Sunday, October 22, 2006

Roy: Trick or Treat?

Reducing the stigma of mental illness has been very effective in helping to educate people about the realities, not the myths, of brain illnesses that affect ones thinking, mood, and behavior.

NAMI has been one of the leading organizations in "stigma-busting", taking exception to insensitive and cruel representations of people with psychiatric illnesses. "Crazy Eddie's", "Psycho-Sam", and last year's "Crazy for You" bear (complete with straight-jacket) are examples of the types of things that they speak out against. Interestingly, these are usually marketing schemes. The Vermont Teddy Bear Company took a lot of heat last year for their "crazy bear", but did not back down (or, at least, not until after the last bear was sold).

'Tis the season. Halloween seems to always bring out the stigma and stereotypes, with insane asylum haunted houses and Cincinnati's PsychoPath, an outdoor "trail of fright."

Folks who speak out about this are often derided as being party poopers or too politically correct. But c'mon, would folks really set up a haunted house filled with AIDS- or cancer-related metaphors ("Look out for Leukemia Lucifer and Candida Casper").

Anyway, I thought this was a good article that brought attention to the issue. The worst one they mention is the newspaper article about the fire at the psychiatric hospital... headlined "Roasted Nuts".

From other blogs:
from Psychlinks Blog: "Recently, I commented on a painfully misguided and misinformed call to remove the term “schizophrenia” as a diagnosis on the grounds that it might be stigmatizing..."
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from GNIF Brain Blogger: "Another serious effect of stigmatization is its potential to erode the self-esteem of individuals with disorders. When an individual expects and fears rejection by society, feelings of self-esteem and self-worth will be compromised, and one research study empirically proved a connection between the level of stigma perceived by individuals with disorder and their feelings of self-esteem."
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from Write Out Of Depression: "What can you do next? Check out the links listed on the right side of this page for information, encouragement, ideas on creating art and literature, and finding a support group, good doctor, or therapist. All of these resources can help you break out of the internal stigma you may be carrying."


Sarebear said...

Cool beans, I have a blog post draft on this I'm working on.

Dinah said...

Great Pic, Roy, that's one talented artist.

Is "Shrink Rap" politically correct? Isn't it kind of offensive to suggest that someone with a diseased brain needs their head "shrunken"?

Personally, I'm stuck on the idea that all gloop is just words: we destigmatize mental illness but...we'll you've read my suicidal students posts, and the who privacy issues around HIPAA feel ridiculous in the era of Electronic Records where, if I get care at the institution where I work, then my co-workers, my supervisees, many of my neighbors, and a handful of my patients, can all access my health information.

It's like we do all these things to set up illusions in our heads that the world isn't the way the world is. I'm sorry, I just don't think that Crazy Eddie is anything more than a marketing gimmick to sell appliances and really doesn't do anything substantive to change mental health issues. "Crazy" is a word with numerous meanings, and I'll point out that not all of them are bad, or even negative. So, if I said, "I'm crazy about my co-bloggers Roy & ClinkShrink" would that really offend someone with a psychiatric disorder? (I am, if anyone's wondering.) What about non-technical terms like bonkers? Can I use that now? "I go bonkers when blogger zorks" that okay, sir?

We're left with the fact that some mentally ill people behave in ways that frighten other people. Do we go through To Kill A Mocking Bird with black markers and block out all passages about Boo Radley because he's a big, mentally ill, scary person???

Gosh, I should have done my own blog post countering you.

I'd like to formally announce that for the next several months, I am the Youngest Co-blogger.

ClinkShrink said...

The problem is that people want to have it both ways. You can't de-stigmatize mental illness while also promoting policies that carve out psych patients as a protected class. I'm not sure we're quite ready, and I don't believe it's a good idea, to abolish ADA protections, disability and the insanity defense. Until then there will be stigma.

Roy: now my browser hangs when I load ShrinkRap on both my machines. I think we're not going to get this music thing to work for everybody.

Sarebear said...

Clink, that's kinda a dilemma I've had, in a way.

I want people to treat me like an adult, not a child (because I often behave impulsively), and yet, I'd like them to take into account the fact that I try really really hard to keep a lid on everything inside but sometimes I can't help it.

