Monday, November 16, 2009

To Tell or Not to Tell? That is the Question.

Should patients with psychiatric disorders discuss them openly? Is it better to let it be known like it's no big deal, or to hold on tight to those secrets? We've talked about this a lot when we've talked about the meaning, the stigma, and the consequences of psychiatric labels. It seems to me that some people advertise their problems and are no more worse for the wear: they start talking at a party about how they have bipolar disorder and suddenly they are the magnet for everyone else's bipolar stories. It's refreshing, in a way, how free they feel to be open. Perhaps some of it is career-dependent: certainly it's more permissible among artists and musicians to have suffered, and some problems with mood or substances can be so much a part of landscape as to defy stigma.

Why now am I bringing this up? Carpool today: "We talked about therapy and antidepressants in chemistry." Hmmm, that's not chemistry, shouldn't they be balancing acid-base problems? "And what does your teacher have to say about it?" Apparently the teacher was on antidepressants for years during a difficult time, but she suggested the whole class probably had issues and things to talk about in therapy. Why not?

What do I think? This is a young, well-loved and respected teacher. If she's comfortable telling the kids that treatment has helped her, more power to her. Maybe someday some troubled person will figure Ms. Chemistry was cool with it and will get help. As long as they get to the acid-base stuff eventually.


Aqua said...

In a perfect world disclosing a mental illness should be no less difficult than saying, "I have cancer, or MS, or whatever physical illness a person might have.

It is sad, but in my experience it has not been that simple. I sometimes even agonize over how much to tell/disclose to some medical doctors for fear my pain/illness might be seen as a figment of my craziness, and not a bona fide physical problem I might be having.

However...I have also had a few incredible experiences because I talked openly about my struggle with treatment resistant depression

A few years ago I was at a mental health conference attended by about 5-600 people. At coffee break a woman came up to me and told me she and her daughter, who had TRD too, had seen me in a video give a speech about how important volunteering had been for my recovery...even if the depression never went away.

She said because of my openess about not getting well, but continuing to find ways to contribute despite my illness, her daughter had seen hope for herself, and had begun to volunteer. The woman said for the first time in years her daughter saw that she might be able to work at something even if she were not "well"...the daughter had for years been feeling devastated by the thought that she may not be able to work again.

I almost cried as I spoke with this woman, because I so easily could be that daughter. This interaction reinforced in me the importance of showing people what is possible even if you are really ill. It showed me that hiding who I am helps no one.

Yet, still I so often hide for fear of the reprecussions of being seen as mentally when I went to rent a place, not disclosing my income source for fear of discrimination, or when volunteering "fiddling" with the facts on my resume to hide my being off work for fear I will not be accepted as a volunteer, or telling people who ask me what I do, that I am an art teacher (instead of the truth...that I volunteer, and am a member, at a art clubhouse for people with mental illnesses).

All this hiding, and lying takes its toll on me, because I want so badly to be an honest person.

Anonymous said...

My initial reaction was that this isn't really appropriate use of classroom time, and that a teacher's medical info should be kept private anyway. Then I thought some more, and I'm not sure. I mean, even in a biology class I wouldn't really want a teacher to be discussing recurrent yeast infections, on the other hand, I think it's fine to give the slideshow on diabetes and weight, or effects of smoking, and mental health issues are equally important. Chemistry class, though?

Dinah said...

Aqua-- what a wonderful story about the woman whose daughter you inspired!

Anon-- ah, a lot goes on in school besides teaching the subject...and it's not limited to mental illness, I heard (via student communication) every detail of the art teacher's pregnancy, including how often she had to pee.

Such is life.

talesofacrazypsychmajor said...

When I was an art major I felt more comfortable sharing about sharing things. Now as a psych major I feel it needs to be more hidden. I was supposed t be eccentric as an artist, now studying psych I feel I' supposed to be a model of sanity.

Catherine said...

I am surprised the teacher shared that much. At my old school, a private school, knowing that I had a mental illness would have been grounds for dismissal. They would have made up a reason other than that, but that would have been it.

At my new school, not so sure. Public school, but they too would be concerned that I would flip out and lose it at school. So sorry, I save that stuff for home.

