Mental illness, the workplace and stigma

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This is a long post, but it’s something I wanted to share, because it’s been niggling at me since I read an article over the weekend which had the subtitle ‘Irritable, distracted, winging it? Maybe you have adult ADHD’. In the main, I wanted to talk about why it is that people with mental illnesses might not disclose them, the problem of labels and measures to quickly categorise a person, and what might be done instead. I don’t have all the answers, but hope this adds to the discussion. So settle down, and please, let me know your thoughts in the comments section.

 

Stigma

Stigma. It’s a horrible word, isn’t it? And it’s even worse to feel it, as I’m sure we’ve experienced from time to time. But imagine living with the stigma, lingering somewhere in your mind, always? That can be the experience for many people with a mental health condition.

As I said in the intro, I read an article on the topic of Adult ADHD in The Sunday Age this weekend.  I read it because someone close to me has been diagnosed recently with Attention Deficit Hyperactivity Disorder (ADHD), and I hoped the article might provide some insight. And it did, especially in terms of the challenges with living with a condition that is not diagnosed. It goes on to talk about the benefits of diagnosis and the measures that can then be implemented to address the symptoms (and in some cases, possibly mitigate the condition itself). I’ve provided a link to the article at the bottom of this post.

To quote from the article:

‘Welcome to the world of adult attention deficit disorders, where drugs such as Ritalin and Dexamphetamine can help your inattention, giving you “hyper focus with tunnel vision and getting 1o times the amount of workload done”, according to Susie*. It’s like “putting on a pair of glasses and being able to see again”, she says, and feeling like your “life has just begun”.’

Feeling that you are able to ‘see again’ sounds pretty good, doesn’t it?

But, unsurprisingly, Susie is not her real name. She doesn’t want to be identified, because she knows there is judgment out there. But it also raised, to me, again, the challenges of being open about having a mental health condition. There is, for many people, a real concern – real or perceived – in being able to share their health condition publicly, because of the judgment that can accompany it. 

To quote again,

‘ADHD drugs are controlled drugs in the same category as cocaine, opium and morphine, to reduce misuse and dependence. This is one reason Susie does not want to be identified. “Because I’m working in a conservative industry, the stigma for mental illness is still there, and I also don’t want anyone knowing I take Dexamphetamine’. 

She doesn’t want anyone to know. That is fear. That is the fear of being judged. And that is limiting.

 

The implications of stigma

I understand this. My friend is the same. Medication helps her manage so much better, and she is very good at what she does. But she wouldn’t be comfortable with me sharing any details of her circumstances, because of the fear of repercussions. Hesitation by current employers if promotions become available, risking future employment opportunities, or the suspicion from clients if they found out she has a ‘mental health condition’. As the major income earner for her family, that’s a risk she is not ready to take.

You might say, ‘well, that’s her choice, and why should she have to?‘, and yes, you’re right. But there are implication from keeping things a secret. Impacts both to her, and to others. Some of the implications include:

  • Not fully  implementing the other measures she needs in order to continue to thrive. Yes, the medication has improved my friend’s life. But it hasn’t fully addressed the impacts of ADHD. Medication alone is often not the answer – not fully. But counselling, and lifestyle changes take time, and require some adjustments for working hours (for appointments, for instance). So the process of overcoming the negative impacts is slower than it otherwise might need to be. And that has impacts to family, to the amount she can give to others, and so on. It is frustrating.If my friend had a physical condition, that would cause no problems. Because it’s a mental health condition, the only way to find out if there is any judgment is to disclose it. Which then risks the judgment I’ve mentioned.
  • Fudging any measures to manage her condition behind other excuses, which creates a sense of shame and anger. By ‘fudging’ I mean actions, and reactions like: making up other reasons for appointments, worrying about being caught out (for instance, when prescriptions need to be filled), being hypersensitive to any vagueness, or lapses in attention that might give away the fact that she has ADHD.The need for ongoing vigilance adds an extra layer of concentration, and an extra barrier to engaging with others. Add to that the mixed feeling of embarrassment, dishonesty and anger that she needs to go to these lengths. Physical health conditions don’t require this subterfuge. Why should mental health conditions?

Reducing the stigma around mental health would have so many benefits, as no doubt she is not the only person, within her work environment or broader community, who suffers from this.

A recent report from the Organisation for Economic Cooperation and Development (OECD) found that, at any time, ‘ around 20% of the working-age population in the average OECD country is suffering from a mental disorder in a clinical sense’ and ‘lifetime prevalence has been shown in several studies to reach levels up to 50%’. Up to 50%!! That’s a huge proportion of people who have some condition that requires management. And that doesn’t include those who, because of the potential stigma attached, don’t even find out if they have the condition or not (and as such, as the article says, ‘are slipping under the radar). There are a lot of people with ADHD – let alone other forms of mental health disorders.

As such, there shouldn’t really be any judgment placed on those who do. But there is. Again from the OECD report, people with ‘mild to moderate mental disorders will often choose not to disclose their problems, largely because of the stigma and discrimination attached to mental illness and often negative experiences from the past‘.

 

Why the stigma?

