This article first appeared in the St. Louis Beacon, March 15, 2011 - Arlen Chaleff grew up in comfortable Clayton "in a class that was part of the American dream," the daughter of a father who made money in the garment industry as a dress manufacturer. Justin Idleburg's upbringing was more on the edge. He was born into a working-class St. Louis family where money and tempers were short, and children learned early that self-reliance was the key to survival.
Their class differences and education -- Chaleff is college educated and Idleburg graduated from high school -- would suggest that the two have little in common. But traumatic experiences with mental illness have indirectly and inevitably linked them though they have never met. Both were diagnosed with bipolar disorder, and both have since learned that stigma is associated with the illness, no matter the social or economic status of the victim.
"The high-income aspect of it is that it allows the person to get the best treatment available," says Jacqueline Lukitsch of the St. Louis chapter of the National Alliance on Mental Illness. "But there's stigma, no matter if you're educated or if you make more money."
The stigma that people attach to mental illness, she says, dissipates only over time through interaction with those with the disease. While there are no class differences in the way people perceive mental illness, NAMI has found some differences in how certain groups respond to help.
"Most of our educational services are provided in group settings," she says. "But we're finding that we are more effective in low-income populations through one-on-one settings. The reason is the huge stigma about mental illness in the low-income population."
Hiding The Illness
Idleburg was in his 20s when depression and other behavioral changes told him he needed to talk to someone. He got help at the St. Louis Psychiatric Hospital on Delmar near Union Boulevard. Still, he kept his condition secret because he couldn't count on family members for help and feared discussing his health with others. Some of them felt consulting a minister was the only cure because they associated inexplicable human behavior with being possessed by the devil.
"I never told anybody about it, not even my family," he says, "because many low-income people try not to acknowledge it at all. They wish you weren't part of their lives."
Karl Wilson, head of the Crider Center for Mental Health in Wentzville, says there's some truth to what Idleburg says about the way certain classes and cultures associate mental health with demonic possession. The irony, he says, is that such groups tend to be more enlightened about the disease in some ways than the middle class.
"The way they'd be treated is through a religious or spiritual approach. And when they were in remission, they are viewed without stigma and quickly join their family and the rest of society."
Not so in much of this country, he says. Making the illness a brain disorder led to more acceptance that people need treatment. "But there's also the tradeoff in that people then think (those with disorders) are still damaged in terms of the brain, and they don't want them living next door."
Idleburg learned early that some communities beyond his West End neighborhood did take a more enlightened attitude toward mental health. But he said in school in particular, students weren't offered much help, particularly for trauma from witnessing violent incidents. He remembers one hallway fight at Sumner High School in which the head of a well-liked student was "split open."
There was an announcement on the PA system, he says, but "they gave us nothing. It was like saying we were used to it and didn't need any help."
The class differences extend to many homes, Idleburg says, where "there's no structure, kids watching TV, parents in a leave-me-alone mode. So kids are raising themselves. They talk to teachers like adults. That's what they have learned to be because they have nobody to rely on but themselves. You're on your own."
Developing Support Programs
When Chaleff was told about Idleburg's school and neighborhood experiences, she was touched and said it raised questions about the extent to which society knows enough about how different groups, including newly arriving immigrants, cope with mental illness.
"In each class or ethnicity, you come with a certain set of ways of how you perceive things," says Chaleff who is on NAMI's board. "We've just started now to have some support programs in Spanish. In doing these support programs, we try to make the services user friendly."
Lukitsch, NAMI's CEO, adds that the group was opening offices and services in community settings as another way to reach the underserved.
Before suffering from mental illness, Chaleff, 68, described herself as a career woman living in Washington and becoming a trailblazer among women in the then-exploding field of data processing. Her mission these days is to ease the stigma associated with mental illness and hold herself up as an example that treatment does work. She has won many awards for her volunteer work in mental health.
Still in his early 30s, Idleburg is just beginning to search for ways he can have a similar impact on minorities, particularly the working class and poor. He is helping to organize a panel at the Missouri History Museum in May to talk about mental illness among African Americans.
Allen Daniel runs a NAMI center on the near north side. Lukitsch mentioned it as an example of ways the group is reaching out with more easily accessible mental-health information and services. In some ways, Daniel says, being middle class can make a big difference in getting services.
"If you're uneducated and lack money, you can have difficulty navigating the system," he says. "It's very complex. You may get treatment and are stabilized in an emergency room, but you're back on the street again."
ER workers may give the patient several referrals, "but if you're uneducated and on the street, you may lack access to a telephone to call the numbers for the referrals. So you're going to fall through the cracks."
On the other hand, he says having resources can make a difference.
"You may be in a position of having someone, a family member, who can offer help, take off from work to help you get to the doctor, or help you get your medications.
"If you have resources and financial wherewithal, it's much easier for you to navigate the system. It's one place where class in terms of education and income can make a difference in terms of navigating the system."
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.