I think it's ok to say I want respect and yet to not be judged harshly, but it can be a dilemma to say I want respect but also some accomodation . . . . that sounds bad, doesn't it? Like I'm trying to get away with something . . . it's a dilemma, though, because without some understanding in certain situations, I may not be able to BE there.

NeoNurseChic said...

Regarding stigma - the one thing that I have noticed is that in this day and age, everybody is going to therapy for something. It almost has made therapy "hip" or "cool." I don't really think that's how I view it at all, but in another day or place, I would never have said that I go to a psychiatrist aloud. Now, several of my friends and family members know that I go to a psychiatrist, and a lot of my friends will tell me that they also do.

When I was in high school, my mom sat on my bedroom floor, pleading with me not to "do" this to her...not to go to therapy. Now she asks me how it's going and tells me about other people who she knows that go to therapy. I don't think she still entirely buys into the concept, but she doesn't treat me like I'm some shameful hellion anymore at least... I honestly think that's because it's become more acceptable to talk about it...

But the stigma hasn't completely let up -

I emailed Dr. A in an absolute panic from work last night. I can't check the blogs from work, but I can check my email. I'm going on a first date tonight with a doctor (intern), and while I've mentioned a couple things with regard to my health, I certainly haven't bared all - nor have I mentioned the psychiatry part of things. So many guys don't want drama, etc... (They say that on their profiles!) I'm not an overly dramatic person if you were to ever meet me, but my life has drama simply in the nature that sometimes I end up in the ER and sometimes I end up in the hospital - and in 2005, I had 3 surgeries, etc... If you're looking for a drama-free life, then I'm not your girl. My date for tonight certainly did not say that in his profile, but still - I hadn't disclosed everything yet! However, when I sent him an email about where we wanted to go for tonight, I forgot to delete my signature, which has my blog address in it.

Hence the panicked email to Dr. A. I had to see if he thought my blog would be a total turnoff to a guy who hadn't met me yet. I was totally freaked that John would see my blog and not want to go out with me. This was before I even realized that I'd mentioned going to a psychiatrist on my blog. Dr. A had assured me that my blog doesn't make me look nuts or anything, and I was just beginning to feel okay about it, but in a return email to Dr. A, I remembered that I frequently mention my psychiatry appts and my own battle with depression. Both emails were entitled, "AHHHHHHHHhhhhhhhhhhh"

So stigma is alive and well in my own fears that someone will learn certain things about me and then look at me as a total freak of nature. I have a lot more to say on this, but not right at the moment as this is long enough! However, when I went to Governor's School for Healthcare at UPMC, my concentration was in mental health and I trained with 2 psychiatrists at Western Psychiatric Institute and Clinic - they were really big on stigma...I think they pounded it in our heads every single day of class. They were the types who didn't like the use of the word "crazy" etc etc. I don't have a problem using it - I guess it's all about context. I can't think of another word to say if I'm not allowed to say, "Thta's so crazy!!" or "I know this sounds crazy, but..." But I don't agree with papers posting headlines of "Roasted Nuts" and so on!

I don't think my date ended up clicking on my blog - at least I didn't see any hits that looked like they'd come from a nearby hospital or the area of Philadelphia where he lives. But that whole stigma issue sent me reeling with anxiety last night! Thank goodness for blog friends who help bring me back to earth from time to time... ;)

Anonymous said...

I saw a new patient today and I ended the session the way I always end first sessions, with the question: "Do you have any questions for me?" Usually people ask if I can help them. This young woman responded, "Am I crazy?" I told her she's under a lot of stress (she is) and she looked at me kind of funny...I realized either I hadn't answered her question, or my deflection was read as a Yes, Totally Bonkers. Finally I said something like, "You know Crazy isn't really a term I use." She looked relieved.

Steve & Barb said...

It's funny, you are all saying the same thing. Changing terms or shunning certain words will not change attitudes. But they do affect attitudes.

When the terms become burdened with stigma and negative emotion, it makes sense to do away with them. An extreme example is "N*gger" (I find it so offensive, I can't even type it). Then Negro, then Colored, then Black, then African-American (at least, in the US). Each change helped to sequentially shed some of the baggage attached to the prior term.

