I’m never too sure what I think about stigma. If you asked me now, my immediate response would be that it has had no adverse effect on my life, and of course that has to be rubbish. Things affect us insidiously, such that we discount them, or don’t even notice them. Sometimes it’s only when you look back that you realise the difference they’ve made, and stigma, by its very nature, is rarely a kind influence. Perhaps sometimes it makes us stronger, but there are possibly better, and less painful, routes to strength.
It’s also very easy to put it all down to self-stigmatisation – but I would argue that the ability to self-stigmatise is not inbuilt, and that we learn it from what we see around us. Some people are quick to blame themselves, and also to feel shame – what has happened to them that they think like this? In a way, the concept of self-stigmatisation is almost stigmatising in itself.
When I first became ill with a mood disorder in my twenties, there was no question that stigma was alive and kicking. It was definitely hush-hush – notes were dispensed with, the very clear implication being that this could affect my career. As a result I kept on working, trying to deny this thing – I would probably have been better off sick. When I moved back to Scotland it was better, but notes were kept separately for health professionals. Why? I didn’t want to be ill at all – I hated what I had become – but my views had been nurtured by my experiences at medical school, and as a junior doctor and GP trainee. I didn’t invent them. I had observed the views of health professionals, I had heard what happened to doctors with mental illness, and it didn’t involve a successful career in medicine. Rightly or wrongly, the dismissive views of some (hopefully few), labelling patients as manipulative and time-wasters had made quite an impact. I didn’t want to be that person. The result of this was an inability to say how I felt until too late, combined with a distrust of psychiatric medication. I don’t think I would have had this less than healthy approach with a conventional physical disorder.
Stigma followed me into my recovery period, even when I thought I had escaped it. Finishing my GP training wasn’t easy – I am quite sure I was observed through a different lens than would otherwise have been the case – and I felt I had to work harder than others to prove my worth. I knew that I would not easily get a job as a GP (more competitive then), seeing it as a business decision – they did not want doctors who might go off sick. But, I reasoned, this would probably apply to any chronic health condition, and I must just accept it. I could say my psychiatry training was easy in comparison, but it wasn’t. I didn’t get a job locally, so had to commute a considerable distance, and I still had to be twice as good as others, just to be as good. Now, looking back, it seems minimal – I got through it, passed my exams – but it was very, very hard, and it could have been made easier.
The problem was – and I blame stigma – that I didn’t even want it to be made easier. I felt that I had to demonstrate that I was tough despite everything. I was always open about my illness (which I think helped), but I didn’t want anyone to think that I couldn’t do things, or cope with things. I thought that I wouldn’t be seen as good enough.
To some extent I have learnt to cope with the stigma of having a mental illness, but probably in a rather maladaptive fashion. I wouldn’t particularly advise anyone to do as I did – and yet I suppose in many ways it has worked. What I would really like would be to absolve myself of all self-blame, to feel no sense of panic and embarrassment about my illness.
But there are other factors that contribute. Social media has opened up a whole new world – one where people can access support and be far more open about their mental health problems. But many feel they have to do this anonymously, which just perpetuates stigma. Yes, they can say things that they would not otherwise say, but you can feel the fear that people might know. There are also nastier recesses of the internet where people criticise and decry the views of others – again, sometimes anonymously. I still have a great deal of difficulty accepting my diagnosis and treatment, and this kind of thing feeds doubt.
Interestingly, I have found that it’s not always easy trying to stand up as a patient when you’re also a psychiatrist. There are many vocal people out there (good), some of whom don’t like psychiatrists, and I have felt that my role as patient can be viewed with suspicion, that I am not a proper patient – or even on their side. A sort of reverse stigma.
I don’t know how best to address any of this. I am open about my own experiences, and very open to speaking with others. But sometimes I think they may just see me as a middle-aged successful psychiatrist who has no real idea. Talking openly about mental health is very much promoted these days – this is probably a good thing, but may not always address the more severe mental illnesses, and can sometimes appear to be more about maintaining wellness. This is good but not always possible.
The truth is that sticking too closely to any one concept or understanding will never be enough, and that thoughts must continually evolve in the attempt to recognise stigma and reduce its impact. It will always be both present and changing, in my view, and it’s far easier to spot retrospectively.