Stigma stings, but when it happens in your own backyard—our own families and friends not accepting us—it is especially hard to take.
Stigma, no matter where it comes from, is insensitive and dehumanizing.
But when discrimination comes from those we consider to be part of our inner circle—friends, family, co-workers, fellow worshipers, others we’d hope would choose acceptance of bipolar disorder over rejection—it can sting even more.
That’s because being able to lean on those we’re most familiar with seems like a no-brainer. But that’s not the case. In fact, sometimes the opposite is true: Instead of support, there seems to be a point at which, at least with regard to nuclear family members, “the stigma might sometimes get worse,” says psychological scientist Patrick W. Corrigan of the Illinois Institute of Technology, and a leading expert on the topic of stigma related to mental health.
Wounding words, condescension, or distancing leads to feeling marginalized by the very people we should be able to count on most. And that—like stigma from anywhere—can terribly undermine self-esteem and lower confidence in achieving success, cause depression and anxiety, contribute to social isolation, and interfere with seeking treatment or adhering to a medication schedule.
In a study of 500 people caring for someone with bipolar, published in 2007 in Psychiatric Services, researchers found that stigma was “prevalent” regardless of whether their relatives and friends were stable or having active symptoms.
Such attitudes too often are stoked by myths or the media rather than founded on scientific information and experience, according to J. D. Van Eaton, a licensed professional counselor in Atlanta.
“When we talk about stigma, it’s not just that people are judging,” he says. “It’s that they are completely misunderstanding and being naive about what bipolar disorder is in general. And the really tough part is, it’s almost like they don’t want to understand it, just to make it easier on themselves.
“Ultimately, it all boils down to fear,” he adds. “We fear what we don’t understand.”
Shortly after Keira moved to Charlotte, North Carolina, she met someone who had a baby her daughter’s age. They became close friends, and Keira eventually disclosed that she had bipolar II.
Soon after, when a mood episode made caring for her daughter intensely draining, she asked her new friend for help. The friend brushed aside the request, chalking the experience up to the challenges of being a new parent.
“So I asked again a couple days later,” Keira says. “She rolled her eyes.”
This has happened with others, as well.
“I’ve tried to share here and there, but it’s not something people can easily relate to,” she continues. “If you say, ‘My mother-in-law is driving me nuts,’ they’re like, ‘Oh yeah, I totally get that.’ But if I say I’m having issues with [my mental health] they say, ‘I know. I get that way when I’m tired.’ I think they are trying to connect, but when I try to explain it’s more than exhaustion we go back and forth until I give up. They seem to think I’m being very self-centered or trying to elicit sympathy.
Keira isn’t alone. A 2001 study by the Mental Health Foundation found that 34 percent of participants felt they could tell none, or very few, of their friends about their mental health issues because they wouldn’t understand—or would react negatively. Thirty-nine percent were worried about doing so, and only 28 percent responded that they could tell most of their friends.
Although Keira does still hold back a bit, she is trying to be more open these days when establishing new friendships.
“I’m always worried that I’m not getting it quite right—that I’m saying too much or I’m being too closed off,” she says. “I haven’t been the best at keeping friends in the past, but I’m determined to do it now.”
In the family
However unintentional, family members can be quick to blame the disorder when they don’t care for a particular behavior or decision that has been made, instead of accepting that the decision was purposeful, according to Chicago psychologist Terry Dornak.
“This comes up quite often with my clients,” he says. “They’re told, ‘You just did that because you were impulsive at the time’ or ‘You’re acting like this because you must be manic.’ But blaming the disorder makes [people] feel like they’re only a patient.”
If it’s accurate to say so, Dornak recommends being open about talking to a therapist regularly, being on schedule with medication, and using coping skills—so the point comes across that you’re stable and capable of making thoughtful choices.
Some reactions can be traced to an implicit bias based on personal history.
Given the disorder’s strong genetic component, a family member might have had a negative interaction in the past with another family member with bipolar.
“Maybe they’re holding on to hurts that haven’t been resolved,” says Heather Z. Lyons, PhD, a licensed psychologist in Baltimore. “They see someone else behaving in some similar ways that they haven’t gotten closure around.
Providing some education might help. That negative interaction might have happened decades ago, when there was much less information and fewer treatments available.
Just try to be cognizant of the timing.
“There’s this idea of ‘striking while the iron is cold,’” Lyons says, “so you’re not trying to have a heavy conversation when everyone’s emotions are amped up. Instead, choose a calm time to broach the topic.”
Also try to be patient. Reflect on how long it took—or is taking—you to truly understand your diagnosis, then realize that others have even less insight into what you’re dealing with.
“They have to go through their own process of learning about this,” Lyons continues. “You can help along the way by providing information, giving them time, being available to talk when they have questions, and recognizing that you can’t force a change in attitude.”
Van Eaton knows from personal experience that while education is the biggest weapon available against stigma, it has its limitations.
“I grew up with friends and family [who had] bipolar disorder, so I’ve been around it my entire life, but there’s no way for me to completely get it because I don’t have it,” he explains. “If your goal is to get other people to fully comprehend what you’re going through, you’re barking up the wrong tree. Just being OK with that is a big thing.”
In the first study of its kind to look at attitudes about mental health issues on the family level, Spanish researchers found that family members are less likely to feel empathy and more likely to feel shame and embarrassment when a close relative is struggling with a mental health condition versus a general medical health condition. The research, conducted by the World Health Organization in 2013, assessed attitudes in more than 16 countries.
