Everyone disapproves of stigma, and yet that doesn’t seem to have had an impact on the way in which mental health professional themselves continue to stigmatize those with mental health problems. At this point I can hear all the professionals reading this saying ‘but I don’t do that,’ and indeed you (singular) may not. Yet those of us within the professions who have been mentally ill have experienced it. Mental illness is still something that happens to other people, but not to people like us.
A good friend of mine, Maureen Deacon, died this spring. She had been a Professor of Mental Health before taking her retirement, and I first met her more than thirty years ago when she was the ward sister in the Professorial Unit at Withington Hospital in Manchester and I was a Senior Registrar in the ward downstairs from hers. We had several friends in common and kept in touch over the years. I also knew her partner very well. In the early 1990’s Maureen persuaded me to recklessly join her on an overland bus journey from Manchester Piccadilly to Leningrad as it then was, which took 4 days in each direction. I remember someone getting on and asking if it was the Blackpool bus, and we all shouted ‘No, Leningrad’ to the interloper’s complete bemusement. You bond with someone when you both eat nothing but hummus and pitta: the only food you have brought with you for the journey, day in, day out. We hadn’t seen so much of each other in the last few years but we continued to meet every now and then for dinner and chat with our respective partners and to see each others’ feline companions.
Maureen had been unwell with cancer for some time. I wasn’t able to attend her funeral because I was in Orkney then, but I know she wanted everyone to dress in bright colours for her farewell, and not come in black. She was always very upbeat, hard-working, utterly reliable and a great friend. I also knew she had been depressed, both before and after her diagnosis with cancer. She never said much about it, but we talked briefly on occasions about what it felt like and taking antidepressants. She knew I had been unwell on occasions too. So it was a shock for me to read in the paper she completed just before her death, and published this month in the Journal of Psychiatric and Mental Health Nursing, that she had experienced six episodes of depression, and had seriously considered suicide during at least one of these. I’m ashamed I never picked up how bad things had been for her, but as she said in this personal account of her experience ‘I was an expert at hiding it.’
She wrote :‘being depressed is worse than having advanced cancer’ and at that time she had a life-limiting illness. She was acutely aware of the stigma that depression carries. This, she said, had two aspects. The self-stigma that is experienced by those of us who get depressed:
“…I tend to see my mood disorder as a character flaw-evidence of my weak and neurotic nature. Currently this is reinforced (for me) by the interest in mental health and resilience, clearly something I’m missing, in some sense at least. Secondly there is the guilt and worthlessness hat comes along for me with depression experience: ‘I should not feel like this I have a blessed life, a partner who loves me, a lovely home…’”
But also the stigma that depression carries, perhaps more so than ever, within mental health services in the UK. Even severe depression is not deemed to be serious enough for mental health nurses, working with Community Mental Health Teams, to be involved in the care of, except if the person is suicidal- and even then only for a limited amount of time. Depression, Maureen said, has been called one of the ‘coughs and colds of psychiatry’ and I’ve called out junior doctors for referring to anyone not under the care of mental health services who is anxious or depressed as the ‘worried well’. This kind of language doesn’t help the mental health professional in their company, quietly keeping their own counsel or indeed anyone with depression to feel any better about themselves. Diminishing their experience does not speed their recovery and discourages them from seeking help. When I was well such attitudes made me angry, but when I was unwell it certainly deterred me for a long time from publicly admitting I had any problems at all.
During my time as a consultant I saw and treated many nurses with mental health problems- students, mental health nurses, general nurses, ward sisters. After the case of Beverely Allitt, the nurse who murdered several children in a paediatric ward, I remember trying to help a seriously depressed young woman who was petrified that having treatment for depression would mean she was thrown off the general nursing course. There seemed, from her point of view, to be very little distinction being made between having treatable mental illness and potential psychopathy by her course directors. This was her understanding, but I would not be surprised if she was right. I’ve met health service managers with similar difficulty in grasping what mental illness actually is, how it affects a person, and how a person who suffers from it is more at risk of harm from others than vice versa. I’ve also seen mental illness treated very differently from physical illness by some managers. I was asked for information about a ward sister who was an in-patient on my ward through the inter-organisational route, following conversations between hospital managers, which was a blatant attempt to breach my patient’s confidentiality. Would this have happened ifshe had been receiving care for a physical illness? When I personally made my first very tentative visit back to unit I was working on when I had been off sick with severe depression, I received a letter from the Personnel manager a couple of days later, saying ‘You looked well. I hope this means you are returning to work soon?’
As Maureen said in her paper:
‘the sheer terror of work colleagues knowing I was unwell was enough to get me moving. Ironically, on the two occasions I was persuaded to take sick leave, I got better much more quickly’.
Reading her account fills me both with admiration…and regret. How I wish we had been able to talk more about how she was feeling, but she didn’t feel able to, and I never picked up the cues.
I will always miss her quiet wisdom and common sense.
Her conclusion was that, to really understand stigma as mental health professionals we have to get away from thinking mental illness is something that happens to other people . Not to us who are always resilient, invulnerable, immune to stress, and as a result far too ashamed to admit when we experiencing something which I can assure you is far from having something like a common cold.
Reference
Patching the Soul 
Very poignant and telling piece; Stigma exists without or before a mental illness/problem; Being poor, black, gay, immigrant, are some examples; There is no doubt that cultural differences and exchanges can require great humility and sensitivity to avoid unintended insult or humiliation; the human desire to befriend and reach out can sometimes result in disagreements about entitlements and mutual obligations and rights.
careif has published- The Careif Position Statement on STIGMA
http://careif.org/category/knowledge/commentary-and-analysis/
Our next piece will focus on Gender, Race and Ethnicity;
http://www.careif.org
Mental Health 4 Life
http://careif.org/category/mh4life/
Sorry to hear about the loss of your friend. Very open & powerful blog. It articulates exactly what many of us experience. I’ve had really quite close friends that I’ve not disclosed all my mental health history to only to find out years later that they have been struggling with very similar things- if only we’d been more open all along!
I can also be guilty of using dismissive language or comments as a way of attempting to ‘hide’ my ‘true self’ I imagine this is more widespread among medical professionals.
My partner is 32 & has terminal cancer. She has survived sexual abuse, addiction, homelessness and mental health illness. She has made similar observations to your friend.
She is treated on an amazing cancer unit with amazing facilities & staff- until the subject of her history comes up & the entire attitude changes with nurses withdrawing & becoming suspicious of her. It is heartbreaking to watch.
I hope you are well yourself & some of the sunshine has headed your way.
I’m really sorry to hear that Lucy. It must be hard for both of you. I am well at present and a long way North and its been a beautiful evening. One of those to remember. Best wishes
Sadly the mental Heath biz has never been great at looking after its own. I recall talking to a ward manager who swore me to secrecy. To admit that she was experiencing intolerable stress at work was the equivalent of committing “career suicide”. The truth is that the distinctions between “worker”, “patient” and “carer” are vanishingly small. Stressed out, organisations with an obsession with power relations will never exhibit much compassion.
I completely agree with everything you’ve said. I am 2 weeks off qualifying as a mental health nurse and I suffered with my second episode of depression during my second year. I was reluctant to get help and refused therapy because it was possible I’d be working with these people in the future. It was only when my dad reminded me about things I’ve said about stigma that I realised I was stigmatising myself. Since then I’ve been more open about it. I think unfortunately in yours and my generation stigma will always be there, although it is getting better. Hopefully in generations to come It’ll be seen in the same light as physical health.