Sanity & The City, Part 2: Stigma in the Workplace

We asked an ex-patient at one of our Priory hospitals to highlight their personal experience of mental health in the workplace as part of a new series of Priory blogs. The post below is the second in a six part series entitled ‘Sanity and the City’, and gives an honest and insightful look into their own experience of mental health at work:

I didn’t even make it to 09:15 on Monday morning this week without someone describing a client as ‘bipolar’ in a meeting. I didn’t make it to 10:30 before hearing someone else called ‘schizophrenic’.

If you listen closely, you will hear people or acts being described in pathological terms all day – ‘That’s crazy’, ‘She’s nuts’ etc. See if you can count the number of times you hear something like that before noon today.

It also seems that bipolar is the new schizophrenia for lazy insults about people you don’t agree with. You used to hear people casually dismissed as schizophrenic all the time in everyday conversation. I liked to challenge those who did so with a list of clinical questions such as ‘Do they have auditory/visual hallucinations? Is there evidence of psychotic thought patterns?’ and so on. 

Challenging stigma with humour

It makes people think twice about it but it also brings it out into the open, challenging stigma in a humorous way that might provoke deeper reflection. I think challenging with humour is more effective than a furrowed-brow serious issue approach. When I challenged my boss on describing someone as bipolar to me, he said he was sorry, he just thought it would resonate with me. That was such an absurd excuse I had to laugh.

That got me thinking about whether this language infiltrates the workplace because of the frenzied nature of much of the work in the City. It is a place of extreme pressure where you commit to projects that will require all of your resources. All of them. Completing a deal is an intense process whether in mergers and acquisitions (M&A) or raising money from investors for a bond issue.

Sleep, therefore, is regarded as a luxury. The impact of lack of sleep is well-documented – anxiety and depression for sure, and psychosis too.

I recall times where I have worked 16-hour days and had three hours sleep and then been expected to make major, rational decisions. At the time, adrenaline can keep you going and it becomes your life. For me, the problems came when the crisis was over and I felt I had no real short-term goal. Rather than welcoming that, I found it uncomfortable.

This kind of behaviour continues to be encouraged and rewarded. I think we all have stories of this leading to megalomania and the cult of the personality and that can’t be healthy for anyone. Elevated self-esteem is just as bad as low self-esteem in my book. What happens when you realise that you’re not better than everyone else? When you’re made redundant and you discover that you are as expendable as everyone else?

I have a favourite anecdote about someone from Human Resources (HR) who was given the unenviable task of telling a senior banker that his behaviour meant that all of his staff (a trading floor of up to 100 people) were afraid of him. His response? To open the door of his glass office and bellow to the whole floor “They better be scared!” before slamming the door and summarily dismissing the HR person.

What does work/life balance mean?

So what does that mean for work/life balance? Someone said to me last week that there is no work/life balance in our world and he doesn’t believe in it. You have to live it, echoed someone with equally distorted values. You need to be a certain type of person to believe that. Do you have a relentless drive for perfectionism? Where does that come from? What would self-awareness mean for you?

Unfortunately, that seems to come after a major life event abruptly stops the treadmill and you bang your head hard on what had been propelling you along. Whether it’s chronic physical illness or mental health problems, it can prompt a reassessment of values and a conscious decision on how you want to live.

That’s when stigma kicks in. Stigma is a funny thing. It’s based on ignorance and fear and the fear is what keeps the ignorance in place. We like to make jokes about what we fear, as a release mechanism, and that’s a healthy thing. But what do we do to reduce that fear and address that ignorance?

I said in my last post that I wanted mental health issues to be treated in the same way as breaking your leg. I regret this now, partly because it’s a cliché, but mostly because it’s not always comparable. Mental health issues can kill you and there are lots of physical conditions that are still heavily stigmatised.

Discussing depression at work

I have had mixed experiences of discussing depression with the powers that be at work. I have had the CEO who was very respectful and understanding and actually caring in his approach. My experiences with HR have been varied. Some have been wonderful, others have been patronising, but in all cases people were genuinely concerned, thank goodness.

HR can be a lifesaver when it comes to mental health, but it’s not always so cut and dried. Compassion does not necessarily mean understanding and stigma can live on through a lack of the appropriate information. Risk assessment is hugely important but it also involves an element of subjectivity. The interventions aren’t going to get better until the awareness and understanding does.

In private conversations with colleagues, people have been nothing but compassionate, but these are people you already trust. For every one of them, there is someone else who thinks you are weak, a waste of time and money, a liability – the list goes on. I know because I have heard – and challenged – people saying this.

There’s a broader discussion to be had about mental health and pathology. Shall we start by having it at work?

Tip of the month

This month a client tried to bully me. It has been a long time since anyone has tried this and it got to me, largely because it was unexpected. I felt angry about the injustice but also anxious about dealing with the situation. It triggered a lot of deeper feelings unrelated to the event. So what did I do?

Revisiting my therapeutic work from last year was helpful – when the feeling is bigger than the situation, what is going on? I could do a chain analysis and see where the feeling really originated. Then I could deal with it appropriately. I also practised mindfulness and ACT (Acceptance and Commitment Therapy) techniques to defuse these strong emotions.

Perhaps most importantly, I resisted the urge to be passive aggressive with the client or to people please. I could see this was about their own issues. I didn’t need to take it personally and I didn’t have to become part of the drama triangle. Just because there’s a persecutor, you don’t need to become a victim.

Eliminating the stigma that surrounds mental health

Dr Claudia Bernat Consultant Psychiatrist at Priory Hospital North London offers expert advice on helping to eliminate the stigma that surrounds mental health.

People who suffer with mental illness have been labeled as being dangerous, unpredictable, lazy and even responsible for their illness. These ideas have been permeated by the media along with a general lack of public understanding. One way of combating the stigmatization of mental health is through increased openness and general conversations. By creating an open and assertive attitude against the representation of negative stereotypes of mental health, we can promote positive interactions among individuals with mental health conditions and the population in general.

Everyone who suffers a mental health condition has a different experience.

It's very important to appreciate that everyone who suffers a mental health condition has a different experience, not every mental disorder presents itself in the same way.

For those working in high pressured ‘city’ jobs, it is often the impairment of the cognitive functions (memory processing, perception, problem solving and language) which enable the recognition of a mental health condition. The phenomena of stigma around mental health can be considered as the second illness and an obstacle to seeking help and treatment. Often it is the sufferer who builds the stigma around themselves, concerned with what society will think about them. According to many the fear of being open about their mental health condition potentially affects what is most important to them; opportunities in life, employment and good health.

The best way in my opinion to combat this stigma, is for health professionals to continue to discuss mental health, highlighting the inaccuracies of the stereotype and focus on recognizing the symptoms and understanding the treatment available. This should be spoken about openly in the relationship with the patient, their families and anyone involved with the person.

Advice for dealing with mental health issues in the workplace:

  • Remember, all humans are vulnerable to mental health illness
  • Approach symptoms in a pragmatic way (it is a medical issue like any other illness)
  • Define the problem with the view to solving it
  • Look for help, discuss with close family members and seek advice e.g. from HR at work
  • Take time off work to get better but refrain from isolation
  • Look for peer support via charities, NHS when available or Private health
  • Comply with any treatment plans
  • Accept your limitations
  • Remember that there is help and treatment available, so don’t give up

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