Inclusion involves sharing the experience and it involves interaction and communication.

In battling with exclusion and discrimination, I think it is important to recognize the historical nature and scale of exclusion. Much of the language and imagery which intertwines with mental illness has its roots in the idea of demonic possession or evil spirits. Some of this still lingers today in public perceptions and therefore public policy. Various cultures and groups depend on folk beliefs for knowledge of mental illness which is also reflected in core beliefs. If an individual cannot understand mental illness they cannot understand an individual with it. To me inclusion involves sharing the experience and it involves interaction and communication.

Although 1 in 5 may experience a mental illness in their lifetime a large portion of society will never feel or experience mental illness personally. It is overlooked or not imagined that illness is part of the human experience. Even the strong and healthy eventually succumb to the ravages of time. Instead of “that can never be me” it needs to be recognized that “it could be me” and “will be me”. I’m not sure how you enforce empathy but to me it is the basis of inclusion. To recognize difference is easy but to acknowledge similarities takes mindful work and it is a process.

It becomes difficult to include when exclusion is a means of psychological safety. People are prone to disengage and disavow what is a threatening possibility in themselves. Exclusion is a deep rooted and timeless function of individuals and societies. Incarceration and hospitalization can and have been forms of exclusion for those who are different, disturbing or difficult. Individuals with mental health difficulties are often unable or unwilling to conform due to symptoms. Unfortunately, it is the still suffering and or untreated by which those who are identified or self-identify are measured. The gifts and unique attributes individuals with mental illness posses are sometimes lost in the telling of only part of the story. More people are aware that Vincent van Gogh cut his ear off than have browsed his significant contribution to the world of art.

If I mention to someone with no experience outside of myth and movies that I have bi-polar disorder, often I am measured and treated as the imagery that occupies the observers mind. With mental illness a point in time or episode of illness seems to define the individual. Gifts or skills take a back seat in identity and dignity is undermined by the perception that a person is an illness. Mental illness is often viewed as a permanent flaw and shrouded in risk. On a personal level it is easier and safer to discount or devalue these individuals than it is to accept or foster diversity. The consequences then become systemic and societal.

“I simply represented a normal part of diversity in the spectrum of differentness in our community.”  Norman Kunc (The Other Side of Therapy: Disability, Normalcy and the Tyranny of Rehabilitation)

Follow the white rabbit.

We sold our chicken coop not long ago. My wife mentioned that the yard looks better without it. I told her it was a painful reminder of my recent mania and psychosis. She said to look at it more positively. “Not many in London have experienced poultry as you have.”

For some reason London doesn’t allow backyard birds. I was certifiably certain the bylaw was about to change when I purchased my birds. In my mania I ended up with five ducks and ten chickens. That’s a slight exaggeration as one of the chickens was actually a rooster. In hindsight I think he was my undoing.

The first month I thought I had lucked out and had a rooster without the ability to crow. It was a delusion. He was however the most beautiful bird I have ever owned. When I picked him up from another Londoner and brought him home I opened the cardboard box and he flew straight to the top of our aluminum shed. My first thought was how to get him down in broad daylight but then, I just watched him.

We had sod in our backyard before all this but with rains my free range flock quickly turned the backyard into a mud-hole. It was too muddy for the chickens and soon they were living on our elevated deck in full view of the neighbourhood. The bylaw enforcement officer seemed quite intrigued with the five that were Jersey Giants but less so than the rooster.

I was warned several times but my seven white rabbits were basically feral at that point. My neighbours don’t speak to me but I cant wait to ask them if they thought they had lost their minds when they kept seeing white rabbits. I found the rabbits a home about 80 bucks too late but I can still hear flapping wings and the knock of a meat cleaver my buddy used to dispatch the ducks. I didn’t see it but I think the effect was about the same.

Now our food scraps go in the garbage and I have no fresh eggs to share but I did not surrender. I now have three Eastern Cottontail rabbits to eat the complaining neighbour’s rosebush. I also own several Canada Geese, at least four Mallard Ducks, a pair of pigeons, about a dozen Morning Doves, some swallows, half a dozen Goldfinches and flocks of Starlings and sparrows. We live in a new subdivision and there are two huge mud puddles right across the street. I walk over there once a week and spread cracked corn. Location, location, location.

