Stigma Toward Mental Illness Within The Legal Profession
by Angela Vickers    

Editor’s Note:  Angela Vickers is a mental health advocate, educator, speaker and lawyer. She promotes accurate mental illness education for all legal professionals, the media, educators, faith leaders, doctors, therapists and school children.

She received the National Mental Health Association's highest consumer advocacy award.  She founded the National Day of Prayer for Mental Illness Recovery and Understanding. She wrote an advocacy book, Brain Bondage—the Delay in Mental Illness Recovery.  Her efforts led the Florida Bar Association, of which she is a member, to add “mental illness awareness” to their Continuing Legal Education categories.Vickers speaks nationally and trains lawyers, law enforcement officers, mental health providers, lawmakers, teachers, medical professionals, advocates, preachers and others, about mental illnesses and needed reforms.


At a local annual bench and bar holiday party in 2004, a fellow bar association member in front of me in the hors d’oeuvre line glanced at my name tag. He then politely asked, “What is your area of practice, Angela?”

In the background was the combination of loud music, voices, laughter and the clinking of glasses. I replied something about doing advocacy and education concerning mental illness.

The stranger responded, “Mentally ill? I think we should lock them all up.”

I replied with the first thing that came to my mind, that is, the first reasonably polite thing I could think of to say.

“I don’t think we can afford to lock them all up. Experts say there are about 54 million.” [Now 60+ million in the US]

“That’s the problem,” he continued.  “I think we should sterilize them.”

This 50 year old lawyer appeared to be sober and serious. He was not the first lawyer I had heard express a very biased opinion of my medical diversity group. I was diagnosed in 1988 with bipolar disorder. I do not think rapidly on my feet. That fact and my having a splash of anxiety disorder in the area of public speaking had kept me from attempting trial law. However, I’ll credit some Higher Power with providing my response. Whether you agree with my comment might depend on your politics.

“Sterilize them? I sure am glad they did not do that to former First Lady Barbara Bush. She has spoken openly about having the common mental illness of depression. Why, if they had sterilized her, we would not have our current Florida Governor Jeb, nor our President George W., now would we?”
  
This fellow partier quickly exited the food line. Perhaps he thought I was nuts. I certainly felt he was prejudiced. I think the example shows the range of fact versus myth associated with common brain illnesses.

This attorney had no idea that from 1997 until its passage in 2001, I led the call to have “mental illness awareness” added to the Florida Bar’s CLE program. The Florida Supreme Court made this landmark addition, giving this new category the same status as the Ethics and the Professionalism hours. This designation was to be an incentive for lawyers to receive training in this important area.

I was in my sixteenth year of wellness with bipolar disorder when this conversation occurred. I am now in my 20th. My label of mental illness has cost me what was most important to me. It has given me a calling and a passion.

I am bold, as I have already survived the greatest losses:

My husband filed for divorce, and for custody of my then five and seven year old children. I was served with the petition the day after I got out of a two and a half week visit to a psychiatric ward. I was manic, too ill to know I was ill, and too proud and fearful to admit I had a psychiatric condition. After driving to the medical bookstore of the university where I received my law degree, with honors. I humbly read a list of symptoms that sounded a lot like me. I went on lithium and quickly became well. The marriage remained irretrievably broken. Lawyers had told my husband I would likely go off of the medicine and wreck his life.

My children’s wealthy father did not get custody of my children in 1989, but when they began having troubling behavior problems six years later, he did. An untrained legal system presumed the children’s behaviors were the fault of a bad, mentally ill mom. National Institute of Mental Health studies now show that half of all people with inherited brain illnesses onset with symptoms before age 14.

I not only lost custody, I was denied all access to my children. I could not find a single Florida lawyer who admitted to understanding mental illness to help me. I wrote the local bar, the state bar and the state supreme court, seeking a referral. I was defenseless, oppressed and alone in my closet of shame and presumed guilt.

I went to work for a lawyer working for a commercial real estate firm. My second day at work I was given a medical insurance application requiring me to list my physicians and medications. I listed my psychiatrist and my mood stabilizer, lithium. My sixth weekly pay check was from a newly created corporation of fewer than fifteen employees. There were many more employees in the original company. I learned later in a Florida Bar continuing legal education labor law course that placing “those” employees into these smaller organizations allows companies to drive off troublesome employees without concern about ADA violations.

After a year of mistreatment, I left and became a full-time self-funded advocate for people like me.

One could say I hit my “rock bottom.” I was blessed to have quickly become medically well. With the help of lithium, I never struggled with depression or the return of a manic episode. My bottom was due to discrimination.

My “bottom” lacked character flaws and moral defects. I had a touch of the OCD perfectionist trait which caused me to consistently make the safe, responsible, hard-working lifestyle choices. I was never involved with alcohol or drugs. I grew up in a home with no alcohol or drug use. I had always been a person of faith. I did not even have a speeding ticket.

The injustices and misunderstanding I faced were based upon stigma. It was founded on myths about my diagnosis. Millions of other people are at equal risk of injustice. Few legal professionals understand the important role that treatable psychiatric problems play in our nation’s health, safety, economy, workplaces, families and routine human behaviors. Misinformation is commonplace and it encourages discrimination.

