ON STIGMA

I remember something that happened to me back when the smoking bans were new and not strictly enforced. A friend and I were sitting inside a bus shelter on a bitterly cold winter day. We were smoking, since it was so cold we couldn’t hold our cigarettes in our hands because they would go numb. An elderly woman approached us and told us we were not allowed to smoke there. I pointed out a man in business suit who was smoking a few feet away. The woman replied. “The law doesn’t apply to him, just to you.”

This underscores the daily insults and humiliation that the poor have to suffer every day. I don’t know how many times I have had a complete stranger who wasn’t a guard or a police officer point out to me that I’m loitering or that I am smoking too close to the door. Sometimes bus drivers would ask me for identification when I showed them my bus pass. This may seem like whining, but what I want to write about is the cumulative effect these behaviours have on mental health consumers.

People sometimes may make an insensitive comment about a homeless person as they pass by, and think nothing of it, but if dozens of passer-bys make these comments every day, then it seems very cruel. For an individual suffering from paranoia or feelings of persecution this behaviour serves to confirm in their minds that their worst fears are true.

It is highly unlikely we can ever change this sort of behaviour, so we must find ways to change ours. We cannot take things too personally. They are complete strangers. They don’t know you. All they see is a stereotype. Over-reacting to this kind of treatment will only make matters worse. Caregivers have to know that stigma is real, and not a figment of our imaginations, and that it isn’t childish to be hurt or upset by it. It is a very real fact of our lives.

THE VILLAGE

It is said that it takes a village to raise a child; it also takes a village to care for the ill and the disabled. The social footprint of any disability includes not only family and friends but also the professionals of all stripes who contribute to their care. Mental illness is a disability, in this and many other important ways. This social footprint causes a shift in the family dynamic of those who are affected. It is moving us away from the “nuclear family” whose family unit consists of a husband, wife and their children. When children reach a certain age they are expected to leave home in hopes of creating another similar unit on their own. This model had its start in the nineteen- fifties, which had a high standard of living and a prosperous economy. During the depression however, people lived in “extended families”, where two or three generations lived under the same roof and the neighbours would often share in many of their duties.

The community has a powerful role in the treatment and recovery of anyone suffering from a mental illness, and they will never become well in a community that does accept and tolerate them. They cannot remain outcasts from the village; they are your friends, your family. You see them every day on the bus, in the malls and on the street, and you wouldn’t know most of them were mentally from looking at them. They used to be hidden away in hospitals, never to see the light of day, but things have changed.

Institutions first began closing their doors out of economic necessity; because housing people in hospitals was very expensive, but there were very few supports in place in the community for these individuals, causing some serious social problems. “Psychiatric Ghettos” sprung up around the hospitals, filled with patients from all over the district, who had been tossed out and who were forced to fend for themselves.

Supports were eventually created, like free clinics, drug plans and affordable housing. This was also out of economic necessity, since the cost of these services was still much less than the cost of warehousing people in institutions.

Hospitalization became even more unnecessary when effective medications were developed to treat the symptoms of mental illness with fewer side effects and less chance of a relapse. Their struggle is now to find acceptance and a place in the community. They now have a chance to contribute to the society that supports them. They have a chance to lead normal lives.

However, there is still a great deal of stigma associated with mental illness. Housing programs have been struggling against the attitude of “not in our backyard”. People accept the need for housing, but don’t want it in their neighbourhood. There have been protests, petitions and demonstrations; even city aldermen have gotten into the act. The best way to fight this stigma is through public education about the facts of mental illness.
We refuse to be driven out of our homes.

A Wake Up Call

Earlier this week, American society imploded. In a cultural environment teeming with intense violence and in a country rife with lethal firearms available to just about anyone, another young man has lashed out at a society he believed had destroyed and rejected him. There was a wide range of reactions to this tragedy. Some are calling for stricter gun laws, others are pointing to violent computer games. There are many people who are calling for armed guards in their schools, and a policy of zero tolerance against young people with emotional problems.

The problems with the later approach are many. The main ones are the implications of punishing people or restricting their freedoms because of something that they might do. There is also the danger that, seizing on the fact that the individual was being treated for a mental illness, many people will come to believe a that all people with a mental illness are capable of such an act, when in fact that they are generally less prone to violence than ordinary individuals, if they are being properly treated.

The stigma attached to mental illness is only going to be reinforced by these events, especially in our schools, and make young people even more reluctant to get help if they have a problem, for fear of being seen as a psycho and a killer. This sort of attitude will only serve to make things worse by making other such tragedies even more likely.

This is no time for the mental health community to shrink from the task of educating the public about mental illness; rather it is a wake up call. People need to know the facts about mental illness now more than ever. This tragedy needs to be placed within a larger context, so that people do not respond to it in a way that will increase stigma. This is a wake up call.

Activism and Volunteering in the Mental Health Community

Often, when asked about various project proposals being discussed, they usually say that they are great ideas, but the is not enough money or manpower to get them under way. However, there is a largely untapped resource for such work, that being the mental health consumers themselves.

Consumers who volunteer are able to give something back to community that supports them, and also gain valuable training and work experience. A meaningful and fulfilling activity to fill their free time can help them a long way to their recovery.

