by Tiffany | Jan 27, 2017 | Health, Intersectionality, Neurodivergence
This is the third in a four-part series exploring the Let’s Talk campaign. Part One is here, Part Two is here. If you would like to read the article in its entirety right now, it is available on my Patreon.
Let’s Talk about social determinants of health, and moving beyond individualism – an interview with Flora
Flora (not her actual name) is a resident physician. She is a compassionate friend, a lover of horses, and a social justice-minded caregiver, with a practice that focuses on removing barriers to health for vulnerable people.
I think the Let’s Talk campaign is an important conversation starter, but it places the focus on mental health in the hands of individuals, when a lot of the mental health issues I see are related to societal issues that can’t be resolved by simply having people willing to talk about the way mental illness has impacted them personally.
No amount of talking about it is going to change housing, food, and job insecurity for vulnerable people. This isn’t to say that mental health doesn’t impact all of us, even those with the most privilege. But the individualist focus erases and ignores a lot of the ways that we create and then reinforce situations that create mental illness.
In medicine we see a lot of focus on resiliency as a cure for burnout in physicians. And I can’t help but read it as “Learn to deal with our abuse better.”
I don’t feel comfortable owning it at all. Like, labour laws don’t apply to us, the expectations on us are huge and the consequences of our mistakes are literally fatal. So don’t tell me that I just need to be more resilient.
To me resiliency is better conceptualized as “coping reserves.” It means the thing is still hard, because you have to cope, but you have the resources to deal with it.
I had a pretty big reserve after about two full years of solid mental health! But I’ve been slammed by a ton of stuff and my backups are empty now.
It’s frustrating, like running through the savings you’ve set aside for years in two months. You know you were putting it away for just this occasion but it still feels very vulnerable.
My program is super flexible and reasonable and supportive (yay public health, we understand the social determinants of health!) but I am terrified of what happens when I am struggling in the real world.
Within our microcosm, the system is designed to support my well-being primarily and then allow me to have output second, but the thing is I had to get through 8 years of “we don’t give a shit, produce the end product” to get to this place.
And so the people who struggled in undergrad, where’s their support and well-being? They provide counselling resources but that leaves the solution in the hands of the person who is struggling.
What about the people who were dealing with mental health and all the intersectional vulnerabilities who never even got the chance to access post secondary because of it? They have to hope they get a job with health insurance so they get $200 of counselling a year, as long as they pay up front and wait for reimbursement?
Starting the conversation is great. I’m glad more and more people are talking about it. It’s like the It Gets Better Project though. “Don’t kill yourself because we support you in a shitty situation and your situation might improve.” Not, “let’s fix the raging homophobia that drives you to suicidality.”
Both approaches are important but we can’t keep pulling people out of the river. Let’s keep them from falling in upstream.”
Flora offered a quick crash course in the social determinants of health with these links:
The Public Health Agency of Canada on “What Makes Canadians Healthy or Unhealthy“
The World Health Organization on Social Determinants of Health
And this comprehensive PDF on Social Determinants of Health from Canadian Facts
When discussing how to refer to her in this article, she said, “I would prefer ‘a resident physician,’ or Flora, because I have no idea what the politics will be like when I go to get hired. You’d think it wouldn’t matter because my entire job is advocacy for social change but…”
That “but” is a critical part of this conversation. The fact that people who are actively engaged in health and wellness still can’t afford to be open about their experiences for fear of the impact on their careers is telling. It points to the fact that systemic change is necessary, and that these conversations are not going far enough. The Let’s Talk campaign may be sparking conversations, but it’s keeping the issue focused on individuals when the reality is so much more complex and systemic. It may be individuals who experience the negative outcomes of unsupported neurodivergence and mental illness, but the systems and structures that make this so challenging are much bigger, much broader, and will require solutions that move beyond the individual.
We need social change.
Let’s Talk about corporations
Shannon, who has accessed a range of mental health resources, questions whether the benefits are worth the cost of providing so much free advertising for Bell.
