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Overcoming Stigma

I was sitting alone in the hallway of the Carter Center conference area in Atlanta during the 2012 Rosalynn Carter Symposium on Mental Health Policy. I had just finished being a panelist and talking about how employment and education helped me overcome the stigma associated with my depression. The conference was still in session, so I had the hallway to myself. I sat quietly, reflecting on the fact that I had been invited to speak here as both a clinician working in community mental health and a person living with depression.

Two scenes flashed through my mind highlighting two very different points in my life: getting offered a job as a therapist at the mental health center where I completed my internship for my Master’s in social work, and sitting in a psych ward on the eve of my 18thbirthday, wondering if I would graduate from high school.

Persevering Through Depression

It took many years of perseverance for me to become that professional sitting on a panel at a national conference. Though I managed to graduate from high school, I dropped out of college at 19 as my depression worsened. I was unemployed, and my only income was Social Security disability. Years of failed depression treatments included medication and talk therapy.

I spent most of my time alone doing what I refer to as “stewing in my own depressive juices.” This lasted for 10 years. During that time, I was challenged by the symptoms of mental illness— insomnia, loss of appetite, lack of concentration, suicidal thoughts. After a decade of being unemployed and living on Social Security, I decided that for my own survival, I had to return to school and complete my social work degree. Of course, my depression was against this:

“You can’t go back to school; you will fail.”

“You won’t be able to concentrate enough to complete your assignments.”

“You’re too stupid to get a college degree.”

Somehow, I decided to talk back to these negative thoughts. My response was simple: “I’m just going to do the best I can.”

And I did. I got myself back to school and finished my degree in social work. Around that time, I also tried a different treatment for my depression, and it worked. Things got easier.

Today, I feel incredibly lucky to say that I am doing exactly what I want to be doing. But really, luck had little to do with it. Besides my symptoms of depression, I faced an additional barrier to school, employment and inclusion in general: unhelpful attitudes from well intentionedhealth professionals—in other words, stigma.

Learning To Reject Stigma

One mental health professional once told me, “Maybe you’re not getting better because you’re not trying hard enough.” Another warned me, “You might not be ready to go back to school full time. Shouldn’t you just take one class and see how that goes?” A psychiatrist decided, without asking for my opinion, that I should be sent to live in a group home for people with mental illness. (That did not happen, and that treatment relationship ended that day.)

These scenarios were fueled by the stigma associated with mental illness—stigma that ultimately serves to limit and exclude rather than encourage and include. Had I listened to those professionals, I might never have returned to school or entered the workforce.

So how did I overcome the stigma that I faced? I rejected it. Rejecting—or overcoming—stigma, whether it be self-stigma, public stigma or structural stigma, is one of the keys for those of us living with mental illness. This is not an easy task, to be sure, but it is becoming more possible and a bit easier as more and more of us of speak out about our mental health conditions.

 

After working as a therapist and witnessing the negative effects of stigma on clients and their family members, I decided to develop a stigma-reduction training curriculum called “Overcoming Stigma.” I spent several months reading every scientific article I could find about stigma research. Most of it simply documented that stigma exists (in hospitals, in psychiatry, in substanceusetreatment centers, in pharmacies, universities, employment, housing, etc.) and that levels of stigma have not changed over the last decade.

According to many studies, effectively reducing stigma pointed to one intervention: contact with someone successfully managing a mental illness. One shining example of this is NAMI’s In Our Own Voice (IOOV) program. People with mental health conditions share their powerful personal stories in this free 60- or 90-minute presentation. I decided to integrate elements of IOOV into the beginning of my trainings by briefly disclosing my own depression and giving a few examples of my experiences with stigma. The rest of the training includes a description of the seven most common types of stigma experienced by people with mental illness and substance-use disorders, research about the effects of these stigmas, ways to reduce stigma, and the clinical and agency assessment tools I developed.

I have presented Overcoming Stigma trainings in many different health care settings, and the curriculum continues to evolve, always guided by the latest stigma research. Recent research shows that stigma training needs to be ongoing instead of a one-time thing and, it likely needs to address many stigmas all at once.

My trainings get everyone involved in the discussion; I like to ask for anecdotes from attendees. Here are some real-life examples of stigma shared by health care professionals who have attended my trainings over the past several years:

• A cardiac surgeon said he would not do surgery on a person with schizophrenia because he didn’t think the person would be able to do the required follow-up care.

