So this week Prince Harry made a number of statements on mental health. I am really glad that he feels able to disclose a need for treatment around the death of his mother. It would be very sad to think of him going on and on in his adult life without being supported through grief which must have been incredibly complex, given the awful circumstances of that loss. He can only have had a very tough time facing such an immense loss at such a young age under the scrutiny of the press and the public. But things got a bit murky when he used that as a jumping off point for speaking about mental health in general. (I’m not going to go into the lack of a level playing field between those with immense material resources and of the rest of us, you can read my earlier thoughts on privilege and mental health here.)
Kensington Palace summed it up on Twitter like this:
“Mental fitness relates to every single one of us, together we can smash the stigma.” “Everyone struggles, we are not robots.” (All one tweet, I’ve preserved the punctuation).
I keep hearing this lately – especially I think from psychologists, and especially I think from the academic variety. The idea that “we all struggle”. We all have “troubles”. We all have “difficulties” and we all experience “distress”. Let’s not use diagnostic language, because that increases stigma. Let’s not use words like “condition” or “disorder” or “illness” because that creates a them and us, the unlabelled and the labelled, again fuelling stigma. Let’s focus on the commonalities between us all. Where’s the harm in that?
I can’t believe that I have to point out the harm, but clearly I do.
You should see the state of my face. Out of the blue, it’s covered with open pores. I don’t know what the cause is. I’ve found a very few references on patient forums about lurasidone causing skin and hair to become more greasy, but not enough to call it a side effect. Whatever the cause, I hate it. On the one hand I feel like a spotty teenager, yet it simultaneously makes me feel old. My skin is not what it was.
So I have problem skin. It’s a skin problem. I’m actually really unhappy about it and have wasted money on products that almost certainly don’t work. I’ve bent friends’ ears about how I have lost control of my skin and it’s affecting my self image. I know that’s pathetic, but it all feeds into my ongoing self-hatred and body issues, OK? I know I’m not alone, though. A great many people have skin problems because, fairly obviously, we all have skin.
Only some people have malignant melanoma. Some people are stared at all day, every day because they have facial scarring. Some people experience potentially life-threatening rashes all over their body.
I have skin problems.
They have skin problems.
Our skin problems are not the same.
I don’t need medical treatment. Nobody’s videoing me on their phone because they think I’m such a freak. Those nasty craters are probably not lifelong and they will not, if left unaddressed, kill me quickly or slowly. To say “we all have skin problems” does not instil solidarity; it grossly downplays the level of impact on those with severe conditions. It minimises the risk, it minimises the implications and it minimises the suffering.
People at the really tough end of things almost certainly know what it’s like to have pimples, or the brown spots that come with ageing, or ragged cuticles. Yet I will probably never know how it feels to be at the severe end of the skin problem spectrum, and I would never pretend to. It’s not a two way street.
So let’s go back to mental health.
Yes, “we all have struggles/troubles/demons/distress” but just like with skin, some struggles are more overwhelming. A good number of mental health difficulties are transient, and many are mild. Some, such as bereavement, are part of the normal course of life – the pain is very real, but it is not necessarily pathological. Some people end up having time off work because their stress levels have built up to the point where they cannot carry on effectively, but often the situation can be resolved by changes in the workplace. Some people get very anxious about things they know don’t merit it but they are able to push on through and live their lives.
Yet some people don’t have custody of their children due to their mental health problems. Some lose close personal relationships or are never able to form them. Some people bankrupt themselves when unwell. Some people are never able to work. Some are detained against their will. Some people have permanent physical effects from self injury, malnutrition, suicide attempts. Some people live in terror because of unfounded fears that people are trying to catch and kill them. Some people are mentally or actively working on ways to kill themselves. Many people do die.
The vast majority of people will never know how it feels to live through that, and I am sincerely glad for them. But most people with severe mental health problems will know what it is like to experiences loss, to experience stress, to be overly anxious. They know the everyday struggles, the common struggles we all have to live through, and they know that they’re not the same.
Please do not tell me we all have troubles. Please do not tell me that the personal relationships I have lost, the overdoses I have taken, the end of two professional careers, the inability to parent my children full time, my endless cocktails of drugs with their endless parade of side effects, my hospitalisations, my community suicide watches are just a normal part of life. Please don’t. Not when I cry in front of Facebook looking at my normal friends having a normal life of little things I cannot have. That’s insulting and painful.
The idea that we’re all just on some grand human continuum doesn’t bridge a gap, it increases it. Being “all the same” feeds into the belief that those of us with severe mental illness are no different to those with the mild, transient kind – so then when we describe the severity of our troubles, what, are we just being divas? Oh you have bipolar? But everyone has their ups and downs, just some people can’t cope with it. Oh, you’ve been diagnosed with Borderline Personality Disorder? We can all feel a but moody at times, you just have to get a grip. We all feel we need to go on a diet in the summer. We all feel low now and then. We all have minds that play tricks on us. Of course we do.
And so it builds in an expectation that severe mental illness should be easy to fix because it’s not all that different to any other period of distress, really. “Well, with the support of Occupational Health and my line manager, I was back at work in five weeks.” “I had four sessions of CBT and was able to put my anxiety into perspective.” Were you? Were you? Good. I’m glad you have been able to put your troubles behind you and get on with life without 30 years of unsuccessful treatment. But that certainly feels like luxury from here.
Comparing open pores and malignant melanoma would, and should, be considered ridiculous and actually rather distasteful. So why should it be considered valid and meaningful to bundle up severe suffering and life-altering consequences with day to day “struggles”? Failure to identify the often excruciating experience of serious and entrenched mental health problems is a whitewash.
Please don’t try to normalise severe suffering. It’s not just a part of life in general, it is a extraordinary experience that dominates many people’s lives and identities. I am like everyone else in so many ways – needs, desires, hopes, skin – but when I am ill I am more unlike the general population than I am like and I am acutely aware of that. Can we please stop pretending otherwise for the purpose of dismantling the medical model? Because you’re marginalising the voices of the people you purport to want to help.
Image: A mass of unidentifiable flamingos
(Source: Flickr, status: commercial use and modifications allowed, creator: angela n.)