Lucy is seventeen. She wears sexy outfits and too much makeup. She has bipolar disorder. Some days she is so with it, I want to send her to Harvard, and some days she can’t tell you her name.
“That’s right, Lucy. Good job. Stigma is a lot like prejudice. It’s a negative belief that exists about a member of a group that is based solely on group membership. Anyone ever have experience with that?” Sometimes, I’m more of a teacher than anything else. When I get into a good discussion, I start kicking my heels against the front of the desk. We are not supposed to be sitting on the desks; it’s another one of the rules about making sure we keep a proper level of separation between “us” and “them.” The longer I’m here, the less I care about this separation.
Everyone raises their hands to indicate they have been stigmatized in the past. Even Richard has his hand up. Devon is the only one who doesn’t respond. I call him out.
“Devon, you see everyone else has their hands up? This has never happened to you?” I’m trying to involve him, not alienate him, but I fear I’ve made the wrong impression. He looks at me and seems to say something.
“I’m sorry, Devon, I can’t hear you from all the way up here. Can you say that one more time?” He responds again, this time unlocking his chin from his neck and seemingly trying to project.
“I’m sorry, still can’t hear you.”
“He says he stays away from people.” Stephan.
“Thank you, Stephan. Sometimes it’s hard to hear. So, Devon, you stay away from people? Is that to avoid being stigmatized?”
He nods.
“It hurts to be the victim of stigma, doesn’t it?”
He nods.
Everyone else nods.
“What kinds of things do you think other people believe about people with mental illnesses? What kind of stigma have you experienced?”
“People say we’re crazy.” As Stephan says this, I start writing the words on the blackboard behind me.
“Lazy. Uneducated. Stupid.” Barry.
“People say we a burden. Like we don’t do nothin’ to help America.” This is Lucy again.
“Dangerous.” I’m surprised at who this is coming from. Adelle is about a hundred years old. She is as frail as they come, and I wouldn’t imagine she experiences the stigma of being dangerously mentally ill. Then I remember that while off her meds, Adelle once stabbed a man in the chest with a pair of scissors.
“Dirty. Disgusting. People don’t want to stand near us. Even we don’t want to stand near each other.” Darryl says this. Darryl is suffering from a traumatic brain injury that resulted from a self-inflicted gunshot wound to the head. He still struggles with major depression, but he swears he will never attempt suicide again. His wife left him after the incident because she couldn’t bear to look at him with the resulting disfigurement.
“Alright, I’ll say it: they say we’re weirdos.” This is Barry making amends. He looks at Devon. “Sorry, man, you don’t need me calling you a weirdo when everyone else already does.”
Devon nods.
“Thank you for that, Barry; that was very nice of you. What else, guys? What are some other stigmas you’ve experienced due to mental illness?” I see Richard looking at Barry, seemingly approving of his apology.
“People think they could catch it from you. Like if they have sex with you, they could get bipolar.” Lucy.
“Does anyone know if that’s true or not?” Me, I’m trying to teach without making the patients feel like they’re in school. I’m looking at Richard, but his head isn’t in the room.
“Nah, you could get AIDS and shit, but you don’t catch crazy.” Barry.
As I’m writing all the words on the board, I’m beginning to feel guilty because I’ve held every single one of these beliefs. I feel simultaneously sad and defensive.
As the group finishes, I wait for everyone to file into the hallway. I am walking around the room putting the chairs back into a semicircle, picking up the garbage left by the patients. As I walk past the chair that Devon squeezed into the corner, I notice little flakes, like paint chips or confetti, scattered at the base of his seat. I brush them onto the floor and keep walking.
I erase the board, making a mental note of all the words written, wondering how often I’ve felt stigmatized. Wondering how many of these things people think about me. Wondering, not for the first time, if I fit a profile.
I’ve given Richard a schedule with weekly one-on-one sessions with me, as well as several group therapy sessions most days of the week. Patients often respond well to structure, and I want to keep him busy while I figure him out. We have our regularly scheduled Tuesday 11:00 a.m. session this morning, and he is shuffling and wiggling and trying to get comfortable in my patient chair. He is too large for my office. He looks like a doll two sizes too big for the dollhouse. He is holding that stack of newspapers under one arm while shifting his weight back and forth in the seat. When he finally finds a comfortable position, he drops his papers onto the corner of my desk and awkwardly bends his elbow on top of them. His left arm bows at a strange angle, and he holds his wrist rigid, so it looks like he has a prosthetic arm.
“So, now that we’re settled, I’m going to try to get going with your file again. Can you give me a few minutes of attention to get this ball rolling?” Hopeful, positive, maybe even energetic.
“What’s this? Another test?” he asks. He doesn’t take off his hat, which pisses me off because I think it would be polite if he did. I realize that the best way to suppress my fear might be to replace it with anger, so I momentarily dwell on being pissed that he is impolite. It’s still the tweed newsboy cap, like the ones R & B groups made popular in the ’90s.
“I’m not doin’ no more paperwork.” His voice is calm, masculine. He isn’t arguing with me, simply stating a fact.
“Any more…” I absentmindedly correct him while sifting through my files and avoiding eye contact.
“Look, I’m here because I chose to be here, and I know that I don’t have to fill out the forms, and I have confidentiality and privacy, and I don’t have to answer any of your questions, and if you want to kick me out then that’s fine. I know my rights. I heard you were the best counselor here and I didn’t think you’d give me trouble like that last dud they put me with.” He shifts farther away from me as he says this. He wrings each hand individually, as if he were wiping something off his thumbs. He is fidgety. He is nervous.
“You don’t have to do anything you don’t want to do. But you’re going to make it harder on yourself if you avoid me. I am the person you’re going to be working with for the duration of your time here. I am here to help you and to make your stay as painless as possible. If you need anything, I am the person you come to. If you have problems with anyone else on the unit, and you need an intervention, I am the person you come to. But I can’t help you until you help me.” Rehearsed.
I