Justice for those with mental illnesses is possible, but it will take lawyers and judges who have been trained in medical truths.

• Basic mental illness facts will explain the medical impact of these common illnesses on the thoughts, feelings and behaviors of the 60 million who show symptoms from time to time.

• Early recognition can prevent chronic and severe illness.

• Interventions can prevent serious problems like substance abuse and addiction which follow attempts to alleviate symptoms.

• Public education and earlier medical and therapeutic interventions will greatly decrease student problems such as academic failure, aggression, bullying, absenteeism, drop-outs, delinquency, substance abuse, incarceration, suicide attempts and suicides.

• An understanding of stress triggers will allow our society to re-think priorities, achievement pressures and definitions of success and health.

These reforms are not occurring due to ignorance and empathy associated with stigma.  Ending stigmatization and discrimination is among our greatest civil rights battles. Changing attitudes is a daunting task. However, lawyers are uniquely trained to take on big impact causes.

Legal professionals often bring major changes. The rights of women, African-Americans, the disabled and many minority groups have been protected through our courtrooms. Media coverage spreads the reforms nationally. Little black children would likely still go to different schools from little white children had the lawyers not gotten involved.

Legal professionals have changed the course of history in areas of civil rights for generations. A few good lawsuits, followed by some great media coverage, will change attitudes about psychiatric conditions. Education will let America finally respect and harness the untapped abilities of millions of citizens. Troublesome symptoms and worsening lifestyles can be prevented. The unique contributions of those who are not quite boring, average or “normal” have always enriched our society.

Current misunderstanding of brain illnesses is harmful to persons with mental illness. Symptoms are triggered by stress. Our present policies and punishments create unnecessary stress. Our criminal justice system and our emphasis on competition may be revisited when our society understands that for many, their human behavior at times is not truly willful and intentional.

Removing the prejudice and discrimination shared by uninformed lawyers is a huge challenge. Many systemic changes, like making our nation computer literate, skipped the older generation altogether. Educators went directly to the youth, putting computers in the classrooms. Achieving student education about mental illnesses from early school grades will educate the next generation and end the misinformation once and for all. However, adding mental health knowledge to curriculums requires convincing school officials who have no mental illness training.

Schools do not teach the subject. A page or two in a ninth grade health class is not enough. Discrimination and misunderstanding must be attacked much earlier. The ultimate reform may require legal action. If mental illness is not taught in the schools, where will the judges, jurors, journalists, preachers, and lawmakers learn the medical truths about these common, misunderstood medical conditions?

Where are the legal helpers? Few stand up for the rights of those with mental problems.  Many legal professionals have mental illnesses in themselves or their family members. Few dare to step out and demand education and justice. Most people have never learned that the majority of those with psychiatric illnesses can easily recover.

Typical medical doctors do not discuss mental illnesses. Physicians could easily screen for mental health symptoms using checklists while patients were in the waiting room. In the past most medical insurers have not paid doctors to diagnose and treat mental problems. Although all physicians have many patients with mental problems, most doctors have not stayed current on the medical data surrounding the brain research and treatment.

Public attitudes about mental problems are often based upon myths and stereotypes. Neighbors will discuss their relative’s cancer or heart disease issues. People seldom talk openly among their families and friends about their psychiatric illnesses. Even acknowledging an understanding of brain illnesses can lead to discrimination. Knowing too much about psychiatric issues may bring a presumption that the person in the know is “nuts.” If a person’s rights are wrongfully violated due to discrimination against their mental diagnosis, where can he or she find a lawyer who is not biased against their condition?

Most people either avoid or joke about things that make them uncomfortable. Whenever I meet a state lawmaker for the first time and say I would like to discuss mental illness with them for a few minutes, often the reply is, “You have come to the right place. A lot of us around here [the capitol] are crazy!” The elected official soon learns from the serious conversation that follows that mental illness is no joking matter. It is the “elephant in the living room” when it comes to the state budget, law enforcement expenses, prison system, courts, homeless problems and solutions, suicides, domestic violence, unemployment, addictions, divorces, delinquency and many other very costly and significant social issues.

For most lawyers, mental illnesses are not something they openly discuss. Many, and probably most, just lack accurate facts about the topic. They have no idea how many clients are displaying mental health symptoms during the stress of a legal problem.

One corporate attorney told me his law firm did not need to learn about mental illnesses because they did not deal with “those people.” The stereotypical view of a “crazy” [mentally ill] person is someone who has not showered or shaved in days, dirty, disheveled, talking to himself and presumed to be high on cocaine or alcohol. Injustice occurs when the more typical client or lawyer is discovered to have a mental health diagnosis. The myths surrounding mental illness create false presumptions and judgments. Stigma brings discrimination. This injustice causes more denial and closeting.

With modern data reflecting the medical nature of brain illnesses, why does stigmatization continue?

In my book, Brain Bondage—the Delay in Mental Illness Recovery, I credit several key professions in spreading misinformation about the mood disorders of depression and bipolar disorder along with the other common mental illnesses. The legal profession is among them.

