The stigma dilemma

The big failing of Mental illness anti stigma campaigns is that they fail to recognise that there are, in fact, two distinct and diametrically opposed forms of stigma. 

Most obviously, there is the classic stigma facing people with complex, enduring and severe mental illness.  This stigma links people with mental illness to violence and antisocial behaviour.  It is institutionalised in law by the power of the state to intern those deemed to present a threat to themselves and/or others.  It is perpetuated by mass media who would bay for the blood of any public figure caught using the "N" word in relation to BME people, but who think nothing of using terms like "bonkers", "nutter" and "psycho" to describe people experiencing mental distress.  Little wonder that the masses object to any community mental health facility in their back yard.

Challenging this stigma should be simple enough.  Two thirds of people with severe and enduring mental illness recover and live ordinary, independent lives in the community.  We simply need to make this group - who account for about 0.5% of the population - more visible.  This could be helped by extending equality and hate crime laws to fully protect this group.

Unfortunately, many anti-stigma campaigns fail because, not content with this approach, they wish to "normalise" mental illness.  To achieve this, they enter into an unholy alliance with Big Pharma and the psychiatry industry in "medicalising" an ever greater range of human experience.  This allows the claim that 1 in 4 people will experience a mental illness at some time in their lives.  But this plays into another quite distinct form of stigma experienced more by people with common mental illness.

This stigma says that, "you're putting it on".  If 1 in 4 of us are affected by mental illness, then the odds are that we can all relate to experiences (bereavement, debt, divorce, homelessness, illness, unemployment, etc) whose symptoms amount to mental illness.  If this is the case, what we need is not a change in attitude, but an anti-scrounger campaign.

It is ironic that on the day that several charities open a mental health at work campaign, Janet Street Porter opens the backlash against the recent spate of apparently spoiled middle class women claiming to be stressed or depressed.  This, at a time when our armed forces turn out to be far more resilient than mental health campaigners had argued.  Far from raising public sympathy and support, the use of the 1 in 4 figure more often results in anger.  "Why should I care if you can't cope?"  "We've all been there, so pull yourself together".

Nobody is sure exactly how many people experience mental illness during their lives.  A large number of over 75s become depressed, perhaps the result of finally having to face up to their mortality.  Indeed, there is a significant risk of suicide in this group.  But this is a very specific group whose experience cannot reasonably be generalised to the whole population.  Take this group out of the equation, and the 1 in 4 figure goes out of the window.

Figures obtained by the BBC last year found that the worse area for long-term antidepressant use (Torfaen in south Wales) had 10.4% of the population on medication.  But the issue that these figures revealed was the geographically and socially uneven spread of common mental illness.  The ex-industrial regions (south Wales, the northeast of England, east Glasgow) and the inner cities have high rates of common mental illness (and alcohol misuse, obesity, smoking, cancer, heart disease, disability, etc).  The suburbs and and rural areas enjoy much better health all round.  So, even if you could argue that 1 in 4 people in the south Wales coalfield area will have mental illness at some point in their lives, this is not true of the whole country.

This is important.  What the true figures are saying is that "mental illness is far from normal"  the fact of the matter is that "you don't know how it feels".  In truth, more than 85% of the population will never experience mental illness.  Sure, they will experience distress, extreme sadness and despair - but not mental illness.

Those who, for the best of motives, continue to use the 1 in 4 figure are doing us a great disservice.  It doesn't matter that people affected by mental illness are a minority.  It doesn't matter that those with severe and enduring mental illness account for less than 0.6% of the population.  It is simply wrong to stigmatise and discriminate against them however small a minority they are.  Conflating illness with ordinary human saddness on the other hand, adds more to stigma than it takes away.