Mark Brown has been wondering about where the ‘battle against mental health stigma is now’ and where it might be going next
We talk about stigma a lot when talking about mental health difficulty, or at least some of us do. A stigma is, strictly speaking, a physical mark of disgrace. It’s something inflicted on a person’s body by a society that is understood by that society both as a punishment and a warning. The thing is, mental health difficulty is something that happens in your head.
Erving Goffman described stigma as “The phenomenon whereby an individual with an attribute is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity.”
So what is it we’re stigmatising? What is it we’re spoiling? I think there’s two possible things we’re stigmatising: the behaviour of an individual and the way in which their condition affects their life. In having a mental health difficulty there is the direct consequence of what you experience and then, following from that, there is the effect this has on you, your life and the lives of those around you.
Anti stigma: Inspiration or corrective?
At present we’re at the beginning of a concerted effort to attempt to reduce stigmatising behaviour towards people with mental health difficulties. National multi-year campaign Time to Change is both creating the impetus of this wave and riding it by funding grassroots anti-stigma activities, promoting positive media images and trying to drive up ‘social contact between people with mental health difficulties and people who do not.
Anti-stigma work in mental health, including Time to Change, has recently focused much on inspirational stories and role models or positive examples of people with mental health difficulties doing things. The logic is that bad implications of mental health difficulty can be refuted by providing a positive image in opposition. Early attempts at this kind of action tended to rather clumsy: ‘You think people with mental health difficulties are lazy? This man built the world’s largest shed!’
It’s often hard to tell whether an individual story is meant to be inspirational to people who already experience mental health difficulties or to mainly act as an answer to an existing stereotype about people with mental health difficulties. Sometimes it feels that campaigns try to kill two birds with one stone, such as in the recruitment or publicity of celebrities who experience mental health difficulty.
It’s easy to fall back upon the inspirational story as the main way in which to tackle poor attitudes towards people with mental health difficulties. The problem with the inspirational story, or indeed the celebrity story, is that it individualises mental health difficulty and, while seeming to appeal for greater acceptance, can inadvertently compound the idea that mental health difficulties are individual failings which may be overcome with a combination of vim, vigour and good humour.
The thing is, sometimes having a mental health difficulty is awful. Or embarrassing. Or disruptive. Or can make you unemployable. Or turns your house into a mess. Or any of the other unpleasant things having an impairment to your mood, behaviour, thoughts, perceptions or motivations might cause if you don’t have some sort of aid to offset it.
Obscuring real needs
I’ve been wondering whether it’s possible that we are managing to obscure the real implications of having a mental health difficulty by focusing on ‘accepting the person’ while, as some would claim, erasing the circumstances under which they live? And, as a result of that, are we failing to focus on what might reduce the impact a mental health difficulty has on the lives of people by being unable to see what adaptations and modifications might be made to situations? In other other words, are we focusing too much on the idea that individuals are ‘judged’ by society and not enough on what it actually is that’s being judged?
The criticism of the foregrounding of celebrities in mental health acceptance campaigns is that the celebrities do not, in most ways, reflect what people are being asked to accept of other people with mental health difficulties. Some people with mental health difficulties frame this defensively, seeing the celebrity with mental health difficulties as a failed inspirational figure who is targeted at them. This might be termed ‘You’re not as funny as Stephen Fry’ syndrome. This view goes as follows: the celebrity is being held up as an example of ways in which people with mental health difficulties can overcome their impairments and be successful. The celebrity, though, has access to more advantages and material aids than an average person with mental health difficulties, therefore is a misleading guide to what ‘the public’ may expect from people with mental health difficulties in their lives.
If we step away from the personalising and relating to own circumstances in that argument, we are left with the core idea that what people are being asked to accept about mental health difficulties is that people have them, but aren’t being asked so much to consider what the implications of those difficulties and impairments actually are.
The reason why the use of celebrities with mental health difficulties by campaigns gets on people’s nerves is because people feel that their use involves asking the public to accept what they have already accepted. They already know and like the celebrity, they are fairly aware of the various aspects of their story. They accept that they have a degree of legitimacy as a person; they have, after all, succeeded enough to be famous. This obscures the fact that for people with mental health difficulties to find a real advancement in our circumstances, we are not only asking for ‘the public’ to accept that people have mental health difficulties, but to also accept the effects having a mental health has upon people’s lives.
Accepting a person, ignoring a situation?
Mental health difficulty is a series of impairments. These impairments have real implications for what any individual needs to live a viable and fulfilling life. At present we are, to my mind, extremely bad at addressing that impairments cause needs which in turn cause outcomes when those needs are not addressed.
We know that having a mental health difficulty tends to make a series of social outcomes more likely for us. We also know that different mental health difficulties tend to make different messes of your life.
I like to think that we are merely at the ‘coming in from the cold’ stage of mental health awareness; the initial stage of raising the idea that people with mental health difficulties are discriminated against and stigmatised. On that basis, I think we need to see current campaigns and understandings as a transitional stage on the way to a better settlements for people with mental health difficulties.
But where are they a transitional stage on the way to?
At the moment, the idea of challenging stigma and the idea of making things better for people with mental health difficulties are viewed as synonymous, but I’d be very worried if this linkage were to continue indefinitely. The danger is that we split into two mental health worlds, one involved in attitude change work and one that tangles with and knows how mental health difficulties play out ‘on the ground’.
For me, what’s holding us all back is being unable to stake out the ground for an exploration of what impairments mental health conditions cause and what we can do to assist and mitigate against those impairments. I think this is the natural next stage after our current period of foregrounding the anti-stigma struggle – the shift from saying ‘accept people with mental health difficulties exist’ to ‘accept that we need to make changes to the way things are so that people with mental health difficulties are no longer excluded’.
I draw no comfort from ‘accept that it’s an impairment having a mental health difficulty’. I have one. I know that. I’m more excited by the question of ‘how do we reduce how much the impairments presented by mental health difficulties actually disable someone?’
Can we get from saying ‘be nicer to people with mental health difficulties’ to reducing the mess that having a mental health difficulty makes of your life?
Mark Brown is the Editor of One in Four magazine. He is @markoneinfour on twitter