Not every mentally ill person is a poster child for mental illness

I’ve spent time in psychiatric hospitals; I look like a “normal” person, too. But what if I didn’t?

All hail the mental health stigma fightback! As the sibling of someone who suffers from schizophrenia, and someone who’s spent time in psychiatric hospitals herself, I am sick to death of all the bigoted crap that gets thrown our way, from “mental patient” Halloween costumes to fear-mongering Sun headlines. Enough! We are not all axe-wielding murderers! We are Stephen Fry! We are Alastair Campbell! We are that bloke in A Beautiful Mind who’s good at maths! And what’s more, we wear normal clothes! Get a load of my jumper – would a mad person wear Per Una at Marks and Spencer? I think not.

I’m not trying to be flippant (much). I think it’s incredibly important that we stand up to bigotry wherever we find it. I like the mass pressure that twitter and other social media forums can exert. Nonetheless, I wonder if I’m alone in feeling a certain unease with the route the mental health fightback is starting to take.

The #mentalpatienthashtag is a case in point. In response to a number of crass, bigoted “mental health patient” Halloween costumes sufferers of mental illness tweeted photos of themselves in their own #mentalpatient outfits – which look just like everyday clothes! Way-hey! It’s a funny and clever way of defying expectations, similar to the Fawcett Society’s This Is What A Feminist Looks Like T-shirts. And yet in both cases, I have my misgivings. So mental patients don’t look mental patients and feminists don’t look like feminists – but what if, sometimes, they do? What if we’re not challenging stereotypes so much as saying “these are indeed where the boundaries of our tolerance lie”?

I understand and appreciate the good intentions behind the hashtag. Nonetheless, I start to feel a creeping discomfort at the sight of so many people demonstrating how “normal” they look. I’ve spent time in psychiatric hospitals; I look like a “normal” person, too. But what if I didn’t? What if my clothes were unwashed, my hair matted, my skin stretched over prominent bones, just like it was in the days when I couldn’t muster the energy for self-care? What if I found myself dribbling incessantly due to the over-production of saliva, a side-effect of anti-psychotic drugs? What if my eyes looked wide and fearful because actually, I didn’t want to be photographed and felt terrified it would steal my soul?

Not every mentally ill person is a poster child for mental illness. While you could argue that those who put themselves forward – the Alistair Campbells, the Stephen Frys – are taking one for the team, it’s not so simple. Thousands would love to share tea with Fry, listening to witty and urbane chit-chat interspersed with stark tales of mental disintegration. Few people want to share instant coffee and out-of-date milk with someone who just doesn’t want to talk, or when he or she does talk is rude or accusatory or paranoid or just repeats the same stories again and again. The more we promote the “normal” mentally ill – the mentally ill on a good day, the mentally ill who aren’t difficult or hostile or embarrassing to be with – the more isolated the “non-normal” mentally ill and their carers will remain. Fighting stigma isn’t just a matter of replacing a Halloween monster with a successful media personality. In doing so we’re allowing the bigots to push us into a corner. We don’t need to go by their extremes.

We shouldn’t have to prioritise making others feel comfortable when it comes to fighting mental health stigma. Just as feminism doesn’t need “rebranding”, mental health doesn’t need “sanitising”. This is not the way that social norms are challenged and changed. If mental illness does not make you feel frightened, uncomfortable, bored or embarrassed, perhaps this isn’t because you’re a wonderfully open-minded, laid-back person. Perhaps it’s because you’re not close enough to mental illnesses, or only engage with sickness eloquently expressed on blogs or on Twitter. Perhaps it doesn’t seem ugly or challenging because your engagement is selective. Mental illness hurts, the way all illness hurts.

Ranting against the Sun and the Telegraph might be a worthwhile pursuit. Calling for better resources for those suffering from mental illness is even better. What’s also important, though, is ensuring that the goal of well-resourced, positive care for the mentally ill isn’t to hide them from view. Sometimes we can’t take away the fear and ugliness. Sometimes minimising suffering has to be enough.

Few of us would pass up the opportunity to spend time with Stephen Fry. Image: Getty

Glosswitch is a feminist mother of three who works in publishing.

Getty
Show Hide image

I am special and I am worthless: inside the mind of a narcissist

There's been a lot of discussion about narcissists this week. But what does the term actually mean?

Since the rise of Donald Trump, the term “narcissistic” has been cropping up with great regularity in certain sections of the media, including the pages of this journal. I wouldn’t want to comment about an individual I’ve never met, but I thought it would be interesting to look at the troubling psychological health problem of narcissistic personality disorder (NPD).

People with NPD (which is estimated to affect about 1 per cent of the population) have a characteristic set of personality traits. First, they have a deeply held sense of specialness and entitlement. Male NPD sufferers frequently present as highly egotistical, with an unshakeable sense of their superiority and importance; female sufferers commonly present as eternal victims on whom the world repeatedly inflicts terrible injustices. In both cases, the affected person believes he or she is deserving of privileged treatment, and expects it as a right from those around them.

Second, NPD sufferers have little or no capacity for empathy, and usually relate to other people as objects (as opposed to thinking, feeling beings) whose sole function is to meet the narcissist’s need for special treatment and admiration – known as “supply”. In order to recruit supply, NPD sufferers become highly skilled at manipulating people’s perceptions of them, acting out what is called a “false self” – the glittering high achiever, the indefatigable do-gooder, the pitiable victim.

The third characteristic is termed “splitting”, where the world is experienced in terms of two rigid categories – either Good or Bad – with no areas of grey. As long as others are meeting the narcissist’s need for supply, they are Good, and they find themselves idealised and showered with reciprocal positive affirmation – a process called “love-bombing”. However, if someone criticises or questions the narcissist’s false self, that person becomes Bad, and is subjected to implacable hostility.

It is not known for certain what triggers the disorder. There is likely to be a genetic component, but in many cases early life experiences are the primary cause. Narcissism is a natural phase of child development (as the parents of many teenagers will testify) and its persistence as adult NPD frequently reflects chronic trauma during childhood. Paradoxically for a condition that often manifests as apparent egotism, all NPD sufferers have virtually non-existent self-esteem. This may arise from ongoing emotional neglect on the part of parents or caregivers, or from sustained psychological or sexual abuse.

The common factor is a failure in the development of a healthy sense of self-worth. It is likely that narcissism becomes entrenched as a defence against the deep-seated shame associated with these experiences of being unworthy and valueless.

When surrounded by supply, the NPD sufferer can anaesthetise this horrible sense of shame with the waves of positive regard washing over them. Equally, when another person destabilises that supply (by criticising or questioning the narcissist’s false self) this is highly threatening, and the NPD sufferer will go to practically any lengths to prevent a destabiliser adversely influencing other people’s perceptions of the narcissist.

One of the many tragic aspects of NPD is the invariable lack of insight. A narcissist’s experience of the world is essentially: “I am special; some people love me for this, and are Good; some people hate me for it, and are Bad.” If people with NPD do present to health services, it is usually because of the negative impacts Bad people are having on their life, rather than because they are able to recognise that they have a psychological health problem.

Far more commonly, health professionals end up helping those who have had the misfortune to enter into a supply relationship with an NPD sufferer. Narcissism is one of the most frequent factors in intimate partner and child abuse, as well as workplace bullying. The narcissist depends on the positive affirmation of others to neutralise their own sense of unworthiness. They use others to shore themselves up, and lash out at those who threaten this precarious balance. And they leave a trail of damaged people in their wake. 

This article first appeared in the 16 February 2017 issue of the New Statesman, The New Times