Nurses Talking to Psych: The Five Lethal Steps of Stigma

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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.



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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:

  1. People suffer symptoms.
  2. People hide their suffering to avoid Stigma. They don’t even seek treatment. Deep cover!
  3. 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.
  4. 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,
  5. 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!



  1. When I was in nursing school and people asked me what type of population I wanted to work with, I always said I wasn’t sure, just now old people or psych. After nursing school I was SURE I wanted to work in psych and decided to pursue a psychiatric nursing degree in the future. I ended up working exclusively in geriatrics and psychiatrics over the past 10 years and I absolutely love it. When I teach classes I always emphasize that a brain illness or dysfunction is no different than any other part of the body dysfunctioning. No different.


  2. A huge part of the problem is that the members of the AZ BON are born and raised in a cult enviroment. Non drinking, smoking so they “think ” they are cleaner or the righteous group and therefore are in a position to “judge ‘ others . ALthough utah has the highest number of anti depressants and suicides and unreported sexual advances using the “faith ” and prophet to justify it. AND this is what is in charge of nurses careers in AZ. Judging others based on the brainwashing they have grown up with . Ordering psych evals to give the defendant nurse, a stigma , ‘crazy’ ‘ unstable” “should be on meds’ . SInful , and shameful .


  3. Hi Big Red Carpet,

    Please read (or listen to the unabridged audio) Robert Whitaker’s award-winning book ‘Anatomy of an Epidemic’:

    And then take a few days to go over his non-profit site:

    You will have an entirely different perspective on ‘mental illness’, psychiatric drugs, mental hospitals/units, and psychiatrists/psych professionals. And if you’re interested in a psych nurse perspective, I’ve seen a number of psych nurses write on Whitaker’s site.

    Lose the ‘stigma’ word. It’s meaningless and benefits the drug companies, whose products don’t treat or cure anything, least of all the so-called ‘mental diseases’ that have yet to be proven exist as anything except ever-changing lists of symptoms in the DSM.


    Liz Sydney
    ourviolentchild wordpress


  4. I tried to respond to your reply to my comment on your Halloween post – but I see you have already deleted it. Just as well, since looking for another place to leave it led me here. GREAT article – though terribly sad and frustrating. Thanks for speaking out.

    In case you are wondering, here’s what I tried to respond on the deleted post:
    Been there – published that! 🙂 So often that I have taken to editing the publish time to a date in the future so at least I can check my “scheduled posts” if my publish finger slips before the post is ready to go. But I have also used that “draft” a title so it doesn’t slip my mind thing too. I don’t think I’ve published any of those – yet. ::gulp::

    Looking forward to Monday’s post.

    Liked by 1 person

      1. My head is crowded with seemingly hundreds of posts “waiting safely” – lol. I read and type more quickly than most, but that time thing always bites me in the butt nonetheless.

        The biggest time-taker is formatting for my readership & getting it up on the site, no thanks to having to work around continued (and increasing) glitches and “improvements” that aren’t. ::sigh::

        Still, I’m grateful for the many things the platform does well, as I pray that they don’t “improve” them out of existence. I so despise the glitchy new editor that I may be forced to stop blogging if they remove the option to use the old one.

        LOL – “blogger rust”

        Liked by 1 person

  5. A book that is worth the read is called SHAMING JUSTICE ” by bartus trust. The was the BAR in AZ operates taking down law students lawyers with MAP (mental assessment program ) that is run by a social worker who has a criminal past. !! They have to pay for the counseling sessions to keep their license . Quit shocking, read and should be read by lawyers everywhere.


  6. The state of AZ uses psych to take people down, the thinking maybe easier than other ways and what better way to smear a reputation than to tell others your crazy. I mean a medical Dr would have show an xray to show your arm is broken a MRI to prove a bulging disk, but can psych ‘get away ‘ with using any excuse , even made up ones that were told in evaluations to take someone down. ? I mean who is going to believe you when the psych says something he has the credentials. He is considered “the expert” . Then when the case falls apart for the state, the ‘expert” uses one theory, and the BON , whom 1/4 are not even nurses, none are Dr’s, or qualified to use a medical label “mentally incompetent” to take you down and get away with it. How did this nurse work for 20+ years if mentally incompetent? It does leave a stigma, on the person and keeps them from getting volunteer work ! No even any job !

    Liked by 2 people

  7. What do you do with the stigma of a nursing board trying to take you down with mental illness when NO Dr has said anything of the kind . A BON that is not made up of one Dr, 1/2 are not even nurses. Absolutely horrifying to think this can happen in this day and age , but hey it is ARIZONA ! A judge bought off to sign their nonsense.
    The AZ state BAR is doing the same with new young attorneys. Any visit to a psych, will get them mandatory into the MAP program (mental assessment program ) run by a social worker with criminal record . SHAMING JUSTICE by Bartus Trust . web page.

    Liked by 3 people

    1. Arizona has long struck me as a remarkably, openly, brazenly corrupt State. If I recall correctly, there was a least one clinician hired for no other purpose than to slap a harmful label on a nurse to be used a as an excuse for punishment. Countless other flavors of corruption, all clearly aimed at enhancing corporate power over employees. I can’t offer much help with such legal/government issues, but the solutions will only come when enough brave people step up and force needed reforms to occur. It will never happen voluntarily. No, it will require a war, and with all wars, political or otherwise, there will be many casualties and no certain outcome.

      Liked by 1 person

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