Mental illness in the workplace
From the UK National Mental Health Development Unit “Fewer than four in ten employers say that they would consider employing someone with a history of mental health problems.”
It is ironic then to consider research that suggests that one in 25 business leaders may be a psychopath, even though the condition may not be formally recognised and certainly undiagnosed. I happened to hear Jon Ronson the author of ‘The Psychopath test’ being interviewed about his work on the radio last Sunday. What he had to say resonated with my own experience of some senior, and feared, people in the corporate world.
Ronson quoted Robert Hare’s work for a definition of the corporate psychopath ‘People who are psychopathic prey ruthlessly on others using charm, deceit, violence or other methods that allow them to get what they want. The symptoms of psychopathy include: lack of a conscience or sense of guilt, lack of empathy, egocentricity, pathological lying, repeated violations of social norms, disregard for the law, shallow emotions, and a history of victimizing others.’ Hare, Robert D. Without Conscience: The Disturbing World of the Psychopaths Among Us. New York, NY: The Guilford Press, 1993.
Ronson claims that one in a hundred people are psychopaths and that they present a façade of normality. In his book he has constructed a check list of defining characteristics, that describe psychopaths, noting the primary trait as a lack of empathy. He names a number of well known business identities who pass the test, ostensibly successful business psychopaths. Apparently corporate culture supports callousness, providing an environment where a disregard of the emotions of others can be an asset. A pyschopath can rationalise and intellectualise about what another may be thinking but the can not grasp what another may feel.
If the above doesn’t sound quite right turn to Scientific American and note that psychopaths are rarely psychotic or violent in fact; “Psychopathy reminds us that media depictions of mental illness often contain as much fiction as fact.”
Funny world and I, for one, am not laughing.
Selfish schmelfish
The tram lurched and so did I. I stepped on the toes of the guy standing next to me and he growled, I thought he was going to bite me. I stepped back smiling apologetically while saying sorry. Sheepishly I looked down while he glowered. The tram ride to work is usually less eventful than it was this morning.
I was still thinking about the snarling executive while sitting in my workplace lunch room at mid-day. A couple of colleagues sat nearby, talking about their weekends. I wasn’t really listening until one said something about someone “suicidal”, she was describing a mother of young children, something, something….she said. The person listening tsk’ed and said “How selfish…”. I nearly choked on my cauliflower soup with nutmeg and lemon, I did sputter…or was it a silent splutter?
I’m affronted to hear someone suicidal described as selfish, it makes me really cross. You can’t look with your everyday rational mind at the intentions or actions of someone in the grip of an inner tempest, and far removed from normal experience, and then conclude they’re selfish. Obviously my last statement is not true, many people do exactly that. As galling as I find the view, many believe suicide is a selfish act and I do not. I can’t see it.
Back in the lunch room, I didn’t say anything. The conversationalists noticed me, with soup on my chin, and they stopped talking. I suspect it wasn’t the drips but something more leper like about me that silenced the conversation: my background, and possibly the the scowl that had congealed on my cauliflower flecked countenance. How do I dream up these situations? Dazed, and decidedly lumpy, I sat silent.
I didn’t say anything. If only I had connected with my inner terrier, like this morning’s tram traveller. With a bit of his energy I could have growled or even howled. I did howl on the inside and then admonished myself (again on the inside)for the next few hours, for not speaking up. I’ve promised I’ll bark next time. If not a bark, I’ll let out a bellow of distress.
If you, or someone you know, needs emotional support call Lifeline on 13 11 14, in Australia. Crisis counselling is available around the world.
That’s what harbours are for
“A ship is safe in the harbour, but that’s not what ships are for” said William Shedd. I quoted him a few days ago. I went on to talk about the exhilaration of confronting dangers, now I want to back-track a little in support of personal safety.
I admit I tend to underestimate dangers, like a falling cat, I land on my feet. It’s something I’ve learned through experience. It is a hard earned super-power, and as much bounce as I may have, I bruise easily too. Sensitivity is also a super-power.
