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PSYCHIATRIC STIGMA
follows you everywhere you go
for the rest of
your life
a warning from
Lawrence Stevens, J.D.
A problem you should think about before consulting a mental health
professional, or encouraging someone else to do so, is the stigma
of having received the so-called therapy. If you seek counseling
or "therapy" from a psychiatrist or psychologist, how
are you going
to answer questions on job applications, applications for
occupational or professional licenses, a driver's license, applica-
tions for health or life insurance, and school and college
applications, such as "Have you ever had psychiatric or psycho-
logical therapy?" When you apply for a job or occupational
license
or a driver's license or apply for an insurance policy or admission
to an educational program you will often be required to answer
this
or a similar question. When you answer such questions candidly
and
admit having received psychiatric or psychological "help",
the
result often will be loss of important opportunities: Answering
yes
to such questions often results in rejection for employment or
licensure or admission to college or other educational program
or
denial of insurance coverage. Sometimes you will be forced
to ask
your "therapist" to breach the confidentiality of your
communi-
cations with him or her by making a report on you in order for
you
to get a job, license, insurance coverage, or admission to school.
If you conceal your experience of psychiatric or psychological
"therapy" by answering "no", thereafter you
will have to be careful
to watch what you say and to whom, and you may with good reason
worry about being found out - since you run the risk of being
fired
from a job or expelled from school or suffering revocation of
licensure if your deception is ever discovered. You
may eventual-
ly find the insurance policy you have been paying premiums on
for
many years is valueless because of what you concealed on the appli-
cation for the policy years earlier.
In his book The Powers of
Psychiatry, Jonas Robitscher,
J.D., M.D., Professor of Law and Behavioral Sciences at Emory
University's Schools of Law and Medicine, pointed out that "Appli-
cants for the state of Georgia bar examination, like applicants
in
many other states, are required to state...whether they have ever
received diagnosis of...emotional disturbance, nervous or mental
disorder, or received regular treatment for any of these condi-
tions. Although there is no known instance of this information
having been used to keep an applicant from taking the examination
or being admitted to the Georgia bar, there are instances of
denying applicants in other jurisdictions" (Houghton Mifflin
Co.,
1980, p. 234).
In the same book Dr. Robitscher
described the case of a
medical school applicant who had graduated from college magna
cum
laude, who was admitted to Phi Beta Kappa, and who scored in the
upper ninety-ninth percentile in the Medical College Admission
Test
- but who was denied admission to medical school because she had
sought psychiatric treatment (pp. 238-239). He said this is typical
of "prejudicial policies of not admitting or readmitting
students
who have had or are undergoing psychotherapy" (p. 239).
An airline pilot told
me he was grounded for seven months
by the Federal Aviation Administration because he revealed he
had
been seeing a psychiatrist (for so-called outpatient psychotherapy)
on the medical history questionnaire he was required to fill out
as
part of his routine periodic medical examinations required of
airline pilots and which involved criminal penalties (a fine of
up
to $10,000 and/or up to five years imprisonment) for concealing
the
requested information. He told me he enjoyed seeing the
psychia-
trist but that the hassle which resulted from his doing so, because
of the questions it created about his job qualifications, out-
weighed whatever benefit came from seeing the psychiatrist. He
said that all factors considered, "It wasn't worth it."
When
taking physical examinations, pilots in the United States are
required to "List all visits in the last three years to a
physician, physician assistant, nurse practitioner, psychologist,
clinical social worker, or substance abuse specialist for
treat-
ment, evaluation, or counseling. Give date, name, address,
and
type of health professional consulted, and briefly state reason
for
consultation. ... Routine dental, eye, and FAA periodic
medical
examinations may be excluded" (FAA Form 8500-8, italics added).
This suggests that, contrary to what some people think, anyone
con-
sulting a psychologist or clinical social worker is considered
suspect. That is, stigma attaches to anyone consulting not
only
psychiatrists, but also psychologists or social workers. Routine
dental or eye examinations involve no stigma or suspicion of
disqualification and therefore are not required to be reported.
The 1988 Democratic Party Presidential
nominee,
Massachusetts Governor Michael Dukakis, in the words of Newsweek,
"was accused of having received psychiatric treatment"
("The High
Velocity Rumor Mill", Newsweek, August 15, 1988, p.
