Stigma blinds us

The dictionary defines stigma as “a distinguishing mark of social disgrace.”  Once upon a time, it was the common term for the permanent mark burned into the skin of criminals and slaves.

We like to think of ourselves as too civilized for such things nowadays. But in fact, the practice continues for all kinds of people singled out for scorn and judgment. 

That we even sort people that way is probably the most interesting aspect of this thing we call stigma.

Scorn and judgment are not attitudes a “nice” society generally wants to cultivate in its citizens, and for the most part I think we’re fairly kind to each other. We’re respectful of each other’s differences.

But not always. Some categories of people still end up singled out for social disgrace, their lives marked as surely by stigma as if we’d burned it into them.  

This is Anti-Stigma Week in Greater Victoria, and I love the theme: “Nice People Take Drugs.” People with addictions experience tremendous stigma, and never mind that almost 90 per cent of Canadians report using alcohol or illegal drugs in their lifetime.

But stigma has an impact on a number of other groups, too. Sex workers are profoundly affected by stigma, as everything about the Pickton case continues to remind us.

If it had been bank tellers or 7-Eleven workers or small-business owners who started going missing, I don’t think we’d be in the situation of pulling together a task force 20 years later to try to make sense of why so many died while we dithered.  It simply wouldn’t have happened that way. Stigma kills sex workers.

Stigma against poor people is growing at an alarming rate. It’s why we can justify keeping income-assistance rates at levels that are impossible to live on. It’s why we build way, way less subsidized housing than we did a couple of decades ago, and wince at every tax dollar spent on supporting people unable to work.

Like every group we stigmatize, the poor have become unworthy and shameful in our eyes.

We use hateful language when describing people living homeless. We ignore our governments’ endless service reductions and policy changes that crank up the misery for people in profound poverty. We watch the creep of poverty in our community, and still think it’s “their” fault.

That’s what stigma does. It blinds you to the obvious. It misleads you.

We’ve selectively stigmatized certain health issues, too. Mental illness is the most striking example of that.

If I sprained my ankle, I’d have no compunction about posting it on my Facebook page and waiting for the flood of caring comments. Or writing about it in my column.

But what if I posted that I was staying home to work through a severe anxiety attack? Or a rough period in my schizophrenia? Or had just been diagnosed with bipolar disorder?

Truth is, I doubt I’d even write such a thing if I genuinely had a mental illness, which is perhaps the worst part about stigma. It demands silence.

I’ve often thought that if a purple light suddenly appeared in the house of everyone in the region who’d had a problem with drugs or alcohol, we’d be blinded by the light.

If we could ever see the faces of the people in our community who have been affected by mental illness - or participated in the sex trade, for that matter -  we couldn’t help but rethink our views just on the basis of how many familiar faces we’d see around us.

But who’s going to step forward with such declarations when the stigma is unbearable? How many people are prepared to be brave for the good of the group, when the impact on their own lives from publicly revealing themselves can be horrendous?

Stigma costs people jobs. It costs them their children, and their housing. It brands them as outside the norm, forever “other.”

Our laws say we don’t allow things like that to happen. But we do.

Fortunately, there’s a simple enough solution. We can stop. Stigma is kept alive in this day and age primarily by our attitudes, and it will die as soon as we quit substituting prejudice for thought. 

We have banished many of the laws and practices that once fed stigma at the institutional level. What keeps it going now is just us. All it will take to banish stigma is for you and me to refuse to let it cloud our thinking.

So quit.

I guess it's no surprise that the Conservative-heavy Senate is bound to crush the bill that would create human-rights protection for transgender and transsexual people, as this story notes. For reasons that I've never been clear on, we're supposed to presume that Conservatives - at least the kind we have in Canada right now - are the type of people who just don't like transgender people.
But really, why would anyone be in favour of allowing discrimination of transgender people? I mean, it's not like providing them with human-rights protection is going to encourage more people to become transgendered, or send a bad message to Canadian children.
It ought to be unacceptable for anyone to face discrimination solely because of who they are. Let's hope the Senate just gets out of the way on this one and lets it happen. 

