Monday, July 22, 2019

Strategy to Reduce Stigma For Lawyers' Mental Health Issues (Without Needlessly Exacerbating Other Types of Stigma)

Unfortunately, stigma is a major issue when it comes to mental health. Moreover, for anyone who has lived on the margins of what society or the profession deems "normal," stigma may very well be a serious problem with or without a mental health issue.

In the effort to encourage lawyers to get help for their mental health issues, it's therefore not uncommon for the mental-health-related stigma to be addressed and the feared associations with other types of stigma to be disclaimed. This type of message often sounds something like: "Being X doesn't mean that you are A, B, or C" (where X is the mental health issue in question and A,B,C are other attributes that may be even more heavily stigmatized).

Less directly, this kind of message can also be invoked to disassociate sufferers of X from other more stereotypical sufferers of X to whom greater stigma may apply: "Just because you're X doesn't mean that you are the version of X that has attributes A,B, C." Often this message is even less direct in the sense of being invoked simply to make the important point that X can happen to anyone not just those to whom you would expect it to happen (such as A,B,C).

I don't see any issue with the most basic form of this type of message (being X need not mean A,B,C)  provided that great care is taken to ensure that the stigma for A,B,C is not invoked and potentially exacerbated as a means of making potential sufferers of X feel better. Given the stigma that exists for so many different types of conditions and characteristics, I don't feel that there is anything wrong with giving those who may suffer from a potentially stigmatizing condition the tools to narrow what their potential health issue may or may not mean so as to limit the stigma with which they may need to cope. But my view is that in doing so we need to be extremely cautious about not inflaming the stigma in relation to other characteristics and conditions to reach the target audience.

This is important not only to avoid exacerbating stigma for A,B,C who don't suffer X, but also for those who have the characteristics of both A,B,C, and X. It isn't okay in my view to try to reach some sufferers of X at the expense of increased stigma for A,B,C, whether they suffer X or not.

Some examples of what I have in mind are:
  • "Having depression doesn't mean you are one of those people who had a bad life, or came from the margins of society. It can even happen to wealthy powerful white men who have great jobs and loving families..."(a perfectly fine and important message in and of itself, but not if (1) the tone and content in any way suggests, even if only inadvertently, that it is not also okay to be someone who had a troubled life or has been marginalized, who may or may not also have depression, and (2) if such people are not also included in the outreach and discourse);
  • "Trauma is something that happened to you, not something wrong with you" (a totally important and okay message, but not if it in any way suggests that those who have mental health conditions that don't originate in something that happened to them, either with or without a history of trauma, are somehow to be stigmatized or disregarded);
  • Being affected by vicarious trauma as a lawyer is completely normal. It can happen to people who started out healthy, not just those people who were already mentally ill, broken, or damaged (a very fine message, provided that it in no way discounts, excludes or suggests that it isn't okay to be someone with preexisting vulnerabilities who also may or may not suffer the effects of vicarious trauma).
In a world where there is so much stigma attached to anyone who doesn't conform to the dominant ideal of what it means to be normal and accepted (e.g., strong, healthy, white, male, wealthy, heterosexual, raised in a typical nuclear family, etc.), navigating stigma is complicated and potentially dangerous. I offer no answers except to say that we need to be steadfastly cautious in thinking about our messaging and the impact that it may have not only on our target audience, but also on others who may be reached and potentially harmed and excluded by our message (or who may be equally in need of being reached, but may fail to be reached due to gaps and flaws in the messaging). This means listening carefully to different voices and perspectives with great humility and care. It also means constantly practicing the art of wondering who else might be affected by what we say and do even if we don't happen to be in a position to hear those voices without actively seeking them out (and perhaps improving the conditions of our discourse so they have greater opportunities to comfortably share their views with us).

So without providing any answers, what am I suggesting? Ideally, in my view, whenever possible, the types of stigma that may be at play with respect to a given mental health issue should be addressed simultaneously. For instance, if the circumstances warrant pointing out that X doesn't necessarily involve A,B,C, then we need to be very clear throughout our messaging that even in those instances where X does involve A,B,C, or where A,B,C, exist independently of X, there is no shame, and we need to proactively address the stigma that may be involved in those situations too.  Also, we should ensure that we provide a balanced discourse that includes non-ABC voices along with ABC-voices to reduce the stigma for all and minimize the risk of decreasing stigma for one target group at the expense of exacerbating it for others. Perhaps it could go something like this (with the caveat that I'm not a mental health professional so I provide these examples more for a suggestion of how to structure the discussion. Please don't take anything I say below as an actual reflection of the substance of how we should address the mental health issues in question. I'm likely oversimplifying and getting it wrong in some ways):
  • Depression can happen to anyone. It can happen to people who have faced serious challenges and setbacks in life, or it can happen to people who seem to have everything going for them. Either way, there is absolutely no shame in it. To demonstrate this, here are some varied examples of people who have experienced depression sharing their stories.  We commit to research and address all the varied ways in which lawyers from different backgrounds can experience depression and the particular ways in which we can best support their recovery, depending on their individual histories and circumstances.
  • Vicarious trauma can affect anyone: e.g., those who have a personal history of trauma, and those who have never personally suffered a traumatic event themselves; those who may have had other preexisting vulnerabilities (such as a mental health condition) and those who did not. Either way, there is no shame. To demonstrate this, here are some varied examples of people who have suffered from vicarious trauma sharing their stories. We commit to research and address all the varied ways in which lawyers from different backgrounds can experience vicarious trauma and the particular ways in which we can best support their recovery, depending on their individual histories and circumstances.
Finally, I would like to offer one further thought. In my view, not only should we aim to make our discourse and outreach inclusive in this way, we should also strive to make it transformative. Let's take every opportunity to not only tell people that being mentally ill doesn't mean they are especially weak or vulnerable, but also to unseat and challenge the narratives that assume that there is something inherently wrong with fragility and vulnerability. At the same time as we demonstrate how facing a mental health challenge can involve great strength and courage, let's also take the opportunity to examine whether it is really necessary to devalue the vulnerability and fearfulness that are undeniably a part of our shared human experience....

As always, please note that I am a lawyer, not a mental health professional of any kind. I have no expertise in trauma or mental health. Also, please note that any opinions and views expressed in this blog are solely my own and are not intended to represent the views or opinions of my employer in any way. For more information about the purpose of this blog, please see here and for a bit more information about my personal perspective on this issue, please see "my story" here

I am very grateful to have received a "Clawbie" Award for this blog (which reflects the importance of this topic): https://www.clawbies.ca/2019-clawbies-canadian-law-blog-awards/

For some of my external writing on this topic, see:  


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