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. 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.
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