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We Have to Talk About Our Collective Mental Health

16/02/2016 11:06 GMT | Updated 15/02/2017 10:12 GMT

For those that missed it, 4 February was Time to Talk Day, an effort to get people talking about mental health in everyday settings and ways in order to break down the stigma that undeniably still surrounds mental ill health.

It's not often though you get much analysis about what and where this stigma originates. Campaigns that seek to challenge it seem exclusively to pursue the logic that by talking more openly about mental health, we normalise the subject and thus reduce discriminatory attitudes. The problem with this - beyond the fact that stigma is a complex interpersonal and internal experience -is that the language of mental health is (and should be much more) contested. The root driver of stigma, I would argue, is actually structural in nature. While I'm reluctant to knock such a well-intentioned and important cause, there really is a problem with these campaigns because sixty years of them appears to have made very little difference to social attitudes on mental health.

Why should this be? In my view, the feelings of shame, personal failure and weakness that surround the stigmata of mental illness - and work to prevent us reaching out for help - are woven into our socio-economic order. They are meant to be there. They are fundamental to maintaining and reproducing the status quo. If we don't recognise this, our campaigning is at best ineffective, at worst an active agent in obscuring what ought to be our real focus: the condition of human wellbeing effected at a population level by our social and economic arrangements.

The recently leaked Five Year Forward View for Mental Health describes the predictable impact that chronic underinvestment in research and services has had on the quality and amount of care available to people. My own service, Off the Record Bristol, an organisation now over 50 years old, bears witness to this daily. I count myself among those calling for much greater resource and far better service design across the mental health system. But I hear almost nothing from any direction on the reason why demand for services is rising. I don't believe for one second that rising demand has much to do with the absence of those same services.

Epidemiologists Richard Wilson and Kate Pickett established the "pernicious effects that inequality has on societies: eroding trust, increasing anxiety and illness, (and) encouraging excessive consumption". Widening inequality has been the defining feature of thirty years neoliberal social and economic policy. For a generation now, we have organised ourselves around values that laud competitiveness and self-reliance, individualism, the pursuit of 'happiness' and consumerist materialism as a form of status. Neoliberalism purports to meritocracy - if we only work hard enough, and play by the rules, we can be financially and materially successful, and thus, happy. But the reality is social mobility is now something from another era. There is no meritocracy.

It's not difficult to see how neoliberal values such as these - when allied to real world nepotism - combine to create a perfect storm of psychological and emotional suffering at a population level. Mental ill health is evidence we can't keep up and play the game; that we're not normal, we've failed; we weren't strong enough to survive. Our being-in-the-world is made insecure and feelings of shame and worthlessness flow. This is the contemporary stigma of mental illness - its function is to frighten us into carrying on working hard, trying to be happy and accumulating stuff. The fright of being shamed, of exclusion, is vital because it keeps us focused on ourselves and prevents us asking bigger, more challenging questions about the status quo.

This is why language is so important. When anti-stigma campaigns work to normalise mental health they almost always attempt to achieve this aim using a language that mirrors physical health. Mental health 'disorders' are presented (through statistics and human stories of suffering) as illnesses like any other; one in four of us will suffer they say. It's an understandable logic, and there's sometimes a value to individuals having - and owning - a label with which to make sense of what and how they are feeling. But in doing this, anti-stigma campaigns can actively obscure the systemic bases of stigma and suffering. Categorising and commodifying our mental health in this way is actually a very way neoliberal way of approaching the issue.

Instead, I'd like to propose we start a slightly different campaign - one that dares to ask why, in a supposedly advanced and materially flush society, one in four of us will apparently suffer a mental health problem. My sense is that in asking this question, loudly and politically, we might achieve more transformative results.