challenging mental-health stigma is the focus of patients and professionals alike
A few years ago and in what was a superb interview with Michael Hainey of Esquire magazine, Bruce Springsteen spoke vividly about some of the difficulties he’d faced over the years. In the style of many a great novelist, his words evoked memories of a life placing you beside him as the imprinting that comes with a family embraced him. As with anyone, some of these moments shaped routes taking him to dark holes and frightening heights and where his greatest question was whether or not, he could mould something new.
As he spoke with candour on the psychological costs, he said:
‘All I do know is as we age, the weight of our unsorted baggage becomes heavier … much heavier. With each passing year, the price of our refusal to do that sorting rises higher and higher … Long ago, the defences I built to withstand the stress of my childhood to save what I had of myself: outlived their usefulness, and I’ve become an abuser of their once lifesaving powers. I relied on them wrongly to isolate myself, seal my alienation, cut me off from life, control others, and contain my emotions to a damaging degree. Now the bill collector is knocking, and his payment’ll be in tears.’
Springsteen’s tender and remarkable handle on himself and his past is inspiring to say the least, and in recent years, celebrities and other public figures stood up to share existential crises in mental-health, too, leading to increased awareness across society. This should be applauded because for too long, poor mental health was the whispered disease that no-one wanted to think about, let alone admit to.
Maybe, the whispers hid a certain fear in knowing there’s a lot to be grateful for in living in the West where water always flows from a tap, light arrives at the flick of a switch and aisle upon aisle of food is restocked. Roads remain useable, the climate is yet to fully turn on us and political stability, remains largely constant. So, as images from around the world remind us of our good fortune, perhaps another reason to be thankful lies in matters of the mind and the balance of health. This is often relative to whatever’s being measured, of course, because higher levels of happiness have been recorded in poorer countries but then not always as a rule.
So, let’s say on one level that it concerns the way poor mental health is seen, challenged and tackled. In 2015, NHS England formed the Independent Mental Health Task Force. This multi-agency body took in charities, mental-health professionals and those responsible for social care and mental-health delivery, administration and governance. Crucially, it also included ‘Experts-by-Experience’ (EbyE), a growing body of people who are informing strategic conversations through their personal experiences of mental health.
Over time then and by February of the following year, the task force produced a report, called: The Five Year Forward View for Mental Health and in response, the then prime minister, David Cameron, spoke to the BBC journalist, Fiona Bruce. As she put existing failures to him, like: “inadequate provision, worsening outcomes and an increase in the number of people committing suicide,” he replied, that: “…it shows how much more we need to do and…we’ve not done enough to end the stigma of mental health.”
Unfortunately, these good faith admissions were and are never enough to save people from the shame of stigmatization or worse, in addition to the socioeconomic impact on people’s lives.
‘Certainly, I think being depressed is absolutely part of the human condition: it has to be, if there’s joy there’s its opposite, and it’s something you ride if you possibly can.’
Bob Geldof
Meanwhile, Karl Eriksson, a senior lecturer in the school of social sciences at Lund University in Sweden wrote an article in the journal, Human Studies. Entitled: Self-stigma, Bad Faith and the Experiential Self, he talks about the imposition of stigma through social relationships, as we try and reflect inwardly. He also references Jean Paul Sartre’s idea of bad faith in which we’ll adopt insincerity to get what we want or perhaps survive, physically and psychologically. Ironically, for some, that may feel like self-betrayal in terms of a conscience which may then end up as self-contempt.
So, where does the word ‘stigma’ come from?
It’s defined by Collins Online, as: ‘If something has a stigma attached to it, people think it is something to be ashamed of.’ Or, as the impressive Michaela Mulenga recalled in reciting the Oxford English dictionary, it’s: ‘A mark of disgrace associated with a particular circumstance, quality or person,’ Well, historically when poor mental health was seen as a mark of Satan causing your friends and neighbours to head for the hills, it was enough to seal your fate.
That’s an existential issue as the risk of rejection swallows you whole, but as the American high-school student, Sam Cohen also said in a brave Ted Talk, in 2017: “You can’t really tell when somebody is mentally sick and that’s why it’s doubted, in our society.” Well, whilst things are changing she’s right, too, because any judgement of mental health is to condemn an unseen entity. He or she looks fine or ‘normal,’ so where exactly is the problem? The issue or possibly part of it lies in the way the media has played a role, in its perception.
