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www.antipsychiatry.org.za
a warning from
Lawrence Stevens, J.D.
A problem you should think about before consulting a mental health professional,
or encouraging someone else to do so, is the stigma of having received the
so-called therapy. If you seek counselling or "therapy" from a psychiatrist or
psychologist, how are you going to answer questions on job applications,
applications for occupational or professional licenses, a driver's license,
applications for health or life insurance, and school and college applications,
such as "Have you ever had psychiatric or psychological therapy?" When you apply
for a job or occupational license or a driver's license or apply for an
insurance policy or admission to an educational program you will often be
required to answer this or a similar question. When you answer such questions
candidly and admit having received psychiatric or psychological "help", the
result often will be loss of important opportunities: Answering yes to such
questions often results in rejection for employment or licensure or admission to
college or other educational program or denial of insurance coverage. Sometimes
you will be forced to ask your "therapist" to breach the confidentiality of your
communications with him or her by making a report on you in order for you to get
a job, license, insurance coverage, or admission to school. If you conceal your
experience of psychiatric or psychological "therapy" by answering "no",
thereafter you will have to be careful to watch what you say and to whom, and
you may with good reason worry about being found out - since you run the risk of
being fired from a job or expelled from school or suffering revocation of
licensure if your deception is ever discovered. You may eventually find the
insurance policy you have been paying premiums on for many years is valueless
because of what you concealed on the application for the policy years earlier.
In his book The Powers of Psychiatry, Jonas Robitscher, J.D.,
M.D., Professor of Law and Behavioural Sciences at Emory University's Schools of
Law and Medicine, pointed out that "Applicants for the state of Georgia bar
examination, like applicants in many other states, are required to
state...whether they have ever received diagnosis of...emotional disturbance,
nervous or mental disorder, or received regular treatment for any of these
conditions. Although there is no known instance of this information having been
used to keep an applicant from taking the examination or being admitted to the
Georgia bar, there are instances of denying applicants in other jurisdictions"
(Houghton Mifflin Co., 1980, p. 234).
In the same book Dr. Robitscher described the case of a medical
school applicant who had graduated from college magna cum laude, who was
admitted to Phi Beta Kappa, and who scored in the upper ninety-ninth percentile
in the Medical College Admission Test - but who was denied admission to medical
school because she had sought psychiatric treatment (pp. 238-239). He said this
is typical of "prejudicial policies of not admitting or readmitting students who
have had or are undergoing psychotherapy" (p. 239).
An airline pilot told me he was grounded for seven months by the
Federal Aviation Administration because he revealed he had been seeing a
psychiatrist (for so-called outpatient psychotherapy) on the medical history
questionnaire he was required to fill out as part of his routine periodic
medical examinations required of airline pilots and which involved criminal
penalties (a fine of up to $10,000 and/or up to five years imprisonment) for
concealing the requested information. He told me he enjoyed seeing the
psychiatrist but that the hassle which resulted from his doing so, because of
the questions it created about his job qualifications, out-weighed whatever
benefit came from seeing the psychiatrist. He said that all factors considered,
"It wasn't worth it." When taking physical examinations, pilots in the United
States are required to "List all visits in the last three years to a physician,
physician assistant, nurse practitioner, psychologist, clinical social
worker, or substance abuse specialist for treatment, evaluation, or
counselling. Give date, name, address, and type of health professional
consulted, and briefly state reason for consultation. ... Routine dental, eye,
and FAA periodic medical examinations may be excluded" (FAA Form 8500-8, italics
added). This suggests that, contrary to what some people think, anyone
consulting a psychologist or clinical social worker is considered suspect. That
is, stigma attaches to anyone consulting not only psychiatrists, but also
psychologists or social workers. Routine dental or eye examinations involve no
stigma or suspicion of disqualification and therefore are not required to be
reported.
The 1988 Democratic Party Presidential nominee, Massachusetts
Governor Michael Dukakis, in the words of Newsweek, "was accused of
having received psychiatric treatment" ("The High Velocity Rumor Mill",
Newsweek, August 15, 1988, p. 22. See also, Andrew Rosenthal, "Dukakis
Releases Medical Details To Stop Rumors on Mental Health", The New York
Times, August 4, 1988, p. 1). The accusations proved to be false, but the
impression given by the news reports about this story is that Dukakis'
presidential campaign would have been doomed by this one fact alone if the claim
he had ever consulted a psychiatrist or psychologist had proven to be true. In
1972 U.S. Senator Thomas Eagleton was nominated for Vice-President of the United
States at the Democratic National Convention but subsequently was removed from
the ticket by the Democratic National Committee when it became known he had
undergone psychiatric treatment, including hospitalization and electric shock
treatment.
