Monday, August 28, 2017

A time and place for full disclosure

I try to be supportive of efforts to de-stigmatize mental illness in the public consciousness. When the topic is brought up, I do my best to discuss it as I would any other malady that someone may have to deal with in their lifetime. Viruses, bacterial infections, cancer, depression, mental disorders; they’re all medically treatable conditions. Why should I–or anyone else–discuss one with a differing degree of empathy than the others? I’ll admit that I’m not always successful in those efforts but I also understand that there are appropriate times and places for sharing information about one’s health.


I’m reminded of a short film—if memory serves, it was a corporate training video—that depicted a person at a job interview. There were two interviewers and one of them asked the applicant about a gap in their resume. The applicant didn’t hesitate to answer honestly, saying that they were being treated for depression at the time and they were looking forward to working again.

The applicant was thanked for their time and dismissed. After the door closed behind them, one interviewer looked to the other and said something to the effect of, “We can’t hire this person. They might go crazy and shoot up the office.”

One purpose of the training video was to illustrate how mental illness is stigmatized, another was to help employers understand the nature of job discrimination.

Of course, this sort of job discrimination happens all the time and it’s very difficult to prosecute. Without hard evidence–an incriminating e-mail, corroborating testimony, etc.–accusing an employer of job discrimination can be easily dismissed with the words, “The applicant just wasn’t qualified for the position.”

It’s wrong but it happens because the cause is largely societal. Until society progresses to a point where it’s generally understood that mental illness is no different from any other kind of illness, the best that someone functioning with such a diagnosis can do is simply not volunteer the information.

The job applicant in the training video appeared to assume—incorrectly—that their prospective employers shared their socially progressive view of mental illness. A little discretion would have made this an non-issue. The applicant could have simply stated that they were hospitalized and/or undergoing medical treatment during the referenced time period and left it at that. It’s a simple matter of fact that medical histories are privileged information and irrelevant to a job interview.

Advocates for the mentally ill—particularly those who are functioning with such a diagnosis—might disagree with me. They might even be offended by the suggestion that people should generally keep their mental health conditions to themselves.

“Mental illness is nothing to be ashamed of and is no different from any other chronic condition,” they will say—and I agree 100%.

I’m not advocating that people be shamed into silence about mental illness, I’m simply reminding them that private medical information is just that: private. Just because one isn’t ashamed of having had appendicitis, doesn’t mean that it’s anyone else’s business. One’s mental health shouldn’t be regarded differently.

Removing the stigma associated with mental illness does not require that people give up their right to privacy. Discretion is not deception and being honest about something does not require making a statement. If certain facts are not relevant to a particular discussion, then there’s no need to bring them up. Judging the appropriateness of sharing certain personal information within the context of a discussion is a criterion of navigating social interactions; not an indicator of one’s commitment to any principle.

When it comes to social media, I’ve observed that many people—myself included—seem to abandon the social mores that they would otherwise rely on when interacting with others in the real world. When people are in a public place, most are aware of their surroundings and of the people with which they are sharing that space. Under those conditions, most people will instinctively exercise a level of restraint that keeps them from drawing unwanted and unneeded attention to themselves. Yet, when those same people are participating in a “public” forum in a virtual environment, that instinct may not kick in. Being physically alone in a quiet space with one’s connected device, it’s easy to forget—at an instinctual level—that the thoughts and opinions one expresses are on display for others to see on their connected devices in the privacy of their own quiet spaces.

Learning to navigate social media is not as easy—relatively speaking—as learning to navigate social situations in the real world. Non-verbal methods of communication that people take for granted in person are not available to us online, despite our best efforts. “Reaction” buttons and emoji’s are a poor substitute for body language and verbal inflections.

Someone with reasonably good social skills in person may fall short when it comes to expressing themselves in writing. Friends and family who know them personally, are accustomed to their physical affect and the nuances of the way they communicate and interact in person, can more easily overlook an awkwardly worded observation. There are other familiar indicators to help them understand the intent behind what’s being said. Most of those indicators are not available when communicating through social media. Whereas a personal friend or family member might have insight into where a statement might be coming from, someone who lacks that perspective has nothing to go on but the words being presented to them on their device. As a result, an otherwise completely affable person in the real world might be perceived online in a way that’s at best confusing and at worst repulsive to complete strangers and casual acquaintances alike.

