What comes to mind when you hear “mental illness?”
Many if not most nurses feel dread. They imagine danger, pain, frustration, hostility, violence, wasted time and energy. For 20 years, I’ve heard such concerns when I’ve mentioned my work as a Psychiatric Nurse. Nurses (and others) talk about people with mental illnesses almost as if they’re intractable problems to avoid, or even some hostile alien race.
Nurses are great people: tough, courageous, and smart. They confidently wade into bloody, chaotic disasters and literal shit shows (if you have to ask…) that would badly overwhelm most people. Yet nurses often despair when it comes to “psych,” thinking it impossible to get along with “such people,” to work efficiently with them, to have fun at it, to enjoy their company. They often cite “psych” as the “one thing I can’t do.”
I disagree. I do it all the time because I’ve learned how. I have lots of fun! And based on decades of experience, research, and teaching, I’m confident that all nurses can “do psych.” It involves skills applicable to ANY interactions. The best “psych” skills focus on people, not illnesses. Such skills help nurses do better work in any specialty and setting, with any patients. Doing right by psych pays off big! Nurses save time and energy. They spare themselves frustration and danger. They gain far greater trust, rapport, and cooperation, quicker and easier. They can even have some fun – fun! – at work. It sure beats dread!
Health care education and training usually skip such skills. Academics don’t get outside of their specialty silos often enough, and students suffer for it. But it’s a problem we can fix. Keep in mind: I offer skills that save more time & energy than they cost. I offer solutions, not burdens. Nurses have plenty of burdens already, right? I offer investments. Spend a little time to save lots of time. Spend a little energy to save lots more. When I work a weekend, Sunday is usually easier than Saturday. Why? My Saturday investments pay off on Saturday, and even more so on Sunday. An ounce of prevention beats a pound of cure… especially when it comes to people. Ignore it and you will lose, as sure as gravity.
It all starts by focusing more on the people than the illnesses. We set ourselves up for failure and suffering when we focus on our differences instead of our common humanity. For now, let’s consider the experience of mental illness, any mental illness. Imagine you have one. What is it like for you? First, you might well feel think you’re unique in your suffering or perhaps a rarity.
First, you might well feel think you’re unique in your suffering or perhaps a rarity. Alone.
Truth is, people with mental illnesses are everywhere: roughly one in five people. If you encounter a hundred people in a day, that’s twenty affected people. Roughly one with bipolar, one schizophrenia, ten with depression and anxiety, each. And so on: it adds up! The exact numbers vary, of course. So why don’t folks notice all these people? Why don’t people with mental illnesses notice each other? How is that possible?
I can think of two main reasons. First, people with mental illnesses don’t experience active symptoms much of the time. That’s how these illnesses mostly work: they’re intermittent. So often, there’s nothing to see.
Second, people with active symptoms mostly hide them rather well. For example, in my youth, I considered my own suicide in detail among various groups of friends and acquaintances. No one had a clue. Not a clue! How could they? Given enough incentive, people can get really quite good at camouflage, hiding, cover stories: what I call Deep Cover. It’s not like people tattoo their mental health issues on their foreheads!
But why hide so desperately? Great question and very important!
It’s simple, folks, as simple as a single word: Stigma. By “Stigma” I mean bias and discrimination against people with mental illnesses. Sufferers know Stigma inside and out, out of lots of bitter experience. Ubiquitous and powerful, Stigma makes it dangerous to let others see our pain. It’s powerful and it’s everywhere. Because of Stigma, sufferers get shamed and abused when they’re discovered. Sufferers lose jobs, careers, respect, and relationships. In short, Stigma presents sufferers with HUGE, terrible risks. So it’s simple, folks: hiding is a crucial survival skill. And yet…
And yet it’s not. Far from it. Hiding offers safety from real threats, but it also prevents sufferers from gaining strength and support in numbers. It keeps us from trading notes, sharing tips, learning from each other, advocating for ourselves politically. Hiding also allows Stigma to flourish unchallenged. And all that’s just the beginning of the cost. Which brings us to The Five Steps of Lethal Stigma:
- People suffer symptoms.
- People hide their suffering to avoid Stigma. They don’t even seek treatment. Deep cover!
- As people hide, their unaddressed symptoms worsen. That’s what often happens with unaddressed illnesses: they get worse, right? Soon peoples’ suffering gets too severe to hide in public, so people withdraw from society. They isolate. Otherwise, they’d risk discovery: unacceptable! It’s far easier to hide in isolation than in public.
- People’s lives fall apart for lack of participation. People get fired for absenteeism. Neglected friends and lovers drift away. Finances collapse. As symptoms and reality worsen, people lose all hope. Finally, out of despair and desperation,
- People kill themselves dead. Over 40 thousand Americans die this way each year: more people die by suicide than by auto accidents or murders. More deaths than all those involving guns, most of which , by the way, are suicides, not the homicides that get so much attention. Ironically, this epidemic is largely preventable, the illnesses manageable, IF sufferers get help. Stigma prevents that.
Notice that the illnesses cause only a portion of the suffering and death here. Stigma does the rest. To the extent we allow Stigma to persist, we help get friends, family, and countless strangers killed. Sad but true! Stigma stalks the land and it kills. Happily, the story doesn’t end there. Far from it, folks! The bigger the problem, the more room for improvement. Let’s talk good news.
Stigma is a social problem, so we can fight it socially. As hiding helps Stigma, openness destroys it.
I’ve been many years weighing these facts, building my confidence and finding people I can trust. At long last, I am openly using my own mental illness experiences to help others. I can’t say I feel comfortable about it: far from it. I’m terrified, frankly. Still, I won’t rest until we’ve completely stamped out Stigma, saving lives and eliminating widespread suffering.
I can’t hope to cure these illnesses: I’ll leave that work to others. But I can, must, will (!) delete the entirely social suffering that is Stigma. And I will throw my own experiences with Depression into the mix as a show of good faith and authenticity. Stuff I told no one for years and almost no one for decades more. I’ll also offer decades of experience and research as a counselor, nurse, writer, and educator. We’re going to learn together that people can get along and thrive, work well with each other, regardless of any mental illness. We can, we must, and we will. I insist! Not bad, huh? Gotta have goals, right? Why not aim high?
Not bad at all! When you get along with people well, it’s vastly easier to work with them. That’s what I do, it’s what I teach, and it’s what I’ll offer in this forum. Do right by “psych” and you will enjoy growing rewards for the rest of your life. Interested? Don’t suffer. Don’t despair. Learn and thrive! Do better, always a little bit better than yesterday.
It’s plenty worth it, folks. I promise you that. Let’s learn together. Let’s win!