Discrimination: why mental illness is a special case - RSA

Discrimination: why mental illness is a special case

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  • Mental health
  • Social brain
  • Health & wellbeing

I’ve had a great response so far to my post about mental health and employment on Monday, and some important issues have been raised. One of the comments made directly in response to the blog was particularly challenging, and pointed to some important issues which I have tried to tackle in some of my previous work on anti-stigma education.

The commentator suggested that people with experience of mental illness being unable to get secure employment leads to them setting up in self-employment and drew attention to the downsides of this. It sounded to me as though the writer might have had first-hand experience of dealing with a freelancer who had continued to work during an episode of acute mental illness. The “ranting paranoid accusations” sound very difficult to deal with indeed, and it is exactly this sort of troubling behaviour that employers presumably have in mind when they say wouldn’t employ someone with a mental disorder. The response also drew attention to the lack of support available to self-employed individuals experiencing mental health problems and the damage that can be left behind for clients and business partners who “tried to work with them in good faith.”

Interestingly, I had a respondent write to me directly (rather than in the public forum) expressing horror at what they saw as inherent stigma in this analysis. However, despite my interest in reducing prejudice and discrimination against people with mental illness, I do not think that this is an instance of such prejudice. In fact, it very helpfully draws attention to what I see as the real nub of the problem in terms of discrimination and stigma in the context of mental illness.

for individuals who experience it, mental illness is not a constant, unchanging feature

Discrimination is treating someone unfairly on the basis of characteristics which ought to be irrelevant. We are familiar with the idea that not employing someone because of their gender, race or sexuality is unfair, and amounts to sexism, racism or homophobia. It could be assumed that comparably unfair treatment of a person with a mental illness is the same. However, I think that mental illness is actually a special case, and differs from gender, race, or sexuality in the way in which discrimination functions in relation to it. It is different in that, for individuals who experience it, mental illness is not a constant, unchanging feature. Forgive my massive oversimplification, but at the simplest level, if you are a woman, you are a woman every day – your ‘womanness’ is relatively fixed and definite; likewise with skin colour or sexuality.

If you have a diagnosis of a mental illness, your status is not only likely to be, at some level, contested, but also fluctuating, transient and shifting. There is the issue of the hugely various types of mental illness you may have. Furthermore, no matter what your diagnosis, it is likely that you have had periods of your life when you have been less able to function than others, along with periods of your life when you are entirely able to function. In other words, the way in which the mentally ill part of a person impacts on their life is inconsistent.

What this means is that there are times when it is appropriate and right to treat a person with a mental illness differently to someone who does not have a mental health problem – for example when they are currently in throes of madness ‘proper’. 

What this means is that there are times when it is appropriate and right to treat a person with a mental illness differently to someone who does not have a mental health problem – for example when they are currently in throes of madness ‘proper’. However, a person with a mental illness who is free of symptoms and yet is unfairly treated differentially is therefore being subjected to discrimination in the sense that they are being judged on the grounds of characteristics which ought to be irrelevant.

The result of this is that the idea of ‘stigma’ in relation to mental illness simply does not make sense as a fixed dimension of people’s attitudes. The interaction between the fluctuating, changeable nature of mental illness along with people’s context-specific, plural position taking in relation to it is characterised by too much subtlety and nuance to be rendered simply in terms of stigma.

This is kind of complex, and it’s something people might only really come to understand through personal experience – either of going through some kind of mental illness themselves or by being close to someone who has. Another respondent to my earlier post told me about being a manager of staff with mental health problems and regarding them as “weak willed fools”. It was only after experiencing a breakdown himself that his perspective changed and he seemed clear in his conviction that without this personal experience he would never have shifted his view

There is no substitute for first-hand experience. Indeed, one of the insightful fourteen year olds who participated in some research I did said to me, “You can’t know what it’s like unless you’ve been through it yourself. I could talk to someone with schizophrenia, or whatever, all day long, but I still wouldn’t know what it’s like.” But, that’s not to say our capacity for empathy cannot be enhanced.

I’m convinced that attitudes to mental illness in the workplace can be improved, but that only through greater understanding of personal experiences, including those which have been troubling. Most crucially, the difference between a person with a mental health problem who is currently acutely unwell, and someone with a diagnosis but no impeding symptoms is vital to understand if progress is to be made in managing mental illness and employment.

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  • I recently came off ssri's I was on for post natal depression, i had a terrible time mentally and physically and broke down at work. I confided in a colleague psychologist and with my permission they spoke to my boss. The following day whilst I was working from home I received a call from my manager which I felt was unnecessary and cruel considering what I was going through. He tried very hard to passively bully me into quitting.. Suggesting I was not perhaps up for the role and it's challenges. I know he wanted me to resign however I explained I would change and do better. It's all been so horrible. I'm disgusted actually at how is was treated. What should I do. I feel I should report it. But I'm so fragile right now.

  • As the "commentor" I'd just like to clarify, as I wrote in my blog post (http://idea15.wordpress.com/20..., that my experiences were based on working with two clients who were experiencing full-on episodes of severe mental health issues. It is important to note that they were receiving no help from the medical profession, from their families (both of which were in complete denial), or, as freelancers, from any work support structure.

    To the respondent who felt that my post was showing stigma against mental illness, that would come as interesting news to the two mental health charities I am currently providing services for.

    Understanding of personal experiences is indeed the key to creating a successful work environment for those experiencing mental health issues. However, when your home *is* your work environment, the conflicts being created - and indeed, in the case of grandiose personality disorders, the existence of the business itself - are the results of untreated mental health issues rather than the day-to-day issues within a business. When that is the case, the commercial realtionship itself is invalid, as the two parties have come into the arrangement for different reasons (IE I expected to provide a professional service to the client, but the grandiose client expected me to glorify their ego.) When this becomes clear, and as a result the client erupts into the rage I described in my post, treating that person differently is not stigma or discrimination. It is basic self-preservation. It is not my job to be the local mental health service.

    I would reiterate that support and assistance need to be provided for those experiencing and working with mental health issues outside traditional supported and staffed work environments.

  • Reminds me of an anecdote of RD Laing (who wasn't always right, but was invariably interesting!) when asked by fellow psyciatrists about a problem patient who would no nothing but take his clothes off and rock back and forth, naked in a padded cell. Apparently this went on for several weeks before Laing arrived. On looking into the cell with the other psychiatrists he asked to be let in, took his clothes off, and started rocking as well. The patient gradually stopped, and started to talk...I don't know what happened next, or whether this is a true story, but I always like the fact that Laing purportedly asked the watching psychiatrists something like: "Did it not occur to you to try to share his experience?"

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