Bipolar Stigma (Guest Post)

The emerging blogger series on Mental Health @ Home -background image of cherry blossoms

In this emerging blogger post, HealthComesFirst!!! Blogger writes about the stigma around bipolar disorder.

I have often felt that the stigma associated with bipolar illness is as big if not bigger (twice as big) than dealing with the illness itself.  Every time there is a school shooting or a gun incident or a drug cartel development that involves an unstable person with mood issues, all parties with a behavioral health diagnosis suffer.  The emphasis in society rarely is on developing preventive care for people with behavioral care diagnoses. Admitting such people to jails appears to be more of the status quo in the years following the closing of many State-run facilities.  Undoubtedly, there has been a cost savings with the closing of hospitals across the United States but the flip side of this is that many people with behavioral health diagnoses end up in jail or homeless on the streets. Too often people may encounter the fact that there are no beds available when they go to be evaluated for admission to a behavioral health facility.

 While I am not an expert in addiction issues at all, I feel that the opioid epidemic of the last several years is evidence of the fact that our behavioral health and addiction facilities are lacking in funding and in expertise while the world is lacking in understanding and compassion.  The stigma associated with having an addiction or an addiction-based personality is a huge factor I believe in addressing this crisis. What is evident now more than ever is that addiction issues (and behavioral health issues) do not discriminate based on race or socioeconomic stature or religion or any other factors.

As a person with bipolar disorder, I have encountered stigma in the workplace, during the job interview process, in the neighborhood, in the place of worship, in the world of health insurance, and just about in every facet of society.  I have often heard of the comparison of behavioral health issues to diabetes. Would you think less of a person who takes insulin daily? Probably not. But would you think less of a person taking psychotropic drugs? Today, the typical answer to this question is probably so.  Would you think less of a person who has exited the opioid epidemic and is actively addressing addiction tendencies? Hopefully the answer is we are learning to be proud of that person for reaching out and for getting help with a problem that is real across all sectors of American society.

The stigma issue at least in behavioral health tends to feed on itself.  Because the stigma is high with regard to behavioral health diagnoses, I find it hard to share my diagnosis and my daily troubles with others.  This need for secrecy or keeping the diagnosis story a secret in turn creates undertones of distrust or lack of trust and/or continuing questions.  If I share my story with person x, will he or she keep that story confidential or not? What will be the fallout if my diagnosis is shared in the neighborhood or in the workplace or at my daughter’s school?  These are serious questions regarding a very serious topic.

Mostly I have found that people outside my family circle are not at all aware of or supportive of mental illness concerns.  The education that they receive typically comes through the news where the typical story involves a young teen or twenty-something who is disturbed at home, who may have sought psychiatric care or may not have, and who decides to engage in some sort of heinous premeditated shooting rampage.  Unfortunately these stories of misunderstood teens and young people on a death rampage have become more of a norm in our society in the last ten to fifteen years than anyone would care to admit.

To me there are very clear steps that society should be taking to counter-act these potentially preventable heinous acts of violence.  These include:

  1. Background checks for the purchase of guns and other weapons such that people with a history of mental illness may not purchase or own a gun or weapon under any circumstances.  This includes background checks for all types of gun sales and gun ownership.
  2. Some form of alert that can be provided by a mental health worker if a particular patient is in distress and appears to be a danger to himself and others, particularly to others.  Right now, most privacy laws do not allow for that disclosure given doctor-patient confidentiality laws.
  3. A clearer understanding for Crisis Intervention workers and teams including training in mental health issues.  First Responders need to be armed with a greater understanding of when a crisis event is a dangerous event for others versus when a crisis event creates danger for only the patient and the patient’s life.
  4. Funding and payment to Crisis Intervention workers for this training.
  5. Funding and training to mental health workers to help distinguish patients who pose a threat to society as compared to patients who are experiencing a threat to themselves.   
  6. Additional early intervention work for teens in inner city environments with behavioral health concerns to get them off the streets and out of association with gangs and gang behaviors with the end game being to treat these kids for psychiatric issues before they get a criminal record and are incarcerated. 

This requires that we look at the cost-benefit of treating at-risk teens for behavioral health concerns versus the current pattern of enabling criminal activity among teens by not providing the behavioral health care that they need until after they are in jails.  In my opinion, society needs to accept the cost of working with at-risk teens on behavioral health issues so as to avoid the huge cost of incarcerating a large and growing sub-population of mentally disturbed people with a history of criminal behavior in our inner cities and towns.    

