The Stigma of Co-Occurring Disorders


Originally published on Psych Central

There is a great deal of stigma attached with both mental illnesses and addictions. That is one reason I talk about my experiences. So, others won’t feel alone, and, to put a face to these conditions. It is scary to get a diagnosis of a life-long mental health condition that all you have heard are extreme negatives. People can lose hope. And, people fear what they don’t know.

I also have shame, or self-stigma. I have worked on accepting the schizoaffective diagnosis and at this point am okay. There was a time when I felt, less than, because of the severe symptoms. Now, I know I could not control what happened in the past, and just work on staying stable.

Social anxiety is something I contend with daily, and I cannot seem to prepare enough. I don’t know if I can ever accept how limiting it is for me. There are some things, like volunteering at my children’s school events, that are just too busy for me. I cannot enjoy shopping or parties, I just want an exit. I have worked very hard on this and work with people now and even do public speaking, but it is difficult.

The alcohol addiction label is new to me. In the program I am doing, SMART Recovery, they don’t give labels. But, I need to call it something. The drinking is not new, just the acknowledgement.

There are choices of programs for changing addictive behaviors. Some people work more than one at a time. This was just one that seems to fit my philosophy. It uses cognitive behavioral therapy (CBT) principles and I already learned some of those for my anxiety.

I haven’t had serious consequences from drinking. No DUIs or jail time, No relationship problems. But, I drink more than I would like  and it is hard for me to abstain completely.

I decided I would like to write about the alcohol component along with the mental illness. So many of us have co-occurring disorders. I was excited, and then, I paused. What will people I know think when they see ‘alcoholic’?

I couldn’t decide which was the worst of 2 stigmas. It doesn’t matter.

Info on SMART Recovery

Info on Alcoholics Anonymous (AA)

A Letter to My Illness

You moved in when I was very young, shoved me into your corner, made me cry and when I cried you caused the kids to laugh at me, taunt me saying “Don’t cry Joel.” Sister Annette told me to buck up, to learn to be a man and hold the tears back. Damn you and damn her. I couldn’t say it at the time. Two years of living under the threat of her ruler, but the taunts were worse, hurt worse. The more they called me names, you and my parents reasoned, the stronger I would become but this practice was flawed. I played alone or with other losers. My mother criticized my choice of friends, calling them slow, hinting that they were retarded. Even among them I lived in a shell and the kids continued to wear at my head, trying to produce the streams of salt water they loved so much to see. I don’t know what brought you to make a home in my head. I don’t know why you made me sensitive to the twist in their voices. Was it the arrival of my two cousins who stayed for a year? If it was, you stayed beyond a year, brought me suffering. I looked at Jesus and wondered what was worse: crucifixion or this hell I was going through? If I was on the cross with Him, it was an absurdity.

A few things I don’t like to hear about my mental illness

I re worked some of my earlier writing

I used to only disclose my mental illness to a few people because I was worried about the reactions I would get. I had already received negative responses when I had to stop working. But not talking about my mental illness limited my ability to converse. It was hard to think of things to talk about. I was afraid my secret would get out, so I’ve slowly been opening up. And although being open about my mental illness makes me feel free, it comes with a cost.

Here are some of the worst things people have told me after I’ve opened up about my mental illness:

1. “I want the old you back.”

First off, I know I’ve lost a lot because of my illness. Jobs, friends, income, time. I feel that loss. I want those things back, too. But, I’m realistic enough to know time has moved on and I have to deal with where I am now. But, more importantly, I’m right here. I may act strange sometimes or think unusual thoughts, but I’m still the person I’ve always been. Accept me as I am now.

2. “You need to…”

I’ve been given a lot of unsolicited advice. But I’m actually doing pretty well at the moment and don’t need suggestions. But, even when I was more symptomatic, I didn’t need people to tell me what I should and shouldn’t do.

3. “You’re too emotional.”

I’m not sure what that means. I have a mood disorder and changing moods come with the territory. When you point out I’m “too emotional” or “too sensitive” it’s completely unfair. I can’t help how I feel.

4. “You don’t look like you have a mental illness.”

I don’t know what to say to that. I think it’s meant as some sort of compliment, but it negates all I’ve been through and denies something that I know is real.

What I dislike the most is being talked about like I am not even there.

All I expect from others is to listen and be understanding. To treat me like a whole person and not something that needs to be fixed. To feel loved and like I matter. That’s all I need.


Sorry, I haven’t written for awhile. I got a job and it has thrown me off my regular routine.