I enjoy some privilege in knowing I have a store of innate resilience. That resilience when measured against others is a form of social rank or status, and I sometimes underestimate the vulnerability of others. At my most unobservant, I can override the fears while hardly noticing my transgression. I tend to bounce along with difficult conversations, sometimes I sail my ship right out of the harbour and straight into headwinds.
A friend just reminded me that safety is not something that can be taken for granted.
Even seasoned sailors don’t take their boats out of the harbour into a storm. Storms are to be avoided, that’s what harbours are for. William Shedd was clear about what boats are for, but forgot to mention what harbours are for. Safe shelter is needed from squalls. I find that shelter/support in talking to my therapist, and even so I don’t know that I ever feel really safe. Sometime more safe and at others less so, but never totally safe.
Safety is different for each. Mottsu, for example, would not disclose his depression and distress to those he worked with. Saying something could have compromised his well-being in his hardened work environment, by changing how he was perceived. As tormented as he was, preservation was paramount – somewhat paradoxically as things transpired.
Be safe and well, safety first. Torment should be avoided, wherever possible, that’s what harbours (and therapists) are for.
Places without rainbows
A friend just reminded me that some of us can’t see rainbows, they’re not visible along darkened roads. That rainbows “…representing the excitement, happiness and joys in life it escapes me, if anything it would be the opposite. Being in these situations becomes almost unbearable, knowing that I should expect to feel these emotions but don’t churns up the sadness adding to the hopelessness and helplessness inside.”
Hope filled yellow brick roads and darkened country roads travelled without hope, one with rainbows and one without. Where one exists the other must too, and there might be too many songs about rainbows, Kermit.
Hopelessness and helplessness are evocative terms. I just read them described in David Webb’s book on suicide, a book that grew out of his PhD research on the topic.
I know how little talk of suicide can be tolerated in general, so it is relieving right from the preface to read of the risks of speaking out and at the same time hear Dr. Webb urging us to engage in community conversation about suicidality. I wonder if suicidality is his word, my spell checker doesn’t recognise it and neither do I. Maybe our conversations and subsequent understanding are so constrained that we don’t yet have a complete language for suicide.
David Webb describes the silence as toxic and he notes that missing from the discussion is the first person voice. The person with experience is not present in the mental health support systems, and as a consequence he sees a failure to really understand what suicidality means to those who live it.
His is another first person account of a place without rainbows; “Hopelessness to me is the ‘black hole’ of despair,or sometimes a profound feeling of utter emptiness inside. And helplessness is the belief that this empty, black hole is forever, that it could never be otherwise. An image I have of this is of being at the bottom of a very deep well, a black hole of meaningless emptiness. This is the hopelessness. And the exit from this deep, dark well is so far up that it can’t be seen; and the wall are so dark and smooth and greasy that it’s impossible to get any hole on them at all. This is the helplessness.” Webb, D. (2010). Thinking About Suicide: Contemplating and comprehending the urge to die. Herefordshire,UK; PCCS Books Ltd.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
Help Police
The Victorian Auditor General published a report in November 2009: Responding to Mental Health Crises in the Community. I am grateful to the friend who shared the link to the report with me.
Stating that “While a mental health crisis is often unpredictable the repsonse to the crisis should not be” the report concluded that “…responses to mental health crises are not consistently meeting the standards set out in the Mental Health Act 1986…” When the support of our agencies and services are most needed we are letting people down, or in the words of the report “The effectiveness of agency responses to mental health crises in the community is not being demonstrated.”
Community expectations are clear and described in the interagency protocol between the police and the government department responsible for mental health services “…people with a mental illness should receive the best possible care in the least restrictive and least intrusive manner, and in providing for their care…any restrictions on their rights, privacy and dignity kept to the minimum necessary in the circumstance.”
What is going wrong, why isn’t the least restrictive least intrusive support being provided?
Action is needed in addition to the acknowledgement that a lot of practices need attention, better co-ordination, monitoring and improvement. The report runs to 50 pages of findings about response effectiveness and failings, and then recommendations. I’m waiting…
Two years on I am still hoping for change in the system, anecdotally I know that not enough has improved.