 

With fewer options when it comes to interpersonal relationships the individual in recovery is prone to prodding the past in an attempt to reclaim valued social roles.  It is understandable that individuals with mental illness and or addictions attempt to return to some state of Eden; a time of better health or perceived ‘normalcy’.

Social exclusion can be a factor in the reoccurrence of addictive behaviours and or a recurrence of mental health symptoms. Substances provide an escape from feelings of worthlessness and the effects of marginalization. Addictions are at times a form of self-medicating but even when medications hold symptoms at bay, stigma and self-stigma can be obliterated temporarily through substances.

Reclaiming valued social roles is sometimes not an option for those with concurrent disorders. Creating a self-directed positive self-identity then becomes more challenging and precarious. In the recovery process, friendships, acquaintances and communities may need to be abandoned to maintain sobriety and incorporate a healthy lifestyle. This can be problematic in that it initially deepens social isolation. These instances can lead to a further withdrawal from social contact which creates challenges regarding self-image, self-esteem and overall social inclusion. If steps towards ‘social recovery’ lead to a reduction of symptoms, it is imperative for individuals who are susceptible to addiction to find meaningful relationships and supportive friendships.

With fewer options when it comes to interpersonal relationships the individual in recovery is prone to prodding the past in an attempt to reclaim valued social roles.  It is understandable that individuals with mental illness and or addictions attempt to return to some state of Eden; a time of better health or perceived ‘normalcy’. Unfortunately some of the individuals rooted in these times and places offer little more than an outdated and unhealthy identity that precede the more serious or institutional aspects of mental health difficulties. By associating with old ‘friends’ individuals are able to return to memories and unearth altered and destroyed status. Individuals can vicariously reclaim or re-experience a social identity by entering the illusion of  “I’m still that guy” or in being “one of the boys.” Addictions are often hidden within this short term and illusory construct.

For individuals with addictions, interpersonal relationships can be manipulations. Some addicts use not just substances but anyone they can to procure a ‘fix’. Those with mental health challenges or disabilities are susceptible to manipulation and may be eager to form relationships without much insight into the validity or health of those relationships. Relationships that occur through acting out addictions are a substitute or mirage of meaningful relationships. When dealers or other users accept you or you are known to them, it can be an affirmation of self. It can be a community albeit with a crumbling and precarious foundation. Standing outside these relationships we can see it is a temporary solution which exacerbates mental health and overall health but addiction by nature often renders the individual incapable of viewing themselves objectively. 

The capacity to create healthier relationships or return to mainstream existence is undermined by the ‘bliss’ experienced in altered states. Remedies and interventions often are weak alternatives to the experience of being ‘high’. It is a costly and temporary ‘bliss’ but it can be obtained with no skills, little effort and with proven or expected outcomes. What can be purchased ‘on a street corner’ is convenient, immediate and it does not require an appointment, an agency or a therapist. Substances provide temporary relief and comfort without real community. 

In Canadian culture to drink is an indoctrination into adulthood which lessens feelings of being treated as a child in healthcare. It can also be an expression of masculinity and a symbol of or celebration of hard work. For someone with a concurrent disorder it can be like jumping into a family photograph without being a relation. Essentially the individual can be more and feel less.

“having no social capital or economic power relegates valuable and dynamic individuals to situations and communities where…”

For those living with serious and persistent mental illness, interpersonal relationships can be fragile at best. The reoccurrence of symptoms can undermine if not destroy what is already precarious. Occupation, relationships, healthy activities and even housing can be disrupted. The energy expended in rebuilding the basic elements of existence leaves little in the way of motivation or resources to devote to self-directed social inclusion and patients can become dependent on formal interventions and services which can highlight and perpetuate powerlessness and the perception of such. 

