MADNESS IN THE UK PART 2: Awareness Raising of What?
By Sue Denim –
These days in Britain we are having our awareness raised a lot about mental illness, through the work dedicated organisations. Attitudes seem to have changed. On paper we can all feel empathy for people who have lived experience of serious mental illness. We have the Time to Change campaign who want to rid us of discrimination. We have access to information from Rethink who want to offer help and support, MIND who want to ensure no-one faces a mental health problem alone and Bipolar UK who offer help, support and education about managing the condition. The Labour Party have elected a shadow minister for mental health, and self-help books, blogs and vlogs galore on how to maintain and manage good mental health are freely accessible. It seems ‘raising awareness about mental health and mental illness,’ especially over the last 5 years is onto a mission accompli. But does some of the content of that awareness raising need scrutinising, as well as some of the unintended but arguably understandable backlashes?
Tokenistic ‘Awareness Raising.’
“The government is to announce measures aimed at reducing the stigma surrounding mental illness, the prime minister has said, claiming social efforts are more important than providing extra money for services…
As part of her vision for a “shared society”, May has announced measures aimed at improving the support available for people with mental health problems. “Money is going into mental health, but it is always wrong for people to assume that the only answer to these issues is about funding,” she said.
Andrew Sparrow and Peter Walker in the Guardian 09/02/17
So Theresa May has decided the “best thing to do” to support people with mental health problems is to get teachers trained up to be “more aware” of the nature of different mental illness, and teach children all about it. She wants employers to be “more aware and more understanding,” by also offering them some kind of training. What the actual content of the awareness raising and training will, inevitably, be led by numerous different and conflicting agendas. AND is it sensible to ‘train’ a group of random individuals who have no choice but to be there, and who will obviously come armed with their own viewpoints which it will be very hard to change. They will range from the patronising and overly empathetic, to the hard, cynical and unsympathetic. So, inevitably this will mostly turn out to be another example of a tick box exercise. I suppose at least the guilt of those who adopt the present politically correct etiquette on what attitude we should adopt about mental illness, will be alleviated.
I am not saying that in some cases, depending on the content, a short course may not be useful. Arguably knowing where to get advice could help. The advice you can get can be inconsistent and hard to navigate. The truth is talking about and understanding notions of mental illness is often an ongoing conversation which starts when people are confronted by themselves or a loved one becoming unwell. As with any physical illness, you soon find out as much as you can when faced with the reality of a particular condition. There’s no ‘one size fits all’ fix to return people to mental health (whatever that means.) At worst this tokenistic training approach could result in everyone being hyper sensitive to every change in behaviour, and labelling people who are struggling with difficult thoughts and emotions as being mentally ill. We could end up with environments of total over zealous paranoia.
Imparting a list of what signs people should ‘look out for’ and how you should treat people on their return to school / university / work during a half day workshop is fraught with problems. The paradox is that this very approach may simply increases stigma, in the sense that it brands people who have any kind of mental distress as being distinctive as opposed to merely human. The truth is people with no experience of themselves or others close to them being mentally ill, can get freaked out when they merely learn about the effects of altered mind states without knowledge and understanding.
OK I am being facetious here. Probably inappropriate and offensive, but hey.
Sticks and Stones may break my bones, but…
It is widely cited that we must be aware that there should not be a ‘stigma’ about talking about mental illness. To signal to all that we have a kind and compassionate attitude to those that are mentally ill, we must adopt designated language that is not offensive and that does not stigmatise people. It’s all about the words we use. One mustn’t upset anyone who is a bit ‘cray cray.’ We must rid the world of the laughing and name-calling of yesteryear….either in taunts or behind people’s backs. That is the right thing to do to make things OK for everyone. People can then see that we are ‘good people.’
What we really think, in terms of our ‘honest’ viewpoints and dismay, still just get expressed behind people’s backs anyway. In some cases people feel it so necessary not to be straight with people because it may upset them, that they are prepared to allow them to carry on being totally delusional about the fact that they are acting insanely. This has happened to me in the past. I ended up in all sorts of unavoidable messes.
