Horizon: how mad are you? Part two

Well, better late than never…  My pathetic excuse for putting this up a whole three days after the programme aired is that, although I originally had the review completed at about 9 pm on Wednesday, ever since then I’ve been having horrendous problems getting online.  In a more normal frame of mind I’d have probably taken a more proactive approach to getting things sorted, but as it was I went for the “cross your fingers and wish really hard” approach and it seems, touch wood, to have worked.

This is a follow up to my review of part one of this programme.  I’ve now seen part two (available on the iplayer here; part one is also still available).  There’s already a review over at Mentally Interesting: The Secret Life of a Manic Depressive – it seems like we agree on a lot of things.

Reading the comments on my review of part one, it’s been fairly obvious that those of us who already have some personal experience of mental illness were less impressed by the programme than people who haven’t.  While I’m writing this second part of my review, I’m going to try and keep in mind that the programme is aimed at general viewers, and that things that seem obvious or self-explanatory to me may not seem that way to other people.  That said, I don’t think my feelings about the programme have changed that much.  I still basically think that some bits of it were good, and other bits were less good.

I’ve just re-read my review for part one, and the first thing that jumped out at me is that my counting skills were up the creek – I listed the six psychiatric disorders that the programme was focussing on (OCD, eating disorder, social anxiety, depression, bipolar disorder, and schizophrenia), and then said there were only five of them.  In my defence, I only made that error because the programme was, in my opinion, deliberately misleading.  The narrator told us that five of the volunteers in the group had a history of psychiatric disorder, and also gave a list of psychiatric disorders, and I had just assumed that the two would tally.  The reason they didn’t is that none of the volunteers taking part had received a diagnosis of schizophrenia.  I think this was a problem for a couple of reasons.

First of all, it drastically undermined the assertion by the narrator that many people diagnosed with schizophrenia go on to live healthy lives.  The same thing had been said for all the other conditions, and the presence of a volunteer whose symptoms were not obvious (or, in the case of Dan and his OCD, not entirely debilitating) underlined the fact that this was the case.  Because there wasn’t a volunteer who’d been diagnosed with schizophrenia, it was hard not to come away with the impression that this was because the programme-makers hadn’t been able to find someone who met the criteria of appearing to be reasonably ‘normal’.

The second problem is that, unlike every other condition on the list, there was no-one to give a personal account of what it was like to have schizophrenia, and how they’d learned to live with it, and to manage it.  That was a shame, because the personal accounts were, I think, one of the best features of the programme, and the part that is most likely to have been useful in breaking down stigma.  It was particularly a shame it was schizophrenia that wasn’t covered, as it’s probably the most widely misunderstood mental illness.  I haven’t gone looking for any research to back this up (I’m feeling lazy…), but it would be my guess that a significant percentage of the general public still think that being schizophrenic means that someone has multiple personalities.  Even if they know a little more about it, there’s a likelihood that they will mistakenly think that the words ‘psychotic’ and ‘psychopathic’ mean the same thing.  The programme did challenge those misconceptions – the brief section of explanation of the illness by the narrator was very good – but because there was no volunteer with a schizophrenia diagnosis, it wasn’t challenged in the direct, emotionally engaging way that misconceptions about the other illnesses were.

In my review of part one I mentioned the point at which one of the panel said that all they could say with certainty is that a particular volunteer wasn’t currently suffering from depression, and I said that I thought that pointed out a major flaw in the ‘experiment’ being conducted in the programme.  There was a similar moment in this week’s episode, when Kamilli asked the panel why they hadn’t picked up on his social anxiety, and they replied ‘because you don’t show any symptoms of social anxiety.’  This reveals exactly the same problem as the comment in the previous episode did – all the participants in the experiment are currently well, and without being able to ask the participants for their clinical history, it’s literally impossible for the panel to tell whether or not someone has previously had problems with a particular disorder.  I also suggested in my previous review that it seemed likely the only real ‘scientific’ conclusion that could be drawn from the programme was that not being allowed to use their usual diagnostic methods makes it harder for mental health professionals to diagnose mental illness.  I think the second part of the programme has borne that out, and in fact I was pleased to see that there was more emphasis on the difficulties caused by the contrived obstacles placed in the way of the expert panel.

