My Sojourn through Bipolar Illness – Stigma

I have often felt that the stigma associated with bipolar illness is as big if not bigger (twice as big) as dealing with the illness itself.  Every time there is a school shooting or a gun incident or a drug cartel development that involves an unstable person with mood issues, all parties with a behavioral health diagnosis suffer.  The emphasis in society rarely is on developing preventive care for people with behavioral care diagnoses.  Admitting such people to jails appears to be more of the status quo in the years following the closing of many State-run facilities.  Undoubtedly, there has been a cost savings with the closing of hospitals across the United States but the flip side of this is that many people with behavioral health diagnoses end up in jail or homeless on the streets.  Too often people may encounter the fact that there are no beds available when they go to be evaluated for admission to a behavioral health facility.

While I am not an expert in addiction issues at all, I feel that the opiod epidemic of the last several years is evidence of the fact that our behavioral health and addiction facilities are lacking in funding and in expertise while the world is lacking in understanding and compassion.  The stigma associated with having an addiction or an addiction-based personality is a huge factor I believe in addressing this crisis.  What is evident now more than ever is that addiction issues (and behavioral health issues) do not discriminate based on race or socioeconomic stature or religion or any other factors.

I have encountered stigma in the workplace, during the job interview process, in the neighborhood, in the world of health insurance, and just about in every facet of society.  I have often heard of the comparison of behavioral health issues to diabetes.  Would you think less of a person who takes insulin daily? Probably not.  But would you think less of a person taking psychotropic drugs?   Today, the typical answer to this question is probably so.  Would you think less of a person who has exited the opiod epidemic and is actively addressing addiction tendencies?  Hopefully the answer is we are learning to be proud of that person for reaching out and for getting help with a problem that is real across all sectors of American society.

The stigma issue at least in behavioral health tends to feed on itself.  Because the stigma is high with regard to behavioral health diagnoses, I find it hard to share my diagnosis and my daily troubles with others.  This need for secrecy or keeping the diagnosis story a secret in turn creates undertones of distrust or lack of trust and/or continuing questions.  If I share my story with person x, will he or she keep that story confidential or not?  What will be the fallout if my diagnosis is shared in the neighborhood or in the workplace or at my daughter’s school?  These are serious questions regarding a very serious topic.

Mostly I have found that people outside my family circle are not at all aware of or supportive of mental illness concerns.  The education that they receive typically comes through the news where the typical story involves a young teen or twenty-something who is disturbed at home, who may have sought psychiatric care or may not have, and who decides to engage in some sort of heinous premeditated shooting rampage.  Unfortunately these stories of misunderstood teens and young people on a death rampage have become more of a norm in our society in the last ten to fifteen years than anyone would care to admit.

To me there are very clear steps that society should be taking to counter-act these potentially preventable heinous acts of violence. 

These include:

1) Background checks for the purchase of guns and other weapons such that people with a history of mental illness may not purchase or own a gun or weapon under any circumstances.  This includes background checks for all types of gun sales and gun ownership.

2) Some form of alert that can be provided by a mental health worker if a particular patient is in distress and appears to be a danger to himself and others, particularly to others.  Right now, most privacy laws do not allow for that disclosure given doctor-patient confidentiality laws.

3) A clearer understanding for Crisis Intervention workers and teams including training in mental health issues.  First Responders need to be armed with a greater understanding of when a crisis event is a dangerous event for others versus when a crisis event creates danger for only the patient and the patient’s life.

4) Funding and payment to Crisis Intervention workers for this training.

5) Funding and training to mental health workers to help distinguish patients who pose a threat to society as compared to patients who are experiencing a threat to themselves.    

6) Additional early intervention work for teens in inner city environments with behavioral health concerns to get them off the streets and out of association with gangs and gang behaviors with the end game being to treat these kids for psychiatric issues before they get a criminal record and are incarcerated. 

This requires that we look at the cost-benefit of treating at-risk teens for behavioral health concerns versus the current pattern of enabling criminal activity among teens by not providing the behavioral health care that they need until after they are in jails.  In my opinion, society needs to accept the cost of working with at-risk teens on behavioral health issues so as to avoid the huge cost of incarcerating a large and growing sub-population of mentally disturbed people with a history of criminal behavior in our inner cities and towns.    

