Time to Talk day is here – a laudable attempt by umbrella campaigning organisation Time to Change to get as many people as possible talking about mental health. A quick scan of the Twitter hashtag shows that charities big and small, NHS bodies, celebrities and politicians are all pledging their commitment today to have conversations about mental health.
As you probably know, I’ve done work for both Mind and Rethink, TTC’s biggest funders, and indeed have volunteered with TTC myself (and taken the pledge!). One of my very earliest pieces of campaigning was propositioning complete strangers at the London Mela and asking them to have a conversation about mental health. Yet I’m left wondering: whose mental health? What are we talking about? What does the phrase even mean?
It’s tempting to point out that “mental health services” are actually services for people who have poor health, but so what? The same is true of “the health service” in general. Equally yes, “we all have mental health” and I suppose this is supposed to point out that we’re all essentially on a spectrum. OK, but how does that help? I have a few minor physical health problems, so by that logic I guess I am on a continuum with someone with multiple serious conditions. Does that give me insight into their life? Not at all. Do they feel comforted by knowing that I’m a little bit ill? Seems unlikely.
Furthermore the spectrum model implies that we’re all at least a tiny bit ill. In fact just this week someone told me that “there is no such thing as a mentally well person”(!). So-called Blue Monday passed in a flurry of attempts to let people know they “were not alone”. Let’s just remember what exactly they might be feeling “alone” with: being a bit low although completely within normal mood range, for one day, because of easily identified factors such as Christmas being over, being in debt, dark mornings and dark nights, and the inevitable anticlimax of the post Christmas and post New Year period.
In other words, they were being asked to seek help for being completely normal for a day. So one effect of the spectrum model appears to be to pull groups of people who do not have diagnosable conditions into the mental health zone. The spectrum concept also makes it easier for people to self-diagnose. I suspect we all know someone who is actually quite well but would secretly like some kind of diagnosis, especially ones associated with creativity or “specialness”, such as bipolar or Asperger’s, and I see them as sliding up the continuum like the “worried well” Blue January dudes. The increasing focus on “workplace wellbeing” and “resilience” by mental health charities sees a big part of their business engaged in the very furthest, safest end of the mental health rainbow.
In terms of people with actual diagnosable conditions, depression and/or anxiety are clearly the marketable face of mental illness. After all, everyone’s has at least a taste of low mood or feeling anxious, right? The theory seems to be that the smaller the gap between service users and non service users, the greater the reduction in stigma. And here of course is where recovery narratives kick in. The conditions that receive the most attention are those with better odds of being completely resolved after a single episode. Even if they aren’t, they’re often seen as conditions which allow the person to be fairly well between spaced out episodes. In other words, these case studies straddle the well and the unwell parts of the spectrum, reinforcing the message that “we all have mental health”.
What I see is an increasing phenomenon whereby “mental health” has pretty much become synonymous with the most common conditions – and those conditions alone, and vice versa. I see newspaper articles that talk about services and policy without mentioning any conditions other than depression and anxiety. Am I being (non-clinically) paranoid? Well, let’s take a look at who the main charities have as their “ambassadors”, which is the term Mind uses, or “celebrity supporters” if you’re looking at Rethink Mental Illness and Time to Change. I won’t bore you by showing my working, but as far I can see the three biggies have 41 supporters/ambassadors. Of these, 20 have direct lived experience. Here’s the breakdown:
Depression: 12 Anxiety/panic attacks: 5 Eating disorder: 1
Bipolar: 2 (the expected “big guns” Stephen Fry and Frank Bruno)
In the big push to further close the gap, charities have adopted a “people with mental health problems aren’t scary, honest!” approach, recommending a water cooler check in with an unwell colleague with the reassurance that they won’t freak out or crumble into dust.
As it happens, I’m big on this idea of people talking to other people about their mental health. I love running Mental Health First Aid training, which encourage delegates to talk to anyone they know or suspect may have a mental health problem. But MHFA encourages sincere, human to human interaction with people – without insisting these interactions feel safe. The course rolls up its sleeves from the get go, unafraid to get stuck in to help delegates figure out how they can talk to people who are suicidal, who self-harm, who are actively psychotic – without promising it’ll be easy.
Because we need to be honest: people with severe and/or enduring mental health problems can be scary. We can be emotionally messy or flat and difficult to engage with. We can behave strangely at work or in public. We can withdraw from contact for days, weeks, months. Sometimes we can be aggressive. We might see or believe things that you just can’t. The shapes of our bodies might make people nervous. We might have forearms covered in scars. We might have pulled our eyebrows out. We might have recently tried to take our lives.
We do not exist to make other people feel comfortable – even if we could.
The closer the “common conditions” of depression and anxiety are pulled towards people with no diagnosable condition, the wider the gap becomes between “common conditions” and “severe conditions” becomes. Experiences of discrete episodes of mental ill-health and lifelong, disabling conditions are edged further further apart. Those of us who are sometimes scary, who don’t or won’t ever fit the recovery narrative, who won’t even get near a water-cooler moment because we can’t get into a workplace, feel left behind
I don’t want people to only talk to me about mental health if I am “relatable” on a given day. I don’t want to be shunned if I seem scary. I think the zone where scary is acknowledged but the conversation goes on anyway is where the magic happens. I call it “compassion”.
purplepersuasion 
Love this post.x
A strong reminder that no approach or initiative or movement is worth a penny if it loses sight of the fact that people are people first and any/everything else after.