Feelings of worthlessness and exclusion are in a way simply a mirror of how society inadvertently and outwardly segregates mental illness and addictions. Having more than one alternative available for social inclusion becomes difficult when finances and housing are barriers themselves. Safe and affordable housing is one key to ensure that individuals with mental health difficulties are able to invest in communities outside of the ‘psychiatric community’. New hospitals are designed to be healthy and beautiful spaces but community housing here in Canada often falls far short. If community planners could incorporate housing that is integrated, affordable, safe and healthy, patients would have more opportunities to develop relationships within social mainstream and the effects of stigma and stigma itself would be lessened. Supportive housing can become or simply is ‘stigmatized housing’.

Mental health patients form relationships among themselves because of common experiences but economic similarities are also predominant in determining social mobility. This can be an effect of stigma but it also perpetuates stigma as individuals with serious and persistent mental health difficulties are inadvertently quarantined from spaces and situations where the general population could witness their humanity and gifts. 

Economic factors often impede recovery, social inclusion and the formation of a positive identity. The financial limitations that a disability income imposes leaves fewer options and opportunities for experimenting with interests or forming friendships outside of the ‘psychiatric community’. Individuals are often relegated to housing and facilities in areas which are substandard and exacerbate mental health difficulties. Individuals are at times forced to navigate neighbourhoods where addiction, crime and violence are more prevalent. Gentrification often disposes and quarantines this vulnerable segment of the population. 

A disability income can become a barrier. It can be a safety net when illness is predominant but in times of equilibrium and remission it can undermine self-determination and it accentuates weaknesses. A disability income tethers a persons identity to that disability. In a culture where identity is synonymous with what employs a person, to answer with ‘I have a disability’ is a mantra of defect, defeat and disgrace. In social situations where a person might find connection, having no social capital or economic power relegates valuable and dynamic individuals to situations and communities where this is not a concern or it is accepted if not expected. Economics can be exclusionary and gaining independence is complicated by being a dependent.

Workplace exclusion is basically societal exclusion. Without gainful employment the ability to contribute financially to self-care and opportunities of community, social inclusion or interpersonal relationships is undermined. This form of societal exclusion also undermines an individuals ability to contribute financially to society and fractures a sense of belonging or contributing. Financial restrictions lead to a dependence on traditional healthcare services and furthers a dependence on these social supports and the community offered there. Limited employment opportunities and or dependence on social services limits an individuals exposure to healthcare workers outside of psychiatry; for example a massage therapist or a yoga teacher. Being able to contribute financially enhances self-efficacy, self-esteem, self-determination and social status which in turn enhance wellbeing and leads to the confidence required for social activity.

Disability support can become a ‘sentence’ as much as a service. Opportunities for self-improvement, social integration, social mobility and even relationship status become limited and can lead to a further withdrawal from activities and excursions into mainstream culture. ‘Money can’t buy happiness’ but by confining individuals with mental health difficulties and or addictions to the poverty line; self-determination, social status, self-efficacy and self-esteem stagnate. The seriousness of these factors is that they perpetuate and exacerbate underlying difficulties which is costly socially and economically for all citizens.

The Non’cents’ of Police Mental Health Strategies

When I first became involved in the Ontario Provincial Police Mental Health Strategy I was a well written mascot for individuals who come into contact with the criminal justice system as a result of mental health difficulties. After pouring my heart and story into a gathering of Ontario Provincial Police (O.P.P.) officers, service providers and community stakeholders I was invited to lunch by one of the O.P.P. “brass.”

We ate at Boston Pizza so funds could stay within the “ranks.” I asked this individual why don’t the O.P.P. have specialized officers like they have officers who are trained in S.W.A.T.? “It would de-escalate the situation if an officer entered the situation with “N.U.R.S.E.” written on their bulletproof vest, I said. No, we want healthcare agencies and community stakeholders to step up he retorted. They are better equipped and we are a police agency, healthcare is not our mandate. This all made “cents” and my only other question was if there was a statute of limitations on perjury. He seemed to prickle at the question. Possibly he thought I was asking for myself but answered, No, but it’s not something we normally pursue.

I made the 8 hour round trip to O.P.P. Headquarters in Orilla a few times so people being paid could bounce acronyms off my brain and to be traumatized by uniforms, locked doors and training scenarios where I could imagine myself and people I have met over the years shot to death. The main take away for me was to make sure I keep at least a distance of 21 feet from armed officers as anything less becomes licence to kill.