If we are going to progress past the stigma of mental illness diagnoses, it may be necessary to give up some of our freedoms.  If we are going to differentiate between a mental health event that endangers the patient versus a mental health event that endangers community or society, we people with behavioral health diagnoses need to be willing to give up some of our freedom.  To me giving up freedom is agreeing to sign off on background checks for guns and other weapons as well as amending doctor-patient confidentiality laws if there is clear evidence or behavioral propensity of a danger involving the greater community.  Clearly if we are going to expect care-givers and first-responders to bear the responsibility of determining if the event scope is patient-only versus community-reaching, we will need to provide topnotch education to both mental healthcare providers and First Responders.  Both groups need to be well-versed in signs that distinguish when the patient is a threat to self but more importantly a threat to others.   Both care-givers and first-responders need to be armed with an understanding of how these two scenarios differ and how they are the same with the end goal being the care for human life – the life of a disturbed teen but also the lives of those in community with this teen.

My Sojourn through Bipolar Illness – Fear of Flying

Note – several names and places have been changed throughout this text in order to keep my story somewhat private. Thanks for understanding that need. I hope you will tell me what most interests you from my story so I can focus on that moving forward.

Although I had had no prior fear of flying, my first episode of bipolar illness was in a tiny airport near my Ivy League college (hereafter known as Ivy College).  While I was waiting for the plane to get ready to taxi off the runway and take me to my first interview for a job after college in advertising, I was consumed by runaway thoughts.  My thoughts were anywhere but on my interview for an Account Executive position at Chicago Avenue Advertisers.  I had no specific directions for my fears but I took out some papers I was working on for my undergraduate thesis at Ivy College and was writing and writing furiously in and around the margins of the pages of the papers I previously had written.  The thoughts seemed to co-mingle with the characters in the fiction as well as characters or people I knew in real life.  The writing was fast and furious until I finally heard the flight that I was to take to Chicago on the puddle-jumper called.

For some reason I did not feel safe in myself enough to board the plane once the flight was called and I came to the conclusion that the plane was going to crash.  I did not communicate this fear with anyone.  Instead I determined that I did not want to get on a plane that was going to crash, so I got my suitcase together and asked the airplane attendant if I could check my bags on the plane but not board the plane myself.  For some unknown reason, the contents of my suitcase were of paramount importance.  I recall a navy suit that I had packed and feeling like that suit should reach a friend who I was going to see in Chicago.   The label on the suit became extremely important at the time – it was an Evan Picone double-breasted navy wool suit.  The airport personnel immediately got suspicious and asked me why I was putting my suitcase on the plan and asked me to move away from the plane with them.  When I refused, the safety patrol man exerted more force and tried to get me to go with him.  In my fears, I turned to run down the runway away from the scene of the fears and ran completely down the airport runway up into a stand of pines, one shoe flying off in the process and resting in the snowy runway.  I recall exactly what I was wearing – a plaid pleated wool skirt in muted tones, a long sleeve silk blouse and a double breasted woolen gray or taupe sweater.  I don’t recall a coat or over-coat.   The safety patrolmen at the airport followed me into the woods with snow all around and made a chair with their arms for me to sit on.  I was in some stage of delirium and thought they were providing me some sort of throne to safety. 

Instead the next thing I knew I was being handcuffed to the backseat of a patrol car with the patrol lights flashing blue and white and was being escorted to the police station down the road.  When I arrived at the police station I kept telling the police that I was a Senior and straight A student at Ivy College and they must have made some mistake.  On the walls there were pictures of wanted criminals – I kept trying to figure out what the pictures meant.  There were three pictures:  a young woman who I thought looked like Ayn Rand, a man with a long beard who looked in my state to be like a long-haired Jesus and one other picture of a youngish man whose face I cannot recall.  What I do recall is feeling like a criminal and being treated like a criminal until a kind policeman named Michael started to ask me questions.  Once I started to talk with Michael I began to calm down.

After what felt like days of swirling and runaway thoughts and a myriad of questions, the police finally called my family and called the school clinic and I was escorted there.  Soon after, several of my college roommates arrived to be with me while the admission process continued.  After talking briefly with the clinic staff, I was transferred to the local hospital’s Psychiatric Unit. 

Within the next few hours my parents arrived in town and tried to begin to make sense of what had happened.  I recall my parents visiting me in the hospital mostly my Dad whose anxiety I could sense was through the roof.  Within a couple of days, we made arrangements to go back home to Augusta, Georgia.  I unenrolled from classes and moved back home to live with my parents for the spring and summer of 1985.  No one was sure yet if this was a temporary reaction to stress as a Senior and as a Senior thesis writer or the beginning of a lifelong behavioral health diagnosis and challenge.