I had originally planned to write about Stigma and Skepticism yesterday, but I guess I get a little side-tracked….

My point was going to be that it’s a double whammy when you have an invisible chronic illness and that illness is psychiatric in nature. The first whammy is that it’s invisible; in our advanced Western society, we don’t believe what we don’t see. We are empiricists; we want to see it. If you’re sick, show me your symptoms.

Well, invisible chronic illnesses, by definition, can’t be seen. You can’t see anxiety or depression (or fibromyalgia, or Chronic Fatigue Syndrome, or Crohn’s disease, or rheumatoid arthritis, or any of dozens of other illness I could name) by looking at someone. The illnesses do often have physical manifestations (e.g. someone with rheumatoid arthritis might have swollen or differently-shaped knuckles), but most of those physical manifestations of invisible chronic illness are not considered evidence of the illness that caused them.

The second whammy is “psychiatric in nature”.

There are still people, even in this day and age, who think that depression and anxiety (and for all I know, schizophrenia and bipolar disorder) are “all in your head”. I cannot tell you how many times I’ve heard “feel the fear and do it anyway!” or “can’t you just decide to be happy?” There is a pervasive belief that “getting over” depression and anxiety are a matter of willpower. Either that, or that we’re all a bunch of hypochondriacs who imagine that we’re ill. Or even worse, that we’re doing it deliberately for attention, or to take advantage of someone.

When I wear the Mask, I know I make it harder for people to understand that I am ill. I can seem confident, capable and competent, but it’s only for a short time, and I will pay a significant price for the illusion. The Mask and my illnesses don’t square well with each other.

Another unfortunate belief is that a person with depression or anxiety is somehow to blame; either for having the illness in the first place, or for failing to “get over it”.

When this perception is still not uncommon out there, is it any wonder that people who have a psychiatric illness don’t want to tell people about it? Trust me, even if you think you can tell, you really can’t tell whether a person harbours this perception.

This belief works nicely with the stigma still attached to mental illness to make the double whammy even stronger. This links back with the “blame” aspect: if I was only strong enough, or had enough determination and willpower, I could get better. Since I’m not better, I’m obviously not trying hard enough.

Well, I’m here to tell you, I am as strong as a bull. I have enough determination and willpower to choke a whole herd of your choice of animal. I have tried and tried and tried, more times than you can even imagine. And I’m still ill. If strength, determination, and willpower could make me well, I’d be the most damn well person you’d ever meet.

I guess I should define my terms here. Stigma is a mark of disgrace or shame. When something has a stigma attached to it, what it basically boils down to is this. A label is applied to that thing (or person). That label comes along with negative stereotypes (see above), and those to whom that label applies are considered to be of a lesser status. They are marked because of it, and seen as somehow “less”. Less worthy, less deserving of respect. And then, stigma is often followed by discrimination against those who have been so labelled.

The stigma and the skepticism often will keep me from revealing my illnesses. Why would I set myself up for all that? If I don’t know you well enough to know what your reaction will be, I probably won’t bring it up in casual conversation.

When I was first recovering, I thought, “To hell with the stigma! I’m going to be a one-woman anti-stigma crusade!” I thought I would tell everyone, and single-handedly change the world. As time went by, I discovered that this attitude set me up for unnecessary arguments about the nature of mental illness and the quality of my character. So now I’m more selective in whom I tell. Not everybody needs to know.

People with mental illness are no different from people with other diseases, like diabetes. When we’re recovering, we’re no different from people who are recovering from heart attacks. Doctors say this all day long. But people… people just don’t buy it… or get it, or something.

One thing that my favourite psychiatrist told me (I affectionately called him Psydoc) was that it took me twenty or more years to get to the point of breakdown; why did I expect that in a few weeks, or even a few years, I could recover? He often told me that we don’t expect someone who has a heart attack to get up and run marathons, so why would we expect someone recovering from severe depression to be well overnight?

Psydoc was also fond of reminding me that not so long ago, people with depression as severe as I have were not out in the community, getting well. They were in sanatoriums, or institutions. But he was right; even a couple of generations ago, someone with a severe case of depression would live in a psychiatric facility, undergoing treatment every single day, under care 24/7. And I was out in the community, having therapy at most once a week, doing try-it-and-see-if-it-works with meds. In a facility, meds can be given intravenously, and it is MUCH faster to do it that way. It takes a certain level of many meds in your bloodstream before they become effective, and it takes time to reach those dosages when someone is taking meds orally. And with inpatient care, they are constantly monitoring the patient, able to adjust meds as needed, and to try many more types of medication in a much shorter period of time.

Psydoc was a wise, wonderful man. I miss him. Psydoc, if you’re reading this, please move back from the Yukon!

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