About a year later I had a couple meetings at the London O.P.P. Detachment and the plan was for me to travel across the province except for Thunder Bay to different detachments to help promote the Ontario Provincial Police Mental Health Strategy. I was starting to go “off script” and received one last phone call.

I was told how the O.P.P. was now visiting mental health consumers in the community and escorting them to doctor appointments and such to instil in these individuals a sense that two uniformed officers at your front door is a good thing. I asked, “what is the salary of a police officer?” “I’m not sure” was the reply. “Well, I’ll tell you, it’s around $60,000 out of the gate.” “Two mental health workers (without uniforms, guns and specially painted cruisers) is about half that.” “Why not have twice as many mental health workers do the same thing?”

For those who are unfamiliar with the difference between mental health workers and police, only one imagines themselves as such which makes all the difference. 

If the O.P.P. and other police forces in Canada do in fact want better mental health outcomes for citizens either specialize or stand down. Until then, like the individual mentioned after buying me lunch with his constabulary credit card: “We’ll let the Queen pay.”

Taking The Long Way Home (Trigger Warning: Deals With Suicide)

 

I don’t usually talk about suicide. Some people believe if we talk about it we may trigger someone who is vulnerable. I committed suicide once and have made a couple of attempts. Thoughts of suicide have consumed enough of my days to compile into years. It comes in waves and can last for months.

I was counselled to commit suicide twice by my x-wife. Once all my medications were handed to me in a grocery bag. I returned home having not carried out her instructions as it was only months since I had died in the back of an ambulance. I told her “I will not abandon my children.” My medications were then presented to me in a cereal bowl as I was having a cigarette in my garage. I was told it would “be easier this way.” It certainly would have!

By refusing these requests I found myself in over a decade of suffering and segregation, it continues today. I lost my children, my freedom, my home, my possessions, my clothes, my eyeglasses and most of my sanity. My x-wife did not want anything near an equitable divorce and so decided on a divorce by cops. Her lies and those of others culminated in her being the irrevocable beneficiary of my life insurance policy. This was a blessing at times as I clung to this world only to prevent her from further wealth.

My plan for a time was to canoe out a mile or two into Lake Huron and capsize my canoe after wrapping clothesline attached to cement blocks around my body. It was my belief that my x-wife would have to wait several years for me not to be considered a missing person. I also thought this would save my family a degree of grief.

The reason I don’t speak about suicide is that I am susceptible to confinement when I am honest about it. In places I have resided and offices I visit, to feel, think or express that depth of hopelessness is a “clause” to losing your clothes. It would probably be helpful to share my suicidal ideation with therapists but to be a danger to self in a building I have no key for is to risk my freedom and self determination. To be suicidal in an institution for me just means in the moments I am not, I am infantilized if not humiliated.

Sometimes I don’t want to surrender my thoughts of suicide. They are somewhat of a companion and a form of escape. When I am suicidal, I can dream that my anguish will cease. Those moments are horrendous in and of themselves but the surrender portion takes less energy. Sometimes these thoughts come from depression, sometimes they tear at me through psychosis and sometimes they would be your thoughts in the same situation.

I sometimes speak to God in these moments. Recently I begged Him to just take me. I was in bed and weeping. “I can’t take any more” I don’t want to see any more” “There is nothing more I want to do” “Please just take me.” Tears were tracing my temples as I begged to be released from my suffering.  

Maybe God doesn’t show His face because He wants us to see others. Maybe He wants us to serve instead of seek. Maybe He wants us to find our humanity and the humanity of others before we transpire and transpose into something else.

I’m not sure what draws me back from the edge of suicide. I wonder if it is a power outside of myself or some small flicker in myself that I ultimately wish not to extinguish. When the thoughts are milder, I find strength in some part of a song or a faint memory of goodness.  When I need mercy and I’m beyond all I can take, beyond surrender and even beyond defeat, I defer death until morning. Its a bad habit, but it makes breathing easier.