Over two decades ago, in a study led by a Senior Clinical Research Fellow in the Department of Psychiatry at the Royal Edinburgh Hospital, Stephen M. Lawrie produced a report, called: Newspaper coverage of psychiatric and physical illness in conjunction with first-year medical students. Published in the British Journal of Psychiatry Bulletin, in 2000, it states that having analysed nine daily newspapers:
‘213 article headlines about various aspects of medicine and 47 on psychiatry, were identified. Ninety-nine (46%) of the former were critical in tone as compared with 30 (64%) of the latter. We gained the impression that negative articles about physical medicine tended to criticise doctors, whereas negative articles about psychiatry tended to criticise patients. Tabloid and broadsheet newspapers did not differ, in their rates of negative coverage.’
These were interesting results reflecting a BBC report in the month before its release, called: ‘Media ‘unfairly stigmatises mental illness’.’ The charity, Mind, had interviewed 515 people with mental-health problems and asked for their views on media coverage. The majority, by nearly three quarters, felt opinion was negative and unbalanced. Yet, in playing devil’s advocate some might suggest the outcome was influenced by the way participants were feeling when interviewed. This applies to any study, of course, and suggesting it doesn’t hide the need to listen to the views of those affected by isolating and negative reporting. Looking at both sides should strengthen, not weaken discussion.
So, what about more recently? How differently would Stephen Lawrie’s original results, in 2000, compare with today? Well, in 2017, he repeated it with Marian Chen and the findings were again published in the British Journal of Psychiatry Bulletin as well as the National Institute for Health, NIH, in the U.S. This time, it found that:
‘In total, 963 articles – 200 on mental health and 763 on physical health – were identified. Over half of the articles on mental health were negative, in tone: 18.5% indicated an association with violence compared with 0.3% of articles on physical health. However, there were more quotes from patients with mental disorders than physical disorders (22.5% vs. 19.7%) and an equal mention of treatment and rehabilitation.’
In some respects, it seems little had changed with around half of the cases looked at still showing negativity or imbalance and over time, it may fuel a sense of hopelessness because environments matter. Why? Because socioeconomics matters as it determines a pecking order when it comes to our quality of life. These studies are almost twenty years apart, too, so what must we do or say, to change things? Well, at least the views of patients and management strategies were weighed by the media this time which bodes well, for the future.
Similarly, in a survey looking at UK media coverage from 1992 to 2008, there was an improvement in the reporting of conditions like depression, eating disorders and bipolar disorder. However, when it came to personality dysfunction and schizophrenia especially: again, little had changed.
The research paper, The Existential Way to Recovery, by Laurie Jo Moore and Mila Goldner-Vukov, supports a philosophical approach towards healing and recovery. This view through the nature of existence seems natural where it encourages a wide-lens take on suffering in the context of the human experience. Nevertheless, as a health-utility measure, it’s hard to assess self-awareness, meaning and authenticity, in terms of years of life gained.
Elsewhere and as part of the ongoing response to discrimination, the Time to Change campaign ran for fourteen years until the 31st March 2021. By then, the charities Mind and Rethink Mental Health had influenced anti-stigma views in the public domain and with a good deal of success:
‘Since the campaign began in 2008, 3.4 million people’s attitudes have improved towards mental health.’
This was obviously great news and with original funding of £20-million from the UK government it should continue, to make an impact.
Stigma is a global concern, however.
Several years ago, in 2012, a three-year-old girl in Malaysia died beneath a blanket after her grandmother, aunt, uncle, cousins and a maid were found lying on top of her. It was thought to be an attempt at exorcism as widely reported in global media, from Kazakhstan to Oklahoma. As police broke into the house, they apparently heard chanting in a darkened room and discovered the suffocated child, lying beneath her family.
So, in many countries including developed nations, mental health remains the modern-day leprosy to coin a phrase. It’s the condition no-one wants to catch and so the less time spent with a sufferer the better because isn’t ostracisation, contagious? It seems that way but again to be controversial, for a moment, if someone is dealing with a mental-health problem and they’re having a profoundly negative impact on people around them: is it actually unreasonable to seek distance?
The question flies in the face of anti-stigma concerns but it can’t and shouldn’t be ignored because some might answer through a sense of embarrassment, whilst quietly exercising freewill. To stretch the analogy then – mental-health hospitals of the past were the equivalent of leper colonies: places to pass at a distance, as curiosity drew the eyes. In the end, though, and as unpopular as it might be to suggest: judgement of stigma whilst always urgent and necessary can also be difficult and occasionally hypocritical, when emotional survival is a universal aim.
Such is the eternal contradiction of the human condition.
It’s no different in Goa, India, where a witch-doctor sits on the ground as he wails to a spirit supposedly inside the man sitting opposite. As the individual tries to escape, he’s pulled back by the shaman and his assistants who place a symbol of exorcism around his neck. Meanwhile, two women nearby discuss, loudly, how he began shouting in church a few days ago before his removal as a warning to others, that his madness is unpredictable and something to be feared. As a crowd looks on, a doctor then arrives to explain that the man is suffering with a mental-health condition, called Schizophrenia.