If we are going to progress past the stigma of mental illness diagnoses, it may be necessary to give up some of our freedoms.  If we are going to differentiate between a mental health event that endangers the patient versus a mental health event that endangers community or society, we people with behavioral health diagnoses need to be willing to give up some of our freedom.  To me giving up freedom is agreeing to sign off on background checks for guns and other weapons as well as amending doctor-patient confidentiality laws if there is clear evidence or behavioral propensity of a danger involving the greater community. Clearly if we are going to expect care-givers and first-responders to bear the responsibility of determining if the event scope is patient-only versus community-reaching, we will need to provide topnotch treatment to both mental healthcare providers and First Responders.  Both groups need to be well-versed in signs that distinguish when the patient is a threat to self but more importantly a threat to others. Both care-givers and first-responders need to be armed with an understanding of how these two scenarios differ and how they are the same with the end goal being the care for human life – the life of a disturbed teen but also the lives of those in community with this teen.

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16 thoughts on “Bipolar Stigma (Guest Post)”

  1. Having the experience of certain family members being ill with schizophrenia, in England – and also an ex husband who has schizophrenia while living in Germany – I saw that there is very little support out there for people with serious mental illnesses. They closed down the hospitals that helped, although my aunt (RIP) was fortunate with the care home setting she had from the ’80s until her death in 2012. Although drugged up to the eyeballs at times she did say she was happy there. It seems governments don’t want to think about these people’s needs. And, by the way, none of these 4 people were a danger to anyone except to themselves – unless you count the various electrical items my ex dropped into a bathful of water!

    I think your gun law and other suggestions make sense.

    Thanks to the both of you for an interesting post. xo

      1. Yes. I remember the panic my dad and his brother had about ‘what to do with Miriam’ when that happened. My fiance said this happened in Canada too. For a while she lived with her father but he was getting on and she did like the staff and some other patients at this other care facility. I don’t know what they called this place. With my cousin, her dad hushed it up like it was one big secret… they later called it depression! The same thing my ex did, calling his schizophrenia depression, but the man did lie about *everything* lol. At least the stigmas of bipolar, schizophrenia, anxiety and other depressions are begging to erode, it’ll take a long time…

          1. The more we all talk about our mental health like this, the quicker it will dissipate. I am complete desensitized to the stigma now because I write with purpose to help someone else. Idgaf what anyone else thinks of me anymore!!

      2. I just need to add… whereas my aunt was fortunate having another place to go I do remember back then – in the mid ’80s when they shut the psychiatric hospitals – that there were people going about on the street muttering to themselves etc, they were clearly ill. 🙁

        And not everyone has a supportive family/family available.

  2. We need a better understanding of mental illness in general and in specific in ambulant care or in the police force. Breaking the stigma down will help people to be more understood and families being more supported. Things can be easier that way.
    On the other hand mental illness can be so unpredictable, can be such an enigma on its own. I understand that we have the need to explain or to foresee things but sadly not all difficult situations can be prevented.
    I must add that I’ve not seen more criminal behavior in the psychiatric population than we can expect in the ‘normal’ population. Being mentally ill doesn’t mean that you’re more of a danger than anybody else. I’m not suggesting that this was implied in the post, I just want to make it clear.

  3. Really nice share & post. I wish more people understood just how mental illness effects everyone in the way they do cancer. Not to compare cancer to mental illness, but to make the point that I think everyone is together on fighting cancer because we all know anybody can get it. Perhaps if we all grew more compassion in our mind gardens we’ d be better able to acknowledge that mental illness really does effect us all in many ways.

  4. You are absolutely right about the underfunding for addiction treatment centers. I often find there is a great overlap with addiction and underlying mental health issues. This makes the possibility of dual diagnosis SO important to be addressed when one agrees to treatment for substance abuse. In the 29 days I spent at my local inpatient facility, I saw my counselor ONCE. The lack of activities and sober living exercises was embarrassing. We had MAYBE 4 AA/NA meetings a week and did nothing with the rest of our time there. I’ve since gone back there (now on the opposite end) to speak to the girls about sobriety. I made a mental health game to play and get them thinking about their negative thought patterns and repeated behavior. They loved it. I’ve inquired about coming in once a week to do activities like this and fully plan to follow up after this baby. It’s so desperately needed.

    1. I hope you’re able to go back and continue doing that! There’s plenty of research to show that addressing co-occurring disorders concurrently is most effective approach.

  5. This was a great blog. Stigma of mental health is serious and I have to deal with it regularly. Your ideas about addressing the problems are very good. Thanks

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