Helpful piece in the Globe and Mail this morning for people like me, struggling to understand what all this fuss about a metered Internet means to them. Count me among the large number of Canadians who, up until all of this became big news, never even knew I had a limited plan. (The "explainer" link at the bottom of the story is also very useful.)
It's been barely a month since I figured out how to stream Netflix onto my TV and I'm totally enthralled, having been completely frustrated and furious over the consistently lousy programming that my pricey cable subscription gets me. So I'm deeply interested in this story line.
The issue looks like it's about Internet providers' right to charge heavy users more, but it's actually about Canada's non-competitive environment. Unlimited internet plans are standard in the U.S.
 Man, this country has some strange ideas around where we'll draw the line on competition. We eat foreign-grown food, work for foreign-owned companies, dress in foreign-made clothes, drive foreign-made vehicles - but damn it, when it comes to our internet and airlines, we're proudly protectionist. And never mind that such industry-driven positions work against Canadians. 

Mental health left to scramble for crumbs

Depending on who you talk to, psychiatric care in the region for people with chronic and debilitating mental illness is either in frightening disarray or just experiencing a few bumps on the way to a better day.

A number of the doctors who preside over hospital psychiatric care in the region say the cuts of the last two years have had a disastrous impact on people with serious mental illness.

Two of the doctors have already resigned in protest from the health authority’s Department of Psychiatry, and more have threatened to.  Last month, department members in the South Island passed a motion of no confidence in Dr. Robert Miller, medical director of mental health services for the Vancouver Island Health Authority.

But a spokesman for the health authority says the vote against Miller was “completely inappropriate,” and that the issue is really about a small number of psychiatrists resistant to change. The health authority has complete confidence in Miller, says Dr. Bob Burns, VIHA’s executive medical director for population and community health.

VIHA has kept a careful eye on the 200 to 300 people (the opposing sides differ on the numbers, too) left without case managers due to service cuts in the South Island, says Burns.

The gamble was whether people would fall back on emergency services once they lost the case managers who used to co-ordinate their care. That hasn’t happened, he says. “I can only presume they have other supports in the community.” 

The psychiatrists who passed the no-confidence motion beg to differ. “Mental health management continues to bury its head in the sand and ignore a very large group of chronically mentally ill patients. They and their families rarely speak out,” Dr. Andre Masters wrote in a Times Colonist opinion piece last summer.

Who to believe? Ultimately, the fight is over quality of care for two very different groups of people with mental illness. I’d argue that it’s crazy to pit one against the other.

One group lives in the madness and isolation of the streets, bouncing in and out of homelessness and addiction. The other has housing and more outward stability, but still faces all the challenges of a life lived with chronic and severe mental illness.

The smart and humane strategy would be to ensure both groups get the kind of care they need. Just like chronic physical illness, severe mental illness tends to get better if treated and worse if ignored. The best bang for the taxpayer’s buck is effective, consistent care based on people’s needs.

But it just doesn’t work that way in times of scarce resources and government frugality - particularly when the issue is mental health.

It has been the poor cousin of Canada’s health-care system since the beginning. Services for mental health and addiction continue to be the first place governments look for savings, and the last to attract new money.

So when provincial money started flooding into homelessness initiatives a couple years ago - and hallelujah for that - I guess we should have all known that some other part of the system was going to have to pay for it.

And that’s what has happened. The money that used to pay for case managers for people with chronic mental illness now funds four Assertive Community Treatment (ACT) teams on the Island working with street-entrenched people in Greater Victoria and Nanaimo. 

Burns says the ACT model has tremendous potential for reducing hospital-based psychiatric care. VIHA acted on that presumption by closing 10 beds in the Eric Martin psychiatric hospital and eliminating six case managers to help cover the costs of the outreach teams.

Patient care hasn’t suffered, says Burns. The current dispute with psychiatrists boils down to “a small group stuck in the way we’ve always done things.”

Maybe. The multi-disciplinary outreach teams certainly have been a wonderful addition to street-level resources. They’re making a real difference in the lives of some of the most vulnerable, ill people on our Island.

But did those additional services have to come at the cost of another group of extremely ill people who also need the support?

VIHA has apparently concluded it was overserving that population, given that the group’s use of emergency services didn’t immediately increase after they lost their case managers.

I fear we’ve merely unravelled another thread in a historically skimpy safety net. Time will tell, but in the meantime two poorly served populations are left to fight over scraps.

This is the kind of reporting I think is really valuable - Robert Matas takes a press release from the B.C. government and digs into what it really means, putting in the context for readers so that they can better understand the significance (or lack thereof) of the announcement on more childcare subsidies.