Why We Need To Move The Mental Health Conversation Beyond 'Stigma'

The anti-stigma message has doubtless worked brilliantly to broaden the public understanding of mental health. Our next challenge is to deepen it.

‘It’s an illness like any other, and you wouldn’t tell me to pull myself together if I had diabetes or cancer or a broken leg.’

So goes the enduringly popular anti-stigma slogan, shaping public understanding about the unfathomable array of human thoughts, feelings and behaviours that many health professionals – and by extension, the rest of us – call ‘mental illness’.

Spearheaded by government-funded mental health charities, endorsed by royalty and celebrities, and shared widely on social media, the anti-stigma conversation is loud and clear. We talk and tweet and post messages about stigma and the problem with stigma and the need to reduce stigma. It’s all so obviously well-intentioned that it can be difficult to countenance the possibility that we might be looking in entirely the wrong direction.

The psychologists Anne Cooke and Dave Harper argue that anti-stigma campaigns individualise what is often an issue of prejudice and discrimination. “We don’t talk about the stigma of being a woman, or of being black,” they explain. “We talk, quite rightly, about sexism and racism.”

Why then are we so quick to internalise matters where our mental health is concerned? Well, one theory is that public education campaigns encourage us to think in this way.

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In 2016, the BBC ran a season of programming called In The Mind. James Harding, director of BBC News, announced the schedule by saying: “We will report and examine – with all the BBC’s expertise, insight and understanding – on what’s really happening in mental health”. One of the biggest programmes in this schedule was a documentary presented by Stephen Fry, entitled The Not So Secret Life Of The Manic Depressive: 10 Years On (a sequel to a 2006 documentary, in which Fry talked about his own painful difficulties in experiencing very high and low moods).

The programme begins with footage of Stephen Fry in 2012 in Kampala, Uganda, where he was filming another documentary, interviewing a Ugandan politician, Simon Lokodo – who in Fry’s inimitable words was “a foaming, frothing homophobe of the worst kind”. He had proposed a bill to make homosexuality a capital offence. In the footage we see Lokodo jabbing a threatening finger towards Fry, a gay man, and shouting him down, stating that he will be arrested if he tries to promote his homosexuality or recruit others, and so on. All vile, nasty stuff. Fry is visibly shaken.

Cut to the present day and Stephen Fry is in the office of his psychiatrist, Dr William Shanahan. Together they recount the events that followed that distressing encounter. Fry recalls how he returned to his hotel feeling the lowest he had ever felt. He had vodka and also pills of some kind in his room and proceeded to take an overdose. Back in the UK two days later, Fry decided he needed to see a psychiatrist. ‘I have a dim memory of arriving here,’ he says, at which point Dr Shanahan takes over: ‘When you arrived, let me remind you [you were] sorry that you were still alive. And wanting to die. And feeling that you should have died.’

So a truly horrible experience for a person to suffer. And we learn that Fry was admitted for a short stay in hospital.

“At the age of fifty-six,” a narrator tells us, “Stephen got a formal mental health diagnosis of cyclothymia, mood swings that lead to disturbed behaviour. But with the diagnosis came the medication and that immediately made him feel much better.”

End of scene.

Watching this documentary at the time, it seemed odd to me that no airtime was given over to the psychiatrist discussing the possibility with Stephen Fry that his plummeting mood was likely to be connected to the terrible thing that had just happened to him.

He had been thousands of miles from home and was forced to try to defend his very existence to a hideous and powerful man, who from the comfort of a ministerial office took delight in humiliating and threatening him. Now possibly none of that is enough to fully explain why Stephen Fry drank the vodka and took those pills, but I would argue that it almost certainly played a part.

We have no idea what private conversations were shared between doctor and patient when the cameras weren’t rolling. Quite possibly they did talk at length about such things. I hope so. My point is that the BBC TV programme did not.

Following its broadcast there was some criticism levied against the BBC. An open letter written to the broadcaster by Peter Kinderman, professor of psychology at Liverpool University, and over one thousand other signatories criticised “a failure to acknowledge that the origins of problems, and the things that keep them going, are often not simply in the brain but in the events and circumstances of people’s lives.”

This may be especially resonant for the disproportionately high number of people who suffer from mental health problems at the other end of the economic ladder. We know that the myriad of difficulties endured by people living in financial hardship have a significant negative impact on mental well-being. Here things turn political: “Look at the politicians and policy makers shouting loudest about anti-stigma,” says psychologist and author Dr Lucy Johnstone. “They’re the very people who are reinforcing the policies that are driving people crazy.”

It may serve the interests of those in positions of political power that a young person who’s falling apart while struggling to pay ever-rising rent from an evermore precarious zero-hours salary is suffering from a ‘panic disorder’ than to confront the possibility that the real sickness is located elsewhere.

Today mental health diagnoses can feel not entirely dissimilar to brands, with the currently more ‘popular brands’ such as ‘depression’ and ‘anxiety’ being monetised through the publication of countless self-help books and the development of new therapies, while less marketable brands such as ‘schizophrenia’ and the so-called personality disorders suffer from a diminished investment – and so yet another inequity is forged. (I should qualify here that I don’t mean depression or anxiety are popular in the sense of being desirable to those of us who suffer from them, simply that more public empathy and resources go their way.)

It’s a complicated situation that cannot be adequately communicated with a simple soundbite. The truth is that the strange human phenomenon we call mental illness isn’t remotely like a broken leg. The anti-stigma message has doubtless worked brilliantly to broaden the public conversation. Our next challenge is to deepen it.

This blog is an edited extract from The Heartland: Finding and Losing Schizophrenia, by Nathan Filer

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