Authors' reply

Thanks to Dr Chrtkova for an insightful letter about my editorial contrasting normalcy versus solidarity messages in order to change stigma. ¹ In my editorial, I recommended replacing messages meant to erase the public stigma of mental illness based on normalcy (‘People with mental illness are just like me’) with messages of solidarity (‘I stand with you where you are at’). Chrtkova and I disagreed with the notion of identity as it applied to this distinction. She said that group identity does not fit well with mental illness, at least not compared to lifelong conditions such as being female or African–American. I believe that identities come from significant life experiences as well as genetic endowment. I viewed myself as a dad when my son was born, and as a psychologist when I earned a doctorate. Some may argue that a person need not identify as ‘mentally ill’ throughout life, because recovery is a reality in which mental illness might be left behind. I agree; this is a reality for some. But for others, the experience of mental illness – its symptoms and challenges – and/or the experience of mental health treatments, marks them. This mark is not always negative; people marvel at their journey, recovery and achievements, often embracing their mental health identity with pride. ²

Consider an analogy with the gay community I have made elsewhere. ^3,4 Stigma and discrimination against lesbian, gay, bisexual and transgender (LGBT) people has greatly decreased over the past 50 years in the Western world. Not so long ago, a gay man trying to escape stigma might have said, ‘I am just like straight people’: a variation of normalcy. At its most extreme, this might mean the person passing for straight, thinking he escapes homophobia as others do not know he is gay. Nowadays, this is likely to be viewed as a problematic message. ‘Passing’ implies ideas of keeping one's sexual orientation hidden. Instead, gay pride celebrates a message of who one is. In this celebration, members of the LGBT community expect others to join with them in solidarity.

Dr Chrtkova has lived experience of mental illness and talks about ‘breaking down my self-stigma’. I thank her for the courage of her message; we share a fundamental perspective for understanding stigma. I have come to identify as a person with mental illness after 40 years of diagnoses, medications, hospitalisation and recovery. Somewhere in the journey, I realised that I am a person with mental illness – that it is as much a part of my identity as fatherhood or professionalism. I am proud of all of these identities. I do not want to have to keep any of them a secret by passing as normal. Instead, I expect others to join me where I stand.