Everybody hurts? Privilege in mental health.

I’ve seen a lot of discussion lately – most recently this morning on Twitter, regarding the footballer Stan Collymore – as to whether celebrities who are open about mental distress are a) wonderful ambassadors in the fight against stigma, or b) unfairly advantaged in dealing with their personal mental distress, and therefore less deserving of sympathy and support than your “average” sufferer.

Tweets such as:

“Show me a millionaire footballer with depression and I’ll show him my last wage slip and then see who has more to worry about”

and:

“Depression is a disease and people get affected but surely seeing an extra £50k a week drop into your back pocket is a bit of a relief”

emphasise the fact that while being rich and famous cannot prevent mental distress, it can certainly cushion recovery by buying in services that reduce day-to-day worries and reduce stress levels. I would have undoubtedly coped better during acute bipolar episodes had I been able to afford childcare, a personal chef to feed us all, a cleaner, and a personal trainer to help me avoid gaining lots of weight due to misery and medication. Whilst I appreciated her candour, when Ruby Wax returned to the Priory for the 4 Goes Mad season, I was struck by the way she immediately felt relaxed and safe when she re-entered the ward environment. The mere smell of it, she said, was like sniffing a baby’s head. The contrast between the feelings expressed by people who have been voluntary or involuntary patients on NHS psychiatric wards could not have been greater. Mind’s independent inquiry into crisis care last year found that emergency mental services were very often too little, too late, and that inpatient services were some of the worst ward environments in the NHS and left many people frightened and traumatised. This is a world away from being able to check into a private care facility which feels safe and comforting, at a time of your choosing, before a crisis point is reached.

And yet, the disparity between celebrities’ experiences and those of ordinary service users is often glossed over. This is partly because large charities rely on entertainers, politicians, sportspeople and so on to act as champions and raise the profile of mental health. But it’s also part of a wider failure within the mental health community to address the issue of privilege.

For those not familiar with the concept, privilege is often used in feminist discussions as a useful and important way of recognising that although all women suffer under the patriarchy, not all women suffer equally. It would be nice to say, “hey, we’re all in it together!” but we know that simply isn’t true. For a start, women in countries where their human rights are enshrined are in a position of privilege compared to women in theocracies. As a white woman in a developed, open society, I need to remember that I am in a position of privilege over women of colour. Equally, as a woman with a disability, I would prefer that non-disabled women recognise and accept that I experience some difficulties that they do not.

My concern is that in taking the line that “rich or poor, we all suffer the same pain”, we are willfully ignoring that some people with mental health difficulties, no matter how much they distress they go through, are more fortunate (or in a position of greater privilege), than others. This can be hard for privileged individuals to accept. Because their illness makes them feel just awful, they are often unable to recognise that they have any degree of privilege at all and that there are others on the receiving end of not just emotional pain, but greater stigma and its effects.

For example:

–          The person is who is able to remain in employment enjoys a degree of privilege over those who cannot. Our culture routinely asks, “What do you do?”, using someone’s employment status as a means of determining their position in society, so those who cannot work are stigmatised. They also have less income and probably less wealth, and are more likely to have to go through the uncomfortable process of claiming benefits and being designated a “scrounger”. Furthermore, the more status a particular job has, the greater privilege it confers. So the footballer who manages to keep working through depression has privilege over the dinner lady who also just manages to hang on in there.

–          The person who is able to remain in work and struggle through the day, “faking it” to keep going until they get home, is also in a position of privilege. I’ve done faking it, It’s awful, is it painful, it’s a debilitating way to live, but the person who can do it still retains a level of choice. They can opt to carry on hiding it, or choose to disclose to a friend, a colleague, a manager. Someone who is floridly psychotic, acutely manic, or beset by panic attacks the minute they leave the house, does not have the luxury of choosing to appear well because their symptoms cannot be hidden. Once you have no control over your symptoms, you face the far greater stigma of seeming “crazy”, “a nutter”, someone a bit dangerous who no-one wants to sit next to on the bus.

