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Confronting the Stigma of Mental Illness

When we consider the environment in which many security professionals operate, we should not be surprised that there is a higher rate of mental health problems. Compared to other professions, the stakes are higher, the responsibilities greater. We are often exposed to harsher realities, especially if we work as a first responder or combat soldier. The physical demands take a toll on our bodies, while consistent stressors can shake even the most mentally fit.

Instead of inviting harsh stigma, practical discussions around mental health in the security field should be a given.

Due to my own fear of this stigma, I hid my mental health situation from almost everyone who knew me for over a decade. As an ambitious American woman in my twenties trying to break into the Israeli security field, what I feared most was not failing basic training or getting shot in the desert. My biggest fear was that my colleagues would find out that I had bipolar disorder. I feared the humiliation and the abrupt end of my career.

It wasn’t until years later, in my thirties and (very luckily) off my medication, that I decided to speak up, due to the dire situation that the security community finds itself in. To illustrate, more U.S. military service members and police officers are dying by suicide than in the line of duty. Our emergency first responders are suffering from post-traumatic stress in record numbers. Alcohol abuse runs high in the intelligence community. Security professionals are afraid of the consequences of asking for help and are struggling with high rates of mental health problems as a result.

Even as leadership works hard to improve policy and bring in more resources to support the mental health needs of its employees, stigma continues to stand in the way of many security professionals who desperately need help. With this in mind, I started digging around for unique resources on stigma. Fortunately, I didn’t have to look far before I stumbled across Dr. Patrick Corrigan’s work.

Patrick is a licensed clinical psychologist and distinguished professor/associate dean for research at the Illinois Institute of Technology. He is also the principal investigator of the National Consortium on Stigma and Empowerment supported by the National Institute of Health (NIH). Over the course of his 20-year career, he has developed anti-stigma programs, served as the editor-in-chief of the American Journal of Psychiatric Rehabilitation, and published over 400 peer reviewed papers on the topics of stigma and mental health.

For all of Patrick’s credentials, one of the most remarkable of them all is that he has bipolar disorder. Initially a source of great shame, he eventually decided to open up about his mental health situation for the benefit of others. As someone who intimately knows the suffering of mental illness, his experience has added depth to his work and given him great wisdom and authority in challenging the stigma.

I’m certainly grateful for Patrick’s courageous efforts and research. I hope readers will be, too, once they read his following insights on the unexpected consequences of stigma and how we can reduce its impact, including specific lessons for the security community.

Jessica: Tell me a bit about your story and what inspired you to pursue a career in psychology?

Patrick: I grew up in the 1960s in love with American medical drama TV shows, which led me to enroll in medical school. But it was just as I was starting my medical career that I got hit with serious mental illness. So, I was forced to drop out of medical school and pursue a different path instead. I wound up becoming a psychologist.

I’ve been diagnosed with bipolar disorder, major depression, and a generalized anxiety disorder, and in the beginning I resisted taking medication. I refused to accept this new identity. I could stand comfortably in a room full of people with mental illness, but I couldn’t admit I was one of them.

I somehow got through a postdoc at UCLA and was accepted as a faculty member at the University of Chicago, before having a meltdown that landed me in the hospital. It wasn’t until that meltdown that I finally understood that I would have to take my medication consistently and accept that I was now truly in the category of people with mental illness.

It took about ten years working as a psychologist to realize that the challenge for people with serious mental illness is not just the illness itself, but the way other people respond to it. As someone who was initially very fearful of the stigma myself, I became intensely interested in studying and tackling this phenomenon, which is what I’ve been doing now for the past 25 years.

In this process, I’ve realized that the single most potent way to change stigma is for people with mental illness to share their stories with the public, which is why I’m glad that based on your own background you reached out to me. I believe you mentioned previously that you were also diagnosed with bipolar disorder while you were in college?

Jessica: Yes, I was 19 years old when I first started experiencing symptoms of bipolar disorder. I was a new immigrant on my own in Israel at the time and didn’t know what was happening to me. It wasn’t until I wound up in the hospital in Tel Aviv at age 20 that I received a diagnosis. I also struggled with anxiety and panic attacks throughout college and in the early years of my career in the security field.

