Stigma is something that can be seen outwardly like when a family member avoids you due to your depression or  you’re passed over for a promotion because your coworkers discovered you’re diagnosed with schizophrenia. It’s also seen in public perceptions as noted in the Surgeon’s General report where 60% of people felt like people with schizophrenia behaved violently. But the biggest danger of mental health stigma is when it’s felt inwardly. Because no matter how unfairly people treat you ourwardly, it’s nothing compared to the effects of feeling the stigma inside.

Mental health is something that matters whether you’re seven, seventeen and seventy, and any of those ages can fall victim to a mental illness. Depression, for example, is quite prevalent and undertreated in the elderly. But if you’re underage, it may be more difficult than just going to your doctor to start the process of getting help for your mental health. It likely means explaining your mental health concerns to your parents; which, quite reasonably, is scary to a young person. (It’s scary to an old person too, but I digress.) So how do you tell your parents you think you need mental health help?

For a long time I didn’t wear sandals. No, not because I don’t like them or because my toes have an aversion to open air but because of the scars on my ankles – that’s where I used to cut. My ankles looked like there were pink, wriggly worms embedded in them. And I was scared that everyone would see them and know what happened, know what I did. I figured people would take one look at me (zero in on my ankles for some reason) and then judge me as being a freak and a lunatic and I would be ostracized from normal, human interaction. That was a bit of an overreaction on my part driven by the shame of self-harming in the first place. I’ve gotten over it.

Natasha Tracy is not, in fact, my real name. It’s a nom de plume. Writers have a long history of writing under pen names for a whole variety of reasons but one of them has always been judgement. People will judge you, as a person, by what you write. Write erotica, for example, and get yourself a reputation as a slut. And as a mental health writer, I face similar stigma. True, people aren’t likely to make inferences about my sexual nature (although it has happened) but they will make judgements about me as a person and certainly as an employee. Because no matter how much I write about stigma and no matter how open people appear to be, a person with a mental illness is simply always assumed to be unequal to someone without a mental illness. Their point of view is always considered to be tainted by their illness. Their thoughts are never considered to be their own.

I don’t remember most Christmases; they tend to blur together in a sea of turkey, denial and wrapping paper. But the Christmas of 1998 was different. That Christmas was the one just before I began medication. That was the one I spent lying on the couch with bandaged arms. Looking back 1998 should have been a good year for me. I had completed an 8-month work term for my university degree, I had some money for the first time in a long time and I went backpacking across Europe. But unfortunately, 1998 was the year that bipolar decided to attack full-force. I spent the end of 1998 slicing and dicing and sobbing and begging for mercy. From what, exactly, I have never been able to say, but from whatever was causing the pain whatever made it impossible to move from my mother’s couch as the activities of Christmas went on around me. But in spite of this I had no intention of seeing a doctor and I most especially had no intention of seeing a psychiatrist. Those people were nothing but pill-pushers, nothing but drug dealers with letters after their name. And everyone knew that depression wasn’t a real disease and that anyone with real strength of character could overcome mental anguish on their own – not with the crutch of pharmaceuticals.

When I told my mother I had a mental illness, I’m pretty sure she didn’t believe me. She didn’t come right out and say it, but it was pretty clear she was suspicious. Once she did feel something was wrong, she was sure it could be fixed with vitamins and herbs. It couldn’t. And this is a pretty common reaction from family members. You have one of the hardest conversations of your life and the family member responds with, “you’re not sick.” Or, “you look fine to me.” Or, “you’re just being dramatic.” Or many other things that will tell you that they don’t believe anything is wrong. So how do you approach a family member and explain to them that everything is not OK.

Bipolar disorder is associated with extremely high (mania/hypomania) and low (depressed) moods. This is typically seen with emotional changes, behavioral changes, energy changes and so on. Psychosis, on the other hand is the presence of delusions and hallucinations. Delusions – false beliefs that persist in spite of the existence of contrary evidence – and hallucinations are most closely associated with schizophrenia. However, symptoms of psychosis can occur in bipolar disorder and depression as well.

There is a persistent myth that having bipolar disorder means you have a “broken identity,” or even, “split personality.” I would imagine the term “manic depression” (an older term for bipolar disorder) conjures up these images for some people. But I’m here to tell you, my identity is just fine as is my personality.

As I work, I battle the stigma around mental illness. It feels like often, all day, every day, it's the only thing I do. But I do it because I feel it's important. I feel it matters. I feel it changes people's lives. And one of the misconceptions I've heard multiple times recently is about bipolar and mental illness diagnosis. That by accepting a diagnosis of a mental illness this somehow removes the responsibility from the individual for their own wellness. That, somehow, a mental illness diagnosis makes the patient weak because now they are looking for someone to "save" them or "cure" them. Well nothing could be farther from the truth. Getting a mental illness diagnosis is only the first step in what a patient must do in order to recover.

Today I was made aware of a site that went up specifically to make fun of, and show hatred towards, those with bipolar disorder. Specifically, the site is aimed at me and all those who use psychiatric services in the treatment of mental illness. Whoever wrote the site feels it's okay to take advantage of people with an illness, people who are in pain. Well, it's not OK. We're not a joke. We are people. Real, flesh and blood people. And we do not accept your hatred. I do not accept your hatred.