Great post. Mental illness can be very scary, severe depression doesn’t look much like blue Monday……I think in a lot of ways the message can be unhelpful.,
Finally someone else has noticed that only the “inert” mental health disorders are ever given proper coverage. The ones that are solvable.
To be perfectly honest, I’m sick to death of specific people who know I’ve got the label “bipolar” assuming I a) want to talk about my mental health with them b) want to talk about ONLY my mental health and c) want to talk about my mental health RIGHT NOW. It’s not always appropriate. I want to just be allowed to get on with life.
Thank you for this intelligent and compassionate insightful article probably the most sensible thing I have read in so many years of trying to fathom out this whole issue of mental health, mental illness and how to communicate. I hope my ramblings make sense, yours certainly do, thank you.
I really appreciate your feedback, it’s such a minefield and I don’t want to dismiss the attempts that do go on to challenge stigma, however I don’t want there to be a kind of “left behind” generation with severe mental illness either.
Lots of great points here. It’s an unfortunate side effect of the human brain that it really can only compare to what it already knows. Hence people trying to “relate” to mental health problems, and digging in to their past experiences or isolated incidences of “low mood” or “worried well” times. Which, on the one hand, is better than not trying to relate at all. But I agree with your stance that true compassion is not relatable. It means diving in when it’s scary, and you can’t relate. It means trusting someone else’s experiences are real, whether you have felt that way before or not (and you probably haven’t). Thanks for this idea.
Brilliant article 🙂
I’ve shared your opinion on the aforementioned organisations and their campaigning strategies for quite some time. I find it incredibly frustrating that mental illness is boxed into the same category as a normal mood spectrum. As you said, feeling low for one day when you do not have a diagnosable mental health condition does not make you mentally unwell, and similarly, being well for one day (or one week, or one month) when you have a diagnosable mental health condition, does not make you mentally well. I always insist that “mental wellness” (the usual undulations in mood/perception) that “normal” people have, is an entirely different spectrum to those that struggle with mental illness. We have different patterns in mood, different intensities of emotion, different perceptions, different coping thresholds, and very often very different life experiences to the “average Joe” who might feel a bit low one day because they can’t be bothered getting up to go to work in the dark. Just because we are all human, it doesn’t mean that our experiences as mentally unwell humans can be amalgamated and absorbed into perfectly normal human emotions/moods/perceptions. We ARE different, and assuming that mental illness or severe mental distress is a minor, relatable variation of a very mild every day experience is completely ridiculous. This kind of attitude, that all mental health conditions (or what they term as “depression” and “anxiety” that is obviously not refractory and/or persistent) is relatable to, easily treatable, and endurable, is also very harmful. Severe depression and anxiety is life threatening and disabling, and certainly not relatable to.
“I think the zone where scary is acknowledged but the conversation goes on anyway is where the magic happens. I call it “compassion”.”
You’re absolutely right about that. It’s sanist and inexcusable for Mad people to be shunned and then blamed for their shunning by calling them “traumatizers”, “scary”, or “inappropriate”.
Hi
I think this is a thought provoking post into which you have invested time and effort.
I seem to find that when I talk to someone about mental health, they find a way of expressing their anger pretty soon. Something has been achieved then. (Joke !)
More seriously, when something might have been achieved, I think it has usually been when a troubled person has started a conversation with me, rarely vice versa.
You have touched on the meaning of the idea of ‘mental health’. This immediately reminded me of a couple of books I read a few years ago – namely, ‘Families and How to Survive Them’, by Skynner and Cleese, and its sequel, ‘Life and How to Survive It’. My point is, they look primarily at what good mental health actually is, and then tend to see poor mental health as a deficiency of good mental health, which isn’t the usual perspective. The books were popular and written in an engaging and readable style, and covered a lot of ground; more from a perspective of family therapy than individual. They are very cheap on Amazon nowadays, and sometimes found in libraries. I know that the first book has been used as an introductory text in psychotherapy training.
I can see that you have made valid criticisms of the spectrum model, but being quite keen on it myself, I’ll attempt some sort of defence. You refer to ‘actual diagnosable conditions’. It’s worth remembering that diagnosis is difficult and inexact, (often a rather fuzzy entity), and that the DSM 5 manual has been heavily criticised.
In a rather academic environment you can try to assess someone’s personality on a load of rating scales for various traits. If someone’s scores on certain scales are rather extreme, then they are probably at risk of being diagnosable with particular disorders. Over time, with interventions / favourable life experience / study and reflection, these extreme scores can move back towards the average or norm, and the persons’ mental health considered to be improved – (hence recovery narratives ?)
If the spectrum model is to be rejected, what is put in its place ? A therapeutic pessimism (which is apparently still all too prevalent), starting out with something like “Sorry young man / lady, you have been diagnosed with an incurable mental disorder” etc. etc., (a bit like my incurable psoriasis, which is, at least, a lot better than when I was young).
regards
James