The chances are that if you have ever been to your GP surgery and been diagnosed with a chest infection it was a very mundane affair. Of course, as with anything medical there is always the risk of complicating factors and underlying issues being discovered. However, in most cases your GP will listen to your chest and if they find an infection, taking into account your clinical presentation you will be sent on your way with some bacteria killing broad-spectrum antibiotics.
For the patient presenting with mental health problems though, the journey is a harder one. Unlike those with physical problems, patients with mental health problems present with fewer definable symptoms which are suggestive of certain diagnoses.
There are no rashes, no physical pain and no real visual or sensory clues.
What an effective diagnosis of a mental health problem relies upon is a positive professional relationship between doctor and patient, consisting of a willingness to listen, and from the patient perspective, a feeling that their concerns have been heard and understood, they can trust the medical professional, and lastly that they feel empathy has been extended towards them.
Even medical professionals though are not beyond reproach and are not above learning more. Clinical training for the best of doctors should not end when they leave medical school. They should have an appetite to learn something new every day, to be scholars and make a difference to people. In the real world outside of the tutorial or the lecture hall, or even a clinical rotation it is arguably patients themselves who make the best teachers.
Too often in mental health though interactions between doctors and patients fall short of this ideal. My main objective in liaising with clinicians about my own mental health has always been to be heard and understood. But I am lucky. I am articulate, and I can converse well. Mental health patients are often hampered by archaic anachronisms embedded within the clinical system. Here’s a paradox for you. Those working with anorexic patients will always tell them that their disorder is not about food and weight and this is true. Yet simultaneously patients get caught in the imbroglio of the Body Mass Index. After being told that eating disorders are not about food and weight, with the aforementioned acting as a cipher for other issues, people are told that they have to be under a certain weight in order to receive treatment in the first instance. This seems to be counter intuitive at best and dangerous at worst, encouraging a dangerous game of eating disorder Russian roulette. It makes people feel that they’re not sick enough,and furthermore that they are wasting people’s time.
Of course none of this is true, but that is of little comfort to someone in the iron -like grip of an eating disorder. The greatest injustice of all is that this is perpetuated by the very system which people rely on to help them and that is wrong. Without getting past the gatekeepers, treatment from specialists in mental health conditions is just not an option let alone a pipe dream. This too can leave people feeling that they are a fraud.
What I hope I’ve demonstrated so far is that seeking help for a physical health problem is far less daunting than seeking help for its mental counterpart. Outside of the clinical setting, there are also the attitudes of your family, your friends and the wider public to consider. One of the most heart breaking realisations I have come to is that people are far more sympathetic to physical health problems than they are to mental health problems. With a physical problem, say a broken leg people receive sympathy and empathy because it is tangible; people can see it, touch it and relate to it perhaps.
When it comes to mental health problems, people’s first reaction is often to lean out instead of leaning in. Instead of showing sympathy or empathy, they are often nowhere to be seen. There is much stigma surrounding mental health. It is that stigma upon which the remainder of my argument focuses.
Halloween can be a challenging time for people with mental health problems. When I was a child we made pumpkin soup and made funny faces out of the pumpkin skin. But now it seems Halloween has taken on a much more sinister, visceral disguise.
I looked on Twitter the other night and happened upon a retweet from Dr Rory Conn a Specialist Paediatric Registrar in Child and Adolescent Psychiatry at Great Ormond Street hospital in London, and a Lord Darzi Fellow.
Dr Conn was drawing attention to this vile poster pictured at the top of this piece. The article from the Bournemouth Daily Echo can be found here and a Storify, containing Twitter’s reaction (credit:SectionedUK) can be found here.
Let us take a closer look firstly at the language and tenor of that poster. Even a layperson who is not a linguistic specialist would know that this disgusting advertisement is going to end in tears for Greene King as a responsible company and provider of leisure facilities.
The Broadway ‘Mental Asylum’ promises free shots for participants. The kind of fancy dress they are looking for is for people to dress as ‘deranged doctors and nurses’ and ‘mental patient’ (sic).
According to the Science Museum the last asylums closed in the 1970’s and 80’s. This harks back then to a time when mental health was less understood, and where people with mental health problems were treated as lepers, people to be feared and hidden from society. What is abundantly clear from the actual poster itself is that some of these attitudes still have some currency today and that is highly poignant. Moreover, it is demoralising for those with mental health problems, as well as those who work in the field of mental health either clinically, or in other capacities. It becomes almost an evangelistic obsession; to break down taboos and stigma so that people do not have to suffer in society.