Do the posts still count if you delete them all tomorrow? That was kind of my plan. But after 20 tweets I just raised a buck and how much did I advertise some shitty company? I don’t think it’s worth it. I’m thinking a better option would be to just give a dollar to a mental health initiative that’s useful and talking can always be encouraged other ways. Also, I don’t think the whole thing should cause so much extra stress for me if the whole point is to “help” mental illness… whatever that means. By the way, I don’t really know what it does mean. I don’t think the campaign generally does encourage openness at all. I agree that having conversations is important. And at the same time they’re jerks for doing it. I feel like they’re taking advantage of me.
Marginalized communities are unfortunately very familiar with being the “benefactors” of awareness campaigns that are nothing more than thinly veiled advertising, or the “awareness” that doesn’t actually accomplish anything.
Corporations using vulnerable groups to generate advertising is not new. Pinktober, or the highly commercialized “Breast Cancer Awareness Month,” is a glaring example. Beatrice Aucoin, a breast cancer survivor and queer activist who writes extensively for ReThink Breast Cancer, says,
I think it’s good in that there is actual good being done with the Let’s Talk campaign: money donated by Bell for hashtag use or texts sent or whatever it is.
I think where criticisms can come in is thinking about what we are actually doing with whatever we share. I’ve seen some people on twitter start important conversations on it. I’ve also seen valid criticism of appearing to support: someone changes a profile photo to have a Let’s Talk frame or uses the hashtag when in reality when people want to talk to them about mental health, they are unsupportive or distance themselves from the person seeking support.
This has a more complicated edge for me than breast cancer corporate ties.
Slapping a pink ribbon on a product that doesn’t give to a charity or help breast cancer patients in some way? That’s bad and making money off of sick people. You also have to keep in mind what cancer charity is being given to, which is way more problematic in the US than in Canada. I’m part of a grassroots counter-culture of breast cancer patients who, mostly in October, examine products that are pink or say something about breast cancer. The ones that are clearly using us without giving back, we take photos and put them on social media and tag the companies to demand #whyisthispink. Some breast cancer peeps object to companies doing pink ribbon things at all, which I actually don’t because corporate giving and selling products are part of how charitable funds are raised.
If Bell supports charities that support mental health, that’s good. If that support doesn’t extend to allowing qualified employees with disclosed mental illnesses to work for them, that’s awful and needs to be called out, just as people who don’t support those in their lives with mental health issues need to be called out if they participate in the Let’s Talk campaign every year but don’t really support the people in their lives dealing with mental illness.
Shannon’s sense that the campaign doesn’t actually encourage openness, which Beatrice also points out, is supported by most of the people I spoke with. Although the campaign sparks conversations (mainly conversations about talking about mental health, rather than conversations directly about mental health) but these conversations didn’t extend far enough to open the door for people struggling to be honest about the details of their neurodivergences, and the impact of that on their lives, especially not with their employers.
In Part Four, we’ll talk about pushing the conversation out of that comfort zone and using the campaign as leverage with employers in an interview with B.
Part One: Mental health and corporate culture; Funding for mental health supports; Starting the conversation
Part Two: Hospitalization, and the “Scary Brain Stuff” – an interview with Emily; Long-term and alternative supports; The intersection of race and mental health
Part Three: Social determinants of health, and moving beyond individualism – an interview with Flora; Corporations
Part Four: Pushing the conversation out of the comfort zone – an interview with B.; Where to find help
by Tiffany | Jan 26, 2017 | Health, Identity, Intersectionality, Neurodivergence
This is the second in a four-part series exploring the Let’s Talk campaign. Part One is here. If you would like to read the article in its entirety right now, it is available on my Patreon.
Let’s Talk about hospitalization, and the “Scary Brain Stuff” – an interview with Emily
Emily is a creative, playful, artistic woman with strong connections to her family and friend group and a penchant for wearing T-Rex costumes.
I’m glad that conversations are trying to happen and that more attention is being placed on people with mental illness – that it`s not the scary, “crazy” thing that we continue to see in movies and TV. The fact that initiatives like this are happening in order to try and destigmatize these issues and get people talking is good.
However, after today people will forget. This isn’t enough. It needs to be a constant public dialogue.
I’m glad people are showing solidarity but I still don’t feel like I can just come out and say that I have a severe anxiety disorder and Bi-polar II.
I told my boss last week about my Bi-polar II. She had no clue what it was and immediately started acting weird.