• A therapist shared that as a Ph.D. student, he was told he would lose his scholarship if he left for “depression” treatment but could keep it if he left for “medical” treatment.

• A mother puts off making an appointment for her daughter to see a therapist despite her daughter experiencing severe symptoms of anxiety because she doesn’t want her daughter to be labeled as “crazy.”

• A physician attendee said it was well known in her neighborhood that her son had been hospitalized with bipolar disorder and no one acknowledged this fact (much less offered any type of support).

• A mental health clinician working in an emergency room said doctors and nurses often referred to patients in the ER with mental illness as “her patients,” rather than “our patients.”

If I do my job well, attendees leave with the understanding that we all have a role to play in reducing these harmful kinds of stigma. Personally, I still experience stigma, but I am no longer limited by it. I sometimes even chuckle when I hear someone say something particularly stigmatizing because I immediately think, “Well, that’s going to be part of my next training.” That’s not to say it isn’t still discouraging to see or hear things that continue to perpetuate stigma, but for me, there is a feeling of freedom and power in being able to turn a potential lost opportunity into one that is gained.

 

Gretchen Grappone, LICSW is a trainer and consultant with Atlas Research in Washington, D.C. Her work includes projects with VA medical centers, community mental health centers and other health care settings around the country. She lives in New York City.

https://www.nami.org/Blogs/NAMI-Blog/October-2018/Overcoming-Stigma

What I’ve Learned about Relationships and Mental Illness

Relationships and mental illness — can it work out? People who struggle with mental health issues might find themselves wondering if they can handle a relationship as well. I know I did. After all, it’s hard to think about being with another person when some days just managing life feels hard.

I didn’t date that much in my twenties. I was diagnosed with depression and anxiety at the age of 19, and I honestly thought that being in a relationship would be too much stress. I had all these worries — what if I wasn’t fun to be with? What if my partner got fed up with my issues and left? What if I wasn’t ready to deal with being in a relationship alongside dealing with my mental health?

And worst of all — what if I told someone about my mental health issues and they ran in the opposite direction? There’s such a stigma about mental health that I worried a lot about how my prospective partner might react.

I’m nearly 40 now and have been happily married for 15 years. Along the way, I’ve learned a few things about balancing a relationship together with mental health issues. Here’s what I’ve learned about relationships and mental illness.

  1. They Are Totally Compatible

Having a relationship is as possible for you as it is for anyone else! Whether we have mental health issues or not, each person comes with their own “stuff.” A mental health condition doesn’t have to be a barrier to a healthy relationship. Yes, it does take a bit of work, but it’s totally doable.

  1. But You Have to Find the Right Person

The key to having a good relationship is to find the right person. You’ll need someone who is open minded about mental health and empathic enough to be willing to learn and understand. Someone who shows patience when you are having a rough day.

  1. Disclosure Is a Must

Keeping your mental health a secret puts immense pressure on you, and that stress will only add to your problems and make your symptoms even worse. To have a successful relationship you need to know you can be open about your issues, even on your worst days.

  1. But Pick Your Time

Knowing when to disclose is a tough call. On one hand, you probably don’t want to mention it on the first date. It’s nothing to be ashamed of, but it is very personal. On the other hand, you don’t want to get really invested in the relationship only to find out they can’t handle it. I waited until it was obvious this was more than just a handful of dates, before we made any commitments

  1. Know Your Limits

Your mental health condition most likely put some limits on what you can do in a day. For me, I know if I get too stressed, my anxiety gets worse. So I have to take things more slowly than some people. Stress might affect you in a completely different way, but be aware when it does.

  1. But Don’t Make Your Partner Responsible

Ultimately, only you are responsible for your behavior and for managing your mental health. It’s a good idea to make your partner aware of how your condition affects you and it’s absolutely ok to ask them for support — but don’t make them responsible for you. For example, sometimes my depression makes it hard for me to get motivated for a night out, but I don’t stop my husband from going out. My depression is not his problem to solve.

healthy relationship can actually boost your mental health by bringing joy, laughter, and support into your life. If you’ve been worrying about having a relationship because of your mental health, I’d say, why not give it a try? Just be aware of your needs and limits — make sure the relationship is nourishing, not draining, you!

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