The Auditors General are watching, and reporting while noting that “another challenge in responding to mental health crises is the stigma attached to mental illness. This has the potential to affect responses in both subtle and obvious ways.” Obviously.
In reviewing information collection activities of the Police I am shocked but not surprised to see that research about police experience, attitudes and knowledge of mental disorder, undertaken by Monash University “found that police attitudes towards mental illness are consistent with the wider community.”
It is a cause of concern that that particular finding is not further remarked upon in the report. How can that statement be unremarkable or unworthy of further comment and remarks? How can stigma be noted as a significant challenge on one page and then dismissed as consistent or expected on another? With all of the recognition of the stigma of mental illness, with all of the efforts to attempt to address that stigma, we know that the attitudes of the wider community are lacking. People struggle with being honest and open about their mental health, the stigma is all too real. For me it is unacceptable that the police attitudes are not better than those of the wider community, particularly given their front-line role in responding to crises.
It is not good enough, I want better.
Normal is as normal does (with thanks to Forrest)
An article about the life and work of Marsha Linehan, a therapist and researcher at the University of Washington. Her work is centred on ‘radical acceptance’, her own method for working with suicidal people . As a therapist she is an ally to her clients rather than an adversary. Radical acceptance of oneself and one’s own feelings, accepting who and how you are rather than how you’re supposed to be.
Radical? It sounds simple, and not really – acceptance is a radical thought. I find I am sensitive to a lot of feedback about what I need to change. Trying to accept who and how I am is not so simple in the face of the opinions and (not so) helpful suggestions of family, friends and beyond…
Perhaps self acceptance is a bit like a building block, if I can find part of me that is good enough (I mean not bad, stupid, wrong, abnormal etc.) then others might discover that good in me too.
Is that it? On a societal level, I think I am saying that others are less likely to marginalise what I embrace… Stigma and marginalisation are symbiotic, one feeds the other – or I imagine a frenzied sort of feeding off of each other. Whatever it takes for stigma and marginalisation survive it is to the detriment of individuals, individuality and acceptance.
Is accepting myself an act of defiance? Possibly not what Dr Linehan is advocating through her work, but these are my own Sunday morning musings. me with lots to say and lots to learn, and defiance appeals to me.
Reading about Marsha Linehan’s life and work one sentence stands out as if written in neon lights. The New York Times journalist, and author of the article, comments that: “No one knows how many people with severe mental illness live what appear to be normal, successful lives…” That sentence, at first glance, may appear innocuous enough but it hits me right between the eyes. I start to think about the stigma surrounding metal health and a pungent whiff of discrimination is apparent. Is it just me who smells it…
Let me rephrase it to test it out:
- No one knows how many people who can’t swim live what appear to be normal, successful lives…
- No one knows how many people with thinning hair live what appear to be normal, successful lives…
- No one knows how many people with cats live what appear to be normal, successful lives…
- No one knows how many people with no imagination live what appear to be normal, successful lives…
What irks me about the statement? I think it is the assumption of what is normal. Worse is the appearance of normal – that I might look normal but really I am not. The deception implicit in maintaining a normal façade and looking successful, hurts me. There is also a discrimination built into the sentence that people with mental illness can not lead normal successful lives. Irk! I’m really irked…and I know it is an innocuous sort of statement that normal people wouldn’t question as not being a perfectly normal thing to say.
The sentence makes me think of Forrest Gump, the park bench philosopher, saying “Stupid is as stupid does”. I think Forrest was saying that having a low IQ doesn’t mean you are stupid. Now I want Forrest to say “Normal is as normal does…” Isn’t the tenet of radical acceptance to defy labels of ‘normal’? My normal may be different to your normal but that doesn’t make me, or you, not normal.
It can be a struggle to keep up appearances and look normal by being who I am expected to be. At the same time I want to bridge the gulf of perception around what is normal and what isn’t, and one way to that is to be less predictable and expected – pushing normal at the edges.
Sunday morning and at my house it’s normal is as normal does. Some days there is no normal.