Folks with different severities of mental retardation used to carry the clinical terms of Idiot, Imbecile, and Moron. Now, even "mental retardation" is falling out of vogue. It's the nature of language to want to change the slate when the old one is no longer malleable.

Anonymous said...

First, Rename All the Lawyers

Published: October 24, 2006
IF a rose would smell as sweet by any other name, will trial lawyers smell better with a new one? That’s the question posed by the impending self-reinvention of the Association of Trial Lawyers of America. After Election Day, the 65,000-member outfit whose lawyers brought us multibillion dollar settlements in cigarette cases, millions of asbestos injury claims and lawsuits over McDonald’s coffee will change its name to the American Association for Justice.

There’s already been much wry snickering about the organization’s vaguely Orwellian new banner. But it’s not the first time the kings of torts have changed their name, and it probably won’t be the last. For a half-century now, trial lawyer identity crises have been exquisitely sensitive barometers of American politics.

In the late 1940’s, a cadre of poorly paid and status-starved lawyers representing injured workers (the claimants) in the workers’ compensation system banded together to form a lobby dedicated to the advancement of their own and their clients’ interests. They called their group the National Association of Claimants’ Compensation Attorneys.

That name worked for only a few short years. The problem was that the workers’ compensation system was designed to streamline the resolution of worker injury cases by eliminating (or at least minimizing) lawyers’ fees. Lawyers in the system therefore had little hope of gaining wealth or prestige. With the assistance of early association leaders like the flamboyant San Francisco lawyer Melvin Belli, the group’s lawyers began to extend their expertise to personal injury cases in the courts, where the fees ran much higher and where their Perry Mason-like trial techniques might earn them a measure of respect.

In 1960, the association formalized its new outlook by changing its name to the National Association of Claimants’ Counsel of America, a moniker that repositioned the group as one of lawyers for victims not just in the compensation system but also in the courts. Four years later, the organization renamed itself the American Trial Lawyers Association. By then its transformation was complete: the lawyers had left the compensation system behind altogether for the free-wheeling, high-risk and high-return world later made famous by Julia Roberts in “Erin Brockovich” and John Travolta in “A Civil Action.”

But the 1964 name stuck for less than a decade. Another lawyer organization — the American College of Trial Lawyers — complained that the names were too similar. The defense lawyers in the college apparently worried that it would be tainted by nominal association with the lowly lawyers’ group. In 1972, the American Trial Lawyers Association gave in to the litigation by the college and altered its name to the current (and now soon to be abandoned) Association of Trial Lawyers of America.

The trial lawyers’ struggle for identity is a near-perfect parable for the course of American politics since the 1930’s. In a political system long dominated by courts and political parties, Franklin Roosevelt and the New Dealers envisioned a new kind of federal government made up of administrative bureaucracies like workers’ compensation, which would provide rationalized services to citizens.

After World War II, however, American politics slowly reverted to form: resistant to European-style public bureaucracy, shaped by powerful courts and the legal profession, and highly susceptible to the influence of interest groups and party politics.

As American politics has changed, so have the trial lawyers. They began as cogs in the wheels of the New Deal’s bureaucratic machinery. They became legal entrepreneurs, identifying creative ways to produce higher awards for their clients in the courts and line their own pockets in the process. Thanks to mass torts cases arising out of things like cigarettes and asbestos, the association’s membership includes some of the wealthiest lawyers in the country. And in the past two decades, the trial lawyers have become a crucial source of financial support for the Democratic Party.

The problem for the lawyers is that the genius of the tort system — its capacity to marshal the entrepreneurial energies of the bar — is also its greatest public relations liability. Indeed, whether trial lawyers are part of a distinctively American regulatory solution or part of a distinctively American problem, the new name seems unlikely to change the way Americans view them.

At KFC (né Kentucky Fried Chicken), the chicken is still fried. At Altria (né Philip Morris), the cigarettes still cause cancer. And at the American Association for Justice, some will say that the trial lawyers are still chasing ambulances.

John Fabian Witt, a professor of law and history at Columbia, is the author of the forthcoming “Patriots and Cosmopolitans: Hidden Histories of American Law.”

Just a thought, op ed piece copied and pasted from The New York Times