22. See also,
Andrew Rosenthal, "Dukakis Releases Medical Details To Stop
Rumors
on Mental Health", The New York Times, August 4, 1988,
p. 1). The
accusations proved to be false, but the impression given by the
news reports about this story is that Dukakis' presidential
campaign would have been doomed by this one fact alone if the
claim
he had ever consulted a psychiatrist or psychologist had proven
to
be true. In 1972 U.S. Senator Thomas Eagleton was nominated
for
Vice-President of the United States at the Democratic National
Convention but subsequently was removed from the ticket by the
Democratic National Committee when it became known he had undergone
psychiatric treatment, including hospitalization and electric
shock
treatment.
Bruce Ennis, an ACLU
attorney who has represented people
deprived of employment because of psychiatric stigma, argues that
"In the job market, it is better to be an ex-convict than
an ex-
mental patient." He says "very few employers will
knowingly hire
an ex-mental patient." He points out that "Almost
all public
employers and most large companies ask job applicants if they
have
ever been hospitalized for mental illness" and that "If
the answer
is yes, the applicant will almost certainly not get the job".
Mr.
Ennis also points out that "if the applicant lies and says
no, he
runs the risk of eventual discovery". On this basis
Mr. Ennis
argues that "It is time for psychiatrists and judges to face
the
brutal facts. When they commit a person to a mental hospital,
they
are taking away not only his liberty, but also any chance he might
have for a decent life in the future." On the basis
of his expe-
rience as an attorney for people saddled with psychiatric stigma
he
observes that "Even voluntary hospitalization creates so
many prob-
lems and closes so many doors that an old joke takes on new truth
-
a person has to be crazy to sign himself into a mental hospital"
(Bruce J. Ennis, Prisoners of Psychiatry: Mental Patients,
Psychiatrists, and the Law, Harcourt Brace Jovanovich, 1972,
pp.
143-144). Mr. Ennis wrote those remarks in 1972, but if
anyone is
inclined to think psychiatric stigma substantially diminished
during the 1970s and 1980s, consider once again the reaction of
the
press and public in 1988 to the apparently false allegation that
presidential candidate Governor Michael Dukakis had previously
consulted a psychiatrist. That it should be such a headline
grabbing issue shows how stigmatizing is any experience as a
psychiatric "patient". This public reaction is
particularly
noteworthy in light of the fact that Governor Dukakis was accused
only of consulting a psychiatrist in his office, not psychiatric
hospitalization.
The presumption of unreliability,
untrustworthiness, and
emotional instability which flows from having ever sought psychi-
atric or psychological "therapy" doesn't haunt only
people with
responsibilities like doctors, lawyers, airline pilots, and
Presidential/Vice-Presidential candidates: In his book, Prisoners
of Psychiatry, ACLU attorney Bruce Ennis reports many cases
of
people who have been denied taxi driver licenses because of past
psychiatric treatment even though "Most of them had never
been
hospitalized" and had never done anything to suggest they
were
dangerous (p. 160).
In a book she wrote,
Eileen Walkenstein, M.D., a psychia-
trist, says "A psychiatric diagnosis is like a jail sentence,
a
permanent mark on your record that follows you wherever you go"
(Don't Shrink To Fit! A Confrontation with Dehumanization in
Psychiatry and Psychology, Grove Press, 1975, p. 22). If you
con-
sult a mental health professional, you will probably get some
kind
of "diagnosis". In at least some states, professional
licensing
laws require mental health professionals, including psychologists,
to keep a written record of "diagnosis" and "treatment".
In 1992, Commenting
on the Americans with Disabilities
Act (ADA), Peter Manheimer, chairperson of the Commission for
the
Advancement of the Physically Handicapped, said "It is most
appropriate that the ADA protects recovering drug addicts,
alcoholics, persons with AIDS, and persons who have mental
and
psychological disabilities, as they form the most misunderstood
and
feared portion of the disability community. They suffer
the
greatest discrimination" (Peter Manheimer, "Reporting
on persons
with disabilities", letter to the editor, Miami Herald,
July 24,
1992, p. 16A - italics added).
And "a study by
the National Institute of Mental Health
in 1993 found that even ex-convicts rank above former mental
patients in social acceptance" (Chi Chi Sileo, "Rip-offs
Depress
Mental Health Care", Insight magazine, January 24,
1994, p. 14.)