As I was saying…
I keep saying we should be talking about suicide as a way, maybe the only way, to diminish the stigma. Here is one discussion hosted by Australia’s longest running current affairs program Dateline. There’s a transcript of their recent show Talking Suicide and even more interesting is the talking done through comments.
Talking also seems insufficient, its a passive sort of activism.
A couple of days ago someone mentioned they had read my blog, and that he was surprised. “You have something to say”, he said “most blogs are about nothing much”. Oh?
I am drawn to do more than simply talk/write and I’m trying to work out where to start. In the meantime talking the talk.
Stephen Fry is frank
Stephen Fry is a well known actor author and comedian. In an interview this week he revealed his fears that he might kill himself one day.
I remember reading of research about typical responses in the workplace to someone admitting they were depressed or suicidal. It was depressing research, with ‘get over it’ and ‘buck up’ being the regarded as most helpful by colleagues of someone with depression. Those same responses were probably regraded as least helpful by those affected by the condition.
A person with depression can’t just get over it or snap out of it. Rather than being helpful, those types responses highlight a lack of understanding about mental health conditions. Lack of understanding and misconceptions about depression contribute to the stigma associated with it, and to the isolation of those afflicted.
Reading the responses from readers posted against the Stephen Fry article I am dismayed. The research was many years ago and I thought, I hoped, we had made some progress. Maybe not. Reading those comments I can see the stigma around mental health is as pervasive as ever.
Stephen Fry was asked about his bi-polar condition in an interview and he was frank, realistic, in his responses. Empathy, it seems,from we the readers, is still too much to ask for.
*I have written about what you can do if a friend is suicidal. There are links to information about what to say, what not to say and how to support a friend in need.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.
Not selfishness or cowardice
To every action there is an equal and opposite reaction, that’s one of Newton’s laws of motion.
This post is required by Newtons law to balance the view expressed in my previous post. Back in May 2009 Andrew Stafford wrote of his own contemplation of suicide “…to level accusations of selfishness and cowardice against those who succeed in taking their own lives, however understandable, is simply not helpful to anyone.”
He explains with heart:
This is impossible to understand from a rationalist viewpoint. Attempts at self-harm and/or suicide are, by their nature, not rational.
When you are mentally unwell to the point you want to die, you are — quite literally — not in your right mind.
This is, in my view, the single most vital insight necessary for those dealing with depression — not only those struggling with it, but those around them.
I have battled depression on and off throughout my life. Interestingly, the most serious episodes come in an almost clockwork-like seven-year cycle (apparently, I’m told, due to hormonal changes in the brain as we age, which affect different people in different ways).While at times the illness has been dangerously debilitating, since that act of serious self-harm I’ve learnt to recognise it for what it is.
Accordingly, I’ve developed medical and psychological strategies to deal with it when it arises. I treat it like I would treat any other illness: I go to the doctor, get a prescription, get a referral to a specialist, talk through the relevant issues and, most importantly, follow advice until I’m well again.
This can take up to six months or even a year. In the meantime, I do my best to remain personally and professionally functional.
But depression is an insidious bastard — insidious because you don’t realise what you’re dealing with until it’s got you in its grip.
Although the trigger can be pulled overnight — be it a death, a relationship breakdown, a family or career crisis — its onset is subtle.
And once you’re “down there”, getting back up is invariably a steep climb.
It’s also heartbreaking for those around you, who find themselves in a uniquely disempowered position.Andrew Stafford. (May 13 2009). A death wish isn’t selfishness – it’s an illness. In The Age On-line. Retrieved May 30 2011, from http://www.theage.com.au/opinion/a-death-wish-isnt-selfishness–its-an-illness-20090512-b1xt.html#ixzz1OBphReNt
You can try to rationalise the actions of someone with a mental health condition or you try to empathise. It’s a difficult discussion, and necessary if we are to reduce stigma and engender understanding. I am talking about topics, that in my experience, we don’t talk about. Judgement is too readily made though, without discussion or perhaps instead of discussion and attempts at understanding.
With sadness, I note that both articles point out the real and heavy toll of suicide on those close to someone who chooses suicide.
Crisis counselling is available around the world. In Australia Life Line 13 11 14.