Others can be brave. I think I'll keep mine a secret (plus, do I *really* want my kids knowing that type of info about me??)

Rach said...

I think that kind of discussion can be catalytic, especially when the information comes from a teacher who is well liked and considered a role model. The potential difficulty becomes making sure that those students who choose to self-disclose about their own difficulties have appropriate support (be it from the role model teacher or someone else).

Anonymous said...

It is obviously not in anyone's best interest to disclose having a mental health problem. They are poorly understood and highly stigmatized. The only possible benefit could come in the following situations:

1) Your mental illness is poorly controlled; or alternatively, you have difficulty coping with it, and will require a lot of time off of work, or a lot of understanding for why you are doing a sub-par job during an episode (this is a better alternative to looking like a lazy employee)

2) You are a lazy person in general and you think if you talk about your mental health problems people will overlook/excuse your general lazy ass behavior at work (being manipulative basically).

Difference between 1 and 2 is that the person in #2 is lying/excusing normal lazy behavior by playing the crazy card to get away with it (there is a girl at work who does this and it pisses me off to no end because I am 100% certain my mental health problems are as bad or worse than hers, but I am one of the best employees at our job meanwhile at any given opportunity she is slacking off HAVING FUN... then later on bitches about her "depression"). I have never told anyone at my job about my depression, she tells everyone at any opportunity.

The only reason I would ever tell anyone is if I got so bad that I was not able to come to work for a long time. If the other option is being written off as lazy, I would rather they think I'm crazy. I've not had this problem yet, I suppose I am not that bad. Work helps me.

Even telling doctors is a big deal. One of the reasons I stopped trying to do anything is because a neurologist made me feel really terrible when I told him stuff. I don't go anymore, I gave up, I accept I will deal with this forever and I probably will eventually get worse or die. OOOOh well.

Anonymous said...

I would like to write that it is OK to disclose, but if one is trying to be a productive member of the "non-diseased" world (and I write that a little TIC) it is not not helpful. Yes, people who are struggling might be helped by knowing that I have had struggles like theirs and still managed to succeed; however, when one lives and works in a world of sharks, one shouldn't reveal the wounds.

I was hospitalized a couple of times during my graduate education. The second hospitalization was announced by my therapist to my department. Afterward, I had to deal with "well, I don't know how people like you process things" when I had a justified disagreements.

As I have gotten older, I have become jaded about the process. Many of the people that I see who are open are actually looking for sympathy/empathy/therapy. I work in a people-contact profession. I often feel guilty for what feels like a lack of empathy.

Several years ago, I moved to a new community. I have told no one here of that part of my past. Despite recurrent bouts of depression, I have managed to continue working (I'm labeled moody or a bitch at work but I get the job done and I do it well). As a woman working in a man's world that's just he way it will be. This process of denying my past as well as much of my present leaves me feeling false. However, this false front is what allows me to continue functioning. If I were to reveal, my career would be greatly compromised (which would effectively add to my depression) so the cloak of deception is a necessary evil.

I do agree as the original post suggested: in some professional areas it is OK to disclose and it becomes a rite of passage. However, I believe in much of the world it is not OK.

Anonymous said...

It's freeing to disclose. At a new job, only one year after having received my diagnosis of bipolar disorder, I disclosed to one select coworker who I trusted. 14 months later, I felt compelled to disclose the situation to a couple of higher-ups, lest they be concerned that I was starting to have more doctor's appts. I did this last disclosure as more of a legal strategy since they couldn't SEE my illness and wouldn't have believed my need for small accommodations in the workplace. I regret telling the higher-ups but am glad I have cemented some legal rights.

The other day in the supermarket, I ran into an ex-coworker from a past job. She left her position 2 months before I had a manic break with psychosis at work. She wanted me to catch her up on my last days at that workplace and why I left my boss. I told her that I went into the hospital and was fired at that time. She pressed me for more details about my health, so I caved in and told her it was mental illness and the boss decided he didn't want me around. I think this was more information than she wanted to hear. How awkward it was to try to avoid her in the aisles during the rest of my food shopping trip! And you always get the feeling that they think you must've done something really insubordinate to not be welcomed back after a full-blown episode. But nobody would've judged recovering from surgery for uterine tumor.

Anonymous said...