The programme did seem at a couple of points to be implicitly endorsing (or, at least, not challenging) the conclusion of the psychologist on the panel, Richard Bentall,  that the difficulties in diagnosis that they had experienced showed the uncertainty of psychiatric diagnoses in general, and I think it was wrong to do that.  Psychiatric diagnosis is certainly tricky to get right, but I think that’s more to do with the fact that lots of conditions present with very similar symptoms than it is a problem deciding how intense a symptom has to be before it becomes clinically significant.  To suggest, as the programme seemed to me to get dangerously close to doing on a couple of occasions, that psychiatrists routinely have difficulty in deciding whether someone is, for example, just a bit pessimistic or is suffering from major depression is badly misleading.  My opinions on this have got a little more definite since I read this review of part one, which points out that Richard Bentall is, apparently, known for being a fierce critic of the concept of classification in mental illness – I can’t help but feel that it might help to further this cause (which I don’t agree with) if it was widely believed that psychiatric diagnoses are more uncertain than they actually are.

I’ve concentrated so far on what I thought was wrong with this programme, but there was also a lot that I thought it got right.  I was especially impressed that Richard Bentall was prepared to talk about his own experiences with depression.  Because it was unexpected, it was a very powerful reminder that anyone can suffer from mental illness, and that it’s not necessarily a lifelong problem.  That said, I did have some reservations, as the situation he described – feeling depressed following a divorce – is not one that I would necessarily regard as clinical depression.  It seems to me that it’s normal and healthy to feel sadness, even overwhelming sadness, after a relationship breaks down.  This is actually a major bugbear for me – clinical depression and ordinary unhappiness are very different (I know, I’ve experienced both), and, for me at least, depression isn’t connected to the kind of negative life events that cause unhappiness.  I dislike the medicalisation of normal emotional responses that this seems to be an example of because it misrepresents what real depression is actually like, and encourages people who aren’t unwell, just unhappy, to worry unnecessarily.

Hmmm, I was supposed to be talking about the things I liked, wasn’t I?

I do think that the programmes are likely to have done a great deal of good, both in terms of providing a lot of useful information, and in terms of breaking down stigma.  I think they did a great thing by pointing out that there isn’t some uncrossable line in the sand that separates ‘mentalists’ from ‘normals,’ and that people can and do move backwards and forwards between the two categories over the course of their lives.  I thought the personal experiences of the anorexia sufferer were especially important, as almost every time I’ve seen anorexia featured on TV it’s been either a fly-on-the-wall documentary following someone through treatment for an acute crisis in their illness, or a general discussion about the effect of the media on body image.  It’s important both of those stories get told, of course, but I thought it was very valuable to see a story told from the perspective of someone who had come through the acute phases of her illness, and built a ‘normal’ life.

I think, by and large, the personal accounts of all of the sufferers (or ex-sufferers) were equally impressive.  I thought Stuart did a good job describing the effects of bipolar disorder, although like, I expect, a lot of people I did find myself wondering whether he might have been a touch too happy about having ‘fooled’ the expert panel.  Yasmin’s description of what depression was like was very good, and certainly resonated with me, although I would have liked to hear her talk a little more about how she had managed to overcome it.  The account of social anxiety by Kamilli was perhaps the weakest of all the personal accounts, as it didn’t really explain how social anxiety as a disorder differs from normal nerves or shyness.

For me, the best of the personal accounts was Dan’s description of OCD.  From his physical appearance and his behaviour he seems to be an entirely straightforward and down-to-earth person, and you probably wouldn’t guess that he had any significant level of mental health difficulty.  Despite that, he talked about his problems in an entirely unembarrassed and open way, and I think the combination of those two factors make him an excellent representative both of what mental illness can be like, and the fact that it can affect everyone, not just obviously ‘highly-strung’ or ‘artistic’ people.  I didn’t find myself agreeing with everything he said – I can’t imagine ever saying or feeling that I was proud of my depression, as he did with his OCD, and I thought it was a mistake for him to compare Stuart’s successes (even in a ‘this will inspire me’ way) with his own ‘failures’ – but I do think his inclusion in the programmes was one of the most positive things about them.