Nice people know how to behave but the ‘uncouth’ need to be taught. It is more likely that in middle-class “polite circles” that the subject of someone’s insanity or madness would be deemed to ‘have to be treated with kid gloves.’ The inference being it is all a bit awkward. Most other sensible folk are happy to say it as it is. They don’t distinguish much between being ill in the head or the body. That’s how it should be. When I was growing up, in the case of mental illnesses like anxiety and depression it was always “oh he’s having a bad time with his nerves,” or he’s seriously down in the dumps and can’t do anything poor sod.” It was part of life. More serious mental illnesses which admittedly induced far more unusual behaviour were sometimes hushed up if they were in your family. Talking about those who still say, ‘so and so is ‘totally off their rocker’ or a ‘total loony,’ with contempt is a smokescreen to blot out the real inconvenient truths. You are no less sympathetic or understanding than those using the present accepted etiquette’s jargon. So we may have people who are more seriously ill being relabelled in more ‘socially acceptable’ ways. We now have service users, formally known as Mental Patients, or ‘those with lived experience’ formally known as Mentally Ill. This is not going to help with this situation. Tutting at people who use the wrong terms totally distracts from the need to actually listen to those who have their everyday lives massively impacted by mental illness.
My step-dad could be heard exclaiming, “if she doesn’t get out of bed and snap out of it we should put her in a bloody funny farm,” when I was in a serious depression. I don’t think he meant any malice by it. He was just feeling unable to help.
I don’t think we’d get away with that song today? Sometimes using the right terms only helps those who deem to use them to signal their virtuosity. I don’t actually care how I am referred to. It’s the least of my worries. I care about the context in which it is said. I care about concrete changes that we could put in place to address the inadequate access to useful support.
Not talking about mental illness is not always due to prejudice and ignorance aimed at the mentally ill, as is the general consensus. The reality is, we appear to have adopted a terrible fear of offending or upsetting people who have mental health issues, and are treading on eggshells around some important questions that need to be asked.
Our current guilt ridden attitudes obviously stem from past injustices inflicted on people whose brain’s malfunctioned. However, ignoring reality in case we offend, is doing more harm than good to the culture surrounding, managing, and treating mental health conditions.
So what should we be raising awareness about regarding mental illness?
Lest we forget the scope of mental illnesses is as broad as the scope of physical illness. Being mentally ill is not a term that can only be applied to ‘that guy at the office, who after a period of stress was triggered into a one-time depressive episode and treated with anti-depressants.’ Theresa May’s feigned outrage at the fact that the poor guy is ignored when he comes back to work, and everyone’s embarrassed to talk to him about it, is not the fucking problem regards to improving mental health in our society.
Theresa May said the importance of support networks for people with mental illness had been brought home to her by the observation that anyone at work with their arm in a plaster would have colleagues talking about their injury, while “if you have a mental health problem, people are more likely to try to avoid you.
Andrew Sparrow and Peter Walker in the Guardian 09/02/17
Firstly, some people in the throes of a full blown episode of a serious mental illness are best avoided. Secondly, I don’t believe that happens very often nowadays. I would argue it hasn’t really happened for some time. Over the last 15 years in my experience, whether working in a large organisation, studying in a higher education institution, or working with partners as a freelancer, if I have experienced an episode of mental disorder and had to take time out, no-one who knows about it has ever run away when they have seen me coming. People ask if I am OK, and if I am better now. They advise I come back in stages and work at my on pace until I am back on track, and are like any decent human being very supportive. I have had support from occupational health in the same way as anyone else returning to work after an extended period of sickness. Colleagues and friends ask me questions if they are unsure about how my condition affects me, as you would ask anyone about any illness that have recovered from. If I chose to not tell certain individuals to know about my personal life I can keep it quiet. Its not everybody’s business. Neither was my having time out to have a hysterectomy. In the same way that many 4th wave feminists like to deny that women are not living the same lives as they were in the late 70’s, it is in some peoples interest to focus on the exception to the rule. Then they can purport to have fixed something that actually is already fixed.
Many who are seriously ill are neglected, living in real distress and not even leaving their house. They are invisible to the system. It is those that do not have caring family and friends that really suffer. On top of that there is an inconvenient truth that you would mostly not be able to work or attend school / university regularly until you can manage the condition. In terms of ‘returning to the workplace’ it is questionable that you would be able to hold down a full-time job for long.
