental illness were any more positive in the past – one only has to look at some of the asylums – but perhaps with a less ubiquitous press and media – it was not something that everyone on the street corner was aware of.

Alastair Campbell, who  co-authors the paper writes

“Churchill with his depressions, drinking and long lie-ins; Darwin with his severe anxiety that showed up in stomach disorders, crippling headaches, agoraphobia, trembling, palpitations of the heart, and mental torment which often left him in floods of tears.

“Would the media and public have been understanding about their conditions? – these statistics suggest otherwise.”

One of the key things to note is the importance of work. Can you imagine if the university employers of Darwin had discriminated on the basis of his anxiety attacks? If Nightingale’s military employers felt that she would not be able to cope?

I think the document – called ‘A World Without’ – is certainly food for thought about changing societal attitudes but also it’s about rolling back a wave of media interest in the personal lives of public people and also, and perhaps this is where the campaign can work most effectively, in presenting positive stories and representations that reduce workplace discrimination against mental illness.

People in public office had moments of privacy in a way that is nigh on impossible today.

Alzheimer’s, Screening and Stigma

A report published on the Science Daily website yesterday explains that UK older adults were far less likely to want to access dementia screening than their US counterparts.

The premise of the study was to find out what difference access to universal health care made to access to services and screening in particular for Alzheimer’s.   The findings were, well, it didn’t make a great deal of difference, in fact, UK patients sought the screenings at a far lower level.

Some interesting points I picked up from the study. The reasons given for Britons being less likely to want the screening were based on the attitudes and stigma that society places on people who have Alzheimer’s.

Interestingly, although none of the sample groups in the UK or US had diagnoses of Alzheimer’s

significantly more of the U.K. participants (48 percent) had close friends or relatives who have or had Alzheimer’s disease compared to U.S. participants (27 percent)

So it made me wonder if the concerns about being screened were not about the cost of treatment obviously in the UK as there is the free universal healthcare, but more from having seen family and/or friends suffering at closer range.

So the conclusion that

Even when taking into account education and race differences, Britons indicated greater concern with the stigma of diagnosis, with potential loss of independence, and with emotional suffering than their American counterparts

may be, at least in part, due to a closer experience of Alzheimer’s in the UK sample.

I hope these kinds of studies are not used to attack universal health care. I think there are a lot of other attitudes and perceptions at play rather than just ‘fear of the cost of Alzheimer’s’.

The researchers intend to extend on this pilot study with further studies.

One to watch.

Sick Days

I have been off work sick this year more than any other year in my working life. I am currently up to six days this year. Four of those days were in a block a couple of weeks back.  Usually sickness makes me feel guilty. I think of the work piling up. I know I shouldn’t but I can’t help it. This time though, I felt less shame than usual. I saw a doctor and was actually signed off sick ‘officially’ for the first time in about 10 years – the last time I was signed off sick with a medical note, I had had an accident that led to it, the day before my two weeks of annual leave and ended up never claiming it back! The other two days this year have involved me actually getting to work – confirmation of the ill-feeling that I had woken up with then driving me back home almost immediately.

mandj98 mandj98 at flickr

There is a reason for me to share this and that is an article that I read in the Times over the weekend.

It is about the stigma that workers feel when producing sick notes that make reference to their mental health or rather, ill-health. Although my sickness related to physical complaints, I still felt a lot of pressure about having to take the time off. I can only imagine it might be more so for mental illness where there is sometimes an undertone of blame attached to those who are not well.

The survey of 1,000 workers by national charity the Shaw Trust found that 18.3 per cent would not reveal a condition even to their HR department and only 17.9 per cent would disclose details of an illness to a colleague.

To be honest, I am surprised it is as low as that. I would have thought it might have been a higher figure would be reluctant to share.

Of the respondents 34.5 per cent said the reason they would not reveal a mental health condition was because they felt worried or ashamed they would be treated differently. This figure rose to 43.3 per cent among 16 to 24-year-olds.

Again, maybe it’s just because I’m overly aware of stigma  but a part of me is surprised the figures here aren’t higher.

The article about the stigma of revealing mental ill-health at work though is one that brought back some recollections of mine when I was in a previous job. A colleague of mine was visibly (to those she was more friendly with anyway) suffering from a massive amount of stress from all angles. I  (among others) spoke to her about going to a doctor because it was very clearly not a ‘usual’ manifestation of work-related stress – which we all suffer from to a degree!