But promotions like the Halloween event The Broadway pub attempted to run are counter-intuitive and reinforce the very stereotypes which clinicians, campaigners and others try to break down. First of all, doctors are not deranged and the word belongs to a bygone lexicon. I don’t doubt the fact that there are clinicians and other people in mental health whose own experiences have driven them to enter the profession. Unlike The Broadway clinicians and counsellors are there to make a difference.
Secondly, where these mental patient costumes you speak of? Do people wear a big flashing neon sign on their head saying mental patient? If so, please send me evidence for it is news to me.
As one tweeter Katie Hodgie enquired, should she come dressed as herself because she has mental health problems? She didn’t realise that she was scary enough for Halloween. I joked frostily that they should offer free shots to all people in ordinary clothes.
That is the crux of the argument upon which this case rests. Aside from prehistoric retrogressive mythmaking by shameful retailers, there is no stereotypical mental patient. Mental illness transcends barriers of sex and sexuality, race, age and disability to name just a few social categories.
A mental health patient could be anyone. It could be me, your best friend, your parent or sibling. It could be your bank manager, your GP, or the person at the checkout when you went to do your shopping. There are no visible signs of mental health problems so therefore anybody you meet today or tomorrow could have one. It is disgusting to cash in on people suffering, verging on the ghoulish and vulgar.
Are The Broadway genuinely so naive as to assume that nobody with a mental health problem visits their establishment? Are they really that stupid?
The fact that the night was withdrawn is a testament to the power of social media, and everybody who took part in the campaign as recorded in the Storify should feel justly proud. The Broadway however, were most unspooktacular in thinking that this cheap gimmick balanced on the backs of those who suffer as a result of mental health problems who have to endure such stigma was in any way a good idea.
The manager of The Broadway, Jay Cutler, quoted in the Bournemouth Daily Echo’s article seemed like a man who had just stepped off a rather scary ghost train, and I quote:
“As of 8am this morning all the posters were taken down, we are sorry if these posters upset anybody, it was just a Halloween theme that all of the staff came up with.
The posters have been up for a week, this is the first we’ve heard of any problems and we acted straight away. We took all of them down and will now come up with a new theme.”
Oh the hubble, bubble toil and trouble they must have gone to taking those posters down at 8: 00 a.m. I can’t help but smile a little really. But the response worries me. As somebody who suffered with mental health problems for a substantive part of my life, the response does not elicit feelings of hope from me. The apology seems perfunctory rather than heartfelt. It’s not a matter of simply upsetting people. Furthermore, such a characterisation only serves to trivialise the matter, and implicitly suggest that Dr Conn et al were making something out of nothing.
Secondly I find it troubling that had been up for a week prior to any complaints. What signal does this send about the attitude of society towards mental health? A society high on cognitive dissonance, jet propelled by the rise of the individual; essentially that as long as one is okay in their own skin they do not need to worry about anybody else. Also Cutler claims that this was the first time that been aware of any problems. The theme was problematic from the outset and any good customer facing business should be able to deduce that at the very least. Why did no light bulb come on in Cutler’s own head when the theme was agreed to between himself and his staff? Notably though approval was not sought from Greene King, the brewery who operate the business. I suspect strongly that if they had been aware the theme would never have made it on to the poster.
But even they don’t get away scot free from admonishment. Whilst I’m aware that diversity is an important and noble cause, and one I actively encourage and support both as a woman with a disability, and a trans woman I feel it is irrelevant here. This does not fall under the banner of diversity but insensitivity. Those with mental health problems are not some diverse separate group with their own needs which need addressed. That is not to say that those with mental health problems do not have needs, rather than those needs should be addressed within mainstream society rather than categorised as something separate and other. This only adds to the stereotype of those with mental health problems as something freakish and beyond everyday understanding.
Staff should not be coming up with themes without approval centrally. Marketing specialists know the kind of ideas to sanction and ideas which are best left in the waste paper bin.
I also blame the retailers, because if retailers did not produce and market these items themes like this would be impossible to conceive. To think that retailers are cashing in implicitly in people’s suffering beggar’s belief in a modern society.