If you are a decent human being with common sense and compassion you would notice if someone you knew was exhibiting warning signs of a period of life impacting period of mental health crisis. You would make a judgement and find out how to get them appropriate help and support. Even then it can be hit and miss. If you are an oblivious type who doesn’t read people you will carry on being oblivious anyway. So is much of this politically induced top-down awareness raising just more tokenistic and ill conceived reactive politics?
What are the real Stigmas?
I see the actual reality is that we are stigmatised about verbalising certain truths of the matter. We are petrified of being thought of as ignorant or cruel. Sometimes this is because there are downright uncomfortable truths, and sometimes they do not fit with certain political agendas. Until we can talk frankly, people with temporary mental illness or long-term mental health conditions will carry on receiving sporadic and inadequate help, which is totally counter-productive at best, and downright dangerous at worse.
Some of not wanting to talk about mental health is cultural. If I’m honest for me, there is some British uptightness and insistence on personal privacy going on. Maybe we just don’t really like talking about our psychological conditions. No-one gives a shit about sharing all the details of their health conditions, physical or mental in the States. In fact you can learn more about someone’s traumatic life story you meet in a line for the bathroom, (aka toilet queue) than you learn about a Brit you’ve known for 30 years. All that ‘telling me your life-story when I don’t know you’ stuff makes us uncomfortable. Its a ‘need to know’ thing. And of course the war generation were total advocates of the stiff upper lip. For some that was how they kept going. For some it did irreconcilable harm.
You can be considered to be in ill-health if you have a bad cold that clears up after a few days. Treatment is tailored accordingly. Calling in sick and explaining your condition is not a problem. I can almost guarantee that if you have short term Mental Illness which may impact on your ability to function for a few days, bought on by stress, trauma, anxiety or emotional crisis you will inevitably explain it to others as something like a cold or flu or stomach bug. Admit it. We’ve all been there. The explanation of why we do this is often not due to there being a stigma of talking about mental illness. This is more likely to be a choice because you really don’t want to tell people something that is quite personal or have people asking questions. This is quite the contrary to Ms May’s assumptions. You may do the same if you have any other condition that is quite intimate.
So are the reasons we are sometimes reluctant to be talking about our personal experiences with mental illness, explained purely by other’s prejudice? Is it because we are stigmatised? It may be true in some instances, but is it useful to only adopt this explanation whilst ignoring other explanations? Does that not serve to exaggerate the extent that the public ARE actually prejudiced?
Mental illnesses are invisible conditions. Obviously if anyone is struggling with mental distress and turmoil which could lead to serious mental illness, those close to them can then recognise the symptoms. Then knowing what kind of symptoms to watch out for can be important. Dysfunctional and inappropriate chemicals, hormones and auto immune diseases creating elevated levels of misfunctioning to flood the brain can have devastating consequences. Sharing experiences can obviously be therapeutic to those who are impacted. However it is not enough to “just be aware.” It cannot be another quick fix job. It is not a simple case of fighting the stigma of people ‘judging’ someone who is or has been unwell. That’s sometimes just a kind of wet liberal smokescreen to make excuses for injustice and politicisation within a complex arena.
We can’t win?
The fact that the “Awareness Raising” makes quite simplistic statements is understandable. There are no simple answers though. It is therefore also understandable that the information we are being subjected to is not always consistent and often contradictory. It’s as hard to navigate through and make sense of all these unique mind states as it is to make sense of any humans different temperaments and unique personalities in general. Some of these simplistic or wrong-headed viewpoints expressed in the liberal “Awareness Raising” are creating all kinds of blocks to enabling those living with temporary or long-term mental health conditions to be able to manage them and thrive, not just survive. The notion of being a “victim” of mental illness can often be disempowering. We do not actually spend our times with our head in our hands. Neither are we just going through the common occurrences of periods of mental turmoil. As we get older and wiser we are most often survivors and build up resilience and tactics to cope. Some of us learn to accept we have a health condition that puts us out of action for various sporadic periods. However some of us try and escape it by using drugs and alcohol. Some lose everything, family, jobs, friends, family. Other people have other shit to bear. There are people facing all sorts of health struggles. There are people living in extreme poverty. There are people experiencing daily abuse. Some of us have to deal with the lot.
Is Discrimination all Bad?