This article quotes a psychiatric hospital patient saying "The
stigma is incredible...Forget telling an employer! Sometimes
they
find out anyway, and all of a sudden you're unfit to work there"
(ibid). In his autobiography, Kenneth Donaldson said after
he had
been committed to a psychiatric hospital, people "accepted
a
psychiatric diagnosis which forever rent the fabric of my life.
Thereafter, not only society at large but members of my family
would not see Ken the son and father and friend, but Ken the mental
patient. From this would flow unimagined misery, a fog which
would
envelop all our lives. And our situation would be, of course,
representative of millions. The fog would seep into my employment,
my relations with doctors, my access to lawyers and the courts.
Every enterprise in which I would engage would be poisoned by
the
label. It haunted me and frightened others" (Insanity
Inside Out,
Crown Pub., 1976, p. 321).
In his book The Powers
of Psychiatry, Emory University
professor Jonas Robitscher, J.D., M.D., said: "Psychiatrists
have
been so criticized for the errors or vagueness in their labeling
procedures because the label produces a new disability, which
often
remains as a burden long after the symptoms that led to the label
have departed. ... A study of the attitudes in a small
town indi-
cates that fellow townspeople reject other members of the community
in a direct relationship to the professionalization and specializa-
tion of the source of help, with the least rejection when help
is
sought from a clergyman, increasing percentages of rejection for
those seeking psychiatric help from physicians and psychiatrists,
and the most rejection for those who get mental hospital help.
A
study of work supervisors shows that the knowledge that an employee
is seeing a psychiatrist would be likely to rule out a promotion
even if the employee is doing good work...The harm and potential
harm done to mental patients and former mental patients is not
only
confined to those who have had serious illnesses, those who have
been hospitalized or who have had to interrupt careers or
schooling. Psychiatrists know that many people who consult
them as
outpatients are much less 'sick' than many or most of the general
population. If these people had decided not to be patients
but
instead to be clients or parishioners and had taken their problems
to a social worker, a pastoral counselor, or a faith healer, they
would have incurred no stigma. ... The ubiquitous
questionnaires
that ask, 'Have you ever consulted a physician for a physical
or
emotional or mental condition?' do not take account of those who
should have and haven't, or those who are able to answer no because
they have taken their problems to an encounter group, a
sensitivity-training session, an est seminar, or a consciousness-
raising group, and so have escaped the discriminatory effect of
seeking help" (pp. 230, 232, 233).
The difficulty
of getting a health insurance policy after
having sought psychiatric or psychological "therapy"
or even
marriage counselling was mentioned in the August 1990 issue of
Con-
sumer Reports in an article titled "The Crisis in Health
Insur-
ance": "Virtually no commercial carriers and only a
handful of Blue
Cross and Blue Shield plans will sell policies to anyone who has
had heart disease, internal cancer, diabetes, strokes, adrenal
disorders, epilepsy, or ulcerative colitis. Treatment
for alcohol
and substance abuse, depression, or even visits to a marriage
counselor can also mean a rejection. If you have less
serious
conditions, you may get coverage, but on unfavorable terms"
(p. 540
-italics added).
The stigma involved
in obtaining psychiatric "therapy"
was discussed in an article by columnist Darrell Sifford titled
"Should You Lie About Psychiatric Care?" appearing in
The Charlotte
Observer (Charlotte, N.C.) on June 10, 1990. A mother
wrote to Mr.
Sifford asking whether her teenage son, who was about to apply
for
admission to college, should answer truthfully the questions about
psychiatric treatment, which he had had at the age of 15. She
wrote: "Many of these [college application] forms request
infor-
mation regarding any psychiatric treatment. And once he
is out in
the real world, most job application forms ask for the same infor-
mation ... Have we [by insisting he get psychiatric care]
doomed
him to a future of lying on application forms for fear of losing
the position or college being applied for? What should we
do?"
The newspaper columnist realized the woman's question is what
he
called "a serious question. Very Serious." He
shared the woman's
letter with Paul Fink, immediate past president of the American
Psychiatric Association. This was Dr. Fink's advice: "I
would tell
them to lie on the forms ... The stigma is there, and to deny
it
and sacrifice yourself by telling the truth makes no sense. ...