I almost can’t believe I am working. It is part-time, as a peer mentor. They know of my diagnosis and will understand if I have symptoms.

I have only been there for a month. I was excited to get a paycheck. I took my mother-in-law out to dinner. It was nice being able to treat her.

It is really slow right now. We are just getting ready to open. I know it will change. I have a great schedule, but I don’t know how I will adapt to getting going in the morning.

If you have a serious mental illness and have been disabled for many years, there is hope that you can achieve your goals.

I have no idea what the future holds but I really wanted to at least attempt to work again.

The Fallacies of Stigma: A Primer

Stigma is often masked as reasonable, but a closer examination shows that the arguments supporting it are flawed. We who live with mental illness have good reason to object to it: Prejudice costs us jobs, friendships, and self-dignity. The isolation which we live in worsens our state of mind. Stigma is not only evoked by people who do not suffer as we do, but also by anti-psychiatrists who oppose treatment and who deny mental illness. Both are often clever in hiding tactics, but I have written this article so that you might recognize and confront them successfully.

Herein I shall describe many logical fallacies that are used by people who invest in stigma either to promote an agenda or directly attack those of us with mental illness, giving examples for each. Remember these the next time someone uses them, identify them for what they are and let them know that they are standing on shaky ground.

Argument by assertion describes the belief that the more you say something is true, the more true it is. No matter how many times what you have said has been refuted by psychological studies, you continue to say that it is true. This you believe overwhelms any real evidence. The idea that the mentally ill are violent or the notion that medications are dangerous or that vitamins have no side effects are examples of this kind of logical fallacy.

One of the reasons why I count antipsychiatrists among the purveyors of stigma is that when they argue that the medications cause violence, they are implying that everyone who takes the medication will be violent. This means that those who take an SSRI are violent (as well as corporate shills — see below). I have often pointed this out to them. The best argument they can muster is that they really didn’t mean it — which is moving the goalposts, a type of argumentum ex culo or, simply, lying.

Related to this is the tactic known informally as bullshit. The evidence can’t be right, so you keep asserting without proof that it is wrong. Your arguments amount to little more than ill-formed, unsubstantiated opinions.

When someone cites a popular movie or television series or novel as evidence that the mentally ill are dangerous or incapable, they are employing a generalization from fictional evidence. Those who deploy this kind of reasoning believe that Jason from Halloween is typical of people like us. Of course, this does not constitute as valid information because the source is fictional and a product of some writer’s imagination.

Those who attack advocates for the mentally ill often depict them using straw men. One particularly vicious proponent of Murphy’s Law used to claim that anyone who didn’t support that dubious measure didn’t care about the mentally ill. Of course, that was just plain wrong: it was our concern that the mentally ill would be forced to undergo harsh treatments such as ECT that they did not want and lose their HIPAA protections that motivated us to oppose the law. It’s a cheap trick and nothing more.

Argumentum ad hominem is something that we all have experienced. Because we suffer from mental illness, our criticisms and opinions are by default invalid. Stigma causes us to lose authority in the eyes of some. The use of this logical fallacy defines the center of stigma, namely the idea that we are crazy and incapable of logical thought. I, however, have noticed that even people in the throes of mania and schizophrenia can make rational arguments. Many people hide their mental illness because they want to be taken seriously.

When you proceed from the assumption that the other person’s opinion is wrong and then go on to explain why they held it, that is known as Bulverism. Bulverism is almost always associated with some kind of psychological condition. Such arguments are cheap shots and an end run around the burden of proving that the idea is wrong. Sometimes there is an actual diagnosis, sometimes the attacker just makes one up. I have known anti-psychiatrists to employ a version of this wherein because my thought process is distorted by medication, my views aren’t worth considering. Of course, there are also legions of armchair psychiatrists who think they can recognize a mental disorder in anyone. Consider those who try to come up with insanities for prominent politicians. I often tell them that when they use my diagnosis they are associating me with people with whom I do not agree with. Their views are not the product of insanity, but of ideology. And it is the ideology which logic demands that we focus our efforts. You argue with the argument,not the person. (If a person is in episode, you may decline to argue with them. But this has nothing to do with the validity of their argument.)

The Shill Gambit is a particular favorite of anti-psychiatrists. Defend the use of psychotropics? You are obviously a thrall of pharmaceutical companies. Once again, you are avoiding making a case by capitalizing on prejudices and conspiracy theories.

