Sunday, 10 July 2011

Blog Carnival - Stigma and Discrimination.

This is quite an important topic to me. So important I am writing my dissertation for my Masters in Social Work on it. In particular the stigma of personality disorders.

With people I know, i.e friends and family I don't make well known the problems I have experienced or experience. Being a Social Work student perhaps I should be more able to let other people be aware of the issues that I face. But I don't. The reason being is I fear discrimination. The friends (if you can call them that, I have written posts before on the problems I have had with friends) that do know about some of the problems have seemed to have distanced themselves from me. The night I fell over and broke my ankle saw me being open-ish with them about what has been going on. Since then, I have not heard from them and not seen them. That's two and a half months ago. I have been left out of group things and no one has really been in contact. I wonder if they think it's catching, or, if they just don't want the hassle of having a friend who is slightly different to them.

I say that in being a student in Social Work I should probably be more open. You know, fighting for acceptance etc of mental health. But in reality, I know there is massive stigma and discrimination of people with MH problems. There are all these campaigns out there such as Time to Change which promote the acceptance of people with MH problems and encourage people to speak out about it. I am a big believer in this. I believe that people should be able to openly discuss that they have problems. I mean, if someone had a physical illness such as diabetes they wouldn't be chastised for talking about that. So why with MH? Yet, even though I am a believer in this, I can't find it in myself to be open with people I know or meet about it.

I want to be a MH Social Worker. I eventually want to do my AMHP's training. Surly as someone who wants to do this I should feel that I could be more open about the issues I have faced? But no, it's because I fear discrimination and stigma.

It's not just the wider society a person experiences stigma and discrimination. It's from the inside also. Especially if you are fortunate enough to have been given the "diagnosis" of a personality disorder. I wont go on about my thoughts of the concept and diagnosis of PD as I have many times before. There are studies out there that have shown that the patient with the diagnosis of PD is the least preferred patient. So what does this mean?

Off the top of my head and sorry if I am wrong, but 1 in 3 people will experience a mental health problem at some point in their life. 30% of people with MH problems have been diagnosed as having a PD. I don't know if this means that nearly 10 in 100 therefore are able to be diagnosed with a PD? Maybe I am getting it round my neck. But either way, the prevalence of PD is quite high. So, why is this the diagnosis that experiences most stigma and discrimination? You would have thought that a person who works in mental health would be used to dealing with people who are diagnosed with this (considering the prevalence), so why the stigma? It's something I am going to look into more when I start writing the dissertation.

I have also seen the stigma and discrimination first hand. Some of the things that qualified members of staff have come out with... such as "that's typical, she's PD" in regards to someone being upset over an event. "Be careful with them, they're a PD patient, they'll switch and use anything you tell them against you". "Typical PD" about someone who self harmed. I have seen people who have been diagnosed as having a PD being treated as second class citizens. This was in a unit specifically for PD. You would expect the staff to be a little more understanding and less harming to patients really. This particular unit I worked at has been in the news a couple of times recently as of bad management though, first a patient succeeded in killing her self as her obs weren't done correctly and then because of a riot breaking out! It was a horrendous place and I was so glad when I found another job to go to. Again, I have written more about this unit previously.

I have noticed the stigma when being in hospital. For instance, when I have had to go to the ED as of self harming or suicide attempts I have found that the staff have been very brisk with me. There is one member of staff who hates me. Well there's probably more but she makes it quite well known. She says things like "you are being a silly girl". "I thought you were going to sort your self out". "There's people who need our help out there"... and a few other nasty comments which have just not been needed. There has been a doctor when I asked how long it was likely to be (in a nice pleasant way) snap at me and say "bloody typical of you self harmers, you come here after self harming, expect to be patched up and rushed through". Never in the ED has someone asked why? They see self harm as an attention seeking thing.

When I have been at the hospital as my own accident proneness (usually 2x a year that is in no way related to self harm), I have been treated with respect, they have been nice to me and caring and showed an interest in my life.