I like people to resemble what they pretend to be. I don't want my shrink to have a mental illness; I don't want my priest to be headed off to hell; I don't want my accountant to be a bankrupt; I want my solicitor to stay out of jail; I don't want my personal trainer to be over weight; and I want my child's chemistry teacher to teach something about chemistry. But I don't mind a little cross-pollination of problems amongst the professions.

EastCoaster said...

Okay anon, I agree with you about the trainer.

And I don't think it's okay for my primary psychiatrist to tell me his medical diagnoses.

In a group therapy context, I think it might be okay for a doctor to discuss personal weight-loss strategies or something--depending on whether it was a psychodynamic group.

But asking all mental health professionals to be free of mental illness is rather a lot. Oncologists aren't allowed to get cancer.

Kay Jamison is a bad psychologist, because she has an illness. Of course, she had to drop her private practice when she wrote her book, but before that I'm sure that she was very good.

Rach said...

(shakes head very very sadly)
That's all I have to say.

Aqua said...

Rach...I'm shaking my head along with you.

Anonymous said...

"I like people to resemble what they pretend to be."
There is a whole lot of pretending going on in the world. That is what makes me nuts. I would rather people did less pretending.It would make everyone else feel a whole lot more normal. Plenty of shrinks have had their own struglles with mental illness especially anxiety and depression and plenty have taken medciation or been in/are in their own therapy. There is nothing wrong in that. They may not disclose to patients but bear in mind they probably also do not diclose the details of their nasty divorce. That is because therapy it is not a part of why you see them. If they function, that is all you need to know.
There are plenty of overweight doctors who advise patients to lose weight. That is part of their job. The fact that they also stuggle with weight issues does not make them less of a doctor.
As was said, a lot goes on in class that has nothing to do with the subject. Miraculously, the kids learn. If the teacher talks about this every day, there is an issue. I can imagine it coming up in chemistry class. medications are made of chemicals. The teachers's brain chemistry causing a depresion, who knows? It is a good thing to let students know that all this chem stuff has applications in real life. It is even better that there is some adult somewhere who is open enough to share with students. I am assuming she did it for their benefit, to normalize mental illness and therapy because yes, quite an awful lot of people could benefit from some sort of help and if that teacher passed that message on she taught a valuable lesson. Not so sure I would say the same about the pregnant teacher and peeing.
It is a lot of pressure to always resemble what you pretend to be.We need to be more open minded and be okay with people who are genuine and accept you as you are because they have accepted themselves first.

Anonymous said...

If you tell, it winds up on the internet. As in this case.

Anonymous said...

As a teacher, I can easily imagine this coming up in a chemistry class. Imagine a weekly or bi-weekly "chemistry in our lives" or "chemistry in the news" segment to help students see why chemistry is relevant to their lives. Antidepresents or whatever come up (maybe a different student reports each time, so the teacher doesn't have a lot of control), some student makes a comment about "crazy people" and the teacher tries to redirect things by mentioning that s/he is on one. For some students, for whatever reason, it makes an impression, and they talk about it carpooling.

Teaching is risky; it's life without a net, really, and it's hard work. The teacher may have taken a risk by being open, but s/he probably thought that was the best way to manage the class at that moment.

Lockup Doc said...

Although there is still way too much stigma surrounding mental illness, I'm glad to see that in the past 10 years it has become at least somewhat more acceptable to talk about mental health problems. I can only imagine in previous decades how many more people have suffered in silence for fear of being labeled "crazy."

I do think, though, that whether there is stigma or not about mental health problems, everyone should exercise a certain amount of restraint about where and with whom they share their personal histories. The social medial culture in which we're living is truly awesome in some ways, but unfortunately some people don't understand that it's still necessary and wise to draw boundaries and to discriminate how much information to reveal and when.

Finally, I believe that people need to examine the reason why they feel compelled to share personal information with others, whether it be about mental health, physical health, relationships, financial info, etc.

As a psychiatrist I always have to be very careful about what personal information I reveal to others and why I want to do it. I have selectively revealed personal information to patients only when I have believed that it would help them in some way--I always make sure I am not doing it for myself.