Sometimes people try to accuse us of distorting the numbers because we are mentally ill and we just don’t want to take our meds or we want special treatment for ourselves. This is appeal to motive. The idea is that you imply that the person making the argument has ulterior reasons for making the argument like they want to cover up the fact that really are the way that stigma claims they are. It can have its place, however, as in when the NRA suddenly becomes interested in promoting Murphy’s Law so that the whole gun question isn’t being discussed, but you have to prove this connection. Most of the time, you know where to stick this one.

Many of those who want to take the discussion away from the ownership of guns point to the head of the NRA as an authority. He claims that mental illness is what is behind the mass killings, not gun ownership. So his followers lick up the talking point and spit it out again. When you point to a famous person and say something is right because they said it, it is argumentum ad verecundiam. (What kind of authority is the head of the NRA on mental illness? Not one we can count on.) Needless to say, famous people cannot be cited as authorities just because they are famous. (This applies to politicians, too.) If they don’t cite evidence for their arguments, there is a good chance that they made it up. There’s a difference between mentioning studies that show that people with mental illness aren’t dangerous and flat out just saying that they are. The former uses empirical evidence and the latter just makes a statement without the backing of such studies.

“C’mon,” someone might say to you, “everyone knows that the mentally ill are dangerous. Look at all the newspapers, the media, politicians, etc. who say that it is.” Just because an idea is popular, it does mean that the idea is right. People can be wrong in scores. The insistence that this proves the correctness of the feeling is Argumentum ad populum or bandwagon. It is the usual short-cutting of proof using a flimsy pretext. I think many climate-change proponents make this mistake when they talk about the scientific consensus for the idea. What matters is not the number of scientists who have been convinced by the evidence, but by the evidence itself (and there is plenty of it). Likewise, the evidence shows that we who live with mental illness are not any more violent than those who don’t. Many years ago, most geologists laughed off the Wegener Hypothesis which showed that the continents have been moving. As the evidence came in, geologists started to look at landscapes anew, not because it was a popular idea but because strong findings came in from the field showed that Wegener was right! Likewise, we don’t just assert that the mentally ill aren’t more prone to harming others: we have information that shows so. Always concentrate on what the evidence says.

The composition fallacy and the related division fallacy are the particular favorites of those who use stigma to advance their agendas against the mentally ill. I have seen it used by both advocates of forced medication and anti-psychiatrists. They are defined like this:

The logical fallacies of composition and division are a pair of fallacies which are based on a confusion between what is true of the part and what is true of the whole. The fallacy of composition is an incorrect inference from what is known of the parts to asserting the same of the whole; and the fallacy of division is the reverse, from the whole to the part. Comparing the fallacy to the figures of speech called synecdoche (as when one says “wheels” to refer to an auto), one might say that the fallacy consists of taking the figure of speech literally.

So, the forced medication advocates reason, if we can show that one person committing a well publicized shooting is mentally ill, they all must be mentally ill. Or, if we can show that one psychotropic medication can be shown to cause people to be violent, then all such drugs cause people to be violent.

Overgeneralisation is a subset of this attack. I see it happen in support groups sometimes when people hear that some people experience a certain side effect, they assume that the drug is going to cause the same side effect for them. You’re taking a few experiences and insisting that they are true for everyone. It is a fact that many people get fat and diabetic on olanzapine (Zyprexa), but it is also true that not everyone does. To point to one or the other end of this continuum — to focus on the negative or positive personal experiences of some of the population of those who take Zyprexa only and then insisting that this is what happens to everyone is to overgeneralize. To say that because some people instigating highly publicized shootings are mentally ill means that all these shooters are mentally ill is another example.

Stigma users like to spotlight. They will focus on one example — e.g. the Aurora shooter — and use this as their proof that the mentally ill are dangerous. You can also perform this trick by focusing on one patient who has a bad reaction, say your sister-in-law or yourself. If they got sick with disastrous side effects, the reasoning goes, so will you. The burden of proof requires double-blind studies and empirical rather than anecdotal evidence. Much of the time you will find that the people who use this tactic don’t have the evidence to back themselves up.

There is a rise in violence, goes another argument, and a rise in the number of people being medicated. The logical conclusion is that medication causes people to be violent. Right? Wrong. False cause means that you draw an assumption based on a perceived relationship. There was a man named Francis Galton who pointed out that when you see a correlation between A and B, it can mean a few things: A might cause B. B might cause A. C might cause both A and B. Or there is no relationship between A and B: it’s just a coincidence. Anti-vaxxers see a rise in the cancer rate that correlates with the rise in vaccinations. Based on this, they say that vaccinations cause cancer. But when we apply Occam’s Razor, we find a better explantion: because of vaccines, people are living longer — long enough to get cancer! As for the argument that I mentioned at the start of this section, I have not seen evidence showing that the people committing the violence are taking medications. It is only an assertion (see above) and a composition fallacy at work here.