–          Those who can be treated in primary care are privileged because there is far less stigma attached to GP services than to inpatient or outpatient psychiatric services. You can walk into a GP clinic and if a colleague sees, they won’t think twice. This is a privileged position compared to those who must walk through the front door of the CMHT or the psychiatric unit – there is only one inference to be drawn by anyone who sees you.

–          The person who has never been hospitalised faces less stigma than, and is therefore in a position of privilege over, someone who has. Those who have been “voluntary” patients are less stigmatised than those who have been sectioned. Sectioning brings legal stigma (e.g. you can’t be an MP or a company director, although we are very close, I hope, to getting this repealed), social stigma (especially if the MHA assessment was very noticeable to neighbours or police detained you in a public place), and concerns about privacy/confidentiality in terms of what the police may hold on record about you.

–          Mental ill-health is more common in groups facing poverty, and recent migrants such as refugees and asylum seekers are likely to experience both poverty and stress caused by leaving their support networks behind. Black and minority ethnic groups have greater difficulty in accessing NHS services they need, and BME people are over-represented in involuntary inpatient care. Service users who are from the majority culture and those who speak English fluently have a level of privilege over recent arrivals to the UK, those who do not speak English, and those from black or minority ethnic groups.

–          Heterosexual service users will experience a degree of privilege over those who are lesbian, gay or bisexual, as well as those who are transgendered. Studies show a higher than average rate of both mental distress and substance misuse among LGBT people.  Homophobic  and transphobic hate crime remains all too common an experience for members of the LGBT community, but those with mental health problems may face a double-whammy of stigma and discrimination.

–          Someone with a diagnosis of, say, anxiety or unipolar depression undoubtedly suffers greatly. But they are still in a position of privilege over someone with a less well-understood diagnosis such as a personality disorder, schizophrenia or schizo-affective disorder. People with more stigmatised diagnoses find it harder to get a job and have a greatly increased risk of being the targets or physical and/or verbal assault in their own local community.

I understand the reluctance to judge another’s individual, personal suffering. That’s impossible to do anyway. But if we work on a basic principle that “we all suffer the same, so we’re all in it together” we’re ignoring some pretty glaring differences between various places on the mental health spectrum. If we tell someone with poorly controlled schizophrenia or bipolar I that they are wrong to view their problems as worse than someone with a diagnosis of stress or mild depression, we are failing to acknowledge the reality of privilege. Yes, we all hurt from our illnesses. But some of us hurt and suffer additional effects of greater stigma and discrimination.

Of course I don’t want the likes of Stephen Fry, Ruby Wax or Stan Collymore to get back into the mental health closet. But it’s disingenuous to say that the suffering of celebrities is just like mine or yours. It also runs the risk that people will think, well, if Ruby can keep doing her stage shows, and Stephen can carry on with QI, and Stan’s out there as a “radio and TV broadcaster extraordinaire” (his words), how come you or I are still on the sofa, crying?

Perhaps we aren’t trying hard enough?

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About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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24 Responses to Everybody hurts? Privilege in mental health.

  1. Becky says:

    Lots of interesting points Charlotte, but I would like to point out that being aware of privilege can sometimes make people feel worse about their illness.

    Not sure how well I’ll express this, but somebody who has no discernible reason to be depressed for example can feel immense guilt and self-hatred when their privilege is pointed out.

    • That’s a really good point and one that I addressed in my original “10 things not to say…” https://purplepersuasion.wordpress.com/2011/07/31/ten-things-not-to-say-to-a-depressed-person/ I think the reality is, pretty much everyone feels guilty and like they should be able to pull themselves together. Wherever there is a potential stick we will find it and beat ourselves with it. You will notice I have been very careful NOT to say that anyone shouldn’t feel awful. We feel how we feel. But if others are in worse circumstances than us, we MUST avoid skating over the fact because it makes us feel bad for feeling bad. This is not about feeling that we should be “counting our blessings” or something. It’s about challenging the view that everyone suffers equally, which is clearly untrue but gets trotted out often, probably because of people’s discomfort about the pain they feel despite the privileges they do have.

  2. Ailsa says:

    Could this be stigma in a new guise, though? Would we be having this discussion if we were talking about cancer? Maybe we would, but I’m just saying.