I think some of this judgment out there, and I think I know a couple of reasons (there may be more):

  • By some people – and some organisations – all mental health conditions are seen as the same. Either you have ‘a mental illness’ or you don’t.But that’s not true. Mental health conditions vary in severity, and the majority, such as mood disorders (depression), neurotic disorders (anxiety) and substance-use disorders, are, according to the same OECD report, ‘generally mild or moderate, frequently referred to as “common mental disorders” (CMD)’. If managed well, these can be no impediment to the way a person performs in his or her workplace.
  • Once a person has been diagnosed, to some people they are ‘labelled’. They ARE their mental health condition.But that way of classifying a person is way too simplistic. No one is just one thing. No one IS anxiety, or depression, or ADHD, or any of the other mild to moderate conditions. They are a person – with relationships, with commitments, with skills, with abilities, with personalities, and with a condition. They bring all of these things to a work place – and to any other situation they are in.In some cases, their health condition can actually be an attribute. To get to the place they are at, they have often needed to learn a lot of empathy (for themselves and others), persistence, and creative ways of problem solving. These are assets to any organisation, and should be seen this way.

 

So, how can we overcome this?

A few ideas:

  • Learn from approaches taken for other health issues

Over the past couple of decades, there has been such an improved acceptance of a range of physical health issues. Thanks to a combination of increased funding, promotion and support groups, publicity, and the bravery of individuals (often those with a public profile), we have much better awareness and a lack of embarrassment around issues such as testing for, and treating, different forms of cancer, conditions such as dyslexia, dementia diseases and the like. There has been an increased recognition of anxiety and depression (although still not within the insurance sector, who often refuse coverage for these conditions). But less well known ones, such as ADHD or OCD, or others that may be seen as similar, do not yet have the same coverage and acceptance.

  • Learn what these disorders actually entail

    Yes, I know that many people think of ADHD, for instance, in terms of children running around, disrupting classes, unable to control themselves. Apart from this often being unfair on the children, it generally isn’t the way it plays out in adults. Better understand – better sharing – would help break down the fear. But to do this, the next step is very important too.
  • Recognise that non-disclosure hinders better identification and better policy within the work place

How can we get to a place where non-disclosure is not a default position for many people? I like the aim from the OECD: Develop broad legal frameworks and legislation, which can then help develop internal work place policies. ‘These should aim to enable those with health conditions to:

* feel confident that the advantages of disclosing mental disorders (i.e. opening up the possibility for adequate support) outweigh the disadvantages (i.e. discrimination and risk of dismissal), and
to provide people with assistance to manage their personal information in a way so as to access sufficient supports while avoiding unfair discrimination too easily triggered by diagnostic labels.’

That would be a great step forward. But a policy, on its own, isn’t enough. How would this work for small business, sole practitioners (with clients), and how would the policy work in practice? (there are many policies that are ineffective). I don’t know. But I do believe a better legal framework and policies would be a start.

I know that articles, such as the one I mentioned, help to raise the profile and are positive. More of these need to be written, and an increased awareness needs to come about
And I am hopeful that we are seeing progress in this sense.
And maybe, one day, my friend will no longer feel she needs to keep her diagnosis to herself. But that day hasn’t yet come.

 

Reading:

There is actually quite a range of material about ADHD available, and I’m sure a lot more on other mental illnesses. But, as a start, here are the ones I referred to (or are mentioned in the articles):

  • ‘Sick on the Job? Myths and Realities about Mental Health and Work” OECD 2011 (Summary and Conclusions chapter) – Click Here
  • ‘Adult ADHD slipping under the radar’, The Age, 1 May 2016 – Click Here
  • Resources and material on the Children and Adults with Attention-Deficit/Hyperactivity Disorder – Click Here
This post is very much a starting point for me and I would love to hear any thoughts you might have about it, in the comments to the blog, or on my facebook page (Helen’s Home Base)
Note – severe mental illness falls into a different category. Sometimes the ones I listed could evolve to become so severe that they would be classified as severe mental disorders (SMD). Often, in those cases, that will occur due to a lack of support, or as a result of life circumstances. And they may be able to be overcome through appropriate medical, counselling, and social support. One of the most effective elements, in conjunction with these listed, according to the OECD again, is retaining some level of involvement in the workforce. Other health conditions, such as bipolar disease, and schizophrenia, are triggered and treated differently, and, as I don’t have enough knowledge of these, this post may not be relevant to those conditions.

 

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11 thoughts on “Mental illness, the workplace and stigma

  1. Hi Helen, really interesting and something I had also contemplated in relation to casual workers . (I wrote a piece for the Union website and can provide link if you would like to read?) Disclosing is very dangerous when there is also NO job security. Raising awareness is great, but we don’t necessarily disclose things like incontinence, or bowel syndromes so it’s quite natural to not share all our intimate details in the workplace, I guess. Today I mentioned my back injury and realised even that will affect my employment opportunities! Thanks for writing such a thoughtful piece.

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    1. Thanks Anna – yes, you’re right about how much more risky it would be if there was no job security. And I guess you’re right about the degree of disclosure – it’s a difficult balance, isn’t it? I’d be interested to look at the piece you wrote, if you could send through the link? Thanks!

