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When Leaders Fail Us

Person clutching their head in distress


Recently the psychiatrist-in-chief at St. Michael’s Hospital in Toronto wrote a piece in the Globe and Mail in which he confessed that he wasn’t that upset when someone calls a person with mental illness “crazy” or a “nutcase”. In his own words “it’s no biggie”. He gave an example of the Premier of Ontario using that language. He seemed to be waving absolution at the Premier by saying “even people we expect to know better in positions of influence or responsibility do this.” Premier Ford’s government is proposing significant cuts to mental health care.

Dr. Thomas Ungar’s article is replete with qualifiers: he doesn’t recommend such language, it can be “hurtful” to people, like me, with mental illness. He does not condone “nutcase” name-calling. Dr. Ungar explains that if we want to “find a way forward” we need to ask what people really think and cautions that “yelling and shaking our fists only alienates the majority of the public.”

I’m not interested in yelling and shaking my fists at Dr. Ungar. He undoubtedly knows a lot about human behaviour. I actually agree that outrage isn’t effective in inducing a change in personal behaviour. And I’m not expressing it now. What Dr. Ungar apparently fails to grasp is how some patients feel knowing that the psychiatrist-in-chief of a major hospital, in fact, my neighbourhood hospital, thinks it is helpful to confess in a national paper that he believes that calling someone like me a “nutcase” is no big deal.

It feels terrifying.

What is distressingly missing from Dr. Ungar’s article, and even from many sensitive letters in response, is any recognition that as a psychiatrist-in-chief he is not just a “psychiatrist and anti-stigma researcher”, he is a leader. And as the doctor responsible for leading the team of psychiatrists and staff providing mental health care in a major hospital, his first duty is to be unambiguously clear, for the benefit of those in the hospital’s care, that stigmatizing language not only hurts feelings, it creates harmful psychological and social dynamics for vulnerable people. The stigma around mental illness is far more than hurtful, for some people it can be soul-destroying. In worse-case scenarios, the use of stigmatizing language by our leaders gives permission for emotional and physical abuse. At a minimum suggesting that such language is “no biggie” validates beliefs that our suffering is no big deal either.

As vulnerable people seeking care, we need psychiatrists who can centre an understanding of what we experience, not the experiences of those who are stigmatizing us. And we need leaders who are clear that dismissing or making fun of vulnerable, marginalized people with mental illness is not acceptable. There is no need for outrage and yelling. What is necessary is empathy, sensitivity and absolute clarity.

Dr. Ungar’s piece has been making the rounds of people with mental health challenges in Toronto. Unfortunately what he has unintentionally done is suggested to those of us who might consider accessing care at St. Michael’s Hospital that instead of psychiatrists who will empathize and seek to protect us from harm, we might end up with someone defending the feelings of our abusers. 

Sadly this failure to deeply empathize with the experiences of the marginalized and the vulnerable is a trend among our current leaders: Justin Trudeau’s blackface indulgences, Boris Johnson’s speech extolling the realities of inequality, and most obviously, the tweets of the President of the United States. Donald Trump’s pejorative and abusive language towards most marginalized groups has coincided with an increase in hate crimes in the US that is appalling. When our leaders do not unambiguously name stigmatizing, pejorative language as unacceptable, that failure gives permission for much worse than name-calling.

What is especially frightening about Dr. Ungar’s piece is how much he gets right. Trump, Johnson and Ontario’s own Doug Ford are in power because they intuitively understand the dynamics of influence Ungar mentions. Politicians have discovered that authenticity is appealing. More and more we find ourselves with political leaders who flaunt their flaws. No leader is perfect, but societies move towards equity and social justice when our leaders unambiguously promote behaviour consistent with those values despite what may be popular. Authenticity comes from honestly admitting mistakes while committing to do and be better.

That is my hope of Dr. Ungar, though such a hope may be unrealistic and the damage to St. Mike’s reputation is significant and already done. When used to describe people with mental illness, stigmatizing language can itself be deeply harmful and can give permission for abusive behaviour. Whatever their personal beliefs, leaders responsible for the medical care of vulnerable people need to be unambiguously clear that when used to describe us, that language is unacceptable.