Now, the UK’s parliament can be and ought to be an adversarial bear pit at times. But one of the most edifying and non-adversarial House of Commons debates I can remember is one where MPs met to discuss mental health. There were many distinguished contributions, with some MPs disclosing mental health problems for the first time. Now, if the UK Parliament can be grown up about it, and if the Leader of the Opposition Jeremy Corbyn can appoint a Shadow Minister for Mental Health in Luciana Berger MP, who by the way is already making a sterling mark in the brief then why can’t the rest of society follow suit?
We can feel somewhat naïvely I think that huge progress has been made in the field of mental health. Every time we see a new documentary, a new symposium or a new initiative, such as the new campaign launched by Care Minister Alistair Burt MP and the charity Time to Change, we often lull ourselves into a false sense of security. We think that this means people get it. But the truth is these initiatives are preaching to the choir. We get it, because we’ve always got it. But there is still a sizeable chunk of the population which to put it quite bluntly does not. It is these people such initiatives need to cut through to. If mental health was truly understood, then BBC Three would never need to devote a whole slate of programs to mental health, and people would not be waiting for huge pieces of time for treatment as highlighted by Liam Fox MP on the Victoria Derbyshire programme this week. Most germane to this essay though, is that reducing mental health patients to a mere caricature, something to be laughed at mocked and traduced would never have entered The Broadway’s theme no brain storming.
As Dr Conn makes plain in his remarks to the Echo such callous ambivalence to mental health problems has direct and tangible consequences. In the worst-case scenarios it leads to suicide, resulting from mistakes and errors sometimes by mental health professionals, but more often the problems begin with society. All people with mental health problems want is a friend, someone to talk not to be solution focused but just to listen and understand. Most often what people with mental health problems want is to be not just understood but to be truly heard. There is a remarkable difference between listening, active listening and truly hearing. I sat and listened to a friend for three hours once. I supported that friend, and I would do it again for anybody. I don’t want to hear endless accounts of people jumping in front of trains or off bridges. That is not because I am dissonant to them. Congruently I’m a highly sensitive and emotional person. But, it is because I want to stop people getting to that stage. I want people to be encouraged by peers to seek appropriate help and to augment their help with love empathy and understanding.
One thing I do know is that we must do better. But the stakes are too high to frame that as some lofty abstract ambition. We must do better, and friends we must do better now. Right now this minute. I wrote a blog in 2013 excoriating the supermarkets for cashing in with mental health problems, after hearing a discussion led by LBC presenter Cristo Foufas on the subject of mental patient costumes. I am furious and embarrassed to find myself in the same position a couple of years later. It proves that nothing has changed. We need to stop preaching to the choir and cut through to those who don’t understand because the stakes are too high and the need is too urgent. Let’s get to work. I have spent enough time with Rogers and Jung to know the benefits of therapeutic support under core counselling conditions. But just because after 16 years I’m antidepressant free doesn’t mean I stop caring. I don’t walk by on the other side. I am also not foolish enough to think that the scrappage of one idea in one pub in Britain means mental health stigma is over. What is saddening and maddening is that there are probably thousands of promotions which are predicated on similar tired boring disgusting tropes. To those who don’t get it, to those who don’t understand I say examine your conscience and walk a mile in the shoes of those with mental health problems. I don’t check my privilege here, I use my way with words to help people who feel voiceless and disempowered in the struggle with mental health problems. This blog is for you. I hope it shows that at least one person cares. When I had mental health problems I needed somebody to care too. I know what it is like to be on the phone to the Samaritans in the small hours. I know what it is like to be bullied at school and emotionally abused by someone who should take care of you. What I also know is that mental health patients are not a costume. So this and every Halloween I implore you to treat them as people, not as your spooktacular theme. You want your zinger marketing idea. I bet you wouldn’t want the mental health problem it mocks now would you idiots? Do better and do better now. We are not your marketing devices; we are human beings. Give us dignity and do better. I hope I never have to write such a blog again. Such blogs fall into the category of stating the bloody obvious. From a writer’s perspective they are the kind of blogs you never want to write, because they remind you that ghoulish voyeurism is still a persistent force in society and as we head towards Halloween I find that depressing, icy and chilling. Think and reflect. What is most chilling is that if Dr Rory Conn’s friend had not photographed the poster the event would have gone ahead and checked and free of scrutiny from Greene King. If that does not stir you from cognitive dissonance nothing will. It really is time to change.
Oh and the costume? You’re wearing it already.