My initial instinct when I received the diagnosis was to hide it from everyone, including family and close friends. I couldn’t shake the memory of what happened to me in a bowling alley, just a few months before I wound up in the hospital. I had been having what was probably a manic episode for weeks, but it wasn’t until this night out bowling with my friends that I really started melting down to the point that it was obvious to everyone something was wrong with my mental health.

Some of these friends lived in the same apartment building that I did near the university. When they saw me a few days later in the lobby, they just stared at me and then walked away. I didn’t want anyone to ever look at me like that again, so I kept my mouth shut for a long time about my illness.

But I’ll admit I’m surprised to hear that someone like you, a professional in the field of psychology, would be so averse to treatment and openness about their diagnosis, at least initially.

Patrick: I didn’t tell anyone about my mental health challenges for the first 12 years of my career at the University of Chicago Medical School. I didn’t want my scholarship to be diminished in the eyes of my colleagues. I once had a disagreement with a very experienced doctor who claimed that if only we could find a pill that would make mental illness go away completely, then the stigma would automatically go away, too. With all due respect, I don’t think this doctor understood how pervasive or complex this stigma is in our society.

Patrick and researcher Sonya Ballentine discuss best practices for engaging patients at the Patient-Centered Outcomes Research Institute (PCORI)

Jessica: So, based on your personal experience as a starting point, you’ve taken a very strong interest in understanding and unraveling the stigma of mental illness. You’ve written several articles and books on the topic, and have even spearheaded anti-stigma programs. Can you go into more detail about the practical reasons that compelled you to focus on this particular aspect of mental health?

Patrick: I’m a rehab psychologist, so my goal is to provide strategies and medications to help people transition from a psychiatric ward back to their communities, their work, their schools, and so on. And what I found is that a lot of these people failed to do so when they should have been able to, because of society’s reaction to them after finding out about their mental health condition.

What emerged from research over the years is that a big stereotype regarding people with mental illness is that they’re dangerous. The belief is that you could snap at any moment and become violent. So, an employer doesn’t want to risk hiring you, a landlord won’t rent to you. Not only that, but you’re to blame for it, you should just learn to control yourself, right? It’s very demoralizing. It hit me that this is a major barrier for people who are on good treatments and just trying to get integrated back into society.

As for my research into this subject, it was basically a matter of being in the right place at the right time. Just as I was starting my research, the National Institutes of Health (NIH) became interested in the topic. The truth about research programs is that you need someone to pay for it. And so we started submitting grants on stigma and NIH decided to fund our research. My colleagues and I then started teaming up with experts around the country, then globally, and it all just took off from there.

Jessica: Let’s focus in a bit on applications of your work for the security community. Studies show that the biggest barrier for security professionals seeking mental health care is stigma, along with the fear of losing their job. And we’re talking about some of the toughest people in our society, a warrior culture so to speak. So, for a combat soldier or police officer, just the mere act of asking for help is detrimental to their self-identity.

Before touching upon the external factors of stigma imposed by the public, what are your thoughts on unravelling the self-stigma that security professionals experience acutely when faced with a mental health issue?

Patrick: Self-stigma essentially refers to the sense of shame someone experiences when they’re labeled with mental illness. This is the unfair situation of mental illness; it’s hard enough to deal with the illness itself, but then you have to feel ashamed of it. Self-stigma, along with public stigma, is what drives people into hiding.

Stigma can also shake a security professional’s confidence in their ability to do their job. Consider the fact that police officers, for example, need to be very assertive in certain social situations in order to do their jobs effectively. Feeling shame from a mental health issue can affect or suppress that ability. Stigma winds up undermining a person’s sense of competence and resilience.

Warrior culture definitely plays a part, too. Layer this over the fact that there are all kinds of policies and procedures that security professionals have to be wary of. In Illinois where I live, to carry a gun you have to have a firearm owners’ identification (FOID) card. I imagine most states have a similar set-up. Either way, if you are diagnosed with a mental illness in Illinois, you are likely to lose your FOID card. For security professionals, that can mean you’re automatically out of a job.