    • I don’t think cancer is a good analogy because these days – thankfully – it is not stigmatised. In fact, it is very openly talked about, people are proud to wear ribbons to support people with particular kinds of cancer. there are FB and Twitter campaigns to support or donate for children with cancer, etc.

      It would be more useful perhaps to compare MH with a stigmatised disease such as HIV/AIDs. Just like with mental health, the stigma is less than it used to be, but it is still there (and is much worse in other countries). But the amount of stigma varies according to who you are and how you contracted the virus. Children who inherit the virus in utero are often seen as “less deserving” victims, i.e. it’s not “their fault”. Given residual homophobic attitudes, people who contract the virus via gay sex are more stigmatised than those who contract it through heterosexual sexual contact. Drug misusers are already a stigmatised (and often criminalised) group in society, and those who inject rather than smoke heroin are generally seen as being the bottom of the heap. Someone who contracts HIV from dirty needles faces multiple layers of stigma.

      The actual circumstances are different, but the principles are the same. Everyone has it tough, but some have it tougher than others, either because of public perceptions or because they face additional challenges by virtue of belonging to another stigmatised group (referred to as intersectionality in the feminist theory I was mentioning). And once again, if you have wealth you are more able to buy in both treatments and services to make your life easier.

      Charlotte

  3. Pingback: Everybody hurts? Privilege in mental health. | Mental Health, Politics and LGBT issues | Scoop.it

  4. Interesting things to think about there.

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  6. I red something similar about this today too, an article written by india knight, in my personal opinion, i myself suffer with mental health problems and the more celebrities which are coming out with mental health issues are a great help, they have the publicity unlike alot of us, and can be heard seen as there in the public eye, what there doing is the right thing, since when has money stopped someone feeling depressed money is money, it comes and it goes, personally if i had £50k dropped in my back pocket every week i wouldn’t know what the hell i’d do with it, life will become pointless cos everything i want i can have there’s nothing to work or aim for anymore, i’d be giving it away, then personally inside i’d be feeling i don’t deserve this money i’m so ungrateful cos i still ain’t happy, money does not buy happiness, ok you can go on holiday, you can visit every country you want, even buy a house in a differenty country like most famous people do, but once your done that whats next. Your got to feel inner fullfillment. I think all the celebrities which are opening up are doing a great job, i absolutely loved Ruby Waxs Mad Confessions on channel 4 as well as all of the people which took part, that show meant alot to me and for certain people could of changed the life’s, for me they got it spot on, yes not all people can check in to a private clinic but she was’nt saying everyone could, the show was about mental health and everything she describe was very well said.

  7. mull1974 says:

    Fantastic subject to cover as i follow Stan and he usually re tweet’s a lot of abuse he gets. It is unbelievable and this weekend took it too a new low. I actually tweeted one person with my anger and the following day he responded to every complaint with an apology ( it was the one regarding cancer). Fine, I accepted. However i was shocked to the core by the hatred and hurtful tweets mainly on education. In this day and age i thought the stigma had began to reduce but in some circles it doesn’t go away. I like Stan,last year he raised 100k for depression alliance to work on a new project and since this, someone or some people have donated 500k and a re pledging to support a system to connect people with mental health issues. He is not perfect, he has spent time in the NHS mental health units but he has done wonders for the stigma, in the public eye. I hope people follow his lead and fight in public against the stigma, abuse and education.
    Rant over , probably not relevant! haha

  8. Ruzena says:

    Last year I went to see the show Ruby Wax and Judith Owen collaborated on about their experiences of clinical depression. She was absolutely candid about the fact that money gave her access to a range of options that most people with serious mental health problems can never hope for. In particular she’s been able to work to her own timescale and without having to think about punitive anxiety inducing things like Asos assesments to find a combination of chemical and therapeutic treatments that are effective for her. I do think that the online support she’s helped to establish via the Black Dog Tribe website and the open access gatherings of sufferers, supporters and professionals which she set up during the show’s run have been fantastic and the best possible use of the weird irradiated gift of celebrity status. I don’t think money actually makes any difference to the degree of suffering you experience at the time (look at Robert Enke, Gary Speed, David Foster Wallace and countless others) but it can make a huge difference to the course and outcome of the illness. That and luck.