• The media has for years covered the sensational, violent acts of a few seriously ill people. Andrea Yates and Ted Kaczynski were covered in every media outlet, creating a presumption that drowning babies and harming people with bombs was normal behavior for a mentally disturbed person. At the same time, the media omitted stories and information about the millions of Americans living peacefully, and productively, in our communities with the same illnesses. Articles about the violence failed to explain that mental illnesses are treatable, and aggressive behaviors can be prevented with medical help. The lack of unbiased media coverage created prejudice by other professions.

• Faith leaders receive no formal mental illness training. The topic is not included in seminary lectures or faith magazines. In repeated sermons, many spiritual leaders have associated bad behaviors of mental health symptoms with sin and demon possession. This further closeted the many families and individuals in congregations who live with mental health issues.

• Medical doctors have consistently failed to screen for mental health symptoms, despite an abundance of medical knowledge about common, treatable mental illnesses which has developed over the last 15 years.  Patients remain ignorant that their struggles with sleep, anger, worry, obsessions, lethargy and hyperactivity are often treatable medical issues. Stigma plays a role in this. Patients might be insulted if their physician suggests that they see a psychiatrist or go on medicine for a mental problem. Many doctors are not skilled in prescribing psychotropic medications. Ignoring the subject has been the easier path for most physicians.

• Insurance companies continue to separate brain illnesses from the rest of the body in coverage and reimbursement practices. A doctor’s lack of attention to mental health matters could supposedly be justified by the fact that medical insurance providers have not been reimbursing doctors for screening, diagnosing or treating mental health problems. Doctors lacked incentive to keep up with advances in a field for which they had no economic interest.

• Therapists are skilled at helping a client with a well brain talk about their painful divorce or another loss. However, most liberal arts counselors have never been trained to recognize the complexities of mental illnesses. They cannot prescribe the medications often needed to correct faulty brain chemistry. When medical treatment is delayed, brain illnesses can worsen, putting marriages, jobs and patients at risk. Working jointly with a therapist and a psychiatrist has been shown to be the most effective way to resolve mental health problems for many people.

• Educators have not kept up with the need to give our nation a realistic understanding of the role of brain health and illness in our culture. From elementary schools to universities, students would benefit by learning how mental problems are another common, treatable medical issue. When myths and misinformation are replaced with accurate screening, early and proper treatment and an end to discrimination, the nation’s current mental health crisis will end.

Far more than just a fairness and prejudice issue, misinformation and misunderstanding about the common brain illnesses of depression and bipolar can be deadly. Suicide is the worst and final symptom of these illnesses which affect 14 to 17 % of our population at some point in their lives. Suicide accounts for 30,000 deaths in America each year. This is a larger number than homicides or war.

Those within the legal profession are at great risk of mood disorder episodes due to conflict and adversarial nature of many law practices. Even the victor in the big cases often faces the additional stress of an appeal, or obtaining more clients due to the notoriety. When the Florida Bar Board of Governors voted to support having “mental illness awareness” added to the Bar’s continuing legal education program with the hours equivalent to the areas of ethics and professionalism, there was testimony about attorney suicides and the importance of prevention through education.

Bit by bit, as more professional bodies replace stigmatization and avoidance with accurate medical knowledge about genetics and brain chemistry, ours will be a healthier, happier and better world.

Reform will naturally follow mental health education. The fastest reform will be by pursuing both top-down and bottom-up efforts. I would place at the top the urgent need to train our nation’s judges about basic mental illness symptoms related to changes in thoughts, feelings and behaviors. Sitting in judgment of human behaviors without having this knowledge is a denial of justice for those afflicted with symptoms. The 170-page report of the Florida Supreme Court organized by Judge Steve Leifman clearly explains the importance of judicial training. An article by Florida’s former Supreme Court justices explains their awareness of the urgency of mental health reform. Litigation is not a fast track to justice, but it has been used for generations as a way to achieve justice.

Raising little children in the appropriate way is accepted by educators and those of faith. When young minds grow up learning the truth about brain illnesses, the stigma will end. The next generation can learn from early childhood that brain illnesses are common.

The jokes, ridicule and shame will end. Just knowing about the many famous and accomplished people who had or have them—from Abraham Lincoln to Ted Turner—will return respect to this diversity group. Some may soon view a diagnosis as a status symbol. Among the most famous and gifted citizens on our planet have been those with non-average brain chemistry.

Routine screening and effective treatment will change attitudes. Students in Australia and Canada are already learning in school about mental illnesses. Teaching our children about brain wellness is no more novel than was teaching them about the inventions called telephones, and then computers. Promoters taught the nation to use telephones by putting them in the classrooms. Computers became commonplace using the same path.

Parents, grandparents and professionals often learn from the youth. Bottom-up advocacy accepts that children will grow into lawmakers, lawyers, employers, voters, preachers, teachers and judges. If we teach our children the truth about mental illnesses, they will end the stigma. Ending stigmatization will allow medical advances to end our nation’s mental health crisis.

To read more about Angela, excerpts from her advocacy book, Brain Bondage—the Delay in Mental Illness Recovery, and to order, go to: www.angelavickers.net