As workers, consumers have special needs that may differ from individual to individual and between different kinds of mental illness. One such need is something I call ‘variable capacity’. The mental and emotional state of many consumers can change suddenly. They may be doing a great job, but then suffer a setback that could leave them unable to work for a while. Later, they may be able to return to their work again, to pick up where they left off. Mental health is a day-to-day proposition for many people, so most consumer volunteers need flexible hours and a bit of patience. It is important that there is a group of volunteers that can be drawn upon to fill those jobs until the consumer is ready to return to work.

These are needs that are very difficult to address in a paying job, which is why volunteering is so important.

Activism is another important activity for consumers to undertake. By activism I mean any group or individual activity that draws attention to social injustice and educates the public about the facts of mental illness. Activities such as raising awareness and advocacy can be part of that definition, and it is vital that consumers themselves take on this challenge. Such work can help change government policies, business hiring practices and the delivery of mental health services.

Consumers must have the courage to speak frankly with the public about mental illness and how it has affected their lives, and break out of the social isolation the illness creates.

The Internet is powerful tool for social change as well. It is an ideal medium for a mental health activist to create change without necessarily announcing their name and their illness to a public that may not understand.

Much of this work has already begun, and as more people get involved it will gain momentum. The more people take part in these activities, the better life in the community will become.

ALTERNATIVE MEDICINE

Many mental health consumers find themselves trapped in a vicious cycle. Whenever their symptoms go into remission, they believe they are cured, and stop taking their medication, which leads to a relapse. Often, the desire stop their medication is due to the terrible side effects of some psychiatric medicines, so they clutch at straws. That is why alternative medicine can be hazardous to mental health consumers, who may believe that alternative treatments can be used to replace their medication. They may have common belief that herbal remedies, which are natural, are safer than medications, which are chemical. However, tobacco and opium are natural plant products, and can be dangerous and addictive. Alternative medicine can be helpful, though, but should only be used to supplement standard medicine, not replace it, and should be used under the careful supervision of a doctor.

MENTAL HEALTH AND THE EXTENDED FAMILY

One of the most important trends in America during the 1950s was what is commonly known as the “nuclear family”. Each family unit consisted of a father, a mother and their children and they lived and worked separately from the rest of their family in houses that were obtained by abundant and inexpensive credit. At the average age of eighteen, the children would be expected to leave this unit in order to set up one of their own. The rest of the family, the aunts, uncles and grandparents, were only seen on special occasions.

If you believe what you see in modern advertising, this has come to be seen as a cultural norm. The reality is that the “nuclear family” was ideal in times of record economic prosperity, but during hard times, it isn’t practical or fair. The “nuclear family” was an invention of the fifties, when a large, prosperous middle class was necessary to prove that the “American way” was so much better than communism. Now, however, the widening gap between the rich and the poor has decimated the middle class, and the happy families dwelling in beautiful suburbs, seen so often on television, are rapidly becoming a complete fantasy.

During the depression, homes were modeled as “extended families” where it was common to have three or more generations living under one roof, and neighbours were included as well, since they would often share in the child rearing and the household work.

Most people who have experienced mental illness in either them or in a family member know that the continued support of family and friends, often well into adulthood, is essential in the eventual recovery of the individual. There is no shame in this, because families have worked together for their common good long before the “nuclear family” was ever invented.

On Thursday, June the eighth a forum was conducted at the Canadian Institute for the Blind in Halifax. Representatives of the four parties who are currently running for office in the upcoming provincial election attended it. Each one spoke on their party’s policies regarding the disabled in this province. They were asked a general question about poverty, and a more specific question regarding three policies the Teamwork Cooperative would like to see instated in this province. Teamwork is a non-profit organization consisting of people with disabilities who were the host for this discussion.

The first policy mentioned was an increase of the money those on long term disability pensions need to return to the province if they find paying employment. This is important because the existing policy penalize those on assistance for finding employment, making it very difficult for those on assistance to join the workforce. The next was about continuing people’s pharmacare assistance after they find work. People who need expensive medications would otherwise not be able to afford their treatment, another barrier to finding employment. It would save the province a great deal of revenue if more people on assistance were able to find work than by saving in short term by imposing these limits on people would otherwise be working and paying taxes. The third policy was financial assistance for post-secondary education.

Howard Epstein, the NDP candidate, seemed to be the only one that had a clear understanding of the policies in question even though these issues were not his department, and stressed that his party knew the importance of these issues and that they would act on them. He spoke of actions he took in his district to create curb ramps for people in wheelchairs, be has recently come to realization that these issues go far beyond accessibility.

Jim Hoskins, the Liberal candidate, spoke eloquently about some of the disabled persons he had encountered during his work as a police officer, but showed no real knowledge about the issues in question. When asked about the three policies he pled ignorance and added that it was “all about the money”.

Shelia Richardson, the Green Party candidate, also spoke of her work with disabled people, both in her personal life and for a number of non-profit groups, but said nothing about what she felt should be done. The Green party, being relatively new to this province, seemed to still be in the process of developing a complete platform to address other issues besides the environment .

Andrew Black, The PC candidate, stressed the need for a balanced budget and spoke of measures that sounded like they were too little, too late. He promised we wouldn’t be left to starve in the streets, he said that we would still be able to feed and clothe ourselves and our families, but it appears that is all we are going to get from a PC government.

It goes without saying that many of the disabled in this province have some sort of mental illness, making these issues very important ones, and also such things as de-institutionalization and community treatment orders. We must continue our pressure on our elected officials to address these very important issues.

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