Bruce Ennis, an ACLU attorney who has represented people deprived of
employment because of psychiatric stigma, argues that "In the job market, it is
better to be an ex-convict than an ex-mental patient." He says "very few
employers will knowingly hire an ex-mental patient." He points out that "Almost
all public employers and most large companies ask job applicants if they have
ever been hospitalized for mental illness" and that "If the answer is yes, the
applicant will almost certainly not get the job". Mr. Ennis also points out
that "if the applicant lies and says no, he runs the risk of eventual
discovery". On this basis Mr. Ennis argues that "It is time for psychiatrists
and judges to face the brutal facts. When they commit a person to a mental
hospital, they are taking away not only his liberty, but also any chance he
might have for a decent life in the future." On the basis of his experience as
an attorney for people saddled with psychiatric stigma he observes that "Even
voluntary hospitalization creates so many problems and closes so many doors that
an old joke takes on new truth - a person has to be crazy to sign himself into a
mental hospital" (Bruce J. Ennis, Prisoners of Psychiatry: Mental Patients,
Psychiatrists, and the Law, Harcourt Brace Jovanovich, 1972, pp. 143-144).
Mr. Ennis wrote those remarks in 1972, but if anyone is inclined to think
psychiatric stigma substantially diminished during the 1970s and 1980s, consider
once again the reaction of the press and public in 1988 to the apparently false
allegation that presidential candidate Governor Michael Dukakis had previously
consulted a psychiatrist. That it should be such a headline grabbing issue
shows how stigmatizing is any experience as a psychiatric "patient". This
public reaction is particularly noteworthy in light of the fact that Governor
Dukakis was accused only of consulting a psychiatrist in his office, not
psychiatric hospitalization.
The presumption of unreliability, untrustworthiness, and emotional
instability which flows from having ever sought psychiatric or psychological
"therapy" doesn't haunt only people with responsibilities like doctors, lawyers,
airline pilots, and Presidential/Vice-Presidential candidates: In his book,
Prisoners of Psychiatry, ACLU attorney Bruce Ennis reports many cases of
people who have been denied taxi driver licenses because of past psychiatric
treatment even though "Most of them had never been hospitalized" and had never
done anything to suggest they were dangerous (p. 160).
In a book she wrote, Eileen Walkenstein, M.D., a psychiatrist, says
"A psychiatric diagnosis is like a jail sentence, a permanent mark on your
record that follows you wherever you go" (Don't Shrink To Fit! A
Confrontation with Dehumanization in Psychiatry and Psychology, Grove Press,
1975, p. 22). If you consult a mental health professional, you will probably get
some kind of "diagnosis". In at least some states, professional licensing
laws require mental health professionals, including psychologists, to
keep a written record of "diagnosis" and "treatment".
In 1992, Commenting on the Americans with Disabilities Act (ADA),
Peter Manheimer, chairperson of the Commission for the Advancement of the
Physically Handicapped, said "It is most appropriate that the ADA protects
recovering drug addicts, alcoholics, persons with AIDS, and persons who have
mental and psychological disabilities, as they form the most misunderstood
and feared portion of the disability community. They suffer the greatest
discrimination" (Peter Manheimer, "Reporting on persons with disabilities",
letter to the editor, Miami Herald, July 24, 1992, p. 16A - italics
added).
And "a study by the National Institute of Mental Health in 1993
found that even ex-convicts rank above former mental patients in social
acceptance" (Chi Chi Sileo, "Rip-offs Depress Mental Health Care", Insight
magazine, January 24, 1994, p. 14.) This article quotes a psychiatric
hospital patient saying "The stigma is incredible...Forget telling an employer!
Sometimes they find out anyway, and all of a sudden you're unfit to work there"
(ibid). In his autobiography, Kenneth Donaldson said after he had been
committed to a psychiatric hospital, people "accepted a psychiatric diagnosis
which forever rent the fabric of my life. Thereafter, not only society at large
but members of my family would not see Ken the son and father and friend, but
Ken the mental patient. From this would flow unimagined misery, a fog which
would envelop all our lives. And our situation would be, of course,
representative of millions. The fog would seep into my employment, my relations
with doctors, my access to lawyers and the courts. Every enterprise in which I
would engage would be poisoned by the label. It haunted me and frightened
others" (Insanity Inside Out, Crown Pub., 1976, p. 321).
