There’s more to supporting those with mental health problems than fighting stigma

It’s not just a case of goodies and baddies, those who get it and those who don’t.

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According to a survey conducted by the BBC to coincide with its In The Mind series, the stigma associated with mental illness is subsiding. More people would be prepared to reveal a diagnosis to friends and employers. Ten years since the release of his documentary The Secret Life of the Manic Depressive, Stephen Fry argues that things are changing for sufferers: “it’s more talked about […] It’s in the culture more and it’s understood more.”

This can only be a good thing. There’s no way of quantifying just how much the pain and isolation of suffering from a mental illness can be compounded by the fear of others finding out. Even now, I find it difficult to answer seemingly simple questions, just in case someone fails to understand or disapproves. What were your schooldays like? Why did it take you so long to finish your degree? What does your brother do? I am cagey, not least because when I do tell the truth, even the nicest of people are unsure what to say, leaving me to feel I should offer reassurance. Yeah, but I’m not mad now! Sure, he’s schizophrenic, but he won’t kill you or anything! Cue nervous laughter, and a relationship ever so slightly marred by the sense that I must now prove myself to be “normal”, an impossible task for any of us at the best of times.

It can be easy to view the existence of stigma as just one more thing mentally ill people have to cope with, on top of loneliness, unemployment, poverty, poor care options and the illness itself. But all of these things are related. As Catherine Shoad writes about the language we use to describe senility, “dismissing someone as ‘gaga’ makes it easier to kid yourself that your responsibilities towards them have gone the same way as their marbles”. Whether we demonise or infantilise people with bipolar disorder, schizophrenia and other conditions, the effect is the same: we make them into people who do not have the same feelings, needs and desires as us. We can pretend it is their illness that places them on the margins of society, and not social structures that could, but do not, include them.

And yet at times I feel a sense of discomfort with the way in which the “fighting stigma” narrative functions. It’s not that I don’t believe in it, but there are moments when it feels a little too sanitised, too self-congratulatory, too unwilling to ask questions. Perhaps this is a measure of my own failures in dealing with my brother’s illness, but I find that combating stigma has promised to solve more problems than it ever really can. Stigma arises for a reason, out of fears that have some basis in truth. We need to look at these head on.

When my brother was first diagnosed, I remember experiencing a huge sense of relief. Finally “it” had a name. There were papers on it, treatment, drugs. Having taken anti-depressants myself, I had no problem with the use of medication to treat a problem that obviously needed tackling. That other people – usually people with less experience of the situation – had their own issues with this was, I considered, a mark of their own prejudice. So they didn’t like the idea of other people experiencing an unhappiness that couldn’t be resolved through fresh air and exercise. Perhaps they didn’t even think mental illness was “real”. Well, that was just tough for them. Some people need extra help. Get over it.

Challenging the beliefs of mental health sceptics gave me something tangible to get behind. If I’m honest, it allowed me to fight the good fight from a remote distance, while my parents got on with the harder task of actual, day-to-day care work. I knew which words one was supposed to use, which magazine columnists were worthy of condemnation, which ones weren’t. I did not know what time of day my brother needed to take his pills, when his blood tests were, the precise list of side effects from the drugs he took. I still don’t. I just knew that other people, ignorant people, thought bad things and thanks to my greater insight and experience, I didn’t.

It’s only now, witnessing the cumulative effect of long-term drug treatments, that I feel more uncertain. I still don’t want to be one of those other people, the idealists, the denialists, the ones who criticise medicalisation just for the hell of it. But by god, the impact of a drug like clozapine can be shocking. I’ve read books on the history of mental illness – all the ones that express horror at how ignorant and brutal the treatments of the past used to be – and I wonder at just how primitive our treatments remain. Some pills seem to work as the chemical equivalent of bashing someone over the head with a mallet, cartoon stars emerging round their head. See? Bet you’re not capable of having any bad thoughts now! It’s not that I’d recommend not taking them. After all, I don’t know of the alternatives and again it’s stigma – always stigma – holding back funding into further research. But what I also know now is that the stories we tell ourselves about mental illness are not simple. It’s not just a case of goodies and baddies, those who get it and those who don’t.

For me, stigma has been something to fight, but it’s also been something to hide behind. It’s offered a way of directing my own incomprehension, fear and anger onto others. I still believe that Fry is right and that stigma remains “the thing we have most to address”. But it’s not the only one. We must not let our acceptance of people become an acceptance of the things that do them harm.  

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