Crazy nation?

‘BONKERS BRUNO LOCKED UP.’ That is how early editions of the UK Sun newspaper announced former boxer Frank Bruno’s sad decline into mental illness. By lunchtime, following a barrage of criticism from mental health charities, the frontpage headline had been toned down to ‘SAD BRUNO IN MENTAL HOME’.

The Sun’s retraction marks a change in our attitudes to the mentally ill. It is not the belief that madness should be handled with sensitivity and compassion that is new – even the founders of nineteenth-century asylums believed that – but rather the rationale for compassion that has changed.

In the past, those who lost their reason were viewed as being fundamentally different to ‘normal’ people. So much so that despite the good intentions of their founders, asylum inmates were often treated no better than animals, to be locked away and lampooned. The Sun’s original headline belongs to that era – suggesting an editorial team that is out of touch with the new etiquette of mental health, which increasingly views madness as just another point on the scale of human emotions.

As Dr Michael Fitzpatrick has argued, both the medicalisation of madness and the anti-psychiatry movement that emerged in opposition to it were motivated by the desire to bring about more progressive and humane treatment of the mentally ill (see Breaking psychiatry’s chains). By transforming madness into an illness, psychiatry not only aimed to arrive at new treatments, but also to remove the stigma of moral culpability. Insanity no longer reflected the absence of moral fibre, but the presence of disease.

Medicalisation may have absolved the mad from guilt, but it did nothing to change their status as outsiders. If anything, it reinforced the divide between the mentally competent and the mentally ill. Anti-psychiatry set out to smash that dichotomy. Madness was no longer to be seen as a disease, but as a form of social deviance, a refusal to comply with conventional behavioural norms.

Rather than defining the mentally ill in opposition to the rational, mentally competent humanist subject, the different strands of anti-psychiatry sought to portray the mentally ill as the victims of unreasonable social pressures, whose mental state and behaviour were nothing more than exaggerated forms of ordinary human emotions.

As Fitzpatrick concludes, the medicalisation of madness survived the challenge from anti-psychiatry, but themes from both ideologies can be found in the contemporary discourse of mental health, particularly in charities and pressure groups like SANE and MIND. The furore around the Sun’s original headline and its subsequent climbdown are rooted in that discourse and reflect its central themes.

One such theme is the portrayal of the mental patient as martyr. Bruno was always more popular as Britain’s favourite affable loser than he was as heavyweight champion of the world. His current troubles are likely to boost his public standing, as the victim culture elevates him, David Kelly-like, to the status of national martyr.

A second theme is the exaggeration of mental vulnerability, which suggests that the trials and tribulations of everyday life (so-called stressors) can easily lead to mental illness. Ex-boxer Barry McGuigan was quick to suggest that Bruno should have received counselling to help him adjust to life outside the ring. But it seems more likely that it was the suicide of his trainer, coupled with divorce and financial problems (and perhaps others factors we are unaware of), that pushed Bruno over the edge, rather than the transition from second-rate boxer to pantomime dame.

A few years ago, SANE ran a poster campaign claiming that: ‘You don’t have to be mentally ill to suffer from a mental illness.’ This reflects the final and most important theme: the belief that the difference between severe mental illness and the normal gamut of human emotions is merely quantitative rather than qualitative – for instance, that clinical depression is like ‘feeling a bit down’, only more so.

Yet changes in quantity eventually become changes in quality, and everyday misery relates to clinical depression in the same way that a duck pond relates to the Atlantic. Since Bruno’s incarceration, pundits have been tripping over themselves to point out that mental illness could happen to any of us. Tory health spokesman Liam Fox suggested that one in three of us will suffer from depression. But there is a big difference between feeling down and being sectioned under the Mental Health Act.

Involuntary admission to a mental hospital requires that the patient is a danger to himself and/or others, so Bruno’s distress must have been severe. When he was interviewed by the BBC in August 2003, as he booked himself into the Priory, a five-year-old could have spotted that Bruno had lost his reason and that his paranoid delusions lay beyond the extremes of normal emotional distress. Bruno’s problems are so severe that, until he recovers, he cannot be held responsible for his behaviour. This suspension of culpability also entails a curtailment of civil liberties – if Bruno cannot govern his own mental life, then it must be governed for him.

Finessing the difference between severe psychiatric distress and minor negative emotions implies that none of us is fully in control of our mental life and that we, therefore, need to be governed by the therapeutic state. Commentators condemned the Sun for stigmatising mental illness, but it is the suggestion that we are all potential mental patients that is really offensive.

David Wainwright is the co-author with Michael Calnan of Work Stress: The Making of a Modern Epidemic, published by the Open University Press, 2002. Buy this book from Amazon (UK) or Amazon (USA)