Dear Imprudence: Getting It Right! (For Once!)

s.e. smith recently passed on a question from a Dear Prudence column (3rd question down)┬áthat, well, actually gets things right. We were both pretty surprised! The question asked is shockingly similar to my own situation, but I swear I didn’t write in to ask it. The questioner writes:

I work in a social-services-related field and have bipolar disorder. I am open and honest about my diagnosis. … I have been having issues with one of our interns, who is in her mid-20s and pursuing a master’s degree in clinical psychology. On the surface, she is very pleasant. The problem is, anytime she and I disagree about something (which is often, because apparently she knows everything and I know nothing), she rolls her eyes, waves her hand, and declares that I am “just bipolar.” This is alarming to me because she intends to work with such populations, and though I can take it without becoming suicidal, many bipolar people can’t. Part of me wants to simply ignore her, but when I do, she continually asks me, “What’s wrong?” She is probably going to be with us for another year, and I want some peace and a little less condescension when I go to work.

Hey! I have bipolar, and I work in a social-services-related field! The difference is, if I ever encountered anyone who put a hand in my face and dismissed me as “just bipolar,” I would have a written warning in their file before they could even blink. This is not only because I don’t tolerate that kind of flip dismissal, but also because the attitudes of social services staff towards people with mental illness can have an enormous impact on the quality and effectiveness of services delivered to people with mental illness. It is damaging to the agency as a whole to have those attitudes expressed to clients by agency staff and it is an amazing disservice to approach people who need social services with such a dismissive, discriminatory, and oppressive attitude. To her credit, Prudence clearly sees this aspect of the issue:

Since she’s an intern and plans to go into your field, take seriously your duties to guide this obnoxious young person… If she doesn’t stop, or escalates her rude and dismissive behavior, keep your cool and explain to the higher-ups that while “Brittany” may have some promising qualities, she needs some serious attention paid to how she treats others.

This is exactly right. Social service agencies need to ensure that staff do not transmit these attitudes to agency clients. Unforutnately, based on my experience, it is not uncommon to encounter agency staff with these kinds of attitudes, primarily because agencies tend to provide little training or guidance to staff in dealing with clients with mental illness. Staff are then forced to rely on the (mis)information about mental health conditions they’ve accumulated through their lives to shape their opinions and actions, which can often lead to attitudes and behaviors like the one discussed by the questioner.

I’ve found that most people have a vague conception of what depression is and that it could be connected to suicide, but have little conception of how depression can affect a client’s everyday life. This is especially problematic when agency staff expectations for client’s behavior doesn’t account for the effects of their depression. For example, we often need to gather and review a client’s entire medical record to evaluate the merits of a potential disability claim. This can be a very complicated process – submitting medical records requests to every medical provider from which the client has ever received treatment, wrangling with records departments who want to charge exorbitant fees, following up with records departments who ignore, misplace, or deny records requests. Understanding the effects of depression is key for agency staff in how they instruct clients to gather these records, how they respond if or when a client fails to follow through, and the extent of assistance the staffer is willing to provide the client in this task. I’ve found that for a client with depression, an instruction to “gather all your medical records for us to review” can be so overwhelming and intimidating that they are unable to manage the task. Staff are likely to perceive this client as “not really committed to their case” and insufficiently willing to cooperate with the agency in pursuing their goals. This can mean the difference between providing the assistance a client needs to succeed and closing the case because the client “didn’t really want this benefit.”

Beyond depression, there is virtually no understanding of the variety of mental health disorders or the impact they can have on an individual’s functioning and ability to participate in their own advocacy. Schizophrenia and dissociative identity disorder are conflated and often ridiculed. Disorders on the autistic spectrum are not understood at all. Post Traumatic Stress Disorder is often dismissed as an overly sensitive reaction to trauma that “everyone has in their lives.”

This lack of understanding means that staff are completely unable to provide reasonable accommodations to clients with mental health disorders. Which in turn means that clients with mental illness, overall as a group, receive less effective and meaningful services from the agency as a whole. Which means that not only are agency resources more likely to benefit folks without mental health issues, but those expended on clients with mental illness are more likely to be wasted and not “land” effectively because they cannot effectively create the change the client is seeking. So, everybody loses.

The solution is more training, education, support, and guidance for agency staff on understanding these issues and providing effective services to this community. While attitudes like those of the intern in the question are unfortunate and disappointing, some of the blame has to be laid at the foot of the agency itself for failing to provide training, policies, and protocols to ensure staff are educated on these issues and know better. So while Prudie’s recognition that the intern’s attitude is fundamentally unacceptable and must be addressed if she hopes to continue in that area of work, I would go one step further and advise the questioner to push for training and support for all staff at her agency to ensure everyone has the information and tools they need to provide effective services to clients with mental illness.

3 Comments

  1. As another person with bipolar, I cannot even tell you how thrilled I was to see her response. She got it exactly right. I also peeked at the comments and last time I checked, the people who were saying that the LW shouldn’t have told anyone about her bipolar were getting gently (and also not-so-gently) corrected by other commenters.

  2. Thank you for this thoughtful and informative gloss on the Dear Prudence Q&A. As a college teacher, I have found myself in a similar position to the one you describe in dealing with students with mental health issues such as depression, bipolar, and borderline personality. My version of your sentence would be something like:

    “Faculty are likely to perceive this student as ‘not really committed to the assignment/class/program’ and insufficiently willing to cooperate with the professor/dept in pursuing their academic goals.”

    Your post was a useful reminder that I should take advantage of my university’s resources for working with these students effectively.

  3. In my experience working inpatient with a similar (but younger) population, the only people who had any empathy for our kids were the ones who had dealt with similar problems. In essence, that meant two of us: one who was working through depression, and me (autistic, cyclically depressed, anxiety, some ocd, lots of parent issues). The other staff split into three groups: NT and without mental health issues who were sympathetic but misguided (and thought they were being soooooo good to these poor, poor children), NT without mental health issues who were unsympathetic (and thought they were martyrs for working with these terrible brats who just needed a spanking), and the handful of people who had mental health or ND issues of their own. They were people who had been or were depressed, or had ADHD, but they had the sort of attitude that is incredibly damaging: I fixed myself so you can, too, and if you can’t it’s because you’re lazy/weak/stupid/damaged/bad. These people were horrific to work with, because my disinterest in “fixing” myself made me a bad example to the children in their eyes.

    I think it would be enormously beneficial to kids and adults alike if one of their counsellors, therapists, social workers, doctors, etc had dealt with problems like their own, be they developmental, psychological, or physical. There are many great doctors and counsellors (etc) who haven’t, of course, but I think there is a specific sort of empathy one can only achieve if you’ve really BEEN there and dealt with those feelings or experiences. Many of us on the spectrum feel quickly comfortable and relaxed with others on the spectrum–why not employ those of us who would be interested as companions or teacher’s aides (or teachers!) for other adults on the spectrum or in classrooms for kids? A doctor who can be up front about the repercussions of surgery or medication because she has had it done to her would be more reassuring and helpful than not.