Replace Stigma with Affirming Attitudes

The public must endorse recovery and empowerment.

Posted Jan 10, 2019

Erasing the prejudice and discrimination of mental illness is not sufficient.  They need to be replaced with affirming attitudes and behaviors.  Soon after Lyndon Johnson passed the Voting Rights Act meant to weaken American racism in 1964, he said, “You do not wipe away the scars of centuries by saying: Now you are free to go where you want, and do as you desire, and choose the leaders you please.”  Civil rights only is achieved by promoting affirmative action.  Affirming attitudes include ideas of recovery and self-determination.  We know anti-stigma efforts are successful when the public endorses processes of recovery: that the human story, even for those with the most serious of mental illnesses, is one of hope and achievement.  Regardless of symptoms and disabilities, everyone is capable of aspirations in vocation, independent living, and relationships--goals that can be attained with appropriate support.  Anti-stigma agenda are also impactful when the public recognizes the primacy of self-determination; that people with mental illness can and should decide for themselves personal goals and ways to achieve these goals.

Picture from Wikimedia Commons
Lyndon Johnson meeting with Martin Luther King, Jr after signing the Voting Rights Act.
Source: Picture from Wikimedia Commons

Attitudes, of course, are never enough.  Anti-stigma effort also demands affirming behavior.  Title I of the Americans with Disabilities Act (ADA) is a powerful example.  The ADA requires employers to provide reasonable accommodations to employees with disabilities.  Reasonable accommodations are modifications in setting and operations in which work gets done so people with disabilities can complete their jobs competently.  Examples are familiar to most readers like changes in a physical setting so people using wheelchairs can navigate the work environment.  Reasonable accommodations extend beyond the workplace to provide accessibility and utility of most public places.  Hence, people with physical disabilities expect public facilities to be fully available to them.

The stigma of mental illness is erased when reasonable accommodations become widespread for those with psychiatric disabilities.  This has by no means been easy.  George H.W. Bush signed the ADA to much acclaim from the disability community in 1990.  It was in place for more than five years before the government asserted its relevance for those with psychiatric disability. The Equal Employment Opportunity Commission released an executive order stating that the ADA does apply to those with psychiatric disorder and directing government agencies to act accordingly.  Despite this directive, reasonable accommodations for psychiatric disability have been slow to arrive perhaps because of intrinsic differences between physical and mental health disabilities.  Most physical disabilities are obvious as are accommodations such as bigger elevators and doors for wheelchair access.  Accommodations for psychiatric disabilities are harder to perceive.  Perhaps first among accommodations are support specialists for people wanting them.  These are job coaches who accompany people with psychiatric disabilities to work each day, helping them plan their daily tasks.  Housing coaches meet people at their home regularly to address practical chores of daily living.  Stigma has been trumped when these accommodations are provided freely within one’s community. 

Affirmative behaviors and reasonable accommodations are not charity; they are the rightful expectations of people with disabilities.  The Civil Rights Act was passed in 1964 to make sure people of color have the same chance as the white majority.  The ADA provides similar assurances.  It is absurd to argue that affirmative behaviors provide unfair advantage to the person with disabilities.  Reasonable accommodations level the playing field.  Accommodations are not unlimited.  The ADA specifies caps to reasonable accommodations, including requests that cause “undue hardship” on employers and their business.  Many 9-to-5 offices, for example, might find it difficult for workers to come in at midnight to do their work.  However, experience suggests the ADA and reasonable accommodations are not viewed as intrusive or demanding by most employers.  Bosses want their workers to be successful, in part, because employers are reasonable human beings, and in part because accommodations are wise policy.  Businesses fail when they terminate and then need to train a new batch of employees.

Anti-stigma messages need to include pro-recovery statements.  People with mental illness should be hopeful because goals can be attained, especially with the help of reasonable accommodations.