There’s a problem of communication here, too, because I spoke to several police officers and soldiers and there seems to be a lack of clarity around this firearms issue. People want to know what exactly can I disclose that would result in me losing my firearms privilege? Can I eventually get it back, and under what circumstances? Am I going to automatically lose my job? I can’t speak to the policy of every organization, but I think it’s important that leadership communicate the parameters clearly to avoid extra stress and confusion.

But back to stigma. I’m a big believer in the best way to deal with stigma and mental health among the police is that it has to be an initiative led by the police. If you want to break it in the military, it has to be led by military service members. And the research shows that that army listens to army, and navy listens to navy, and so on. It has to be peers coming out and promoting empowerment.

As the program director for Honest, Open, Proud—an organization designed to facilitate discussions on the impact of mental health disclosure—I don’t try to convince people whether to disclose their mental illness or not. Rather, our organization helps people who choose to do so disclose their mental health situation in a practical and empowering way. We provide the resources to aid these people in making strategic, safe decisions with the objective of reducing stigma in their environments.

* To learn more about how police departments are tackling the mental health crisis among their community, read the article titled “On a Mission to Protect Police Mental Health.”

Jessica: In an effort to address the mental health stigma in the security community, the Defense Counterintelligence Security Agency (DCSA) recently released reports publicizing that less than one-percent of security clearances are denied or revoked based on mental illness. Meaning, it is actually extremely rare for someone to lose a clearance for a psychiatric issue alone.

Yet, many security professionals remain highly cynical. (To illustrate, when I asked security professionals across the spectrum to guess the percentage of revoked security clearances due to mental illness, they predicted between 35-50%.) It seems that our community’s mental health policies are changing, but the culture is struggling to catch up and therefore the stigma remains. How would you advise leadership to pragmatically close this gap between the realities of policy and the perceptions of culture?

Patrick: I don’t agree with the underlying assumption in your question. Meaning, the index is not valid. We’re talking about police officers, soldiers, intelligence officers, right? They’re not morons. If they know they have a mental health issue that will likely get them fired, they’re not going to disclose that to their employer. Therefore, the numbers being publicized by the DCSA are not a valid measure because we don’t know the true numbers of security professionals with mental illness who are carefully choosing to hide their situation.

Jessica: Well, Dr. Corrigan, I’m more than happy for you to challenge the underlying assumption of my questions. What do you estimate are the true numbers of mental illness then among the security community?

Patrick: If you want a ballpark number, approximately 20% of adults across the U.S. meet the Diagnostic Statistical Manual (DSM) criteria for a serious mental illness. So, for the DCSA to claim only 1% of their population has a serious mental health issue is ridiculous, based on the numbers we know to be true among the general population.

Jessica: Based on conversations I had recently with Dr. Phil Baquie, a combat soldier who became a therapist specializing in PTSD, approximately 60% of the security professionals he tested scored above average ACE (adverse childhood experience) scores, indicating a higher risk for depression and stress-related mental health issues among this population.

* To learn more about Dr. Phil Baquie’s assessments and program for preventing PTSD, read the full interview titled “A Combat Soldier-Turned-Therapist Stops PTSD in Its Tracks.”

Patrick: I’m not surprised to hear that, especially considering what experiences might motivate someone to seek out a career in the security field. When I tell people that approximately 20% of the country is suffering from a serious mental illness, they don’t believe it. I mean, imagine walking into a party of 100 people and 20 of those people are hiding a mental health issue.

My advice to leadership is that they need to face this reality, whether it’s among their current community or how this might affect recruitment. It’s definitely a complex issue with no easy solution. Obviously if you raise the bar regarding mental health standards, you’re going to have a difficult time in some circumstances filling enough vacancies in your security organization. Moving forward, it will be important for leadership to work with recruiters to find that right balance.

