De-stigmatization seems like such a no-brainer.
Stigma, whether associated with an affliction like AIDS, or (in our case) mental illness, is a bad thing. It brings suffering to victims above and beyond that inflicted by their illness. At its worst, it brings with it such shame that people often don’t obtain the care they need.
Ironically, this sword has another edge that’s not immediately apparent, for when true de-stigmatization starts to take hold, some of us start to feel, well, a little uncomfortable. Some of us remember the edginess we felt when we first heard Betty Ford talk about her breast cancer. Or Magic Johnson talk about AIDS. Or Robert Downey, Jr. talk about his chemical dependency.
Surviving suicide attempts
A less well-known, present-day example is the emergence “from the shadows” of people who have made suicide attempts and survived. The field of suicide prevention has seen a lot of change over the past few decades, as we have sought to make suicide okay to talk about. The last thing most of us would want would be shaming around this topic.
But we mental health professionals also place high value on the individual’s right to privacy, and we can even get a little (or a lot) protective of our patients’ privacy (such as not even acknowledging we know a patient, much less divulging information).
By extension, we can even become a little paternalistic about even the patient’s own right (or the advisability) of disclosing information. To wit: Is it really OK for a current or former patient to disclose on Menninger’s Facebook page or blog site, or perhaps at a conference we sponsor, that he or she made a suicide attempt (and perhaps continues to have suicidal episodes?). Not that he or she doesn’t have a right to disclose whatever he or she wants on his or her own, but can we ethically be a party to this disclosure?
You might think, “obviously not,” but consider this: The American Association of Suicidology (AAS) recently began sponsoring an interest group devoted to bringing suicide attempts “out of the closet.” This group of “attempt survivors” now has space on the AAS website where individuals can post messages about their own experiences with suicidal episodes.
Now these are not clients of AAS, nor is AAS a clinical organization; so no confidentiality is being breached here. Nevertheless, these are arguably vulnerable people putting highly sensitive information “out there,” where it cannot be controlled by the AAS or anyone else. Or are these perhaps paternalistic sensitivities of an overprotective clinician, viewing these individuals as less resilient than they actually are?
Here’s a recent post, a remarkable video of a young man, Misha Kessler (his real name). He nearly killed himself, and here he shares his story:
Questions to consider
Misha is remarkably articulate and apparently unabashed about this self-disclosure. Is this OK? Is he harming himself, now or potentially in the future, with a video that he can never take back? Or does the good done by this courageous act trump any adverse future consequences? Does the empowerment and de-stigmatization (there’s that word again) bring more benefit to his psychological health than the cost of any judgment that he might experience from others (including prospective mates or employers) who don’t “get it?”
From a distance, I am cheering Misha on. De-stigmatization of suicide, like de-stigmatization of alcoholism or homosexuality, can’t come too soon. Then, putting it to the ultimate test, I ask myself: What if he were my son?
Can I get back to you on that one?
Take a look at the video. Let us know what you think. No right or wrong answers here.