From Shame to Empathy: Dissolving Stigma around Mental Illness
Last spring I attended an Addiction and Mental Health program at Selkirk College here in the Kootenays. I was blessed to have a teacher that encouraged us to really challenge our current views on mental illness. For our final assignment we were asked to write an “anti-stigma” paper highlighting how society’s governing views on mental illness and addiction are affecting the quality of life of many of our country’s vulnerable. Since this month is Mental Illness Awareness Month, I thought I would share my paper with you. I would love to hear your thoughts on this important subject matter. Find me on Instagram and post your thoughts. Let’s raise awareness and dissolve suffering.
Anti-Stigma as Pro-Connection
“It isn’t the things that happen to us in our lives that cause us to suffer, it’s how we relate to the things that happen to us that causes us to suffer.” ~ Pema Chodron
I’m about to proclaim something quite radical: there is nothing innately wrong with mental illness or substance abuse disorders. They arise as the body’s natural way of signalling that we need to restore balance. (chopra.com) It’s our society’s reaction to mental illness and addiction that causes unnecessary suffering. Considering that mental illness indirectly affects all Canadians at some time through a family member, friend or colleague, and 20% of Canadians will personally experience a mental illness in their lifetime (CMHA), if our reaction is one of disgrace, this puts the health of our country in high distress.
In this paper I examined the current views of mental illness, the impact stigmatization has on the life expectancy of people with mental illness, and the role that fear, shame and compassion play in the quality of life of our most vulnerable.
What I examined was that mental illness is not so black and white. Just like physical illness, it is all part of the ebb and flow that is the human experience. As Pema Chodron says, “We come together and we fall apart, we come together and we fall apart again.” It is our fear of things falling apart that causes us to suffer. But there is an antidote to this suffering. This antidote is connection. With this as the view, it made sense to approach anti-stigma as pro-connection.
Mental Illness: The Current View
“We must change our culture if we are to succeed in saving lives and ending suffering. We must come to accept that mental health and mental illness are elements of the human condition – just as physical health and disease are.” ~Dr. Barbara Van Dahlen
The older governing view of mental health is very black and white. You are either mentally healthy or you are not. You are either normal or abnormal. Many health professionals still hold this dichotomous view of mental illness. The DSM5 (Diagnostic and Statistical Manual of Mental Disorders), a classification and diagnostic tool used by health professional, has shaped and articulated understanding of mental health problems for several decades. Although, diagnosis is useful because it allows individuals to access required services and treatment, this system of categorical judgments tends to ‘stereotype’ all people with a particular diagnosis. The purely symptom-based diagnostic criteria that the DSM5 go by, fail to adequately take into account the context in which a person is living, and whether there is real internal disorder of an individual or simply a response to their situation. (Armstrong, K. (2016))
The newer uprising models of mental illness (such as Psycho Social Rehabilitation, Harm Reduction, and dimension models) challenge this perspective. The view here is that there is no normal or abnormal. Mental health and mental illness are simply seen as elements of the human condition. Individuals fall on a continuum of health/ illness. With this approach there is no need to decide if someone has a “disorder” but instead identifies aspects of their behaviour that may be problematic to the individual. (Armstrong, Kay. (2016))
Unlike the older medical models, the whole person, not the illness, is the focus of Psycho Social Rehabilitation (PSR). The perspective is that all persons, no matter how disabled, have the capacity to learn and grow. Their main principle as well (as well as Harm Reduction) is that all people are to be treated with respect and dignity (Armstrong, Kay. (2016))
Although we are moving in the right direction, change takes time. The harsh reality is that our current negative stereotypes are contributing to the unnecessary deaths of people globally. The difference in the quality of medical care received by people with mental illness is one of the reasons why they live shorter lives than people without mental illness. (www.ted.com)
But the reaction of others is not the only factor that reduces life expectancy. Self-stigma, our internalization of the stereotypes that define us, causes worse consequences than the mental illness itself.
The True Illness: Shame
“I define shame as the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging – something we’ve experienced, done, or failed to do makes us unworthy of connection.” ~Brené Brown
Here’s the truth of the matter: mental illness and addiction makes us uncomfortable. It makes us uncomfortable because, really, it can happen to anyone of us, and that reality creates a lot of fear.