That said, I think the single most positive thing was when the panel came face to face with the whole group of volunteers on the lawn outside the castle at the end of the second programme.  This was the climatic moment in the ‘reality show’ aspect of the programme, as it was the point at which the people who hadn’t been correctly diagnosed by the panel outed themselves to the experts, and each other, and to us.  That’s not the reason I thought it was the most positive part, though – I’m still fairly ambivalent about the ‘big brother, but with loonies’ approach, although I do understand the argument (made here) that it helped to attract a different audience than might otherwise have watched.

The reason I thought it was the most positive part is because it showed all the people who have had problems with their mental health standing together in the sun, and laughing and joking with each other.  Usually the images that are associated with mental illness are pretty bleak and depressing – the stock images used on the BBC News website are a good case in point – and this was a great antidote to that.  If the lingering memory that’s taken away from the programme is of a group of happy people in nice surroundings who were very difficult to spot as being different from anyone else, then I think that’s got to be a good thing.

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6 Responses to Horizon: how mad are you? Part two

  1. I was again going to write my thoughts on the programme but I haven’t got around to it and I think you do it better than I would. I agree with you and Seaneen that it was wrong to not have someone with schizophrenia. If they weren’t going to have someone it should have been left off the list of diagnoses completely as it does leave the wrong message.

  2. Mandy says:

    Hi Aethelread

    I think your review of the programme is thorough and articulate.

    Having watched the first part of the programme, I decided not to bother with the second half. It was that irritating for me.

    I don’t know anyone (in my close proximity) with mental illness who would be willing or particularly able to participate in such a programme and I wonder what the criteria was to be a participant. Possibly, to be mentally ill but appear quite normal.

    Things started to grate on me as soon as they had to perform a stand up routine. I have to ask why? What real purpose did that serve> Because I don’t know many people without mental illness who would be prepared to do that, miles away from their comfort zones and surrounded by strangers.

    As the programme panned out, it seemed like some whacky version of the Krypton Factor..and that flitting back and forth to the panel of experts was plain daft.

    The nail in the coffin of my interest or belief that it was serving any moral purpose was when participants were herded together in a corrider and then 1 or 2 were called in individually (whilst the others remained outside in the corridor) to answer panel questions. Talk about singling people out and then putting them through an inquisition. At that point, I switched off.

    My friend watched the second half and said the expert panel got it wrong and on most counts. So what did that prove? That shrinky people who spend a few days monitoring (via a television set) what a group of people do are unable to work out who is ill and who isn’t?

    If that is breaking down stigma then I think I best walk into my next meeting with my psychiatrist saying “Yes, I am ill”.

  3. aethelreadtheunread says:

    Thanks for the comments.

    intothesystem – i agree with you. It would have been much better to have left schizophrenia out altogether than to include it in the rather half-hearted way they did. I’d be very interested to read what you have to say about the programme, btw (but i mean that in a not-piling-on-the-pressure kind of way). :o)

    Mandy – i can certainly understand you not wanting to watch the second part. And i hadn’t thought about it like that, but you’re right, the way they had all the volunteers sitting together and then called in only one of them is exactly an example of the kind of ‘singling out’ that’s a big part of the problem with stigma. It doesn’t really matter if the people are being labelled wrongly, if they’re being labelled at all, that’s still stigmatisation (is that a word?).

    As for your suggestion about what you might say to your psychiatrist at your next meeting, i think i might have to follow your example. Maybe that way he might actually diagnose me with something definite rather than just saying he’s not sure… ;o) (Actually, to be fair, he has diagnosed me with anxiety and depression, it’s just the question of whether there’s something else going on that he’s not sure about.)

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  5. mortjo says:

    Hmm, I like your review, and I’ve read others too. I agree largely with most of the points raised.
    But frankly I think everyone is over analysing the program, and bordering on getting all uppity about it.
    I found it entertaining, and to be quite honest I’m happy that programs about Mental Illness are created at all. I’ve had several people in my family comment positively not about the intricacies of the program but the fact a program about mental health issues was on at all. And that is a very good thing indeed.
    Maybe that’s just me.

    For what it’s worth my CPN didn’t watch it at all. Not sure what to read into that though heh.

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