“Monitoring and tackling discrimination is an important issue for Irish society” Frances McGinnity
“Discrimination takes place when one person or a group of persons are treated less favourably than others because of their gender, marital status, family status, age, disability, ‘race’ – skin colour or ethnic group, sexual orientation, religious belief, and/or membership of the Traveller community” 
Disability is “an impairment that may be cognitive, developmental, intellectual, mental, physical, sensory, or some combination of these. It substantially affects a person’s life activities” Wikipedia.
About 4 years ago I was sitting in a pub with a friend and the barman sat down close to us and said “You are Bipolar, you are on medication and the whole town knows about it!”. While I was aware of social stigma and discrimination and had experienced it, this was the first blatant “in your face” experience of it that I remember. I let it go at the time as I live in a relatively small town but since then I have been inspired to dedicate a complete blog to the subject (having touched on it in the last blog I wrote Family, Friends and Community).
By the way the barman had a lot of inaccuracies in what he said but it still affected me deeply. The “Bipolar” he mentioned (or Manic Depression to give the condition its correct name) is in fact an adverse reaction to antidepressants I took for anxiety, I am not on prescribed psychoactive drugs (since 2011) and I don’t know the “whole town”.
When researching this area I came across a lot of interesting books and resources. Erving Goffman’s book Stigma “is an illuminating excursion into the situation of persons who are unable to conform to standards that society calls normal. Disqualified from full social acceptance, they are stigmatised individuals. Physically deformed people, ex-mental patients, drug addicts, prostitutes, or those ostracised for other reasons must constantly strive to adjust to their precarious social identities. Their image of themselves must daily confront and be affronted by the image which others reflect back to them” . This often happens in subtle ways.
“New research entitled Who experiences discrimination in Ireland? Evidence from the QNHS Equality Modules published jointly by the ESRI and the Irish Human Rights and Equality Commission (IHREC) examines people’s experiences of discrimination at work, in recruitment and in accessing public services (education, transport, health, other public services) and private services (housing, banks/insurance companies, shops/pubs/restaurants)”.
“Discrimination can be damaging to the individuals who experience it, in terms of their self-esteem, well-being and for their material outcomes, such as their income and access to valued positions and services. There are also costs at a societal level. Discrimination in the labour market may be economically inefficient, as the skills of individuals are not effectively used. Discrimination can also undermine social cohesion. Monitoring and tackling discrimination is therefore an important issue for Irish society.” lead author Frances McGinnity in study for the Economic and Social Research Institute (ESRI) .
Approaches to overcoming Social Stigma and Discrimination
One of the key ways of overcoming social stigma and discrimination is Education. But people also need to be more supportive of each other in families, our social circle and communities. I sometimes find empathy is lacking and people can be very judgemental about others. Listening non-judgementally, while keeping certain boundaries, is an important part of supporting people going through emotional distress.
The following three quotes are taken from a report ~ Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016). Chapter 4 ~ Approaches to reducing Stigma .
“Educational anti-stigma interventions present factual information about the stigmatized condition with the goal of correcting misinformation or contradicting negative attitudes and beliefs. They counter inaccurate stereotypes or myths by replacing them with factual information”.
“In contact-based behavioral health anti-stigma interventions, people with lived experience of mental illness or substance use disorders interact with the public describing their challenges and stories of success”.
Peer support is where “people with lived experience who work as health care team members and foster the provision of nonjudgmental, nondiscriminatory services while openly identifying their own experiences. When integrated into service-provision teams, peers can help others to identify problems and suggest effective coping strategies”. I did very well in an interview for a part-time position as a Peer Support worker but unfortunately don’t have a car so couldn’t take up this position in my local service area.
Protest and Advocacy is another method. “Protest strategies are rooted in advancing civil rights agendas. In the context of this report, protest is formal objection to negative representations of people with mental illness or the nature of these illnesses. Protests are often carried out at the grassroots level by those who have experienced discrimination and by advocates on their behalf”. In a way this blog is a protest!
A review by Dr. Eleanor Longdon and Dr. John Read evaluates the effects of mental health anti-stigma campaigns. They “found that although biomedical explanations of mental illness predominate in current anti-stigma discourse, not only are they ineffective but they also tend to increase stigma. Conversely, evidence indicates that psycho-social explanations of psychosis are effective in reducing stigma and humanizing those who live with the condition” .
Referring to the same study “There is a reasonably substantial evidence base supporting the hypothesis that anti-stigma campaigns which frame psychosis as a meaningful response to adversity are effective. They are a more promising approach to ‘humanizing’ people with complex mental health problems than strategies based on models of disease and disability” .
