... to be considered sick?
Reprinted from "Stigma" issue of Visions Journal, 2005, 2(6), p. 18
When people, including professionals, think of mental illness, their perception may be of a person who is not taking care of themselves and their responsibilities, and whose behaviour is out of control. As true as this is for some individuals, there are also people affected by mental health conditions who do not present in that way. This does not negate the fact that there are times when treatment and intervention are clearly needed to prevent further decline in a person's functioning, regardless of how they appear externally.
How have I come to understand the difference between looking healthy and actually being unwell? My perception of mental illness has changed because of my own experience of it. I used to have the stereotypical idea that people with mental illness appear 'out of it,' and were identifiable by their erratic behaviour and messy appearance. I realize now that I also believed mental illness was a character weakness. My perceptions were due in part to my family's attitude towards mental illness. Several relatives have experienced depression, but within my family mental illness was considered a weakness and was treated with a 'hush-hush' attitude. Thankfully, their attitude, and mine, has changed as a result of my experience.
During the past two years my mental health has been challenged, and it's only recently that I've been properly diagnosed. Knowing that I needed medical attention for what was occurring was not something I was pleased about, given my independent nature. However, deep down I knew treatment was necessary, including the need for medication. If it were not for my general practitioner (GP) and associate and staff, I don't know where I'd be today. The treatment, understanding and proactive care I receive from these individuals is supportive beyond words. Sadly, some of my other experiences have not been as positive.
I believe that my education and external presentation has had a bearing on some professionals' misperceptions of the intervention I have needed at certain times— I have a post-secondary education with plans to further it, have a professional career in a health care field, and have experienced other successes as well as challenges. Many professionals, it seems, have the same prejudicial ideas that I used to have about what mental illness 'looks like.' Even though I may appear okay on the outside to others, I can be significantly challenged internally and experiencing changes in my normal pattern of functioning and energy level. I can appear strong and confident, but feel unwell. Those who know me have the proper insight to understand this change. This is why, in my opinion, a person must be viewed individually and not placed into a defined category where assumptions are made solely on the category itself.
Prejudice and stigma in our society about the appearance and behaviour of the mentally ill may stem from the fact that people do not receive adequate treatment until their condition and functioning deteriorates significantly past the point where they ought to receive intervention. The prejudice can be that of the person who is ill, their family, friends and co-workers, or that of health care professionals.
The experiences I've had in recent months make me wonder if one has to be totally 'out of control' before intervention can occur. Do we have to look or act a certain way even if we are not quite at that point clinically, but instinctively know we will soon end up there without the proper treatment? Does a person have to arrive at a hospital emergency room (ER) with very little or no ability to function before they are taken seriously? What ever happened to the basic premise of listening to the patient/client and gathering the proper information before making an overall objective and subjective conclusion? Does the health care system want to prevent/limit repeated ER visits and hospital or community facility stays? If so, where does proactive medical care fit into the picture?
These questions may be difficult to answer in a quick and easy way, especially with all the constraints the health care system is facing. But not taking the time to listen or over-medicating a person and sending them home from the ER, on their own because there are no inpatient or community facility beds available on that day, is not the answer.
I believe these questions deserve close consideration by mental health care professionals and governments. Policy makers should also seek input from individuals who use mental health care services, regardless of their background.
In the past few months I have experienced difficulty with medications and have had to visit the local ER, where I feel there were misperceptions about the level of care I required. As a result, I now have a written "Crisis Health Plan" to help me to receive consistent and unconfused treatment when I feel I have to go to the hospital. I created this plan with my GP, and it includes contact information for my physicians and details about my diagnosis, symptoms, coping skills and tolerance of medications and dosages. The plan is on file at a large community hospital where I was able to receive what I feel was appropriate care.
My condition is improving, and I'm very satisfied with the medical professionals involved in my immediate care and treatment. I also benefit from a high-quality group therapy program.
I hope that sharing my experience will help each and every one of us to take the time to reflect upon our own situation (personally or professionally) and what we can do to help all people with mental health conditions receive the best of care. Above all, let us all consider how we view and treat individuals—regardless of their background or external appearance.
About the author
Kate is a Mood Disorders Association of BC (MDA) member and has been a recipient of care from the mental health care system since 2004. She lives in the Lower Mainland. You can contact her at firstname.lastname@example.org