Stigma and mental illness: The Joy of Cooking

For those of you who may have become accustomed to a more light-hearted treatment of issues related to mental health: You may want to skip this entry. Why? Because I’m mad as hell and I don’t want to take it anymore.

The source of my disaffection? The results of a survey commissioned by the Canadian Medical Association (CMA) addressing Canadian attitudes towards the mentally ill. I’d like to comment on two of the more prominent highlights:

Highlight #1: 25% of Canadians claim they are afraid of being around the mentally ill

That’s interesting. I can sort of understand this reaction; after all, we are “inundated” by reports of decapitations on public busses, mass killings by deranged gun men, and “familial” suicides. Really, the surprise here is that ONLY 25% of people are fearful of an encounter!

Well, folks, let me put your minds at ease. Research has shown that the mentally ill are more likely to be the victims of violence then they are to be the perpetrators. Why? Regrettably, the mentally ill are socially-disenfranchised, disempowered, and lacking appropriate social support. They may not have a lot of possessions, but the cost-benefit ratio of attacking someone with a mental illness to steal a watch can be enticing to the street-wise riff-raff looking for a quick and easy score!

Now, don’t make another common error: don’t confuse the mentally ill with the riff-raff! Riff-raff are just nasty people, who don’t care one way or another about who they hurt, as long as the end result brings some reward. No, riff-raff are not mentally ill. They definitely are not nice human beings; being incapable of empathy, sympathy and compassion, but the last I checked none of these “symptoms” constitute any current mental illness. Maybe they should be symptoms, but they aren’t. And they aren’t because including these criteria as candidates for inclusion into the mentally-ill alumni would be an insult to the millions (that right, millions) of people afflicted with schizophrenia, bipolar disorder, depression, anxiety-disorder and attention deficit disorder. The great majority of these people have the same (if not greater) degree of empathy, sympathy and compassion as do you or I.

Some of you are probably thinking right about now: I’ll take Rochford on his word, and accept the idea that the mentally ill are more likely to be victims rather then perpetrators. You may also be thinking that this is unfair and unjust. But you may also be thinking that the mentally-ill do commit acts of violence. Yes, they do. But what are the risks? As I state to people who are shocked when I tell them I work in a psychiatric organization: I am less concerned about being attacked at the hospital or the environs then when I am alone on the corner of Peel and St. Catherine Street at 3:00 AM on a Saturday morning. This kind of reminds me of the fear that surrounds flying. Many folk will readily admit to at least some degree of apprehension over the possibility of an airplane crash. But the statistical facts do not lie: we are far more at risk driving our cars then we are flying in an airplane.

So, why the concern? Like airplane crashes, the violence perpetrated by the mentally ill is generally more likely to catch our attention. It often has more bizarre components, it may be less explicable. People don’t like to hear about a home invasion where the robber terrorizes a family of four and runs off with the family fortune, but at least they have an inkling of why someone would perform such an act. It is not as easy (even for those of us who work in the field) to encapsulate the reasons that lead to a decapitation or a father taking the lives of his four children prior to taking his own life. But then again, most of us don’t know what it is like trying to control the voices inside our heads, the ones that try to convince us that the person sitting next to us on the park bench is really an alien whose intentions for you are less then honorable. Most of us have never plunged to the depths of despondency that can lead to the false impression that taking the lives of your loved ones along with your own is an act of kindness.

Highlight #2: 50% state they avoid socializing with or marrying someone with a mental illness

Here’s a revelation for you 50%: You probably already have socialized with a mentally ill person! Did you know that one in four people will suffer at least one major depressive episode in their lifetime? So, if the average person has 25 relatives and close friends, the likelihood is that at least one of them was (or will soon become) depressed. And the news on this front is not at all good: the World Health Organization published a recent report predicting that by the year 2010 major depressive disorder will be the second most common illness in the world (after cardiovascular disease). The incidence of anxiety- and attention-disorders has also risen over the course of recorded history. Fortunately, rates for schizophrenia and bipolar disorder have remained relatively constant.

So, why don’t you know that you have socialized with this already? Because we’ve kept it a secret from you. That’s right, we. The happy, devil-may care grin on the mug that first greets you when the page loads conceals the fact that two years ago I was a stone’s throw away from ending it all. Woke up one day, looked at the ceiling, and concluded that I just would not be able to rise to the challenges that faced me.

Two things saved me: The first was my son leaving for school with his comforting daily adieu: “See you tonight, Dad, have a good one. By the way what’s for supper?” That small comment gave me the glimmer of light that I was not worthless and useless. The second was a dedicated circle of family, friends, colleagues and coworkers who supported me with Herculean effort and dedication.