It is widely agreed that another purpose of “Awareness Raising” and talking about the topic, is ‘to rid us of discriminating against those that have lived experience of mental illness.’
Discrimination however is not necessarily a negative thing. It actually means to recognise a distinction or differentiate. We often need to do that. If it weren’t acknowledged that living with a mental health condition or illness impacts lives, we would have no reason to award ‘disability’ benefits which are essential financial safety nets. It’s like trying to ignore that people sometimes need help.
People would potentially be expected to work regular, full-time hours and cope with stress and manage it like everybody else. Stress can be a major factor for setting off episodes of debilitating non-functioning. Managing these episodes requires taking lots of time off sick, which is likely to result in strained work relations, or the loss of a job altogether. If a distinction were not made between those who suffer from mental illness and those who do not, people who need it would not be able to have time out when needed, or work flexibly. We need to acknoweldge that such people are often not reliable in terms of structured work hours. Like any other health condition or disability, it needs to be acknowledged that people living with a mental health condition have restrictions that people in good mental health don’t have. A change in medication for example can put you out of action for months.
People who don’t employ people who have mental health conditions are not always unempathetic monsters. Not everyone can afford to take on an employee who is unreliable, needs time out randomly, and works sporadically. A lot of small businesses can’t, unless they get extra funding to do so. The same applies to employing someone who is physically disabled. That’s OK and understandable. The fact they can’t take on people who have a psychological disorder is not because they think badly of them, wilfully misunderstand them, or are simply bigots. They often don’t have the money, resources, or time to hire someone like this. This leaves less jobs available for people with mental health conditions. Hence they need extra financial support. How that should be obtained and distributed is an area that also needs reassesing. The system is not fit for purpose and often leaves people in a poverty trap.
In the end the ‘Awareness Raising’ should be grounded in common sense.
Be aware that if someone has a mind-state that’s impacting their ability to function, you can find out as much as you can about it, identify appropriate help and ask them what they need from you, being clear about your limitations. There are all sorts of resources/ mental health charities online as I outlined earlier, principally through MIND, as well as help and organisations for specific conditions.
Be aware that people can only get help if they acknowledge they need it, and that may take some time. Being able to support them and/ or get them help ‘against their will,’ only occur if they have reached crisis point, and are a serious harm to themselves or others. That is fucking hard.
Be aware that difficult thoughts, feelings and emotions do not necessarily constitute a mental illness. They are part of life. Learning to navigate them is desirable and builds resilience. Protecting people from them makes people less able to cope.
Be aware sometimes even after help they will resort to self-harm and escape and get into a vicious cycle. In that instance it is your choice how much you can take on.
Be aware about the frustratingly inadequate mental health provision as outlined in part 3.
Be aware that you are not powerless to campaign to change current provision.
Be aware that as I said, what constitutes mental illness in the first place is a minefield? Treat it as you would any other illness. It affects everyone differently.
Be aware some mental illness is something people will soon get over and you should do what it takes to get them out of it. Some of it will be a sudden episode that you can’t control which you may recover from. This may need professional support. Some of it will be a life long condition that people can learn to accept and manage the best they can, or not.
Be aware there are preventative tools available that may be useful to different people.
Be aware that it is actions, intentions and compassion that matter not whether or not you use the right words.
Be aware they there is no one-size fits all solution in terms of treatments and it is often trial and error. People can recover but sometimes there is no cure.
Be aware that prejudice is not always the cause of not talking about, seemingly stigmatising and discriminating against the mentally ill. That would makes us all less paranoid and far more confident. Can you imagine if you were told everyone around you was scared to talk to you, scared of what you might do and will treat you as a lesser human? No wonder we might feel like victims.
Be aware that we are all fucking mental in some ways.
This is part of the MADNESS IN THE UK series interrogating the issues surrounding the subject of Mental Health and Mental Illness. My knowledge and experience has evolved out of managing a long-term mental health condition. It has been much more difficult to write about this than I thought, as it has necessarily made me focus on one aspect of myself that I do not want to be identified by. I manage my health condition and it is part of who I am, and a bloody cross to bear at times. We all have crosses to bear. This series is a starting point for some new conversations and ideas for reframing the subject matter, and offering some explanations and solutions for some of the prevalent issues.
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Featured image “life is hope” ashalifeishope.blogspot.co.uk