    Warmest wishes to you and strength in your journey to recovery.

  9. doricgirl says:

    Hey – I know you’re taking a twitter break but I thought you might be on here – I would really like to quote the last two paragraphs of this post in a talk I am doing on mental health and privilege. I work for independent mental health advocacy and have used services as well and would be more than happy to send you the whole talk – let me know what you think. Take care

    • Hi, thanks for coming to find me and for asking permission – lots of people would’ve just gone ahead since the content is out there on the web. More than happy for you to use it and would appreciate if you could credit me and give the web address. Would love to see the content of your talk just out of interest – you can get me on BipolarBlogger2011@gmail.com 🙂

  10. Long Ben Avery says:

    To quote my Mum, “Money may not make you happy, but it does allow you to be miserable in comfort”

  11. Pingback: In it together: the Mind Media Awards, social anxiety and me | purplepersuasion

  12. Anothernumber says:

    You have some great points and I completely understand what you are saying. I think the main privilege for celebs is that they can afford to been seen by very expensive doctors and be seen quickly. I have had to face 10 years of back and forth with the NHS and the postcode lottery in order to finally be seen by CMHT, at first I was being seen for PTSD but the nurse said something about ‘a personality disorder not unlike bipolar … Rapid cycling’ I wasn’t really paying as much attention as I should have been. I don’t know I have seen her once every two weeks since mid September so I haven’t seen her very much.
    If a celeb had been feeling how I have the past 10 years they would have paid to go private and had some proper help to feel better. I suppose I’m lucky because I can shut off, and when I do get down, it doesn’t last long. I would say that makes me more privileged than someone who suffers chronic depression. But then I don’t know what is going on yet, I don’t know if I want to know…

    Sorry I was rambling….

    Just thought I’d add in the fact celebs don’t have to wait for the NHS or find they missed out in the postcode lottery.

    • Yep, this is exactly what I was trying to say where I wrote: “Mind’s independent inquiry into crisis care last year found that emergency mental services were very often too little, too late, and that inpatient services were some of the worst ward environments in the NHS and left many people frightened and traumatised. This is a world away from being able to check into a private care facility which feels safe and comforting, at a time of your choosing, before a crisis point is reached.” I see it as central to why relying on “celebrity mentals” is a problem.

  13. tristan says:

    Nicely said.

    I think the idea of being able to “struggle through the day” is a bit of a double-edged sword. A lot of services at the public level are really only for those who have lost the ability to make it through the day. Some MH diagnoses even have things like ‘inability to work’ built in to their diagnostic criteria, so those who are just barely able to drag themselves to work each day aren’t considered to have a problem until they “burn out”.

    In many ways it widens the privilege divide as those who can afford private therapy can get help discreetly without interrupting their careers, whilst those who cannot are essentially required to get worse before they can access decent support. It’s especially critical as dragging yourself to work whilst suffering from a mental illness can be extremely damaging itself.

  14. Sarah King says:

    I apologise but I find this an offensive article, I believe that it is impossible to quantify another person’s suffering or to suggest that there is a hierarchy of suffering. Frank Bruno was in a position of so called “privilege” however his fame and money did not cushion him from the embarrassment of being sectioned in front of his neighbours or protect him from having the headline “Bonkers Bruno” displayed in the Sun. Fame in his case rather than being a protective factor exposed him to even further stresses and a public loss of dignity.
    As a single parent with a serious mental illness, I am one of those people you define as being more “privileged” than someone who stays at home because they can’t work, however I have no options, I must go to work as I don’t have a protective nest egg of money to tide me over, I don’t have a partner who can care for my children and I battle every day of my life to hold our lives together. I take offense at the suggestion that there is a monopoly or hierarchy of suffering. and that I am in some way “privileged” I take 400mg of Quetiapine plus 600 mgs of Lithium every day and yet I still have to get up at 6.00 to keep a roof over my family’s head. This is not privilege it is a hard, hard battle and I often wish I had the “privilege” of sleeping late, staying safe at home etc etc but I don’t. However this does not make my suffering any less than someone who it could be said is in the “privileged position” of saying “I am too ill to work”.
    Equally being famous and wealthy may provide some additional supports however they may not, public exposure could further add to the distress of mental illness.
    No one has the right to comment on anothers lived experience unless they have lived that experience, lets not judge each other, coping with mental illness is hard enough rich or poor, working or unemployed, life can sometimes be hell.