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  2. The issue is a bit of a minefield. I think that ADHD in particular has a lot of stigma attached to it, and in quite a different way to that of say Aspergers and classic autism for instance. Like depression not being treated as a “real” illness in many workplaces, ADHD in my experience (being around the parents of children with ADHD, my child has classic autism), half the stigma is people not even believing it to be a real thing, and so then you would also be faced with the issue of possibly being viewed as some kind of malingerer in your workplace.
    We have a long way to go. Thanks for writing such a thoughtful piece addressing it. I wish your friend luck.

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  3. I think you are right – it does seem to be thought of by some as a made-up disease (I guess the way chronic fatigue was – don’t hear that as much nowadays). Thanks for your good wishes too – I’ll pass it on xx

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  4. Dear Helen, as a friend of mine once said: you are only as well as people allow you to be…! (She has bipolar disorder).
    Like max lucado’s little book about stars and spots, our aim is not to let our self worth be determined by the labels people out on us. On a personal level this might work ok, but living in a larger system it is so much more difficult.
    You’re teasing out tricky stuff. Hope your friend has people close to her appreciate her unconditionally!

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    1. Thank you, Ilse – that’s a big factor, isn’t it? Yes, my friend does some wonderful friends (but at the same time, it’s hard watching her sort these things out – but I guess that’s life). Love to your friend too xx

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  5. There seems to be stigma attached to so much these days, but particularly when it comes to mental health. I am writing a fictional novel and my protagonist has schizophrenia – it is so misunderstood and I began my journey into investigating it due to someone making a flip comment about me having the condition (fortunately, I don’t!). But for those that do there is a real tendency for people to become that ‘label’ and be branded for life, potentially missing out on so much which then compounds the problem further. I hope to (eventually) raise a bit of awareness through my book and will check out your links for further reading. Thanks for highlighting this important area.

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    1. Oh, your novel sounds interesting – best wishes and I hope to see it in print (please let me know when this happens). I happened to look at Eden Riley’s blog today (do you know her – she writes under the name Edenland) – and she has also written about stigma from her personal experience. Worth a read (she is very emotional about it, which brings a really lived experience to it) -http://www.edenriley.com/2016/05/you-need-help-what-is-wrong-with-you.html

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  6. The best way to combat the stigma of ADD/ADHD, and other mental illnesses, is to prominently point out the value individuals with these “disorders” have, especially to businesses. Sure as an adult with ADD/ADHD there are some challenges, I might forget things every now and then, I might misplace things, or go off topic. But the benefits far out weighed the challenges once I learned to properly harness my abilities. Some examples: I already know that I’m prone to forget to do things, so when tasked with a job I complete it immediately instead of putting it off. My ADD, necessarily, means I’m prone to jumping from one thing to the next, sometimes without any transition or warning, I’ve put this aspect of my life to work in problem solving – I don’t get tunnel-visioned into one method of solving a problem, if it doesn’t work the first or second attempt I can quickly, and willingly, move on to some other strategy. This also empowers researching, I can consume and internalize information rapidly, from multiple different sources, sometimes this can happen simultaneously by listening to a video while reading other material. I passively digest information that I over hear or see meaning I often learn without actually being directly presented with any information. My ability to mulit-task is greater than many people – it’s not atypical for me to be watching a video, reading articles, and performing my normal job duties. It’s rare for me to be focusing on a single task, but when it’s necessary to focus on a single task I’ve learned to “hyperfocus” on that task and drown other things out.

    It’s taken me years to learn how to harness my ADD/ADHD to work for me instead of against me, it wasn’t easy and there was plenty of struggling along the way. Nowdays, I don’t see my ADD as a disability, and don’t think that I could function “normally” were I to suddenly be cured of it, nor would I want to. The only way we are going to get rid of the stigma of ADD/ADHD and other mental illnesses though is to point out the value it can bring to the table rather than the negatives.

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  7. Furthermore, other mental illnesses can also bring things to the table that might not have been present otherwise. For example, many mental illnesses are correlated with creativity and passion. Many artists, of all sorts, have been known to suffer from all manners of illnesses from depression to schizophrenia. It’s a simple fact that people with mental illness have a valuable and unique perspective on a great many aspects of life that “normal” people simply just don’t have access to. It’s important that we have a paradigm shift in the realm of treatment from suppressing the “disorder” to empowering the mentally ill by teaching them how to hone their skills and abilities which their “disorder” enhances.

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    1. Hi Wes – thanks for you comments, and I absolutely agree about the attributes people with mental illnesses can bring. I am still wondering though how my friend (and others) – plus the rest of us – can make the paradigm shift without sacrificing themselves in the process?

      For instance, do you have an employer and does that employer know about your ADD? If so, how have they accepted / accommodated it, or have you accommodated your approach so it doesn’t need to be exposed? (in which case, I admire you, because that’s not easy to do – but it’s a shame that you would have to). And there is a tendency for a greater shame / dismissiveness around women with ADD/ADHD – this article sets it out well: http://nymag.com/thecut/2015/08/what-its-like-to-have-adhd-as-a-grown-woman.html

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