Treating life itself as a mental illness

In the UK, there has recently been the launch of yet another awareness campaign on the issue of mental health.

The ‘Time to Change’ campaign is run by leading mental health charities – Mental Health Media, Mind and Rethink – and claims to be ‘England’s biggest ever attempt to end stigma and discrimination and improve wellbeing’ (1). Running for four weeks from 21 January, it will feature television ads by celebrity sufferers such as Stephen Fry, Ruby Wax and Alastair Campbell, public stunts (such as the Sheffield tram done up to resemble a padded cell), and newspaper adverts challenging public perceptions of mental health. It has the endorsement of numerous high-profile supporters, including politicians such as Gordon Brown, David Cameron and Nick Clegg.

The campaign acknowledges that there have been both social and medical advances in recent years in relation to mental health. The problem today, according to Time for Change, is people, whose ignorance and discriminatory behaviour are a root problem. It aims to expose the many ‘myths’ about mental health issues and has devised an online questionnaire and placed newspaper adverts in order to do so. There are eight statements, and you have to decide which are myths and which are facts; you are then given the correct answer. Below, I have highlighted three of the statements to illustrate some of the problems with campaigns such as this, and with the current mental health debate.

Statement one: ‘Mental health problems are rare’

Time for Change answer: ‘Myth’

If, as stated in the campaign literature, mental health problems affect one in four of us, then they are certainly not rare; on the contrary, they are very common. However, the term ‘mental health problem’ is so all-encompassing today that it can be meaningless, conflating the more unpleasant aspects of human existence with severe and debilitating mental distress.

The campaign is similarly unclear on prevalence (that is, how many people have mental health problems during any given year), claiming that the one-in-four statistic refers to the annual rate (2), and then elsewhere that it refers to the lifetime occurrence (that is, how many people will have a mental health problem over the course of their lives) (3). It would indeed be rare for someone to go through their whole life without some form of emotional issue. There is a lot that can and will affect us as we go through life (bereavement, unemployment, crisis of meaning), but these are not new. What is new is that we are now expected to interpret them through the prism of a therapeutic culture, with professionals seen as the solution to our problems, and our friends and intimates viewed as potential problems.

Statement two: ‘People with mental health problems are violent’

Time for Change answer: ‘Myth’

Technically speaking, this answer is wrong. A small minority are violent. This is a slightly higher proportion compared with the population in general, but not significantly so, and the relationship between mental disorder and drug and alcohol misuse further complicates matters. The vast majority of homicides (91 per cent) are committed by people without a psychiatric diagnosis, and the risk to the general public is negligible (4). The public’s perception of the danger posed by psychiatric patients far outweighs the reality of the threat.

The reasons behind today’s culture of fear are complex, but many of those endorsing the anti-stigma campaign are guilty of stoking such fears. For example, many of the politicians supporting this campaign will have been involved in passing the Mental Health Act 2007, a piece of legislation that many viewed as unnecessarily coercive, but which was justified by government on the basis that community care had led to the public being put at risk from psychiatric patients. According to then home secretary, Jack Straw, the new Act was necessary as clauses in the 1983 Act designed to protect patients’ rights were ‘an impediment to public safety’ (5). With the new legislation now in place, politicians can safely pose with celebrities while berating the public for their misguided fear of violent ex-patients.

Statement three: ‘People can recover completely from a mental illness’

Time for Change answer: ‘True’

This is undoubtedly the case. Some people make a complete recovery and put it behind them; others may have sporadic episodes over the years, and others may require long-term psychiatric and social support. Many will benefit from self-help groups such as the Hearing Voices Network or Asylum Associates, groups which use alternative approaches to dealing with mental distress outside of the dominant medical framework.

However, compare the wording of the question with the previous two. The former ask about ‘mental health problems’, the latter about ‘mental illness’. If you carry on you find that question four refers to ‘severe mental illnesses’. In other words, they are not talking about the same things. Using these terms so interchangeably, and without clarity of definition, allows the most severe and debilitating mental distress to be conflated with the more mundane, if unpleasant, aspects of life. And it allows the human condition, with all its pleasures and pain, to increasingly come within the remit of the mental health professions. It is also far from clear what a public awareness campaign can do about the problems of life, apart from teaching us to cope with, rather than transcend, them.

In the past, psychiatry’s critics often pointed out that it was used as a form of social control, as a way of manipulating behaviour; the fear of being labelled mad ensured there would be no deviation from the status quo. Of course, we would be more alert to such manipulative attempts by the powerful today.

Or would we? I forgot to mention the ‘world first’ claimed by Time to Change: ‘Other anti-discrimination programmes have measured their ability to change public attitudes around mental health, but we are the first to aim to change behaviour.’ (6) And they are using £18million of public money in order to do so. Money that could have helped those patients and services who really are in need is being squandered on a celebrity therapy session and public beratement of the masses.

Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University, England. His book Social Work, Politics and Society: From Radicalism to Orthodoxy is published by Policy Press.

(1) See the Time to Change website

(2) See the Time for Change quiz

(3) See How does mental health affect me?, Time for Change

(4) See Scare in the community, by Ken McLaughlin

(5) See The Times (London), 13 Febuary 1999

(6) See the Time to Change website