“One of the reasons mental illness is alarming is that we all have a very real fear of losing our reason, and of losing control.” K. Armstrong
When we fear something that makes us feel vulnerable, our natural reaction is to push it away and get it away from us. (www.psychologytoday.com) When we do this as a society, we move from a place of empathy (where everyone is treated with dignity) towards a culture of shame, (breeding fear, blame, and disconnection).
When we move away from the belief that every being (including ourselves) is innately worthy, intrinsically healthy and sane, when we believe there is something fundamentally wrong with ourselves or beings that we perceive different than us, we create suffering. We give birth to shame. In my work as an addiction recovery coach, there is not a day that the topic of shame does not arise. Individuals with mental illness and their family members often experience “self-stigma”, viewing themselves with embarrassment or self-loathing as a result of internalizing the negative perceptions around them. (CMHA)
Brené Brown, a research professor at the University of Houston, has spent the last decade researching the negative effects of shame. Brown discovered that shame is associated with a host of issues including addiction, violence, and depression. Knowing that approximately 8% of adults will experience major depression at some time in their lives and that 15% of people with major depression commit suicide, shame is not a topic to be pushed aside. (CMHA) The harmful effect of shame is even more devastating in the Youth population. Mental illness is increasingly threatening the lives of our children; with Canada’s youth suicide rate the third highest in the industrialized world. (CMHA) The CMHA reported that Youth are more likely to commit suicide when feeling hopelessness or isolation. Internalized shame breaks down the individuals sense of worthiness to the point where the person no longer believes he is worthy of change or belonging, to the point where he believe his own life has no meaning.
“Shame corrodes the very part of us that believes we are capable of change”. ~Brené Brown
Shame, whether from an outer source or an inner dialogue, is neither helpful or productive. In fact, Brown believes that shame is much more likely to be the source of destructive, hurtful behaviour than the solution or cure. It is no surprise then, that the War on Drugs, has only exacerbated the problem of addiction in our country an beyond.
“Shame needs 3 things to grow exponentially in our lives: secrecy, silence and judgement.” ~Brené Brown
Here’s what’s truly alarming: shame breeds secrecy. Almost one half (49%) of those who feel they have suffered from depression or anxiety have never gone to see a doctor about this problem. 60% of people with a mental health problem or illness won’t seek help for fear of being labeled – (www.mentalhealthcommission.ca). Early identification and treatment can stop problems from developing; prevent problems that have developed from getting worse; shift the life trajectory for individuals from negative to positive. (Armstrong, K. (2016)) Breaking this secrecy and silence is therefore of utmost importance.
The Antidote: Connection
“Connection is our ability to forge meaningful authentic relationships with other people. Connection is the essence of human experience.” ~Brené Brown
Brown defines connection as the energy that exists between people when they feel seen, heard, and valued; when they can give and receive without judgment; and when they derive sustenance and strength from the relationship.
When I meet my clients in this way, when I offer them unconditional positive regard, powerlessness transforms into empowerment. The individual begins to cultivate a strong sense of self worth and, from this place, is better able to advocate for himself. With this new confidence, the individual is inspired to advocate for others in need as well. This is how courage grows, this is how compassion grows. This is how connection grows. Compassion is the only true form of connection. It is when we someone is listening and hearing us. It cultivates empathy, and empathy dissolves shame. (brenebrown.com)
“If we can share our story with someone who responds with empathy and understanding, shame can’t survive.” ~ Brené Brown
Human beings are bonding animals. We need to connect and love. (psychologytoday.com)
When we feel connected we are more able to engage. When we are engaged, intervention happens organically. We intuitively look out for one another. We expand our ability to really listen and broaden our view. As a society, when we experience this, we move from a culture of shame to one of empathy.
“By the time you’re a social worker for 10 years, what you realize is that connection is why we’re here. It’s what gives purpose and meaning to our lives. This is what it’s all about. It doesn’t matter whether you talk to people who work in social justice, mental health and abuse and neglect, what we know is that connection, the ability to feel connected, is — neurobiologically that’s how we’re wired — it’s why we’re here.”~ Brené Brown
Social workers are at the front line of the compassion crusade. Armed with weapons of compassion, human dignity, and unconditional positive regard, they are cultivating healthy soil for change on a daily basis. But the responsibility weighs heavy on the shoulders of the social worker. Many in the field are burning out as there are just not enough compassionate hands to reach out to all in desperate need.