Add to these already complex social interactions factors like mental illness and spectrum disorders and the possibility for misunderstandings and confusion in online interactions grows exponentially.

I’ve written elsewhere about how unfiltered use of social media can have professional consequences. While that essay dealt primarily with the potential fallout associated with sharing political content, haphazard public references to one’s mental illness—while possibly intended as an effort to de-stigmatize it—most often backfire.

"Public Post"
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I’ve personally “unfollowed” colleagues on social media for making public references to their mental illness; sometimes in the context of a passive aggressive joke about the consequences others might face due to an “accidental” lapse in their medication regimen, but most often lacking any context at all. My decision to unfollow them is not because of a lack of empathy on my part, I simply find it demonstrative of a general lack of self-discipline and/or the inability—or worse, unwillingness—to consider the feelings, perceptions or experiences of others, which can affect their professional prospects and runs counter to any efforts to de-stigmatize mental illness.

*"Limited view ability"
Social media icon.
When I see a social media post that appears to be of a sensitive and personal nature, the first thing I look for is an indicator* that the audience for it is limited. This tells me a couple of things: 1) the person doing the sharing is doing so with some degree of discretion. And 2) that I’m someone they feel they can trust with the information—it feels good to be in the loop.

It’s not impossible to be selective about who can see one’s posts on social media. It may take a modicum of effort and an extra moment of thought and reflection but whatever time and energy one might lose by making these considerations is more than compensated by avoiding potentially damaging repercussions—both major and minor.

When it comes to my own experiences with mental illness and my interactions with others, I’m not averse to open discussion but I do make an effort to consider the context in which I speak—or write. In a blog post that I might share on social media, no one is obligated to click on the link and read what I have to say if they’re not interested; but if they do, being redirected to a web page that’s completely separate from a social media interface may suggest that what one is about to read might be more important than a quick observation or meme that can be easily scrolled past on their newsfeed.

In 2010, I ran for public office. I had no illusions about where my efforts would lead and the experience was simultaneously educational and soul-crushing. One of the more interesting aspects of the experience regarded the need to disclose personal information. For starters, candidates for certain elected offices are required to pay an administrative fee to participate in the election. If a candidate is unable to afford to pay the fee, it can be waived if they file an “Affidavit of Impecuniosity,” which literally means, “statement of having little or no money.” Regarding my mental health—and other matters I felt were important for potential voters to know—I created a “Dirty Laundry Page” on my campaign web site (elements of which have since been incorporated into this blog). It was on this page that I discussed my experiences with mental illness, mistakes I’ve made and lessons I learned.

The page starts with a section that as simply titled, “On Narcissism” in which I briefly discuss the fact that I have been diagnosed with “Narcissistic Personality Disorder” or “NPD.” Having written about it in more detail elsewhere, I won’t rehash the particulars of the condition here. I will say again that it is something that I have sought treatment for—which anyone who is familiar with the disorder will tell you is highly unusual (I’m not bragging, I’m just stating a fact).

I’m glad that I’m able to say that I’ve made progress in my efforts to understand the root causes of the disorder for me, to be more aware of my general attitude and to identify triggers that might cause me to “act out,” but I also understand that there is no “cure.” I’ve sought treatment for one of the ancillary symptoms—depression—for much longer, but knowing what the primary condition is has helped me a great deal, not only in better managing my mental health but in strengthening my relationships with others.

While I do not share information about my NPD outside of what I judge to be appropriate contexts, I’ve found that it’s been most important to share it with the people that I am closest to. It’s been interesting to note that upon revealing this particular trait about myself, the response I often get is, “You’re not a narcissist.” I suppose, in those particular moments, I don’t seem to be but I will usually address this observation by saying, “I’m a recovering narcissist.”

Like those struggling with an addiction, there’s no such thing as “recovered.” I know this because from time to time, I’ll still act out in a narcissistic way. I’ve been getting better at recognizing triggers and taking a moment to consider them before I speak; to remind myself that what I might be perceiving as a slight against me may not be that at all and I can simply deal with the facts of the matter at hand without harming my relationships with others. But this is not always the case. When I do act out, I don’t usually realize it as it’s happening. Only upon reflection—sometimes moments afterward, sometimes days, weeks or months later—do I recognize the behavior. On some occasions, I have the surreal experience of being aware of it in the moment but I can’t seem to stop myself. I’ll realize it at a level of awareness that causes me some alarm but not at a level where I can hit the metaphorical brakes.