Mental illnesses such as Bi-polar, Depression, Schizophrenia, are all under a blanket of “scary brain stuff” that people don’t seem to understand and don’t get because the people that have these can look and act “normal”. It’s scary because we can’t identify it or label it right away.
Initiatives like #letstalk are nice and all but it’s not actually starting a conversation. It’s just giving most people something to do so they can feel good about themselves and have their Good Deed of the Week crossed off.
I still know that I can’t call into work because I’m having an awful day and can’t get out of bed because today I’m out of spoons and crying. It’s not visible, it’s not understood, and therefore not an acceptable illness or weakness. Mental illness is still joked about, feared, and not taken seriously.
I spent almost a year (on and off) in the hospital because my brain was literally trying to kill me. I am doing so much better now and I’m on medications that make it so I can live and love and FEEL and work. I HAD to go to the hospital in order for that to happen.
But I can’t tell most people that I spent time in a psychiatric ward because to them that’s where “crazy”, “unstable”, “weirdos” and “freaks” go.
It’s not a place that is viewed as where you go to get help.
If I were to say that I had to be in the hospital because of kidney issues or another major physical illness, but that it was all good and I’m well and there’s nothing to worry about, no one would bat an eye. There would be minor concern, obviously, but it wouldn’t have the impact that saying I had to be hospitalized for mental illness would.
One of those wouldn’t keep me from getting a job.
Let’s Talk about long-term and alternative supports
That issue of being able to get, and keep, a job is one that came up in most of the conversations I had about this issue.
The standard work week, and the expectation that people will be productive in these normative ways – work the regular job, pay the rent, see your therapist after work and read some self-help books on the weekend – really limits the avenues to health that are available. For most of the working population, taking an extended period of time away from work to access support is not a reasonable option. And for individuals who find themselves without a choice because their neurodivergences don’t allow them to work, the costs are huge. Emily needed that time in the hospital, but the impact on her ability to find work after an extended absence was significant and the financial impact of that time is still an issue for her.
Current workplace culture and expectations also cut off access to alternative supports and paths to healing.
Teresa says, “So, I’m not a huge fan of the Bell campaign although I’m certainly for more talking, reaching out and asking for help. I am a big fan of peer supported open dialogue, sanctuaries like Soteria and Diabasis House, health and lifestyle coaching, depth and transpersonal psychology, humanistic, existential, ecotherapy, art therapy, narrative therapy, trauma therapy…there is lots of good stuff out there but psychiatry holds too much power and is far too often the first place people are directed by campaigns like this.”
Accessing a sanctuary like Soteria or Diabasis House is expensive and time-consuming, and although sanctuary-supported living has significant positive outcomes for participants, it doesn’t have the necessary funding and our work culture doesn’t support it.
Part of the reason sanctuary spaces aren’t commonplace or accepted is because they challenge the deeply individualistic model that we take towards almost everything. Community care is critical, but our emphasis so often is on self-care and self-reliance.
Although I am a “self-care coach,” I believe strongly in the importance of community care. Often, community care is self care, and it is only possible to maintain sustainable community care when you have good self care practices.
We need safe spaces to fall apart in community, and we need to find ways to integrate community care with self care.
Let’s Talk about the intersection of race and mental health
Communities that have been marginalized for generations, and denied access to mental wellness supports, are the leaders when it comes to finding and creating alternative strategies for self and community care.
Black women, who are so often held to an impossible standard of strength, and whose struggle is often dismissed as nothing more than anger, are doing a lot of work when it comes to moving the conversation around self-care and community-care forward. This post at Blavity, by Amani Ariel, is important. She speaks explicitly about the ways in which self-care culture – with its heavy individualism and the isolating effect of an underlying message that says “you need care, so take care of that yourself” – can exacerbate rather than heal trauma.
Let’s Talk included Gloria Swain and the Let’s Actually Talk initiative, acknowledging the ways in which access to mental health supports and even space for the conversation is restricted for marginalized communities. It’s an important step.
It’s hard to talk about mental illness, especially if you’re a Black woman whose ancestors have suffered in silence for centuries because we were told we had to be strong and not complain. It’s difficult for the Black community to end the stigma when the people speaking about this illness look nothing like us. Mental illness does not see race, sex or economical status; yet, those who are marginalized are the ones whose voices and needs are not prioritized in such campaigns and dialogue. Making me feel like my depression isn’t important doesn’t help me heal. I am not invisible.
