On Mental Health Stigma and Embracing Respect

I worked with a client for years on developing mastery over her severe OCD. While OCD alone played a huge and painful role in this client’s life, it also mined her family history of trauma and invalidation for its material. Obsessions and compulsions intertwined themselves with self-doubt and self-hatred for every part of her narrative that was harder to navigate than expected. OCD is like an insult comic in this way. It’s the master of ceremonies at your roast, but rather than you being invited as an honored guest, you’re just kidnapped without warning and shackled to a front row seat. It took time and effort on both our parts to find the roadmap of recovery and follow it toward her audacious goal of becoming a doctor. What is it about suffering that leads people into helping professions? Maybe the answer is obvious.

So now, with OCD in a more manageable place and her sense of self in a more accessible place, my client is deep in the throes of medical school. Today she emailed me about a lecture she attended given by a medical doctor. It was a screenshot of a slide saying, “Embrace Your OCD Qualities: checking, re-checking, and checking again”. Presumably this had something to do with checking labs, or notes, or prescriptions or something like that.

Surely fastidiousness and attention to detail are important attributes in being a doctor. It is a good thing to teach this. But what else is being taught when people in the actual medical profession, teachers of that profession, use diagnostic terms as glib throwaways? Embrace your OCD qualities? Shall these students embrace their schizophrenia by acting out future interactions with patients as if they were real? Embrace bipolar disorder by staying up for days in a row studying? Embrace their major depressive disorder by isolating and ruminating over mistakes on past exams? How, oh how should these hard-working medical students embrace their suicidal ideation?

Consider what a slide like “embrace your OCD qualities” means for the OCD sufferer who is taking that course. Really picture it. Maybe you’re in a classroom, at a tiny desk surrounded by your peers who you already feel you don’t measure up to because of your “qualities.” Or maybe you’re taking the class virtually, and you’re seeing the slide for the first time, alone in your room, a prescription bottle of your SSRI medication at your nightstand, just off to the side. Or maybe you downloaded the lecture at a library and right before you saw that slide, you were lost in a rumination about whether or not you harmed a child who walked by. Or maybe you just finished a therapy appointment where, for the first time in ages, you could tell your CBT specialist that you really nailed your ERP homework, that it was hard, and that you were proud. And then this slide reminds you that you really are who you always thought you were; you are one of those people.

Many will say that we live in too serious a society and people just need to lighten up. A joke, after all, is just a joke.  It’s funny because it’s true, they will say. But this reflects a wildly misinformed position on what comedy is. Things are funny when they are not true. This should be obvious. A person who looks like he’s lost control of his body when he trips over a cat and scrambles to keep from dropping a hot cup of coffee is pretty funny (a daily occurrence in my house). A person with ALS who loses control of his body is not funny. This is so incredibly basic, even a highly educated professional can figure it out (that’s funny).

I typically like offensive humor. It validates the things that pop into my restless mind by saying them out loud. But even intentionally offensive humor works because the joke is on the speaker, not who the joke is about. You can do a review of the comedy of Ricky Gervais, for example, and be hard pressed to find a single instance where the punchline is a person who is suffering. The punchline is him for appearing not to grasp it. The curator of this offensive slide is not making a joke about their own ignorance, but a serious claim about the perceived silliness of OCD and what it compels people to do.  

I have no doubt this teacher would be shocked and appalled at the discovery that they are perpetuating stigma. They are simply inept at comedy, which I find an almost acceptable excuse. People say ignorance is no excuse, but I disagree. It may be the most valid excuse. Intentions matter, not just words. What we should be concerned about is not this individual (however much feedback they should certainly receive), but how this individual gets to the position of teacher of medicine without having been truly educated about medical conditions like OCD.

If my optimism has gotten the best of me and the intention was not humorous, there is another problem. Embrace Your OCD Qualities could be meant merely as a “good recommendation” because the teacher believes psychiatric conditions are not real medical conditions. My entire life people have been telling me OCD isn’t real. I tell people I treat OCD for a living and frequently I hear, “Yeah, but doesn’t everyone have a little OCD?” This has always struck me as an odd way to communicate. “I work at a grocery store” followed by “Yeah, but doesn’t lettuce just come out of the ground?” More to the point, describing the symptom of an often-debilitating mental health condition as an asset is very murky territory. It may be true that individuals with some mental health conditions are attuned to the fine details. The part of this that is an asset belongs to the same brain as the part that is a liability, but the disorder is only in the painful part.

Whether the teacher was making a joke or simply didn’t mean anything by the comment, I think we’re ready to stop using OCD and other clinical mental health challenges as metaphors for things we actually want to see in the world. I think we can do it. I especially think the most educated among us should go first. But let’s go beyond the individual and get to the systemic. If you know anything about mental health conditions, just talk about them like they’re real. If you don’t know much about them, look them up (you can learn a lot about OCD here). If you have a mental health condition, you can become an advocate, but let me be clear – you are under no obligation to be the poster child for your hardest thing.  

If you have a mental health condition like OCD, treat yourself like you have a real condition, with real symptoms, and real treatment, and not just some shameful character flaw that makes you someone else’s weak metaphor. You can respond to, educate, or dismiss these OCD “jokes” – that is a personal choice. But don’t internalize anyone else’s bad ideas about mental health. Self-compassion and self-respect may only be treatment tools and not a cure for OCD, but then they may just be the cure for stigma.