The genetic fallacy holds that you trust or don’t trust an idea based on where it comes from. But the reality is that sometimes E. Fuller Torrey and D.J. Jaffe have a good idea, sometimes the antipsychiatrists make a reasonable point. As stigma, it holds that because a mentally ill person or one on medication offers the idea, you can’t trust it. Logical discussion is about the arguments and whether they are valid and truthful, not who made them in the first place.

A recent alliance between the likes of E. Fuller Torrey, D.J. Jaffe, and the NRA is founded upon the “my enemy’s enemy” fallacy. Given that the NRA is promoting the idea that we have to do something about the mentally ill, we can draw the conclusion that they have the best interests of the mentally ill at heart because the people who oppose its solution are antipsychiatrists goes this illogic. People all along the spectrum of opinion can be drawn into this, so it is always important to return to the heart of any discussion.

The Nirvana Fallacy is currently being used by the proponents of Murphy’s Law. It is refusing reasonable solutions such as more commmunity mental health clinics and demanding that we impose forced treatment and bring back mental hospitals because the community mental health solutions don’t help 100% of the mentally ill. Of course, they ignore the expense of their proposals and the fact that many people with mental illness will likely go undiagnosed because they don’t have clinics. But the main problem is that their proposal is fantasy and that there are more realistic solutions out there.

Colorblindness or rather something similar to it affects discussions about mental illness. This is used by people who deny mental illness from many fronts, beginning with antipsychiatrists and extending to those who tell us just to get over our depressions. It is a false equality that states that all people have emotional problems, but some people are big whiners. This type of stigma colors us as fakers of our illness who should be ignored.

The same people are often guilty of the fallacy of relative privation which is also called “whataboutery” or the “not as bad as” fallacy. You who live with mental illness know the song: “What do you have to be depressed about? Your cousin Leonard broke both his legs and had to have twenty nine stitches. He’s not depressed, so why are you?” It is little more than a guilt trip, one of the cruelest forms that stigma takes.

Emotional appeal is often what is left when you have identified and refuted all the tactics above. Fear is a powerful emotion. We do not like the unknown and we don’t like being bothered to take the time to understand it. If any fallacy is central to stigma, I think this is it.

When we have become exhausted refuting these points, we may choose to retreat. We do not have to argue with fools. Yet there is a snare that trolls and stupid people use to attempt to trap us known as the Chewbacca Defense. This tries to declare a win by several fallacious principles:

  • If you can prove the other side wrong (even if they are wrong about something totally irrelevant), it makes you right.
  • If you can word your statements and arguments in a way that is too confusing, intelligent-sounding, or nonsensical for the opponent to respond to, it makes them wrong and it makes you right.
  • If you can shock or confuse your opponent and make them think you are a lost cause and not worth arguing with, you are right.
  • If you can make your opponent give up on arguing with you, because you appear too crazy to understand them and/or don’t seem to be listening, then they must be wrong and you must be right.
  • If you can make an opponent look bad, their logic must be equally bad, and therefore you are right.
  • If you are more popular or have more support than your opponent, it makes them wrong and it makes you right because more people agree with you.
  • If you just keep arguing and shouting, even if everyone else (not just everyone else in the debate — everyone else in the world) thinks you are not just wrong, but insane, until everyone else just gets tired of listening to you spew nonsense, you’re the last man standing, and, by default, you are right.

Realize that they will continue to be wrong no matter when you choose to end the “discussion” and be satisfied that you have mastered them.

We must not only out these when we see our opponents use them, but we must also be aware of them in ourselves. The facts and how they are to be interpreted are what are relevant. Plenty of studies show that the mentally ill are not as dangerous as the promulgators of stigma hold, so we should use these as our principle sources for our defense. It does not help us to use anecdotal evidence and slippery slope reasoning. The truth is our aim.

In all things, be a Credible Hulk.


See also Misleading Vividness

Two great sources for information about logical fallacies:

The Night of The Cut *Graphic Self Harm Trigger Warning*

******TRIGGER WARNING: Anorexia somewhat and EXTREMELY GRAPHIC SELF HARM******


You have been warned.

This is probably the single most important story in my life. It led to a cascade of events: hospitalization, my correct diagnosis of bipolar, getting kicked out of school, and finally getting the real help I needed.