And that’s the key. I was fortunate to have had that circle of support. Unfortunately, many others are not so blessed. Again, look at the numbers. If 50% of you don’t want anything to do with most of us, then the support we get is about as good as that provided by an old jock strap. . And just because we try to keep our little secret to ourselves, don’t think it’s our fault. One other “highlight” of the CMA survey is that about 50% of people polled believe that mental illness is often an excuse for personal weakness. So it’s not surprising that we are reticent to open the door to ridicule and belittlement. When I opened the door, I tried to do so carefully, to people who I thought would not be critical; family, friends who I knew or suspected had similar difficulties, colleagues gifted in providing support and care. I did make a few miscalculations: suffice it to say that those people with this holier than thou attitude have now been regulated to the “past acquaintances” category.

There is one other thing that kind of got me a little upset about the survey. Why would the CMA spend money on a survey that told us what we already know? Well, those of us who work with or have suffered from mental illness may already be aware that “In some ways, mental illness is the final frontier of socially acceptable discrimination” to quote CMA president, Dr. Brian Day. But many in Canada do not, and I would not be surprised to learn that stigmatization of the mentally ill is an exclusively Canadian phenomenon.

As a colleague of mine once mentioned to me “defining a problem means you are half way towards solving it”, and the CMA survey has clearly defined the problem. So now that we have defined the problem, what’s next? Well, here’s a suggestion: the next time you hear of a colleague who is off on sick leave for burn out, try giving him a call and ask if there is anything you can do to help. Or, ask him “What’s for supper?”

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Posted in Human, Mental health.

Posted on 19 Aug 2008

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5 comments to Stigma and mental illness: The Joy of Cooking

  1. Marie-Gabrielle
    On Aug 20th 2008 at 10:51

    Indeed, the Canadian Medical Association (CMA) report reveals that a lot remain to do to fight stigma and educate us about mental illness. I met so many people who were so ashamed about having a son or a friend suffering from a mental illness. Thank you.

  2. Stephanie
    On Aug 20th 2008 at 16:17

    Your arithmetic is off. If 1 in 4 people will suffer depression, then that means that if you know just 4 people, then one of them has/had/will have depression. If you know 25 people, then 6 of them will suffer from depression.

  3. Joe Rochford
    On Aug 21st 2008 at 11:10

    Hi, Stephanie:

    Thanks for your comment. I appreciate that the math doesn’t quite make complete sense. One of the problems with “incidence rates” is that most people think they are over-exagerrated. And i cna tell you form past experience that when I use the 1 in 4 rate for depression, most people just laughin disbelief. So, what I was trying to do was to combat this impression, by using the lowest end of the estimate scale. You are quite right that we would expect to have encountered 6 people with depresion, which most people would see as being way out of whack with reality. On the other hand, I think it is easier for people to see that we all might have encountered “at least one” depressed person, even if we don’t know about it.

  4. Romualdo Barillaro
    On Aug 25th 2008 at 12:26

    HI Joe,

    I agree with you, everytime I mention to people where I work I get the same reaction must be afraid working there with all those crazies..My answer is I feel more safe at work than being in shopping centers during a sidewalk sale..I remember when we removed the decaying fence around the grounds there was a public meeting because some people in the community said that more patients will be running around now that the fence was going to be taken down ..not so! anyway you will always have people saying stupid things until someone in their family gets hit with some sort of mental illness then maybe just maybe they will understand.


  5. Liz
    On Aug 25th 2008 at 13:31

    Brilliant piece. Here are a few thoughts:

    I think there’s a particular image that people have of the mentally ill…. and it’s usually composed of the material you mentioned, namely the bus-killers, street-corner whackjobs, parents-gone-cannibal, etc. I’m not saying this is right, or even remotely appropriate, but the nature of the stigma surrounding mental illness renders those survey findings pretty much irrelevant, in my opinion, because the layman might not even consider the more common afflictions, such as depression, bi-polarity and the like, as fitting to their generalized view of mental illness. I mean, I’m not convinced that the people polled didn’t picture Charles Manson, rather than a post-partem afflicted mother or the burnt-out colleague, for example, when confronted with the ideas of “mental illness”

    Again, I don’t support this phenomenon, nor am I in any way an expert, but this is the fruit of experience after having worked at Douglas for a few years now. Like you, I always get the “whoa, isn’t that dangerous” or “with crazy people?!?” response, when I mention where I work, which I find absolutely disheartening.

    When it’s conversing with people I know, I always mention my bout with depression, and ask them if they consider me “crazy”, because yes, I was medicated, and yes, I needed to consult a professional. I offer to them the notion that some patients here suffer from more extreme versions than that, and that they are no different than me or them, really, in certain ways. And because my symptoms were not violent or dramatic… it was ruled by some to be a case of “buckle your bootstraps, and get back on the horse”. My experience, and those of others, like you it seems, have definitely given me a slightly disturbing perspective on how people see, or don’t see mental illness.

    Basically, I wonder if those polled were given an acurate description of what was defined as “mental illness” before they answered the question, because a lot of people I’ve encountered are far too quick to jump the gun in terms of generalizing just how broad the idea of someone with a mental illness is.

    Anyway. Thanks for this, I really enjoyed reading it.