Moving Beyond the Stigma of Hopelessness:
Paradigm Shift in Treatment of Mental Illness
As a Licensed Practical Nurse who has worked for over twenty years in psychiatric hospitals, there is one part of my life I have hid from my past employers and my patients: that I also struggle with mental illness and have been hospitalized. There is a word that explains why I haven’t shared what I call my “dark night of soul.” The word is stigma and it means a mark or label imposed by others that leads to devaluation and discrimination. Sociologist Erving Goffman in his ground breaking study in 1963 explained the origin of the word.
“The Greeks, who were apparently strong on visual aids, originated the word stigma to refer to bodily signs designed to expose something unusual or bad about the moral status of the signifier. The signs were cut or burnt into the body and advertised that the bearer was a blemished person, ritually polluted, to be avoided, especially in public places.”
Rosalyn Carter, in her book entitled Within our Reach: Ending the Mental Health Crisis (2010), describes stigma as “the most important damaging factor in the life of anyone who has a mental illness. It humiliates and embarrasses; it is painful; it generates stereotypes, fear and rejection; it leads to terrible discrimination.” The most common myths and stereotypes about people who suffer from mental illness is that they are dangerous, weak-willed, and incompetent, beyond recovery or they are morally evil. In my own life it was the latter that struck me with a vengeance. The stigma or what I felt from experiences from a few in the community was what I call the mark of disgrace. As I think about it now, it reminds me of the book written by Nathaniel Hawthorne – The Scarlet Letter in which a woman by the name of Hester Prynne must wear a scarlet letter A on her dress as a badge of shame for conceiving out of wedlock. Her small community persecuted her.
I was a minister in a small rural town in Iowa when I began to experience the symptoms of depression. There were a few who thought my suicide attempt was a sign of demonic oppression. They were praying for my deliverance. Someone even had the nerve to drop by a CD of deliverance music “especially anointed” to cause the demons to flee. There were others who thought I had some deep sin that I was not dealing with in my life. I heard them saying “he’ll never preach again.” Most people just avoided me. While these marks of disgrace were based on ignorance and fear, the problem for me was I began to internalize them and believe them. I made them my reality. I began to believe their perception that I would never preach again. I believed I was all washed up. I bought into their perception which was an illusion. I began to live that illusion that I was worthless and without hope. Understand what I am saying, these symptoms were not entirely from the depression I was struggling with but it worsened my depression. The social stigma became a self-stigma that in reality was worse than the symptoms of depression. It is true- what you believe about mental illness may be more disabling than the illness itself. To solve the stigma problem I moved across the State, only to discover later that a change of scenery and oppressing the feelings of disgrace was not a healthy thing to do. It actually led to an all-encompassing fear in my life, that someone would discover my mental health history. It was a haunting fear that led me to lead a secret life which I have discovered is quite common to those struggling with mental illness. Stigma leads to fear and secrecy. I never talked about it. My wife never brought it up. My children, if they knew about it, never mentioned it. It has been that way for 18 years.
I also discovered as I returned to nursing that our current medical system perpetuates the stigma. How so? Our current medical system treats people with mental illness with compassion and care but does so only with the ideas of maintaining and stabilizing symptoms; by only looking at disability, problems, symptoms and the illness of people. It continues to see people with mental illness as needing to be fixed and thereby dependent of the system. It is a system that depersonalizes and makes treatment plans without talking to the person to see what they want. It is a system that informs nurses not to share their own stories of illness and recovery. That is a rather hopeless system; a system rooted in the stigma of hopelessness and the incapacity to live one’s life to the fullest.
But, within the last five years I have been introduced to an entirely new way of thinking about mental illness and to an entirely new way of treating mental illness. It is known as the recovery movement. It is revolutionary, in the sense of a paradigm shift in thinking about the treatment of mental illness. It is rooted in hope and the possibility of recovery, that is, of regaining control of one’s life. Now, instead of hearing that “John Smith can’t make it on his own in the real world,” we hear “What can John Smith do and what does he need to make it on his own? What kind of support does he need?” It gives hope and focuses on strengths. Instead of focusing on “what’s wrong?” with John, it focuses on “what’s strong?” The stigma of having no hope is removed. It also recognizes that an individual with mental illness can learn about his disease and self-manage his disease just like someone with diabetes.
I no longer hide the fact that I am a person suffering from mental illness for I have learned that my story of illness and recovery is not something to be ashamed of but to be shared with those who haven’t heard the good news that there is hope of moving beyond the disabling power of a mental illness.