They don’t speak for us: the mental health establishment, “stigma” and, now, “casual stigma”

You know something? I really hate this preoccupation with the concept of “stigma” in relation to mental illness. It’s trivial, and middle class – “but, my dear, there’s simply nothing worse that a mental patient might have to face than what the neighbours say about them”. And I hate as well that this bizarre and misguided preoccupation with the supposedly all-powerful “stigma” monster is relentless pursued by the big mental health charities. They claim to speak for those of us with mental health problems, but they’re actually motivated by the desire to keep themselves on the gravy train. Helping the mentally ill features somewhere in the list of things they do, but it’s not the most important thing.

You don’t have to take my word for that – just take a look at Mind’s most recent set of accounts.

Who ate all the pie? The evil “stigma” monster!

As you can see, 32% of their expenditure in the financial year 2011/12 was spent on ‘changing public attitude’ versus 7% spent on ‘providing direct support’. That’s 32% spent campaigning against “stigma” and 7% spent on, you know, actually helping mentally ill people. Mind spent more than five times as much on their running costs (the combined cost of their fundraising activities and ‘governance’ accounted for 39% of their expenditure) than they spent on direct support for the mentally ill. In my view that’s scandalous and, frankly, immoral: that the professional fundraisers employed by the charity make a good living while the mentally ill people the charity was set up to help are abandoned to their fate.

And they pretty much are abandoned. Here’s what Mind have to say elsewhere in their annual accounts about the benefit changes that are unleashing a tsunami of suffering, anxiety and degradation in the lives of those people most seriously affected by mental illness:

The current direction travel [sic.] of government policy, particularly on welfare and employment, has had a detrimental impact on people with mental health problems. This is likely to continue over the coming years.

So that’s not much more than a shrug of the shoulders and a “meh, what can you do?” For the purposes of comparison, here’s what they had to say about their own financial welfare in the current difficult circumstances:

Once again, and despite the challenging economic climate, Mind has had another good financial year, leaving the charity well placed to weather current and future challenges. […] Turnover of almost £30 million was in line with our expectations and £3.2 million higher than the previous year.

Seem a lot more hands-on and engaged when it comes to making sure they can afford to pay their own bills than they are when it comes to making sure someone with bipolar can still afford to eat after they’ve been “reassessed” out of their DLA and Incapacity Benefit, don’t they? Though perhaps we shouldn’t be surprised by the charity’s Trappist approach to benefit changes: the government are a major funder of Mind, so maybe they’re just getting what they paid for.

Or maybe the funding model has nothing to do with it, and Mind’s low-balling of the benefits issue happens for other reasons. Maybe they’re are so inherently middle class that they simply can’t imagine a world in which anyone might have anything worse than “stigma” to contend with. Maybe they’re so comfortably off (and so incapable of empathy) that they have no insight into the devastating effect of phrases like “notice of eviction” and “sorry, your card has been declined”, and how mental illness might have something to do with how often you see and hear them. Possibly there’s such a concentration of cappuccino cyclothymics and occasional obsessives in the organisation that the realities of serious mental illness seem entirely strange and distant to them. Or maybe it’s that they want to keep them distant from themselves, and anti-stigma is just a thinly-disguised way of saying “we’re not all dirty and poor, you know”. That was pretty much the message I took from those infamous big-charity adverts a few years back: there’s no need to be scared of mentally ill people who can afford nice kitchens.

Maybe it’s for some other reason altogether.  But one thing’s for sure – Mind, and many other parts of the MH establishment, are obsessed with the issue of “stigma” to the extent that it overwhelms any other aspect of their work.

I’ve written about “stigma” before when – in a fit of hyperbole (you can’t trust us non-U mentalists not to exaggerate, you know) – I described it as a ‘first world problem’. I don’t entirely stand by that description, because someone who is ostracised for having a mental illness will suffer social isolation, and that can worsen their prognosis. But I do stand by what I went on to say after that: that someone can only afford the luxury of worrying about “stigma” if they’ve got a stable and secure place to live, and they know where the next meal is coming from, and they can get access to the treatments they need.

You need to have all of those things before “stigma” starts to loom as a problem. That’s why it angers me to see such a heavy emphasis on “stigma” in the current circumstances, when it’s getting harder and harder for mentally ill people to access those basics they need just to keep their heads above water. As I said at the start of this post, it’s trivial – how much does a schizophrenic facing homelessness because of the benefit changes care that the sister of a minor celebrity misused the word ‘schizophrenic’ in a radio interview?