It was a play produced by Sangath, an NGO based in Goa seeking to promote and maintain positive healthcare, in developing nations. Dr Vikram Patel, a psychiatrist and Professor of Global Health at Harvard Medical School and also a co-founder, explains:
‘There are really two big challenges. The first, is the enormous amount of stigma and discrimination against people with mental illness: and the second is the lack of skilled manpower to treat people with mental health problems, and I think the two are linked. Because when you are not able to access appropriate mental healthcare, you’re more likely to face discrimination and this perpetuates stigmatising views, in people’s minds.’
In addition to other entrenched difficulties, these hurdles are all too common in trying to update the global public on current psychiatric approaches. These modern-day reminders also take us back to perceptions of poor mental health, during the European Middle-ages. Then, a person’s psychological distress was usually seen as a product of divine retribution for immoral conduct or possession, by evil spirits. Either way, a person was doomed to horrific forms of ‘healing’ that included being flogged and or drained of ‘bad’ blood.
Now, if a mind hadn’t been pushed over the edge by that point then surely, trephining was enough to do it. As a hole was drilled into the skull to expose the brain, the patient was conscious – some might say of the lottery of life. As a procedure, though, trephination dating back thousands of years and which has been found in ancient skulls worldwide is still used today, in modern medicine. The term is now craniotomy and fortunately, operating conditions have improved.
Fast forward, and the Centre for Global Mental Health once carried a statement on its website, reading:
‘The vast majority of the hundreds of millions of people with mental, neurological and substance use disorders (MNS) in the world, do not even have their basic health care needs met. 80% of these people live in low and middle-income countries, but when it comes to mental health ‘all countries are developing’. Global Mental Health, is the discipline concerned with addressing this public health crisis, both in low income countries and in higher income countries.’
In 2011, at the Seventh International Conference on Sustainable Development, a research paper called: ‘Existentialism – A Philosophy Against Poverty Alleviation in Nigeria’ looked at how this approach could reduce scarcity, in the African country. Despite the confusing title; in citing the ‘”authentic values” of human existence’: it looked at the structural inequalities of capitalism, alongside the needs of those living in relative and absolute poverty. It concludes that with deficit being an integral part of life, existentialism’s focus on freedom, purpose and essence shines a light on redressing systemic imbalance. That’s a steep mountain, making equivalence an ongoing project in ambitions of social development.
In the modern era, it remains a struggle to provide adequate mental-health care, in many parts of the world.
Ever hopeful, though, Dr Patel promotes a solution that seems to be working. He explains that as a result of shortages in skilled mental-health workers: ‘Task-shifting‘ involves training lay-people in developing countries, to work alongside trained medical staff. He goes on to say that delegation is allowing them to reach large swathes of a population in not waiting to upscale mental-health services.
In Britain, meanwhile, and in line with progress, the tectonic plates of mental health shifted dramatically in recent years when two members of parliament stunned their colleagues, charities and the media. On the 14th June 2012, as the House of Commons held a debate on reform of the mental-health system, Kevan Jones, the then Labour MP for North Durham put down his papers and stood up, to say:
‘In 1996, I suffered from quite a deep depression related to work issues and other things that were going on in my life, at the moment. That’s the first time I’ve spoken about it … because like a lot of men, what you do is try and deal with it yourself. You don’t talk to people. I just hope you realise Mr Speaker [that] what I’m saying is very difficult for me now. I thought long and hard, but didn’t make the decision until just now, to do it.’
That was an authentic and courageous moment in an environment famed for tradition, ritual and formality. However, what came next made it all the more remarkable. Charles Walker, the former Conservative MP for Broxbourne, followed him with an account of having suffered with mental-health problems and specifically, Obsessive-compulsive disorder, for over 30-years. During a humorous and moving statement, he said:
‘This is society’s problem … can you imagine going through your whole life feeling miserable, excluded [and] discriminated against with little hope?’
Many people can and do, but with growing challenges to the established nature of stigma and mental-health-skills shortages around the world, there is hope for change in a real sense.
Shame can be applied to a great many things but poor mental health, should not be one of them.
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Images:
Despair in the Rain, by Amrul Qay, Pixabay – Main Image – AI Generated
Happy Africa – by Iterpeal, Pexels
Thinking on a Bench, by Pixabay
Media Messaging, by Craig M. Dennis, Pexels
Walk on the Beach, by Chris Walks Around, Pixabay
A Christian Cross, by Pixabay
Surgery, by Pixabay
Community Connections, by Mr Rabindra Bagh
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