To offer an example, I once received a phone call from a Production Coordinator coming to Utah from California for a single-day shoot. They were producing an online promotional video and wanted to hire local crew members to fill support positions on their production. I was hired as a Production Assistant and when I was asked if I knew anyone available for a couple of other jobs, I happily referred a number of colleagues. When the date of the shoot arrived, I said to one of them, “You’re welcome by the way.” Then he thanked me.

Before I even wrote down that memory, just reflecting on it, I looked at myself in that moment and thought, “What a dick! What kind of jerk fishes for a ‘thank you’ when he refers someone for a one-day gig? Damn it, Joe! You didn’t hire them. You weren’t the producer on this project. Be grateful for the chance to work with your friends and keep your mouth shut and maybe they’ll return the favor down the road. And even if they don’t, who cares. Appreciate what’s happening now.”

There have been other times that I’ve caught myself fishing for gratitude for some little thing that’s ultimately meaningless or took place so long ago that I feel ashamed for still holding onto it, hoping for some sort of recognition.

Considering, once again, the difficulties associated with navigated interactions on social media, I serve as an administrator for an online forum for regional filmmakers. At present, there’s probably no other situation that presents a greater challenge to me when it comes to potential NPD triggers and I try to remind myself of this every time I take part in that forum. Being in a position where I have tools at my disposal to affect the experience of other users in the group, I have to put forth a great deal of effort to try and maintain a sense of objectivity when engaging others either in forum discussions or when addressing administrative issues. I try—not always successfully—to be mindful of how I address topics and anticipate different ways that my remarks can be interpreted. Sometimes, I have to step away from my role as an administrator if only to put my ego in check and to remind myself that the group is largely self-managed. On more than one occasion, I’ve been accused of being “on a power trip” or just a “know-it-all.” I don’t resent the “power trip” accusations because I feel they actually help to keep my ego and narcissism in check. As for the “know-it-all” remarks, while I’m not an expert, I’m not a novice either and from time to time, I try to express my gratitude for the things that I’ve learned from many discussions in the forum over the years.

Learning to be mindful of my behavior when it comes to interacting with others—especially in a professional context—has certainly helped me to address my NPD but it has also served to aggravate another condition that I struggle with: anxiety.

I’ve had anxiety attacks at various times throughout my life. Until my diagnosis, I didn’t know what to call them. I’ve endured the typical symptoms of anxiety: hyperventilation, rapid heart rate, confusion, insomnia, avoidance. I’ve also been hampered by lesser known indicators like stammering, irritability, and gastrointestinal problems.

In my professional interactions, I generally adhere to the social parameters described above. When I’m hired onto a project, my colleagues—especially those I may only work with for a brief period—simply don’t need to know the particulars regarding my mental health. Such information is irrelevant to the job at hand anyway. Anxiety attacks, on the other hand, usually warrant a discrete explanation.

However, when I find myself in a position of collaboration with others in a more creative capacity, when the work can be drawn out over several weeks or even months, there are benefits to being frank about one’s struggles with conditions like anxiety and depression. The nature of the work in creative fields like filmmaking and television production requires a level of intimacy and trust between colleagues that isn’t usually experienced in other industries. Despite that fact, I have experienced some pushback from a few individuals.

A number of years ago, I was developing a local television project and experienced a severe anxiety attack at the END of a shooting day. I was alone and not even on location but knowing that the episode was the direct result of my experience on the production, I felt that it was important for me to discuss the situation with my production team.

One of the writers on the project made it fairly clear that they didn’t want to be privy to this information, to be aware—to use their words—of my “mental defect.” This person’s lack of understanding, sensitivity and eloquence (ironically, for a writer) was on full display. That they subscribed to the stigmatized view of mental illness was clear but they also suggested that my openness about my mental health wasn’t professional.

I could not disagree more. Awareness can ensure preparedness. If someone deals with a medical condition that has the potential to hamper a production, then I think that person has a professional obligation to disclose it to those they work with. This was especially the case for me since I occupied an “Above-the-Line” position on the project, fulfilling creative, executive and administrative responsibilities associated with it.