Relating this to my own personal experiences of adversity I’ve have a number of traumas over the past number of months, on top of my other diagnoses . A few of them include a cancer diagnosis, major surgery which left me temporarily physically disabled (as it cut through my core muscles), the breakup of a relationship, loss of an uncle that I was close to in early December 2017 and the loss of my friend to the Shannon river in January 2018. He was missing for 37 days and I spent the first 2 weeks searching for him and giving some feedback on the extensive search to family members who lived on the other side of the globe. It has all taken it toll on me and I particularly notice this in the past month. It’s taken a lot of resilience to get through. I sometimes underestimate my own coping ability, even if I have some coping strategies that aren’t perfect !
Discrimination when it comes to employment is another area of importance. “People seen as ‘mentally ill’ are often avoided, treated harshly and subject to discrimination. For example, although having a job can be very important in people’s recovery, employers are less likely to offer work to someone if they know that they have a psychiatric diagnosis and unemployment rates for people with a ‘psychotic’ diagnosis are very high” . This report by the British Psychological Society has a lot of information on stigma and discrimination, including the effect of racial discrimination on mental health.
As an example of what can happen in employment I came across article on a website called Sprudge. After Sharon “revealed to her employer that she had had, and been successfully treated for, bipolar disorder, she says the cafe owner became very withdrawn and Sharon was later let go via a phone call” .
In Ireland there is an organisation called Employability that does help people with disabilities get back into the workforce. It’s an employment support service that provides the person with a job coach.
This is a world full of social stigma and discrimination. But also some good, supportive people. Social stigma can be a trigger for the person and can seriously impact their recovery. Due to the subtle nature of social stigma I notice people may initially seem nice but then use information you gave them against you. Some of the things we say can be thrown back at us in dis-empowering ways. These days people are asked to talk and share their story around any mental health struggles. But the reality is we need to be careful who we share with. At the same time if someone is in deep distress or about to take their own life they should reach out to others who care or ring a helpline (e.g. The Samaritans 116 123).
I find it a bit frustrating that people seem more comfortable complaining about symptoms of mental health issues than they are at supporting the person in overcoming or managing their condition. For example a person with Manic Depression/Bipolar who seems to be developing hypomanic or manic symptoms may need help in identifying some habits that are not helping them (e.g. over spending or drinking to try to cope with the symptoms). There are certain ways to help or even to phrase feedback to the person that is more effective than others. See my blogs on:
Tips on dealing with symptoms of Bipolar and
Family, Friends and Community (in section Strategies to enable family and friends to help someone through mania and/or Psychosis).
“From the perspective of people with lived experience of a mental health condition, recovery is an individual process of discovering one’s own strengths, values, meaning and aspiration; a self-determined journey that can take place inside or outside the mental health system, through personal development, through partnership relationships with professionals, through peer support or through community support. It is a process of reconnecting with life that can happen for some with the continuation of symptoms while for others, a reduction in symptoms is important” from a document by Mental Health Reform .
As someone that went through the mental health system, found it harmful overall and ran away from it 6 years ago I think there is a misconception that its the responsibility of doctors and this system to fix people. There is a danger when we hand over responsibility to others to “fix” us, instead of doing our best to take personal responsibility for our own healing journey. I learned this the hard way! I’m not recommending running away from the system, as you need supports in place and everyone’s journey is unique. There are parts of the system that I found helpful e.g. Occupational therapy and I had a very good Occupational therapist called Orla.
Seeing as none of us live in a vacuum and we are all very much interconnected, families, communities and society in general can benefit from helping people on their healing journey. People who have lived through difficult symptoms and experiences may need some ongoing support in their community. This would also take some of the pressure off the already stretched mental health service. At the same time this system should be able to provide timely psychological support, especially to children. At the moment it seems to be still very biomedical based, with a focus on drugs and blaming faulty genes!
How Prescribed drugs can have a disabling effect on the brain/body
Prescribed Psychotropic substances can have very damaging effects, especially when used long term. In 2005, a study funded by Eli Lilly, the maker of Zyprexa / Olanzapine, found that chronic / long term exposure to this major tranquilizer causes shrinkage of the brain, “significant reduction in brain volume that affects both gray and white matter” . I first learned this from honest Psychiatrists Dr Peter Breggin and Dr Joanna Moncrieff. I was put on it at what I now consider too high a dosage (10mg) long term in 2008. I did not have informed consent about this powerful but potentially damaging drug!