It's not just with self harm that they are bad. I went in with a service user a few months ago. Basically I was concerned that the stress she was under because of the housing issues would trigger an episode for her as they had in the past. So I went out my way to take her to the emergency doctor, miles away from her house and then to the ED as the emergency doctor wouldn't do anything. Anyway, I took her to the ED as I wanted to get her seen by someone as I was concerned. They were awful to her. Shoved her in a cubicle and didn't come check on her or anything. 6 hours we waited and not once did they come to volunteer how long it was likely to be. The only information I got was when I kept asking and asking and then eventually saying I felt we were being fobbed off as no one was telling me anything.

Everyone holds prejudices. If you think you don't then you are not human. It's how you handle them that count. I have also written posts on the prejudices that I hold. But, most people learn to not let them affect what they do. I leave my own personal feelings and values at the door when making decisions. I think in some cases they are ingrained in to you from a young age.

When I was growing up I lived near a Psychiatric Hospital. We used to scare each other with stories of what the "psychos" would do and we would worry about them escaping. This is from being about 4 or 5 and talking about it with your friends. I have found myself correcting people now though about it. My brother being one of them calling it a mad house. And then he was getting it all wrong about the difference between the drug and alcohol ward and the normal wards (normal psychiatric wards). I was trying to explain that not all the people and the D+A ward were mentally unwell etc etc etc. And he was trying to tell me how it had moved from a place where it wasn't to the place he was now. Anyway, I had a lot of correcting to do. But it's amazing how people will describe psychiatric hospitals and wards with such throw away words like "mad house, crazies, loony bin" and a few others. Why can people get away with this, you don't hear people talking about physical illnesses like that. Why is it worse to be seen talking about someone with a physical illness in a derogatory way and not a person with mental health problems?

I've not quite written this blog how I wanted to so maybe I will come back to it and change it at a later point, but for now it will do...



Jill said...

I've been a nurse for over 20 years and have seen first hand how people in my profession and even doctors talk about patients with mental health issues as though it is something they are faking or even worse, label them as wacko. I've witnessed patients being judged (behind closed doors of course) about how many medications they are on and such high doses, etc. I never ever shared that I had panic disorder or social anxiety with my professional colleagues for this very reason.

Anonymous said...

I'm a psychiatrist who was subjected to severe abuse at my workplace due to severely personality disordered psychiatrists and other doctors. There is a lot of personality disordered doctors out there; they benefit psychologically from projecting disdain and psychopathology onto vulnerable people. In fact, the medical system is especially abusive to people with mental conditions presenting as patients, but much less "abusive" toward violent and personality-disordered doctors. In fact, they are often rewarded as they self-select each other and reinforce each other's malignant behavior.

The most violent places are emergency rooms, especially those that do not have psychiatric services on site. Never go to a doctor's office or hospital alone. Be especially wary of Harvard doctors, Jewish doctors, psychiatrists and orthopedic surgeons. Many people enter medicine to gratify career expectations but have little motivation to perform their sacred duty. There is a nasty culture in medicine which must be confronted aggressively to limit the unnecessary and self-gratifying abuse.

theurbanworrier said...

following on from Anonymous, I want to yell & scream about the disparaging of one end of the PD spectrum and valorisation of another. Board & Fritzon (2005) studied british executives against broadmoor inmates and found that PD was more prevalent in the former group - ie the success stories are more mental than the criminals. I know I keep getting told by my whitecoats that my expectations and the socialisation that fed into it (having been intelligent, to the 'right' school on scholarship and having gone to the 'right' university) are unreasonable, that it's wrong that it's been discussed with my 4-year-old niece that she could study at Cambridge. You don't end up at decent university, doing medicine, by accident. Yet the creation of the them & us approach by the docs seems purpose built to safeguard their own egos against the realisation that they are no different from us.

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