I had barely gotten the words out before my doctor was reaching for his prescription pad.
I hadn't been sleeping, eating or accomplishing much of anything, really. It had been going on for some time. I had recently suffered a significant personal loss, but no, it wasn't the first time I was experiencing these symptoms.
Was I mentally ill? Or was this just typical grief? Was this diagnosis just one more weight on my shoulders now? I was officially "medicated" for a mental health issue, something that seriously didn't fit the self-image I aspired to. This had gone pretty far off script.
It's not a twist ending that drugs — in particular, Selective Serotonin Reuptake Inhibitors (SSRI) — are the first line of defence against any complaint that even borders on psychological. The efficacy of their enthusiastic (over) prescription is the subject of some debate, but that's for medical professionals to sort out. My beat is workplace issues, and of particular interest is the lingering workplace stigma inherent in a mental health diagnosis.
Despite increasing openness and understanding about mental health issues, and despite their statistical prevalence (one in five people will be affected in any given year, according to CAMH), most employees still don't disclose their diagnosis to their employers. Forty per cent of employees report that they are willing to disclose mental health difficulties to their employer, according to the Anxiety and Depression Association of America.
We seem so much more willing to talk about mental health these days, unless, of course, the issue is our own.
I was interviewing two of the experts behind the Canadian Armed Forces' (CAF) Road to Mental Readiness program in 2014 when I first saw mental health presented as a spectrum, instead of an oversimplified binary. In the CAF mental health program, mental health is not whittled down to the two reductive options of "mentally ill" or "normal." It was different than the pathology approach we've all seen in the past, where someone is immediately slapped with a diagnosis, and all the associated stigma.
It's not that there's anything wrong with diagnoses — they can obviously be quite useful, and necessary — but the spectrum-based approach is interesting for its stigma reduction.
The military is a unique employer in that it can be an extremely high-risk environment for psychological stress injuries. Coupled with that is a very particular culture where "toughness" is prized and praised, while disclosing a mental health diagnosis hasn't historically been well received.
To address this, the CAF's spectrum based approach presents mental health much like physical health. It exists on a continuum, is highly variable and can change from day to day, and perhaps most importantly, it requires ongoing care. Your mental health could be green or "healthy" one day, and slide into "reacting," "injured" or "ill" over a very short period of time.
One of the most interesting elements here is that this model does not place individuals on a fixed point on the spectrum; it can always change depending on your mental hygiene, support and resources. This is invaluable in terms of stigma reduction, because is removes the illusion of separation between "us" and "them" — mentally ill or healthy. We all exist somewhere on the continuum, and every single one of us has the potential to slide down the spectrum if faced with a stressor or catalyst.
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It also communicates the crucial element of agency. On the spectrum, you're not simply a victim saddled with a diagnosis that's indefinite and ongoing: you have the ability to do something. Using resources like coping tools, self-care, good mental hygiene, therapy, medication and support systems, we have the actionable ability to move back up the spectrum, and to stay in the "healthy" zone.
Many workplaces already focus on a recovery-based approach to mental health, with accommodations and leave time structured with an end goal of return-to-work. However, as with so many things, education is key. The CAF provides extensive mandatory training and education about the mental health spectrum, resources and coping skills, and good mental hygiene. Many civilian workplaces could probably take a few cues.
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