“Be kind wherever possible. It is always possible.” ~ Dalai Lama
What my buddhist teachings have taught me is that within us we all hold goodness, kindness, wisdom and strength. Our true nature is courageous and kind. We are all capable of creating a compassionate space for those who are suffering. It is time that we take responsibility for our share of the global suffering. To do this we must investigate our own inner negative stereotypes and how they influence our actions. But first, we must find the will to actually take a look.
“The world has never lacked great spiritual guides, percepts and practices, but surely it has had a shortage of people willing to learn.” ~ Gabor Maté
Just as people with substance abuse disorders go through different stages of change, so do we as human beings. Though often we look for outside sources to guide us, at some point, somewhere deep inside we recognize that we must slow down, reconnect with ourselves, and listen to our own inner guidance. In my work as a Yoga Therapist, I have witnessed the tragedy of disconnection. We have become numb as human beings, avoiding discomfort at all costs.
“You are the sky. Everything else ~ it’s just the weather.” Pema Chodron
Through self-inquiry, we learn that discomfort, confusion, fear, and suffering are all impermanent. We realize that what is permanent is our innate sanity, our worthiness. When we see ourselves as worthy of love and belonging, we recognize that all beings are worthy of this belonging. That is the view of our true nature as human beings. That is the view that will heal.
It all starts with us
“For any shift to happen, we must start with ourselves. We must be courageous and lean into what scares us. We must believe that we ourselves are worthy of love and belonging so that we may extend that belief to others.” ~Dalai Lama
As difficult as it may be to lean into our fears and touch our vulnerability with courage and compassion, we as a nation do not have the luxury to wait any longer. Stigma infects every issue surrounding mental illness, often with worse consequences than the illness itself. Only one in three people who experience a mental health problem or illness, and as few as one in four children or youth, report that they have sought and received services and treatment. Of the 4,000 Canadians who die every year as a result of suicide, most were confronting a mental health problem or illness. ( strategy.mentalhealth.com)
We must broaden our perspective about mental illness, seeing it as a natural part of our human experience. We must hold the view that all beings are innately worthy, deserving of dignity, and capable of change, including ourselves
“We are in this together. The truth is at some level when you hurt, when your children hurt, I hurt. I hurt. And when my kids hurt, you hurt. And it’s very easy to turn our backs on kids who are hungry, or veterans who are sleeping out on the street, and we can develop a psyche, a psychology which is “I don’t have to worry about them; all I’m gonna worry about is myself; I need to make another 5 billion dollars.”
But I believe that what human nature is about is that everybody in this room impacts everybody else in all kinds of ways that we can’t even understand. It’s beyond intellect. It’s a spiritual, emotional thing. So I believe that when we do the right thing, when we try to treat people with respect and dignity, when we say that that child who is hungry is my child, I think we are more human when we do that, than when we say “hey, this whole world is me, I need more and more, I don’t care about anyone else.” That’s my religion. That’s what I believe in.” ~ Bernie Sanders
We must acknowledge that we are all and in this together and share responsibility of our current mental health crisis. Bruce Alexander, professor of Psychology in Vancouver, believes that we need to talk about social recovery, how we all recover, together, from the sickness of isolation that is sinking on us like a thick fog. To put an end to the harmful isolating effects of stigma and shame, we must find the courage and compassion in ourselves to look at and talk about what makes us feel vulnerable, moving beyond fear to a place of empathy. We must recognize that the suffering of one person affects all of us. As Bernie Sanders says. “When you, hurt I hurt. I hurt.”
“If you want to make a difference, the next time you see someone being cruel to another human being, take it personally. Take it personally because it is personal!” ~Brené Brown
It is time to reconnect, engage, and show up for one another with kindness. If we are to find our way back from the the darkness of stigmatization, connection will be our guiding light.
Armstrong, K (2016). HSER 257 2016-powerpoint slides