When I surface, I sometimes see my worth. Sometimes I see that I have a purpose. Sometimes I see that it is my brokenness and suffering that are my gift. Sometimes I don’t want people to have to travel for my funeral and leave with nothing but questions. “Why did he give up now?” “Why didn’t I see, say or do?” Sometimes I don’t want to pass my pain onto others. Sometimes I don’t want to leave a mess or be found with shit in my pants. Sometimes I see that to throw away a second chance would probably give some doctor the opportunity to give me a third which would be harder to swallow.

Sometimes I can trace my suicidal thoughts to specific losses or pain. Sometimes I can’t escape the loops of traumatic experiences. Sometimes it is anger or even rage. Sometimes it is shame. Sometimes I simply think too much and feel too much. 

We sometimes judge those who have made attempts or been successful. It is not for us to shame an individual who is incapacitated to the extent of not noticing what is worthwhile or for an inability to find what we might see on the surface.

Usually when I’m suicidal, all I see is the worst in my circumstances, people and the world. It’s like wearing an old raincoat that doesn’t breathe. My perceptions repel that which makes most things thrive and I am drenched by my own manoeuvrings. My efforts and small solutions are basically more discomfort and I am soaked in sorrow.

My wife pisses me off by showing me that unconditional love crap. She cooks and keeps a schedule which makes it hard for me to get worse. In my flight from life I do dumb shit all the time. I use humour, answer requests to speak, grow plants, talk to my dog and therapists with less hair and recently I applied for a distance education course. I won’t hear back for a few more weeks, so bridges will just be bridges until the end of August.

If you can’t be well, be here.

London Joint Mental Health Research Day: Mental Illness Stigma

The following is an excerpt from a keynote panel I participated in with Dr. Heather Stuart on Mental Illness Stigma on June 21, 2018.

I think when we use the word stigma it can be a disservice. It becomes a boogyman for those who find its flavour and it seems a less harmful substance for those who administer it. I was not even familiar with the term stigma in the 1980’s which may be why I prefer the term shame. I think we all experience or have experienced different forms of stigma for various reasons. What makes mental health stigma so dangerous is the uniqueness of the experience. I can identify with psychosis, depression, mania and more but those terms seem trite to the realities of such and the comradery of other forms of stigma do Not exist for me. 

I recently visited an optometrist. The lenses are switched and we are asked “better …or worse?” When healthy I strive to choose that which offers a clearer view. When I am unwell I start choosing the lens that Feels correct. My stigma and stigmatism frustrate but it becomes familiar. I recently asked myself, which is greater; self stigma or societal stigma? The image that came to mind was a terrarium. Societal stigma exists and acts upon the individual but that which fogs the glass most are the processes within.

To me stigma is a veiled judgement but in my sensitivities I can see the hearts and forms as they maneuver to safer spaces. My father and step mother had a sheep farm. Sheep wander to graze but when the border collies are pushing them where the shepherd calls; they follow the same path. The pasture areas were a series of pathways. They lead to the barn, the pond etc. These pathways illustrate two areas of significance. One is mine. My mind has many pathways that lead to points of pain. I see or hear things and I am faced with the very things I seek shelter from. The other relates to stigma. When we are presented with a mentally ill person our minds travel well worn paths.

We also compartmentalize. A sheep farm is often a system of segregation. The ram is sometimes left in a paddock, the male lambs are eventually shipped off. The ewes that have lambed are left in the open area of the barn and orphaned lambs are brought into the farmhouse.

In caring for and processing a sheep herd the farmer uses ear tags with identification numbers to manage genetics and tend to the herd. As sheep are cared for sometimes the tag on the ear is of no use so the farmer uses a big grease pencil to mark the nose or back of the sheep that have been cared for. The mark is a way to keep track of feet trimmed or which ones have been inoculated etc.

Stigma is similar but at times with less planning, purpose and on levels we are not conscious of. The labelling; the branding marks of stigma allow the one or the group using the grease pencil to flee to the pond, the barn or some point of psychological safety. We are sheltered from our fears and we can nourish and replenish our perceptions of self. It allows the mind of the marker to safely segregate and build fences around misconceptions, misunderstandings and the unusual.