Antidepressants that I took between 2005 and 2008 for anxiety/panic, led to mania and ‘Psychosis’. Psychosis is usually a temporary loss of touch with so called reality. There is a Yale study from 2001 that highlighted this but I was never informed of this link when I became unwell in 2008 . I also suffer from Tardive Dysphoria where anti-depressant use turned mild/moderate Depression into a chronic and more severe condition . And I have a physical hearing problem in the form of hyperacusis / misophonia. This can be very difficult to live with at times .
In the area of mental health there are various ways we can support each other on our life journeys including tolerance and listening non-judgmentally when someone is in distress. To quote from Ivor Browne, now in his 90th year, “the only real, lasting change comes when we help a person to bring about the painful work of change within themselves”. This needs to happen within a supportive environment and community. A community that strives to tackle social stigma and discrimination. As we are all interconnected this will mean a healthier, content and more productive community for those who live in it.
 Experience of Discrimination in Ireland: Analysis of the QNHS Equality Module ~
 Stigma: Notes on the Management of Spoiled Identity by Erving Goffman, 1986 ~
 Who experiences discrimination in Ireland?
 Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change (2016). Chapter 4 ~ Approaches to reducing Stigma ~ https://www.nap.edu/read/23442/chapter/6
Study produced by the National Academies of Sciences Engineering Medicine in Washington DC ~
Patrick Corrigan ~ https://humansciences.iit.edu/faculty/patrick-corrigan
 Psychosocial Explanations of Psychosis Reduce Stigma, Study Finds ~
 ‘People with Problems, Not Patients with Illnesses’: Using Psychosocial Frameworks to Reduce the Stigma of Psychosis (Eleanor Longden & John Read, 2017) ~
 Understanding Psychosis and Schizophrenia. A report by the British Psychological Society from 2014. Updated in 2017 ~
I was at the launch of the original report in London in 2014 where I got to meet clinical Psychologist Dr Lucy Johnstone and had written a review of her book A Straight Talking introduction to Psychiatric Diagnosis shortly before that. I also got to know clinical Psychologists Anne Cooke and Peter Kinderman (now former president of the British Psychological Society). When they came to Ireland to speak in Trinity College in 2015 I was asked to go on The Last Word with Anne Cooke, where I was interviewed by Matt Cooper. Matt did a great job at interviewing us about ‘Psychosis’. A very misunderstood subject, where the public are trained to associate the word with violence and danger, which is usually not part of the experience! See link below for interview and I have a separate blog on ‘Psychosis’.
 Mental Health in the Service Industry: Confronting the Stigma ~
 “Recovery … what you should expect from a good quality mental health service” by Mental Health Reform (2013) ~
 “The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation…” ~ http://www.nature.com/npp/journal/v30/n9/full/1300710a.html
 Antidepressant-associated Mania and Psychosis resulting in Psychiatric admissions (2001) ~ www.ncbi.nlm.nih.gov/pubmed/11235925
 Tardive Dysphoria: Anti-depressants can turn mild/moderate Depression into a chronic condition
 What is hyperacusis ? http://www.hyperacusis.net/what-is-it/
Other relevant links
* Bar staff should get anti-racism training, says Traveller activist ~
* Blind nun wins discrimination case against pub ~
* Irish Human Rights and Equality Commission ~ https://www.ihrec.ie/
* Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies ~
* Pull Yourself Together! A survey on the stigma and discrimination faced by people who experience mental distress ~ by the Mental Health Foundation (2000) ~
* Psychiatry in Context : Experience, Meaning & Communities by Dr Philip Thomas 2015 ~
My review of this book ~ www.goodreads.com/user/show/46943899-anne
“It’s necessary to engage with people in emotional distress within the social and cultural contexts of the communities they come from. The author explores the impact racism has on the mental health of people in Black and Minority Ethnic communities.”
* “The Secret Life of a Manic Depressive” presented by Stephen Fry ~
* Mental Health and the Service Industry: How to Get Help (from US) ~ https://talesofthecocktail.com/wellness/substance-abuse-addiction-insurance
Some of my efforts at tackling social stigma head on (2015)
A rebellion against that “in my face” local discrimination was to actually speak on radio and write an article at a National level the year after.
* One woman’s account of suffering from ‘Psychosis’ (which was an adverse reaction to antidepressants and fuelled by other prescribed psychoactive substances!) ~
* More on my experience ~ ‘I was unaware of potential adverse effects to my prescribed antidepressants’