It was 6am when I finally asked my ex-boyfriend for my knife back. We aren’t on speaking terms and we are clear that we can never be. We’re either together or not. And together is awful, dangerous, addicting, full of love, full of hate.

Today I see him to get it back, so I stress out about it of course. I overthink what I will wear. I felt the need to show him how much my appearance has changed, how much have changed. Both of which are major improvements.

Should I go laid back in my cute dorm-room college girl get up all from Victoria’s Secret? Or should I go with my traditional assemble which people describe as “edgy” because its boots and leather jackets and what not?
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When are remarks “remarkable”?

Not long ago I was listening to the Heidi and Frank show on the radio. They were doing a show on OCD. I don’t listen often and hoped maybe it would be okay. After all, it was mental health awareness month, at the time.

No. It was a comedy bit. I realize that is their job. but they were making fun of callers and people they know. Calling them “Freaks and “Weird”.

I rarely respond to those types of things but I contacted the radio station and NAMI. I didn’t expect to hear back from the station. NAMI told me they don’t deal much with that diagnosis and to contact an OCD foundation. I passed on the info and let it go.

Now I see this article:

Mike Huckabee and Schizophrenia; NAMI Calls for Apology Over Supreme Court Remarks on Iowa Radio Talk Show;-NAMI-Calls-for-Ap

I understand Mike Huckabee is a Presidential candidate. Is that what makes him a good example of stigma? He called a man with no mental illness (Supreme Court Justice Roberts) “schizophrenic”. I don’t think that compares with calling someone with a disorder “Freak”.

I do think he should be called on it, like others in the media. The choice  just seems arbitrary.

Unseen Contributor to Teen Mental Illness?

It has been bothering me for a few years now. The surge in young teens who seem absorbed in mental illness.

I first noticed it after I’d had my iphone for a while. Probably over a year after (I was 18 when I got it). I’d been diagnosed when i was 17, and was probably 19 when I noticed. I was on instagram when I got the random desire to see if there were posts about mental illness on there.

And what I saw horrified me.

Kids as young as 12 were posting horrible photos. Typically it was just the cliche depressed quotes over and over again. But there were also photos of other things… there was “thinspiration” where people would post skinny girls who were their “goal” look in terms of thinness. And then there was the pencil test to determine if you really are thin or not, so people posted pictures of those. And pictures of thigh gaps. But I can’t relate to eating disorders, never had one and don’t think I ever will. Then there were ones that flooded my search and were even triggering to me- self harm photos. They were everywhere. I was horrified.
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Caretaker Dominance in Mental Health Discussions

A few days ago, at the Orange County Mental Health Associations “Meeting of the Minds”, I attended a workshop on caretaker-patient-provider partnerships sponsored by our local NAMI. The material was very interesting and I sympathized with the panelists. Caretakers, they pointed out, can be a helpful part of the team that brings the patient to a place of recovery. They deserve to know what they can do to help the patient and this doesn’t mean that they have to know all the patient’s “dirty little secrets” as they characterized them.

But a few things struck me: First, at least a third of the panelists promulgated a “no fault” model of mental illness. This belief has been spread without challenge or acknowledgement of the studies that link the onset of mental illness to emotional abuse and bullying by NAMI. Though one speaker did allude to this, most of them adopted the model as applying in all circumstances, including their own. I can’t say for sure if they were telling the truth — I give them the benefit of the doubt — but I also know of plenty of abusive parents who use the shibboleth to hide their own history of family violence.
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Tiered healthcare system U.S.

You get what you (can) pay for

I don’t know enough about the intricacies of our healthcare system to give a explanation on how they different insurances work and why some people fall between the cracks.  I just have been in or visited facilities that didn’t require private insurance and they are night and day from ones that my employer provided insurance covers.

My first hospital stay was after I had refused to get back in the car during a road trip. I ran to a mini-mart and asked the clerk to keep my parents from me. He let me stay there and called the police. I thought they would call my husband or sister to come get me. I guess it would take too long. The officer handled it well. He kept my parents seperate from me and listened to both of us. They he had me go into an ambulance to got to a hospital.

The hospital they took me to was a County hospital. I wouldn’t recommend it. I was confused. I wouldn’t speak and then blurt things out. They pushed a cart in the room with juices and yogurt. I wasn’t sure what to do, but I soon learned to take what I needed. There was a room full of cots. I would go and lay down on a cot. At night one of the other patients helped me find the linens and make a bed. I had been lying in the cold.
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