Patrick speaks on a podcast to the American Psychological Association about the challenges faced by sufferers of mental illness when trying to integrate with the rest of society

Jessica: In an article for USA Today, you made this interesting point that while the pandemic facilitated people becoming more open about struggling with depression or anxiety (which is becoming increasingly common among the U.S. population), the rarer diseases, such as bipolar disorder or schizophrenia, still invite harsh stigma. What do you believe is the best way to educate the public about these lesser-experienced illnesses?

Patrick: To give some numbers for context, schizophrenia affects only 1% of the population, bipolar disorder is around 3%, and major depression is about 10%. There’s been this big push in educating the population about mental illness to refer to it as a “brain disorder.” After 20 years of research, we’ve realized this was a naïve assumption. We thought if we just educated the public about how mental illness is a brain disorder and we show them pictures of MRIs lighting up, then we’ll decrease the stigma. Instead, people are going to look at the mentally ill like they’re broken or they’re a ticking time bomb.

What works most effectively is not education, but exposure. Meaning, the more you interact with people who have a mental illness, the less exotic they are. To give a comparable example, let’s talk about the evolution of race relations following the dissolution of segregation in the 1960s. Blacks and whites didn’t magically start interacting with each other as peers overnight. In fact, studies showed that trying to lecture the white population on the merits of black achievements and the positives of their history and so on had the opposite effect of promoting closer relations. So, what actually worked? Contact. Consistent, direct interactions were ultimately a key component in improving relations between the two populations.

Now, when you walk into a party, you can look around the room and see pretty clearly who’s black. You can’t see who’s mentally ill. You won’t know who is suffering from a mental illness unless that person chooses to disclose this information. It’s only somewhat helpful when celebrities come out in public with a mental health issue. It’s more effective when it’s your neighbor or coworker or the person who sits next to you in church.

When someone like you speaks out, for example, telling their story in a calm and unapologetic way, it sets a good example. It also allows the people who already know you to perhaps change their perspective of what mental illness looks like.

Jessica: You know it was a funny thing when I publicly came “out of the closet” about my mental health history, very recently actually. Several people approached me and said, “Wow, I would have never guessed that you were mentally ill. You’re so polished and articulate!” It made me chuckle, but it also provided this insight into how so many people can misinterpret what mental illness looks like.

Even in my twenties when I was struggling with full-blown bipolar disorder, I had several stretches in between where I didn’t have any symptoms, which is not untypical for the disease. I was also a high-performing student with a lot of friends, which I don’t think fits the mold of people’s expectations of mental illness.

When I was first diagnosed, I went on a bit of a rampage and researched my illness almost obsessively. I was so grateful to come across Dr. Kay Redfield Jamison’s memoir, An Unquiet Mind, which chronicles her journey with bipolar disorder, as well as her successful career as a clinical psychologist. I think it’s important to share not only the stories of people who struggled with mental illness, but the people who thrived and led great lives.

Patrick: The revolution against the stigma of people with serious mental illness needs to be led by people with serious mental illness. Doctors and researchers can treat and advocate, but when people speak for themselves it’s more powerful. It’s like as a straight male I can support the LGBTQ community as an ally, but it has to be an LGBTQ person who leads the fight against the stigma that hurts their community.

To apply this to the security field, it has to be the soldiers and police officers and EMTs themselves speaking out. God bless the police chief who speaks publicly about struggling with his mental health. It’s a clarion call to others in his department. But at the same time, I think it’s more impactful when the average police officer comes out to his fellow officers, just because he’s more relatable.

I understand it’s not right for everyone to come out, or at least to come out beyond close friends and family. But the more people with mental illness speak out, the more we’re going to chip away at the stigma.

* * *

About Jessica Lauren Walton: Jessica is a communications strategist, video producer, and writer in the U.S. defense industry. She has written articles on a range of security and mental health topics and conducted interviews with military leadership, psychologists, filmmakers, CIA officers, journalists, and more. Jessica recently completed her memoir about her experience as an American woman struggling with mental illness while trying to get into Israeli intelligence.

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