One final thought: Although it can be very helpful to get support from family, friends, and coworkers, I believe that too many people with mental health problems unintentionally fall into the victim trap, and this keeps them from growing and recovering. In other words, I've seen too many people who have let their mental illness become their identity. When they meet someone new or when they talk with people they know, instead of thinking of themselves as human beings with many different qualities who also happen to have a mental illness, they are a bipolar, depressive, borderline, etc. Caroline Myss wrote a book called "Why People Don't Heal and How They Can" in which she coined a term called "woundology." She claims that people bonding to each other through their wounds is what keeps them from healing.

Anonymous said...

Anon No. 3 or something?

Having struggled with severe mental illness for going on 15 years, and having gone through times of telling and not, I never choose to tell anymore.

I can put forth a good, sane face. I am incredible at hiding. So that's what I do. I pretend. And you know what - it works. People treat me normally. If I'm pissed off, they don't assume it's because of my illness.

I hate the stigma that's attached to mental illness, but I'm not feeling called to be a martyr for the cause. My goal is to be normal, and if I can't, then I'll do my darndest to fake it.

There are some things I can't hide - many of my scars are visible. I've got lie upon lie to throw out to obnoxious people who question me.

Until the diagnosis of mental illness is more concrete, with lab results or genetic testing to clarify once and for all who has what, and to prove it's not just imagined, this stigma will continue.

I hate knowing I can never tell my employer or friends, or even family members about my illness. But that's safer than risking ridicule, misunderstanding, and prejudice that comes from exposure.

Anonymous said...

I teach math at a large urban high school on the west coast. Just this year alone, I have overheard a few of my students share their bipolar diagnosis with their classmates. Another shared with the entire class that she saw a therapist when she was "having a hard time. And it really helped!"

I am bipolar. I never share this information with any coworkers or school administrators. I'm not so concerned about a coworker's reaction. It's parents' reactions that are my concern. I have no illusions that if I tell someone about my mental illness that they won't share this info. Eventually, it would get to some parent. There are plenty of folks who do not fully understand a diagnosis of bipolar (and how I can be a fully functioning member of society and darn good math teacher). It wouldn't surprise me if a parent didn't want their child to be taught by someone with bipolar.

tracy said...

Anon Re: Scars That's what i was going to's pretty hard to hide when you have scars all over your forearms...and i have gotten to the point i refuse to wear long sleeves in hot, humid weather.

mysadalterego said...

Ah, the double bind. I am high functioning and very lucky that I can hide my illness...and yet, I know that I am using my luck to disservice other people like me who can't hide. I have the choice to disclose or not...and I contribute to letting people think that crazy people are only among the homeless, not among their colleagues or social circles.

itsjustme said...

I'm selective about who I tell. I've told my parents and a few close friends about my depression. A while back, one of my co-workers was telling me that she was really depressed about a breakup and wasn't coping well. She thought that maybe she should go see someone but "she isn't crazy". I couldn't bring myself to tell her that I'm not really meeting a friend for lunch every Wednesday at noon. Instead, I told her that a lot of people find therapy helpful and there's no shame in going or in taking antidepressants if you need them. Part of me wishes that I could have been honest with her but she does have the biggest mouth in the office and I really don't need everybody knowing my personal business. I have to admit that even if it was a more trustworth co-worker, I probably still won't have told him/her. People can be so ignorant and I don't want them to look at me differently just because I see a shrink & take antidepressants. I still show up for work everyday and I'm good at my job. It's too bad because I think that maybe telling my co-worker may have made her more likely to try therapy herself.

Sunny CA said...

I volunteer at a science museum and was introduced to a fellow volunteer who in the first 3 sentences he spoke said he is bi-polar and struggles with depression. I thought that was a little weird. I did not share that I had a psychotic break and was hospitalized and don't intend to.

I got my teaching credential in June and am currently substituting. I witnessed a lunchroom discussion among teachers who agreed that a teacher who had had a breakdown should not be allowed to return to teaching. My psychiatrist says there are many people who have an isolated breakdown and do not have another. He thinks I am in that group. What would happen to me if I disclosed? I likely would never get a full-time teaching job and might be banned from subbing. I would never tell students. I formerly was a photographer and did tell my "friends" in the business what had happened and I lost all my referrals from them for shooting events.