That example is not chosen at random. It was just such an event that inspired Inspector Michael Brown – who blogs as the Mental Health Cop, in which guise he has been lavishly praised by the “stigma”-obsessed folk at Mind – to set up a new twitter campaign against “casual stigma”. In a recent blogpost, he wrote about hearing Professor Carole Barrowman (sister of John “Torchwood” Barrowman) use the word ‘schizophrenic’ to describe something other than the recognised psychiatric disorder:

It got me thinking about casual stigma in our discourse and in our attitudes – […] from the playground to the boardroom this country is consumed with stigmatising attitudes to mental health disorders, despite the fact that a quarter of us will suffer a mental health condition during our lifetimes. […] All of this got me thinking – we should collate and document examples of casual stigma in mental illness with a view to highlighting them, challenging them and giving feedback to the people involved. So I have set up a new Twitter account under the name @casualstigma.

(For the record, I’m not sure that Prof Barrowman’s comment was “stigmatising”. You could argue that it trivialised schizophrenia, but trivialisation – making out schizophrenia is less serious than it is – is not the same as stigmatisation – making out that schizophrenia is so serious you should shun people who have it. In fact, trivialisation is pretty much the direct opposite of stigmatisation, and I’m not at all convinced by these concerted efforts to stretch the term to mean “anything that might annoy or upset someone with a mental illness”. But that’s a different discussion.)

Now, I don’t want to be unfairly critical of, or mean to, Inspector Brown (and, in fact, what you’re reading here is the third draft of this post, which I’ve worked on over several days to try and make sure that I’m not being unfair). For a start, I think he’s one of the good guys – if we must empower police officers to detain ill people even though they’ve broken no laws, I’d very much prefer that those powers rest in the hands of thoughtful and sympathetic people like him. I’m also aware that the restrictions placed on police officers’ use of social media are onerous, and that he probably wouldn’t feel able to campaign on an intensely political issue like changes to benefits even if he wanted to. “Casual stigma” may be an absurdly trivial topic, but it’s one where Inspector Brown obviously believes he can make a positive difference, and I applaud the kindness of his intentions.

But, really, it has to be said: if Inspector Brown is genuinely worried about public attitudes towards people with mental health problems, he needs to look at his own role. I mean, which of these is more likely to cause a neutral observer to acquire a negative attitude towards people with bipolar disorder: someone joking that changeable weather ‘is a bit bipolar’, or a police officer using their legal powers powers to say “this person with bipolar disorder is so dangerous we have to immediately lock them up”? Which is more likely to persuade a neutral observer that mentally ill people don’t deserve equal treatment: a comedian suggesting that we’re ‘fucking mental’, or the practice of “sectioning” the mentally ill, thus depriving them of rights available to every other citizen of England since the time of Magna Carta? Which, for the record, insists that:

No free man shall be seized or imprisoned, or stripped of his rights […], nor will we proceed with force against him, or send others to do so, except by the lawful judgement of his equals

What does it say to that neutral observer that – unique amongst all the hundreds of millions of people who have enjoyed the protection of the founding document of English law over the last 800 years – mentally ill people are not to be regarded as ‘free men’ within the definition of Magna Carta?

Now, you can argue, if you like, that these derogatory derogations are necessary, that the higher purpose of protecting life and well-being justifies these infringements of the fundamental human rights of mentally ill people. Personally, I would dispute that. I have a naïve hankering for a world in which mentally ill people are treated like adults – free to seek treatment or not, as they choose; free to mingle in society unless they break the law (including all those laws against threatening, intimidating and abusive behaviour); and free to take their lives if they don’t want to live – rather than overgrown children. But lots of people can and do take an opposite view, and that’s fine. What’s not fine is to pretend that this official approach to mental illness has no impact on “stigma”.

It’s a common complaint that people with mental illnesses are “stigmatised” in a way that people with physical illnesses are not. (I’m not sure someone with HIV would agree, but never mind that for now.) The number one reason for that discrepancy is that people with physical illnesses are treated by the medical and legal establishments as being ill, while people with mental illnesses are treated by those same establishments as being dangerous – so dangerous they have to be locked up. It would take wilful blindness not to recognise that this has a far greater impact on “stigma” than every instance of careless language or thoughtless joking from now until the end of the world.

I don’t begrudge people their spasm of anger against “casual stigma”. If jokes about mental illness make you angry, then by all means say so – I’ve done so myself in the past. But please don’t let’s pretend that “casual stigma” is the major driver of negative public attitudes towards people with mental illness, or that “stigma”, casual or otherwise, is something that actually matters in the current political and economic climate.

Public attitudes to the mentally ill are principally driven by the way the establishment handles mental illness. Only the most fortunate amongst us can afford to worry about “stigma” or “casual stigma” at a time when many of us are struggling to keep ourselves fed, housed and treated. Let’s hold on to those realities, please.