With the public at large I work to decrease stigma, but with
individual patients I impress on them how widespread and deeply
rooted the stigma is. ... If two people who are equal in
creden-
tials apply for a job and one has had psychiatric treatment, that
person will be discriminated against, and he'll be the loser in
the
competition for the job. ... Even if the person with
treatment
had better credentials, he most likely still would lose out to
the
other person. That's how deeply rooted the stigma is. ...
I will
not encourage anybody to acknowledge that they had treatment"
(p.
4E).
Do you want to
go through life with this kind of secret?
How do you feel about lying on applications for the rest of your
life? If it is your rebellious adolescent or troubled spouse
for
whom you're considering psychiatric "treatment", ask
yourself this
question: Do you really hate your rebellious teenager or spouse
enough to impose this kind of problem on him or her? Is
it really
the right thing to do? The problems motivating you to impose
so-
called therapy on a member of your family are probably temporary,
but psychiatric stigma is forever.
The Americans
with Disabilities Act (ADA), is unlikely to
help much, despite its aim of eliminating discrimination in employ-
ment against people with disabilities, including alleged psychiat-
ric disabilities. As Jonas Robitscher, J.D., M.D., said
in his
book The Powers of Psychiatry prior to the enactment of
the ADA:
"The disclosure that one is or has been mentally ill can
lead to
rejection, and other reasons for the rejection can always be found.
... Forcing private employers to hire the disabled would
raise
issues of invasion of privacy and problems of enforcement.
Stigmatization will continue to be a problem, and discrimination
will continue to exist" (p. 241-242). In areas covered
by the ADA,
availing oneself of its protection will probably require large
amounts of time spent in litigation and a lot of money paid in
lawyer's fees, with uncertain results.
And there are
many areas of stigmatization and dis-
crimination the ADA and other laws don't cover. One example
is
colleges and universities that do not receive federal funds.
Another is the effect of psychiatric stigma on personal relation-
ships: Keeping secrets conceals parts of who you are and prevents
emotional intimacy of the sort most people want with friends and
especially with one's spouse; but sharing this secret leaves
you
open to blackmail or similar kinds of pressure. Concealing
psychiatric "treatment" from an employer (as is often
necessary to
get a job) but revealing it to one's spouse or a friend gives
the
spouse or friend knowledge that can be used against you if your
relationship turns sour. Should you be put in a position
where you
must lie to your spouse or a friend to keep secret your history
of
so-called psychiatric or psychological "therapy" (e.g.,
if he or
she should ask), you introduce deception into a relationship where
probably you wish you could be honest and sincere. Even
if you
don't tell your spouse or someone you are thinking about marrying,
divorce now occurs in close to a majority of marriages,
and in a divorce -
especially if you get into a dispute over child custody or even
visitation rights - your spouse's attorney will probably ask you,
under oath when you are subject to the penalties of perjury, if
you
have ever had psychiatric or psychotherapeutic "treatment"
-
perhaps confronting you with the choice of committing perjury
or
jeopardizing your employment by telling the truth. Whether
you
admit having had psychiatric or psychological "therapy"
or it is
discovered some other way, the resulting stigma may result in
losing your children in a custody battle, and threats to reveal
it
to your employer may be used to pressure you to agree to property
division or alimony (or lack of it) or an amount of child support
that is not appropriate. You may have to consider these
problems
when contemplating the wisdom of getting married or divorced -
problems you could have avoided by simply avoiding having received
"therapy". You are likely to face a similar dilemma
if you are
ever called for jury duty, since during the jury selection phase
of
the trial potential jurors are often asked, under oath, if they
have ever had psychiatric "treatment". Another
time you will
probably be asked about past psychiatric "treatment"
is if your
job requires you to get a security clearance or bonding.
If the so-called
therapy helped enough, it might be worth
the problems created by the stigma of having had psychiatric or
psychological "help". However, the benefit assumed
to come from
psychiatric and psychological "therapy" (itself a questionable
assumption) is vastly outweighed by the stigma that comes from
receiving it. The stigma that results from seeing psychiatrists,
psychologists, or psychiatric social workers is a strong argument
in favor of instead consulting friends, family, or nonprofessional
counselors whose expertise comes from life rather than from
"professional" training, or simply working at solving
your problems
yourself.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has
included representing psychiatric "patients". His
pamphlets are
not copyrighted. You are invited to make copies for distribution
to those who you think will benefit.