In his book The Powers of Psychiatry, Emory University
professor Jonas Robitscher, J.D., M.D., said: "Psychiatrists have been so
criticized for the errors or vagueness in their labeling procedures because the
label produces a new disability, which often remains as a burden long after the
symptoms that led to the label have departed. ... A study of the attitudes in
a small town indicates that fellow townspeople reject other members of the
community in a direct relationship to the professionalization and specialization
of the source of help, with the least rejection when help is sought from a
clergyman, increasing percentages of rejection for those seeking psychiatric
help from physicians and psychiatrists, and the most rejection for those who get
mental hospital help. A study of work supervisors shows that the knowledge that
an employee is seeing a psychiatrist would be likely to rule out a promotion
even if the employee is doing good work...The harm and potential harm done to
mental patients and former mental patients is not only confined to those who
have had serious illnesses, those who have been hospitalized or who have had to
interrupt careers or schooling. Psychiatrists know that many people who consult
them as outpatients are much less 'sick' than many or most of the general
population. If these people had decided not to be patients but instead to be
clients or parishioners and had taken their problems to a social worker, a
pastoral counsellor, or a faith healer, they would have incurred no stigma.
... The ubiquitous questionnaires that ask, 'Have you ever consulted a
physician for a physical or emotional or mental condition?' do not take account
of those who should have and haven't, or those who are able to answer no because
they have taken their problems to an encounter group, a sensitivity-training
session, an est seminar, or a consciousness- raising group, and so have escaped
the discriminatory effect of seeking help" (pp. 230, 232, 233).
The difficulty of getting a health insurance policy after having
sought psychiatric or psychological "therapy" or even marriage counselling was
mentioned in the August 1990 issue of Consumer Reports in an article
titled "The Crisis in Health Insurance": "Virtually no commercial carriers and
only a handful of Blue Cross and Blue Shield plans will sell policies to anyone
who has had heart disease, internal cancer, diabetes, strokes, adrenal
disorders, epilepsy, or ulcerative colitis. Treatment for alcohol and
substance abuse, depression, or even visits to a marriage counsellor can also
mean a rejection. If you have less serious conditions, you may get
coverage, but on unfavourable terms" (p. 540 - italics added).
The stigma involved in obtaining psychiatric "therapy" was discussed
in an article by columnist Darrell Sifford titled "Should You Lie About
Psychiatric Care?" appearing in The Charlotte Observer (Charlotte, N.C.)
on June 10, 1990. A mother wrote to Mr. Sifford asking whether her teenage son,
who was about to apply for admission to college, should answer truthfully the
questions about psychiatric treatment, which he had had at the age of 15. She
wrote: "Many of these [college application] forms request information regarding
any psychiatric treatment. And once he is out in the real world, most job
application forms ask for the same information ... Have we [by insisting he get
psychiatric care] doomed him to a future of lying on application forms for fear
of losing the position or college being applied for? What should we do?" The
newspaper columnist realized the woman's question is what he called "a serious
question. Very Serious." He shared the woman's letter with Paul Fink,
immediate past president of the American Psychiatric Association. This was Dr.
Fink's advice: "I would tell them to lie on the forms ... The stigma is there,
and to deny it and sacrifice yourself by telling the truth makes no sense. ...
With the public at large I work to decrease stigma, but with individual patients
I impress on them how widespread and deeply rooted the stigma is. ... If two
people who are equal in credentials apply for a job and one has had psychiatric
treatment, that person will be discriminated against, and he'll be the loser in
the competition for the job. ... Even if the person with treatment had better
credentials, he most likely still would lose out to the other person. That's
how deeply rooted the stigma is. ... I will not encourage anybody to
acknowledge that they had treatment" (p. 4E).
Do you want to go through life with this kind of secret? How do you
feel about lying on applications for the rest of your life? If it is your
rebellious adolescent or troubled spouse for whom you're considering psychiatric
"treatment", ask yourself this question: Do you really hate your rebellious
teenager or spouse enough to impose this kind of problem on him or her? Is it
really the right thing to do? The problems motivating you to impose so-called
therapy on a member of your family are probably temporary, but psychiatric
stigma is forever.
The Americans with Disabilities Act (ADA), is unlikely to help much,
despite its aim of eliminating discrimination in employment against people with
disabilities, including alleged psychiatric disabilities. As Jonas Robitscher,
J.D., M.D., said in his book The Powers of Psychiatry prior to the
enactment of the ADA: "The disclosure that one is or has been mentally ill can
lead to rejection, and other reasons for the rejection can always be found. ...
Forcing private employers to hire the disabled would raise issues of invasion of
privacy and problems of enforcement. Stigmatization will continue to be a
problem, and discrimination will continue to exist" (p. 241-242). In areas
covered by the ADA, availing oneself of its protection will probably require
large amounts of time spent in litigation and a lot of money paid in lawyer's
fees, with uncertain results.
