The worst thing about psychiatric hospitals isn’t the treatment, it’s the patients. Or rather I guess it depends. Personally, I’ve had good treatment and bad, brilliant treatment and terrible. The one constant has been frustration with the other patients. Whatever else is going on, both inside and outside your own head, they’re always there with you and dealing with that can be hard.
My brother suffers from schizophrenia while I’ve suffered from depression and anorexia. I’m fighting the urge to write “therefore it’s a laugh a minute round our way” but actually, sometimes it is. Not always – for my brother, the impact of increasingly large doses of medication has been devastating – but the dark humour offers some degree of comfort. If we feel traumatised, it’s often more by treatment than illness itself. We’ve occasionally spent time in the same institutions and end up reminiscing on some of the same people. It’s rare that we’re complimentary about any of them. We remember all the bad things. In a reversal of the way prejudice often operates, we’re brilliant at defending the mentally ill in principle, terrible at hiding revulsion at some of the sick people we’ve encountered in the flesh. I have no desire to defend this – I can’t – but it is, I think, a problem with chronic mental illness.
Familiarity breeds a special kind of contempt. Perhaps more so if you have suffered yourself, you become unwilling to separate the personality of the sufferer from the manifestations of his or her illness. To do so would seem patronising, maybe even a denial of his or her personhood. It’s difficult to think “they’re someone else, but for the illness”, equally difficult to think “the illness doesn’t inconvenience or frighten or anger me, because it’s not really them”. I’m not able to do this with my brother, but then I’m not sure I want to. How much of him do I want to discount, and how much of him would then remain? At what point has so much been amputated that there’s no person left? I don’t want to start chipping away at the person but if I fail to do this, to what extent am I seeing only the illness? People are not their diagnosis but the symptoms of mental illness can colour everything.
There is a need to combat the deep-rooted and irrational fear of mental illness that many people carry with them. Schizophrenia sufferers are not likely to be violent towards others. Those of us with depression don’t fall apart at the slightest touch. Mental illness can be incredibly lonely, with the psychological isolation of the disorder compounded by a real lack of contact with others, because these others are afraid. Charities such as Mind  and Rethink  have fought hard to challenge perceptions, in the face of constant scaremongering and casual bigotry throughout the national press. This element of their work – only a small part of all they offer sufferers and carers – is incredibly important. All the same, there are times when I wonder whether the message that filters through to the mainstream ends up being the one people want to hear rather than a true reflection of the instability and ugliness of some types of mental illness. When I see advertising campaigns such as this one  and this , emphasising the “normality” of people who are mentally ill, I don’t feel as though they have much to do with those closest to me. If anything, I worry that my brother is letting the side down by conforming too closely to the stereotypes that are being questioned. That doesn’t mean the bigots understand him, but it might mean different tactics are needed to make them see the human being.
I remember my own family’s mistrust when the National Schizophrenia Fellowship became Rethink in 2002. I can see reasons for the decision being made – it is more positive and more inclusive – but to them it felt like New Labour-esque rebranding. “They don’t want people to hear the word ‘schizophrenia’,” was my father’s view. “They’re pandering to the stigma.” This may be unfair but there are reasons for such a degree of defensiveness. Rethink sounds nicer than any phrase that contains the word “schizophrenia”. But you can’t make schizophrenia nice.
Just as sufferers of physical illness are often expected to make up for their “flawed” status by being brave little Pollyannas, mentally ill people need to exhibit compensatory features in order to earn the right not to be discriminated against. Well-meaning people tell me “well, your brother must be really good with numbers” and obviously I’m tempted to say “yes, he’s just like that bloke in A Beautiful Mind” (a film I haven’t actually seen) rather than admit he failed GCSE maths three times in a row. After all, I’d only disappoint and embarrass these people following their plucky attempt to look on the bright side. Nonetheless, once it’s clear you don’t actually measure up to the compensatory factors, this can be used against you. I remember hospital staff telling me that as far as anorexics went, I wasn’t “one of those Best Little Girl in the World types  but a selfish attention-seeker”. Well, yes. I never promised to be anything other than that. The point is, even if the symptoms of your illness make you a selfish attention-seeker – and even if these symptoms are so enmeshed in who you are it’s impossible to tease out the strands – all people who are mentally ill deserve human contact and support, not just the “good” ones.
You can’t always tell by looking whether a person is mentally ill. Nevertheless there are times when you can make a pretty good guess. Sometimes the mentally ill person is the man shouting on the street corner, rather than that nice man who was off work but is back in the office having “good days and bad days”. Sometimes mental illness is so debilitating that a person never experiences paid employment. That doesn’t mean they’re not a part of our society. It doesn’t mean we’re not responsible for them and it doesn’t mean we’re allowed to stick to what for them may be impossibly high standards for social interaction. Suffering from a mental illness and/or engaging with a sufferer can be messy, embarrassing and deeply distressing. You might never reach a point at which it isn’t. That doesn’t mean understanding is impossible or that attempts at contact and inclusion are worthless. For many people, they’re worth far more than can ever be expressed.