Fighting the stigma against mental illness is an ongoing battle, and often an uphill one, as illustrated by many of the posts in this series. Sometimes it seems like we make two strides backward for every stride we take forward in terms of reframing the way people think, talk about, and handle mental illness. A slew of stigma-fighting campaigns have erupted in the last few years: Stamp Out Stigma in the UK, a US version, Bring Change 2 Mind, Time to Change, and many others. Despite the efforts of such campaigns, stigma and discrimination against people with mental illness continue to be problems, illustrating that we have a long way to go.
These campaigns approach public outreach and education from a number of perspectives, but many of them focus heavily on the coming out model. The queer community deserves all due credit for popularizing this approach to fighting social attitudes; by reminding people that we’re here, we’re queer, and they may as well get used to it, we weaponize the stigma against our identities and force people to confront their internalized attitudes about queerness. Yet, at the same time, coming out as queer, lesbian, gay, bisexual, and any number of other permutations of human sexuality beyond monogamous heterosexuality can be extremely dangerous, highlighting the major flaw in this model: It’s not safe. Coming out is only as effective as it is safe, and the only way to make it safe is by encouraging more people to come out—to normalize it—which creates a double bind.
This is also the case with coming out campaigns for mental illness. A number of prominent celebrities have started openly talking about anxiety and depression, though fewer are willing to disclose what I often think of as the “big three” of mental health stigma: bipolar disorder, borderline personality disorder, and schizophrenia. In a handful of cases, celebrities have basically been forcibly outed. Out of respect for their privacy I’m not going to provide specific examples in this case, but I can think of at least two in the last year.
People are told that the only way to end stigma is to come out, and that the best way to educate members of the public and to reach out is to be open about mental illness. While I understand the sentiments behind this attitude, people who argue this ignore the very real dangers in coming out, and often end up underscoring the good crazy/bad crazy dichotomy in the process. It is safer to come out with some forms of mental illness than others, and pretending otherwise makes it impossible to confront the very real risks associated, not just with the big three but with all mental health diagnoses.
Coming out, with any mental illness, can result in losing your job and it can be disastrous for your career as a whole if you are in a small, close-knit industry. It can be a relationship-ender, and there is a delicate balance and dance that happens with deciding when and where to disclose mental illness in relationships. If you wait too long, you’re being deceptive. If you say something too early, you may be written off as a potential partner because you’re mentally ill. It can also destroy friendships, even very old ones, because suddenly you are dangerous and frightening because of a diagnosis. It can make you more vulnerable to abuse, because people with mental illness are viewed as legitimate targets.
Forcible outing of people with mental illness still happens, and it is extremely dangerous. For people working in fields like academia, for example, it can be the death knell of a career. If you’ve spent 10, 15, 20 years developing a reputation, you can watch it crumble around you in a matter of weeks. You can watch callbacks on job interviews dwindle away to nothing while your friends quietly slink around and refuse to talk to you. Coming out can have an intensely isolating effect, despite the claims that doing so can make you feel like a member of a community. If you don’t have support from family and friends, it can be extremely dangerous. Not everyone is able to put their identity on the line like that and not everyone should have to.
Especially in the context of dehumanizing campaigns like Bring Change 2 Mind. abby jean discussed the problems with this campaign really well:
I literally gasped out loud. She is a mom, his mom. And he is not even her son, not even a person, not even a person with schizophrenia, not even a schizophrenic, he is labeled with his diagnosis.
The tendency to label people as their diagnoses is particularly common with some mental health conditions, especially the big three. When the very anti-stigma campaigns that are supposed to be making the world safer for us actually make it more dangerous, add to our experiences of isolation and dehumanization, well, it’s hard to see how coming out would be safe, or good. In that environment, who wants to be the first to put everything on the line in pursuit of a better world?