Removing the Stigma of Mental Illness One Note at a Time

Those with mental illness and their families are aware of the stigma associated with these disorders. We share information about other medical conditions with friends, co-workers, and casual acquaintances without worrying that by doing so we might be rejected as employees, friends, or participants in volunteer, religious, and charitable organizations. But sharing information about one’s major depression, generalized anxiety, or bipolar disorder, or the more “scary” disturbances like schizophrenia, may result in the recipient of such information becoming detached and not interested in pursuing a relationship.

Concerns arise: “How can I work with this person on this project if he/she becomes manic or anxious or doesn’t make sense?“ “Do I really want my child to have a play date with the younger sibling of a child who is very depressed or ‘disturbed’?” “What happens if the person I just hired stops taking his/her meds?” The stigma even creeps into evaluating the desirability of a mate for one’s child. You the parent learn that one parent of the potential mate for your child has been hospitalized for mental illness or committed suicide. And you worry that the offspring, your future grandchildren, may be affected by the same mental illnesses.

Now a symphony orchestra composed of musicians with mental illness, or family members of those with mental illness, is attempting to remove the stigma with every performance they give. The Me2Orchestra is a new musical organization whose founder, Ronald Braunstein, was a globally acclaimed conductor, winning a prestigious prize for classical music conducting in his early 20s. But according to an interview he gave in June of 2019, he struggled with bipolar disorder for decades.

About 10 years ago, he started the Me2Orchestra in Burlington, Vermont for musicians experiencing mental health issues and/or struggling with addiction. Braunstein said that about half the players have mental disorders, and the other half are family members or friends.

With regard to the ability of the players' range, some are professionally trained and others haven’t played since high school. But according to one player who was interviewed, their expertise matters less than their ability to leave their mental disorder labels behind once they enter the practice room. “We are just musicians,” she said.

And even though they play for traditional concert-attending audiences, they also perform in hospitals, prisons, and juvenile detention facilities. And everywhere they play, a sign declaring that they have entered a “stigma-free zone” greets the audience.

One of the remarkable and indeed courageous aspects of this endeavor is advertising, if you will, the stigma toward those with mental health issues. The presence of a stigma-free zone implies of course that other areas of communal interactions may harbor a real, although silent, stigma.

As much as one might and should admire the formation of an orchestra that welcomes players with mental illness, it also poses a difficult problem. Why is it necessary? And why is it necessary for there to be a sign saying that the music venue is a stigma-free zone?

People who are stigmatized are likely to be discriminated against in their employment opportunities, social relationships, and even where they may live. The federal Fair Housing Act prohibits discrimination in making available housing to those with mental and/or physical disabilities. But its existence points to the discrimination that existed before the act was passed, and does not ensure that a landlord will always abide by its regulations.

And according to the U.S. Equal Employment Opportunity Commission document on one’s rights as an employee with mental health conditions, employers cannot refuse to hire you because you have been diagnosed with depression or other mental health problems. According to the ruling, you cannot be rejected for a job based on your mental health condition unless there is objective evidence that the condition prevents you from carrying out your duties, or that you may pose a significant safety risk. Employers are required to provide a work environment that is able to accommodate the needs of someone’s mental health conditions. For example, the employee may need to be able to take more frequent work breaks or require a quiet work environment. (Although who wouldn’t want a quiet work environment?) I knew a woman, a college professor, with bipolar disorder who cycled from a mild mania to depression every three and a half weeks. Her academic department accommodated her cycling mood changes by allowing her to lecture the weeks she was not depressed.

But despite the safeguards built into the Commission’s ruling, including the right of the prospective employee not to reveal the presence of a mental health issue, difficulties may arise in the performance of the job. Being confined to bed with severe depression for over three weeks every month, as described by the college professor, makes it almost impossible to hold down most jobs. Jobs that are inherently stressful (junior high school teacher, air traffic controller, etc.) may be more difficult for someone with generalized anxiety or panic attacks. Even short-lived depressive episodes such as those associated with PMS may make performing a job harder. Years ago when we were carrying out a study at MIT with women who suffered from premenstrual syndrome, we had as a subject a woman who was in charge of the entire computer system of a local university. She was eager to find some relief from her monthly depression and overwhelming fatigue because as she told us, “When I have PMS, I go into my office and cry and hope that nothing goes wrong with the system. It is really hard to work when I feel that way.”

Thus a workplace, a symphony orchestra for example, that is able to accommodate a player whose mental illness may temporarily prevent participating in a performance, is an enormous benefit for those who might not be able to play in conventional musical organizations. A conventional orchestra may never hire such a musician. The players in the Me2Orchestra do not encounter any stigma and, just as important, there is an acceptance of the possible limitations in carrying out the obligations of the work due to the underlying mental illness.

But the story of the Me2Orchestra is of interest because it is unique. One hopes that at some point the working conditions of the Me2Orchestra are sufficiently common so that such stories are no longer unique.