And there are many areas of stigmatization and discrimination the
ADA and other laws don't cover. One example is colleges and universities that
do not receive federal funds. Another is the effect of psychiatric stigma on
personal relationships: Keeping secrets conceals parts of who you are and
prevents emotional intimacy of the sort most people want with friends and
especially with one's spouse; but sharing this secret leaves you open to
blackmail or similar kinds of pressure. Concealing psychiatric "treatment" from
an employer (as is often necessary to get a job) but revealing it to one's
spouse or a friend gives the spouse or friend knowledge that can be used against
you if your relationship turns sour. Should you be put in a position where you
must lie to your spouse or a friend to keep secret your history of so-called
psychiatric or psychological "therapy" (e.g., if he or she should ask), you
introduce deception into a relationship where probably you wish you could be
honest and sincere. Even if you don't tell your spouse or someone you are
thinking about marrying, divorce now occurs in close to a majority of
marriages, and in a divorce - especially if you get into a dispute over child
custody or even visitation rights - your spouse's attorney will probably ask
you, under oath when you are subject to the penalties of perjury, if you have
ever had psychiatric or psychotherapeutic "treatment" - perhaps confronting you
with the choice of committing perjury or jeopardizing your employment by telling
the truth. Whether you admit having had psychiatric or psychological "therapy"
or it is discovered some other way, the resulting stigma may result in losing
your children in a custody battle, and threats to reveal it to your employer may
be used to pressure you to agree to property division or alimony (or lack of it)
or an amount of child support that is not appropriate. You may have to consider
these problems when contemplating the wisdom of getting married or divorced -
problems you could have avoided by simply avoiding having received "therapy".
You are likely to face a similar dilemma if you are ever called for jury duty,
since during the jury selection phase of the trial potential jurors are often
asked, under oath, if they have ever had psychiatric "treatment". Another time
you will probably be asked about past psychiatric "treatment" is if your job
requires you to get a security clearance or bonding.
If the so-called therapy helped enough, it might be worth the
problems created by the stigma of having had psychiatric or psychological
"help". However, the benefit assumed to come from psychiatric and psychological
"therapy" (itself a questionable assumption) is vastly outweighed by the stigma
that comes from receiving it. The stigma that results from seeing
psychiatrists, psychologists, or psychiatric social workers is a strong argument
in favor of instead consulting friends, family, or nonprofessional counselors
whose expertise comes from life rather than from "professional" training, or
simply working at solving your problems yourself.
THE AUTHOR, Lawrence Stevens, is a lawyer whose practice has included
representing psychiatric "patients". His pamphlets are not copyrighted. You
are invited to make copies for distribution to those who you think will benefit.
1997 UPDATE
The following appears in a pamphlet titled "Serving on a North Carolina Jury,"
published in 1997 as a public service of the North Carolina Bar Association in a
section titled "The Questioning of Jurors": "When you report to the court
for jury service, you will be asked certain general questions by the judge
regarding your qualifications to serve as a juror. ... Then, when you are
called to the jury panel for a particular case, the lawyers in the case have the
right to ask additional questions." The pamphlet doesn't say so, but included
in these questions may be whether you have ever had psychiatric treatment. You
will be asked these questions while under oath, meaning you may be charged with
the felony offence of perjury if you deny having had psychiatric treatment when
in fact you have. Jury pools are taken from public records such as lists of
registered voters and holders of driver licenses. So if you register to vote or
have a driver license, you are at risk of being called for jury service. There
are legal penalties for refusing to serve, so you may not be able to avoid the
problem by simply refusing to appear for jury service.
1999 UPDATE
A new national survey reveal by the National Opinion Research Center at the
University of Chicago found that the
Stigma of mental illness still exists. The survey found that "The public
appears to hold an exaggerated view of the impairment faced by those with mental
illness and the level of danger they present to themselves and others."
2000 UPDATE
"Being psychiatrically diagnosed, medicated, or hospitalized gives a child a
stigma that a lifetime will not overcome. It should be avoided at all costs."
Peter R. Breggin, M.D., in his book
Reclaiming Our Children (Perseus Books, Cambridge, Mass., 2000), page
56.
2002 UPDATE
"The ADA [Americans with Disabilities Act] was passed in 1990, prohibiting
employers from discriminating on the basis of disability, including mental
disability. Employers may no longer ask applicants about their mental health
and hospitalization histories. ... The best the ADA has been able to
accomplish is to change the workplace from one where applicants had to
affirmatively lie about their psychiatric histories and diagnoses to an
environment of 'don't ask, don't tell.' ... when it comes to psychiatric
disabilities, it would be fair to conclude that the ADA has failed to provide a
remedy against employment discrimination." Susan Stefan,
J.D.,
Hollow Promises - Employment Discrimination Against People with Mental
Disabilities (American Psychological Association, Washington, D.C.,
2002), pp. xiv & 19-20. Susan Stefan is an attorney at the
Center for Public Representation in Newton, Massachusetts. Until 2001, she
was a professor of law at the University of Miami School of Law, where she
taught disability law and mental health law. She graduated magna cum laude from
Princeton University in 1980, received a master's in philosophy from Cambridge
University in 1981, and received her law degree from Stanford University.
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