    • So, your condition and treatments are almost the same as mine. But surely you can see that if we able to work at all, we are privileged over someone who’se never been able to work – for example, just 8% of people with a diagnosis of schizophrenia are in work. I think you have misunderstood – acknowledging privilege is NOT about saying our lives aren’t hard, that we have things easy. It’s about acknowledging that *compared to others* we are fortunate in some way. I have suffered enormously lately. I lost my job due to bipolar. This acute has lasted nearly 3 years, with two major crises – one of the two worst crises of my whole life. Yet I am privileged because my partner can just about keep us afloat although I’ve been unable to work. I literally could not work, so we’d have gone under financially, but it’s pure lucky that I have him. I am privileged in that bipolar is a more “acceptable” diagnosis than, say, schizoaffective disorder. I am privileged because my partner is able to supervise me, meaning that I have not had to go into hospital when other people would’ve been admitted.

      The whole point of the article is to say that you *cannot* compare two people’s suffering, that it’s pointless to try and do so, but you *can* compare the effects on people’s lives. Many people have a much easier time that I do – less serious conditions, needing less brutal treatments, with less impact on their careers and relationships. But many people have a worse time, a much worse time. And it’s pointless to pretend otherwise.

      • Sarah King says:

        This is a far too simplistic view of the world. How was Frank Bruno priviliged during his breakdown? I don’t believe that anyone should comment on how easy or how difficult life is for any individual and we shouldn’t try as it helps no one. Of course some people have it worse than others but that is really not the point. The point is you can be trapped in work because you really do have no choice and suffer more than someone who isn’t at work. Or you can have a mental and a physical illness and be homeless, the list of scenarios is endless ,but why compare, there are no prizes for suffering.
        We should support each other not vie for who feels the most pain. Pointless!!!!! You are only a “expert by experience” on yourself and shouldn’t judge others.

      • My whole point was that I *wasn’t* judging others’ distress, because, as I state very clearly, I don’t believe that’s possible. But the relative impact upon some groups (e.g. LGBT, BME, most stigmatised diagnoses) is unarguable in the face of the evidence and we do members of those groups additional harm by pretending otherwise. Pretty silly to say that the post is based on me being an Expert by Experience when the entire post is backed up, point by point, by evidence. This is probably one of the posts that is least based in my own experience! You are completely free to disagree with me, but I’d prefer if you took the piece on its merits, thanks.

  15. Pingback: Stabby and Fakey – popular constructions of ‘mental patients’ and diagnostic privilege « zedkat

  16. Maddi says:

    Hi, I found this article very interesting, and appreciate the relatively simple but in depth explanation of various forms of privilege. I think a lot of people feel very defensive when the term privilege is used as it can be quite a difficult position to accept, particularly if it is a new concept. I don’t disagree that there is a hierarchy to people’s difficulties etc. I do feel though, that the celebrities who are open about their difficulties and diagnosis are doing their best for others with mental health problems. They cannot change their own stories to be less privileged etc. By sharing their experiences I believe they do help the general public to realise that ‘normal’ people experience mental health distress, that people who do, are not dangerous etc. I have worked with lots if newly diagnosed young people (usually psychosis/schizophrenia*) who often took great comfort from hearing about celebrities struggles with mental distress and the correct inference that it did not have to be a life sentence etc. I understand the point of view that celebrities’ experience may give the public a skewed perception of access to services available and would certainly not highlight many of the difficulties faced by ‘regular’ service users, however I feel the alternative (celebrities not sharing their experiences) would be a greater shame. Anyway, thanks for the piece, I enjoyed reading it.

  17. Bea says:

    This is misinformed because people with schizophrenia aren’t always suffering as much as someone with moderate or even acute major depression. They do get better, and can just as easily relapse. People are not static, especially those suffering from a mental illness (not that those are static either).

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