My name is Gloria and my depression is political. (Text from this Let’s Talk campaign image.)
Indigenous communities also face significant barriers to access, and see their traditional practices and sacred teachings appropriated into contemporary self-care/self-help practices that erase and exclude the indigenous cultures being used as inspiration. This happens throughout our culture, but particularly in many new age approaches. (A similar appropriation, erasure, and exclusion happens in a lot of yoga studios. Decolonizing Yoga is a great resource for folks who want to bring an intersectional awareness to their practice.)
SooJin Pate has also written about self-care within marginalized communities. This post includes specific ideas for self-care practices, including narrative framing strategies that are similar to my own work.
Communities that are vulnerable in multiple ways face significant barriers to accessing the mental wellness resources that are available, and since those resources are underfunded, understaffed, and the demand far exceeds the current capacity, it is often the most vulnerable who are the least able to access care, or to find care that acknowledges the specific intersections of their experience. Race, class, gender, orientation, ability – none of these identity categories exist in a vacuum. It can be difficult to understand how someone else’s experience is different from our own, but the willingness to stay present for uncomfortable conversations is a critical part of deep community care, and it is a valuable tool for self-care and growth.
In Part Three, we’ll talk about social determinants of health, and moving beyond individualism in an interview with a resident physician.
Part One: Mental health and corporate culture; Funding for mental health supports; Starting the conversation
Part Two: Hospitalization, and the “Scary Brain Stuff” – an interview with Emily; Long-term and alternative supports; The intersection of race and mental health
Part Three: Social determinants of health, and moving beyond individualism – an interview with Flora; Corporations
Part Four: Pushing the conversation out of the comfort zone – an interview with B.; Where to find help
by Tiffany | Jan 26, 2017 | Health, Identity, Neurodivergence, Personal
This is the first part in a four-part series exploring the Let’s Talk campaign. If you would like to read the article in its entirety right now, it is available on my Patreon.
Introduction
Today is Bell Canada’s #letstalk day. There’s a lot of hashtagging happening, and a lot of billboards up and good intentions, but it’s a complicated and messy issue. It’s not a simple narrative – “this is a good thing” or “this is a bad thing.” What this is, as many health issues are, is complicated. It’s messy. It’s a big conversation.
One critical part of the conversation is the language we use around it. I use the language of neurodiversity, because the illness model is not one that works for me. I appreciate the Drop the Disorder movement, and the Mad Pride movement, and in my own personal narratives of mental health and neurodivergence, allowing myself to move away from an illness model and view myself as divergent rather than broken has been important. However, I know that the frame of illness works for a lot of people, and the idea of a “broken brain” can be the right fit for some. (I definitely understand the appeal of a metaphor that includes the potential for “fixing”!) It’s not the language that I use, but that’s not because it is wrong language.
But the larger conversation gets narrowed, at least in Canada, on one day in January, to the viral and hugely successful Let’s Talk campaign. The campaign has run annually since 2011, and has raised over $100 million for the various charities, research foundations, and grants that Bell supports through this program. Bell’s website says, “For every text, call, tweet and Instagram post, Facebook video view and use of Snapchat geofilter, Bell will contribute 5 ¢ more to mental health initiatives. So let’s work together to create a stigma-free Canada!”
Their initiative is built on four pillars, described on the site. “Dedicated to moving mental health forward in Canada, Bell Let’s Talk promotes awareness and action with a strategy built on 4 key pillars: Fighting the stigma, improving access to care, supporting world-class research, and leading by example in workplace mental health.”
It is sparking conversations. My facebook feed is full of temporary profile pictures featuring the hashtag, I’ve heard multiple spots on the radio, and people are talking about how important it is to talk about mental health. These conversations can absolutely reduce stigma, and that is a critical step.
But I’m also seeing a significant amount of skepticism, as well as deep personal pain.
Let’s Talk about the intersection of mental health and corporate culture
People are skeptical about another corporate initiative that hopes to raise awareness but may not do enough to shift the corporate cultures that actively harm people struggling with unsupported neurodivergence. It’s not just the stigma surrounding issues of mental health, unhealth, and diversity, it’s also the fact that there are very few acceptable ways to be a “productive member of society.” In order to be productive, you must be a worker, and mental health impacts productivity and expectations in the workplace.