She went but was terrified that she would be signed off sick – as it happens she received a ‘formal’ diagnosis of depression and was initially signed off for two weeks. She begged the doctor to make reference to more vague ‘stress’ rather than putting ‘depression’ on the sick note because she was so concerned about future employment prospect, about how it would be received back at work and possibly more concerning, how the GSCC would respond to it.

He did. She perhaps received support from her managers in a way that might not have been entirely what she needed and ended up being signed off for 8 months after things didn’t get any better for her a couple of months later.

Going back to my own feelings of guilt about taking days off work, I wonder if it is related to that. Especially working in the ‘caring’ professions, you feel you should somehow be better equipped to deal with these things or that you should be immune in some ways, or that admitting an illness will make people approach you in a different way.

Perhaps some of the current climate of uncertainty in the financial markets and the knock-on effects on employment and job security will lead to additional stresses and a few more ‘brave faces’ that cover an enormous amount of pain and turmoil as more people face the stresses and tensions that can trigger mental ill-health as a result of a fluctuating job market. It is perhaps, something to be more aware of.

Ironic then, that The Shaw Trust who have a great website about combating stigma of mental ill-health at work and who conducted the survey referenced above – count – among their supporters and funders, Lehman Brothers. A salutary lesson for all.

Stigma in Parliament

More than a quarter of parliamentary staff surveyed, including MPs, Lords and support staff, suffer from mental illness brought about by stress according to an article published in The Independent today.

A MIND press release further breaks down the figures revealing that

An anonymous questionnaire completed by 94 MPs, 100 Lords and 151 parliamentary staff has revealed that:

  • – 27% had personal experience of a mental health problem including 19% of MPs, 17% of Peers, 45% of staff
  • – 94% had family or friends who have experienced a mental health problem
  • – 86% of MPs said their job was stressful
  • – 1 in 3 said work-based stigma and the expectation of a hostile reaction from the media and public prevented them from being open about mental health issues.
  • image dlade at Flickr

So in effect, they are no different from any of us really. Except arguably they have a more stressful job that draws them into the limelight.

Both the article and the report though, highlight the additional stigma that exists regarding mental illness in the sense that even policy makers are not able to admit to it openly for fear of harming their careers.

Currently the Mental Health Act (1983) bars an MP from re-election if they are admitted to hospital under compulsion – and MIND highlights the discrepancy between the treatment of a someone who has recovered from a physical illness with someone who has recovered from a mental illness by stating that

… if an MP is physically incapable of working for six months due to a serious illness they would not be forced to stand down. The majority of MPs who responded thought this rule was discriminatory and urgently needs to be changed.

Without wanting to be too harsh, there does seem to be something a little ironic about MPs calling for the law to be changed.. especially as a new amended Mental Health Bill has not long passed through their hands.

The Independent quotes one unnamed MP who insisted on anonymity as saying

“I would love as an established MP to talk openly of the serious depressive illness I endured long before I became or even thought of being a MP.

“It might serve as some small encouragement to those few young people currently shrouded in despair, feeling their life is hopeless. I have no confidence though that national or, importantly, local media will not succumb to the temptation in their coverage to make life more difficult for my party.”

I would also love you to, anonymous!

It should be something that absolutely works in a positive way to lead the way for others who are experiencing difficulties or seeing the difficulties that family members are experiencing to show what is achievable and the potential to increase public understanding and awareness could be immense.

Concern about career is a major obstacle to a wider openness about mental illness and any widespread attempts to further batten down the stigma that is so often associated with it.

Totalblue writing yesterday referred yesterday to  an article which highlights the difficulties of workplace prejudice relating to mental illness suffers by those in The City.

Of course, this comes as no great surprise. The figures suggest though, that a lot more people suffer from mental illness than are able to speak about it – which indicates the excessive levels of stigma that exist. It seems to be something like the proverbial elephant in the room that no-one wants to talk about.

I certainly don’t exclude members of my own profession either. A good friend of mine – also a social worker – was suffering from depression  (and quite severe)  and tried to insist  her doctor signed her off with ‘stress-related’ unspecified illnesses because she was terrified that it would forever mark her career.

Figures suggest almost everyone is affected, if not personally, then a family member, close friend. I would wager a bet those journalists in the national and local papers that the MPs are concerned about are affected and certainly the constituents that vote for them, everyone.

It just needs a few more to be open and of course, who is in a better position to change discriminatory laws than the MPs themselves!