The circumstances that I find myself in do place a limit my ability to work for extended periods, but it has also afforded me opportunities to be of service to others and to make a greater effort to cope with and seek out effective treatment for my particular challenges, develop my ability to empathize with others facing similar struggles and help to foster an environment that’s more sympathetic to those dealing with chronic conditions concurrently with their efforts to grow creatively and professionally.

It’s my hope that these remarks will not only resonate with others who struggle with their own challenges as they navigate personal and professional situations but that my personal friends and colleagues who read this will have a better understanding where I’m coming from in our interactions.

Friday, January 27, 2017

Universal healthcare and slavery?

I saw this graphic on social media that incorporated a photo of Bernie Sanders smiling at a podium and next to it was written, “I’ve been criticized for saying this so let me say it again: I believe healthcare should be a right, not a privilege.” Below the image of Sanders was a photo of Rainn Wilson in his role as Dwight Schrute from the U.S. version of “The Office” and the words: “Wrong, healthcare is a service[.] No one has a ‘right’ to the labors or services of another person[.]”

The Sanders quote is accurate. He wrote it on Twitter in February of 2016.

The text accompanying the image of Wilson was never written for—and thus never spoken—by Dwight or any other character on “The Office.” I’m sure that it was never intended to imply that Dwight said this, only to prompt the reader to use the same inflections that Wilson used for his character as they read it to themselves.

There was an affirmative comment on this social media post that read—with obvious sarcasm,
“what? but sometimes there's a lot of good intentions behind slavery….” (sic)

I've heard this slavery argument against universal healthcare before and it’s never made sense to me. The reasoning in the graphic doesn’t really support it because it's always been my understanding that slaves are not personally compensated for their work (food and shelter doesn't count, since it's the equivalent of fueling a vehicle or paying for electricity to power a machine—yes, it’s a cold, inhumane description but slavery is a cold, inhumane practice).

In all of the advanced countries that offer universal healthcare, name one that provides it with enslaved doctors and nurses. Considering the acumen, effort and expense—to say nothing of the desire—required to become a medical professional, where exactly is the incentive to become a doctor or a nurse in a universal healthcare system if it means becoming a slave? How many aspiring doctors have there been in the world who changed their mind at the last minute because they just didn’t want become enslaved and have to do all that work for zero compensation? I suppose if one already owned a slave—again, in which advanced countries is this still permitted?—one could just force a slave to become a doctor. Which would mean a lot of expensive and time-consuming education and training of a lot of candidates just to find out which ones would actually be able to do the job—not all MDs are cut out for patient care, after all—their actual desire to do such demanding work would be irrelevant because, well, slavery. It would be a lot less expensive and much quicker to just hire existing doctors and nurses to do the work. They’d be much better at it, since they would be more likely to have chosen to work in the medical field and voluntarily invested their own time and resources into the required schooling and training for those jobs.

The U.S. doesn’t have a single healthcare system. It has a strange mishmash of different systems similar to others that can be found all around the world. These American systems overlap in some areas and leave gaps in others but not a single one of them involves enslaving doctors and nurses.

As a veteran, I make use of the Veterans Administration for my healthcare. The VA system is funded and administered by the government. This is similar to the NHS system in the U.K. which provides healthcare to all its citizens. The doctors, nurses and other medical professionals that I interact with are not slaves. They’re government employees.

Many senior Americans make use of Medicare which is a “single-payer” system, not a “single-enslaver” system. Doctors, nurses, etc. are all paid for the services they provide. Again, “payer” is right there in the describing term.

The Affordable Care Act (i.e. “Obamacare”) implements several different mechanisms to enable people to get healthcare. Again, no slavery is involved. Some people complain about the health insurance mandate—yet remain silent on the requirement to have insurance if one drives a car—despite the fact that it’s been among the preferred means of conservatives for increasing healthcare coverage… Until Obama embraced it and then it became anathema to their core American values somehow; this idea that Americans should be required to pay for their own health insurance as if we function is some sort of market-based economy.

I think I’ve made my point pretty clear that universal healthcare does not equal the enslavement of doctors and nurses. Of course, there are going to be a lot of people who will continue to ring that bell because they won’t allow any amount of evidence, logic, reason or common sense to conflict with their ideology.