Some of that may be attributed to so-called courtesy stigma, what sociologist Erving Goffman as far back as 1963 defined as a type of stigma by association—when a negative impact results from being connected to a person who is stigmatized.
For Jess from California, who lives with bipolar I, her father’s attempts at support miss the mark. He is perpetually optimistic that she will be able to discontinue her bipolar meds one day, despite her repeatedly telling him otherwise.
“I love him to death, but … it’s sort of like he’s being strong for me instead of just being honest for me,” she says. “I kind of want the honesty sometimes.”
On the job
A survey of 2,000 employees, commissioned in 2017 by the Mental Health Foundation, revealed that 40 percent of Scottish workers wouldn’t talk openly about a mental health problem for fear it would jeopardize their career. Forty-two percent said they would be likely to make up an excuse—such as a stomach or back problem—if they needed to take time off work for mental health reasons. And one in five workers said they’d seen the label of mental health misused against co-workers.
Unfortunately, after disclosing a mental health condition on the job it is not uncommon to find one’s work being checked over more often, or to repeatedly be asked, “Are you OK?”
Roger Reif from Charlestown, Indiana had done a good job for decades of keeping his bipolar II from co-workers he knew well. Even when he was hospitalized for five days after a manic episode, no one knew. He returned to his job as a service manager for a food and beverage company, at first admitting only to having depression. No one treated him differently.
Then he decided to disclose his bipolar disorder, after being encouraged to do so during a group therapy session. He told a colleague and his boss, who “looked scared.” Within weeks, according to Roger, his job responsibilities were reduced, he was left out of meetings, and he was no longer asked to travel for work.
“I tried to work a little harder, to convey that nothing had really changed, but that caused me anxiety and paranoia about what was going through their heads,” he recalls. “I kept asking myself, ‘Why are they thinking of you like this? They’ve known you for 20 years.’ I tried to suck it up and swallow my pride, hoping one day that things would turn out.”
They didn’t. He kept it up for another two years, then took early retirement. These days he has turned his anger into something positive, however, by joining another support group and becoming vice president of his local Depression and Bipolar Support Alliance chapter.
Robert of South Carolina is trying his best to deal with losing a friend and a job at the same time. The friend had helped him get the job in the first place, even after knowing Robert had bipolar II.
“I thought that my friend would be someone who was empathetic and know how to work with me if I experienced an incident at work,” he says.
That friend ultimately became his supervisor. After a hypomanic episode set off a string of behaviors that intensified, forcing Robert to take a few days off, he came back to a meeting with the supervisor and human resources director—a termination meeting.
“My supervisor, using language from an email I had sent her two weeks earlier about what I was experiencing, [said], ‘That irrationality is an issue and it can return,’” remembers Robert, who still gets choked up when discussing the 2016 incident.
He adds, “Regardless of the emotional pain, it’s important to revisit these events over time and re-evaluate [them] with new perspectives so they can be re-framed as learning opportunities. That’s what healing is all about.”
While data from LifeWay Research shows that churches typically are supportive when it comes to dealing with mental health issues, it also reveals that almost one in five people broke ties with their church because of a negative response—or lack of response—to their diagnosis.
Negative reactions to a diagnosis can take the form of an ill-informed comment—such as “Just pray about it”—to more drastic measures, such as a planned exorcism.
When Katie, a devout Christian, heard a televangelist several years ago tell her she could be healed from her bipolar I “if she only had enough faith,” she took that as a sign to stop her medication. Two months later she underwent voluntary hospitalization; it took four more months to settle in to a good medication regime.
Since then she has mixed feelings about the role that church plays in erasing stigma.
Katie feels she can turn to her congregation for prayer and to share her burdens, but “maybe that’s because I’m successful and stable. If I shared more about a major episode, I feel like they would be like, ‘Whoa, what is she smoking?’ and they wouldn’t know what to do.
“The church in general has a responsibility to nurture and grow and lead,” she adds. “But given all the knowledge about mental health stigma we have now, and the anti-stigma research, I don’t think it’s being the change agent it’s expected to be.”
“We want to empower people with the condition,” Corrigan says, “and those of us without it need to be allies.”
Keira, who is from North Carolina, wholeheartedly agrees. “I started trying to grow my tribe for my daughter’s sake,” she says, “but now I realize just how much I need it for me.
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Getting past the stigma, even if others can’t
You can’t control whether other people buy in to the stigma around bipolar, but you can take control over how you respond. Here are some tips for preventing fear and ignorance from leading to self-doubt:
Realize your strength Just because bipolar requires constant monitoring doesn’t mean you can’t have a fulfilling life. “I’ve seen more success with my clients who have bipolar because they have to be so introspective and work so hard,” says licensed professional counselor J. D. Van Eaton.
Get support In addition to counseling, seek out a support group. “It helps you deal not only with your illness, but also your feelings,” says Roger from Indiana. “And it’s good to know you’re not the only one out there going through this.”
Educate others You can’t make someone understand what you’re going through, but you can pass along information about bipolar to foster a more open mind. If you’re comfortable with it, you can also invite a parent, sibling, partner, or friend to a joint therapy session. “It’s always better to offer education rather than go the defensive route,” advises Terry Dornak, PsyD.
Be prepared If you’re going to disclose your diagnosis at work, ask your supervisor or the human resources director what accommodations can be provided for someone with bipolar disorder, suggests Robert of South Carolina. “And have an action plan in place to take care of yourself when you are ill regardless of whether or not you disclose,” he says.
Printed as “When Stigma Strikes Close to Home,” Spring 2019
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