Acceptance, medication, stigma and the DDA

But even so, despite valiant efforts by Rethink and other organizations - and, indeed, the Disability Discrimination Act (DDA) - stigma is still very much alive and kicking. 

When I first became a 'service user' (a term I hate with a passion, though that's for another blog, perhaps) in 2004, I had my own set of pre- and mis-conceptions, many of them based on my older sister's experiences with mental health services. (Sadly, the one brief spell I spent on a psychiatric ward some months later actually met most of my preconceptions, but I know that it's not the same country-wide. I just happen to live in a town that still has its original, pre-Victorian 'lunatic asylum'.) I didn't want to be labelled 'mad', even though I was dysphorically manic and psychotic when I first entered 'the system'. For a long time, my own stigmatic views stood in the way of me accepting my illness. Initially, I accepted it for all the wrong reasons, because I felt as though I didn't have any choice, and then because I was too depressed to care what I'd been labelled with. The problem for me is that when I'm depressed, I know my psychiatrist is right; but when I'm manic, I know he's wrong. That makes the whole issue of acceptance a thorny one. I do accept I have an illness; I have good insight. But I don't always accept my psychiatrist's medication recommendations. I haven't been properly psychotic for 4 years, so I question the need for an anti-psychotic. He insists I need it, and he may - or may not - be right. Let's just say my medication compliance is hardly high.

I think stigma is probably born out of a lethal cocktail of fear and misconceptions. People have an image in their mind in the vein of One Flew Over the Cuckoo’s Nest, or a rampaging schizophrenic as falsely portrayed by the media, and their fear is a double-edged sword - they are afraid of 'mad' people, and they are also afraid of being 'mad' themselves. Perhaps that is why so many are afraid of seeking help. I was. I knew it wasn't 'normal' to be doing the things I was doing (what's 'normal' about trying to throw yourself down a stairwell?!) but I was afraid of being sectioned and of being labelled 'mad'. It took me three years to achieve the kind of self-acceptance that enabled me to start telling my friends about my diagnosis. I was afraid that they'd run for the hills. But they didn't. Now, they're supportive and understanding, and for the first time in my life, I feel as though I don't have to pretend anymore. The only piece of advice I can give anyone unsure of how much to tell friends is this: if they're true friends, they'll accept you for who - and what - you are. If they're not true friends, then they're not worth bothering about.

I mentioned the Disability Discrimination Act (DDA) earlier as an effort to stop stigma. I think it's a brilliant idea, honestly I do. The concepts of equality in the workplace, of a requirement for companies to employ people with disabilities, of allowances being made for hospital appointments and sick leave are measures that have been needed for a long time. But I do have a problem with the DDA. It says that people shouldn't be discriminated against on the grounds of disability. Sounds fair enough. But I did recruitment for 18 months in the last job I held, and I happen to know that despite the company operating an equal opportunities policy, I had enough loopholes to avoid employing anyone who was likely to cost the company money - in sick leave or time off for appointments etc - and, indeed, was told by my manager that while I could interview 'unsuitable' candidates to make the equal opportunities policy look fair, I was to find an alternative reason (not enough experience/not enough flexibility in working hours etc) not to employ them. It's very easy, in fact, to find reasons for not employing someone without breaking any discrimination laws. I may be a cynic, but I don't hold out much hope of being protected by the DDA if I applied for a job - and, of course if I don't disclose my diagnosis, firstly the DDA isn't applied and secondly, I would be likely to be dismissed for gross misconduct or falsifying information should I become ill again and the truth come out. Catch-22 or what?

In an ideal world, the DDA would work, the Victorian-like attitudes towards mental illness would be gone, and there would be no shame at all in admitting you see a psychiatrist. Unfortunately, we don't live in an ideal world. I'm not ashamed of my illness now, but I don't shout about it from the rooftops, because there are people out there who would cross the road to avoid me, and start Chinese whispers about me. Yes, indeed, stigma is alive and well in street near me - and near everyone else. It's a monster I'm not sure can ever truly be beaten.