As one resident physician described it, “I’m struggling a ton right now and the cultural narrative of “work=productive member of society and therefore notwork=lazy layabout who needs to get their shit together” is really bringing me down. Self care isn’t gratifying in the way working for 14 hours straight is for me.”
Unsupported neurodivergence fucks with productivity. It doesn’t mesh well with contemporary corporate culture, and no #letstalk hashtag will change that. Depression, anxiety, PTSD, and other mental health challenges are viewed in terms of both absenteeism and presenteeism, and framed as economic issues – not because an inability to work means an inability to live in our culture, with its eroding base of social supports, but rather because of the cost to corporations.
Google absenteeism and you’ll see pages and pages of search results talking about the cost to corporations when full-time employees are absent, and mental health is a huge factor here. Absenteeism costs Canadian corporations an estimated 16.6 billion. And it’s talked about in terms of a problem that corporations need to fix – and that fix? Usually means reducing the number of days employees are absent.
But then corporations run into presenteeism. Presenteeism, or being physically present but disengaged, costs Canadian corporations 15-20 billion per year. Those are big numbers. Big numbers. The cost of unsupported neurodivergence for an individual is much smaller in terms of dollar value, and it’s much harder to find quantifiable numbers when discussing the personal costs. But does that mean the cost is less meaningful, less worth acknowledging and honouring?
And when employees are fired after disclosing mental health challenges, what is the recourse? How do we protect people from employment discrimination when the illness they are experiencing is still cloaked in mystery and fear and shame and stigma? How do we change corporate culture to make space for truly productive conversations about mental health when it is still not even remotely acceptable to speak openly with employers about depression, anxiety, PTSD, bipolar, or other neurodivergences?
So the skepticism regarding the Bell Let’s Talk program is justified. Reducing the stigma by sparking conversations is an important step, but it’s not enough. And individuals who are facing under- or unemployment as a result of their mental health challenges feel frustrated that it is a corporation leading (and financially benefiting from) this initiative.
Let’s Talk about funding for mental wellness supports
The money raised through the hashtag interactions is tracked, and a lot of money is put towards various grants and funds. The money supports research, and funds community supports for children and youth, aboriginal communities, and military families, among others. These are important initiatives.
But mental wellness supports are chronically underfunded. Valerie points out that, “It’s great we’re donating and sharing and hashtagging to Bell (who does not seem to have Alberta partners this year) but here in Calgary we just lost 2 low-cost therapy programs this month because they lost funding. These were the Alberta Health Services women’s health resources (which offered 6 free sessions of psychology/year for all women) and Jewish Family Services (which had a great individual/couple/family counseling program at a sliding scale).
It’s frustrating talking to folks who are motivated to start the work and having to tell them it’s public waitlists or expensive private options. Every day I wish I had more to offer our neighbours when we’re discussing referrals. I’m glad we’re confronting stigma, but disappointing to know that just because you’ve recognized the problem doesn’t mean the help will be easy-peasy to find.”
Let’s Talk about starting the conversations
For others, the conversation is enough to make the campaign worthwhile. Angie K. says, “For me, this initiative is a huge positive. The fact that conversations are being encouraged, and had is a sign of progress. A few years ago I would have still been too ashamed to admit I have mental health issues. It may not be as much or as fast as we would like, and there is still much work to do on the behalf of the companies to accommodate those with mental illness, but it is a good start.”
A lot of people’s responses to the initiative include that same cautious optimism – the conversations are good, but they’re not good enough. It’s a place to start, but it can’t be where the conversation ends.
Unfortunately, it is where the conversation ends a lot of the time.
In Part Two, we’ll talk about hospitalization and the “Scary Brain Stuff” in an interview with Emily, and about other long-term and alternative support options.
Part One: Mental health and corporate culture; Funding for mental health supports; Starting the conversation
Part Two: Hospitalization, and the “Scary Brain Stuff” – an interview with Emily; Long-term and alternative supports; The intersection of race and mental health
Part Three: Social determinants of health, and moving beyond individualism – an interview with Flora; Corporations
Part Four: Pushing the conversation out of the comfort zone – an interview with B.; Where to find help
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