The need for a large campaign

For a simple mind like my own, the ‘stigma’ thing that we have been wondering about lately can reside in only two places.  Crude models are all aspiring social scientists have sometimes so, here goes nothing.  Alterity can work only from the basis of a particular subject’s on-going self-perception against the other, which resides somewhere in the area of general understanding.  If you want to talk to children about this then perhaps individual and society are both useful abstract metaphors that we can all employ. 

To start like this, with grand pronouncements, is fairly usual when you want to try and pretend that your own perspective outweighs that of other people’s who you want to engage with.  It would be false though, to presume that a recent article I have read is not well informed, passionate, powerful and inspired, but may I also say overtly muscular and angry? 

Neither of these last two traits can be met with disapproval, for the potential in the would-be discussion is far too great for quarrel to dominate just now.  The article I am referring to is by Flo Bellamy and is available for perusal here.  With luck, a nuanced appreciation by way of an open letter that discusses some of the themes she raises might lead (more than two of us) onto something of deadly seriousness and urgent importance to a significant populace, the sort of populace that no statistical survey will ever capture or define.

If we start to talk about what’s important to you in your article ‘Time to Change- Why the UK’s largest stigma busting campaign increases stigma’ then it's because I acknowledge immediately the incredibly firm sense of value embodied in your choice of subject matter.  I concur, for whatever it’s worth, that the ‘time to change’ debate, for want of a better phrase, really does need some more vocal responses: be they admonishments or be they from those caught in the act of applause.  If cynicism teaches you anything, it’s the value of any publicity for loosely branded enterprise.

Let us start with your useful pointing-out that the Time to Change campaign (from here TtoC) is funded to the tune of £21 million pounds.  If we accept this as a figure then the UK population of over 63 million has little over 30 pence a head to be persuaded that their attitudes towards we 'crazy-folk' are deplorable and, that they should be ashamed of themselves.  The cost of a second class mail-shot for all households might be negotiable just within budget from some sort of warehouse with as few administrative staff as possible.

The point is not to mock, the point is that greater sums of money change hands at lottery terminals each week and I need to claim that firstly; that is not a large amount of money given the scale of the task and secondly, there is a misnomer of sorts in your appropriation of the campaign.  Do you really undervalue the plight of many millions of people within economic times where billions are common currency?

If we try to think of other similar movements to change those much vaunted ‘hearts and minds’, (for changing minds alone is an impossibility in my view) then do we have some suggestions for comparison between us?  Firstly, I might start with Jehovah’s witnesses and begin to run short of others when I mention extreme or less extreme political parties?  Perhaps a really controversial although slightly different example from macho-sport would be the ‘Kick it Out’ anti-racism campaign, which has both supporters and detractors.

The point for me is that the somehow mental terrain we’re on is a total-bastard mix of psychosocial and historical factors; or civil society in other words.  If, to explain my own view, I were to say that the two main competing explanations for the dynamics inherent in the formation of civil society still stem from GWF Hegel (1770-1831) and a certain K Marx (1818-1883) then perhaps I could also summarise as follows.

For Hegel, civil society embodies or actualises the moment at which tensions between competing forces say, are able to be resolved in eventual essence at the level of the state.  One might have less faith in the UK government than a German philosopher had in the final realisation of historical truth and absolute knowledge in general terms, and that is understandable.  Where Marx turns things on their head in theory, for better or worse, is by pointing to the contradictory nature of a civil society which frees the constituent elements of what would have been ‘spirit’ for Hegel and atomises individuated concerns irresolvably in what is referred to as the state/civil society complex.  For freedom and truth to be pregnant with their opposites of wage-slavery and false-consciousness might be going too far: but the importance of acknowledging the arena within which TtoC gains funding and operates cannot be understated.

On the first page of Flo Bellamy’s article the statistical claim is made that TtoC has hardened attitudes to a very difficult to define target group,  those of us in serious mental distress.  On statistical method, there are but three types (as the American author Mark Twain well knew when attributing the famous dictum to Benjamin Disraeli).  With no disrespect intended, we must start by acknowledging that he suggested three types of lie,  “There are lies, damned lies, and statistics.”  Similarly, if your later objection to the language and categorisation of vague biological illness devoid of personal content is to hold, we can’t use tickbox exercises using these very sick categories to work out what people think of ‘us’.

Although very serious, the more pertinent point here is that attitudes, even if recorded very near-perfectly and at crystallised moments of opinionated certainty- are subject to change in the manner of ebb and flow.  It is almost not worth saying that there are such things as general opinions, or general consensi which can be measured in numbers and that aren’t more accurately characterised in this example as smaller pockets of thought which are endlessly debatable.  Anyway, perhaps we can beg to differ on method as far as ‘stats’ go?

An observation to progress through is that Flo Bellamy has a very high opinion of the one campaign known as TtoC.  It almost seems like they are charged with ending distress for all within four short years.

We will need though, to discuss the ‘illness’ issue without further ado.  I can find areas for major consensus within the following  “The problem is not a biological illness, lying dormant somewhere in a genetic code in some poor unsuspecting random individual, the problem is that life can be really hard.”  The claim is extended, and rightly so in my view, that greater levels of social justice are needed.

Where the discussion might benefit however, is by using the comparative example of borders in the language of ‘illness’ and in the bases for common causes that would benefit all of us who have known forms of lived experience and severe distress, without discriminating against folk without a diagnosis.  It's a really complex area, but as I have tried to put across elsewhere and as you have stated in your article, starting lots of conversations in public places with something intelligible and of immediate benefit might be one of those things you just have to let slide for the time being.

While you may find my argument weak, the muddle of legal and general-linguistic concepts is probably something that can only be worked out by large scale mobilisation of individual participants who are open and incredibly forthright about their troubled histories (in as much as they have the time to explain on popular media channels) and which brings us to the point where critique is possible.  In other words, this is a practical question.  Therefore, one must pitch in and help, whilst being as careful as possible to walk the tightrope associated with volunteering for the campaign without falling off in disillusionment or feeling the need to become another willing martyr.

I do believe that there are very many helpful things that your article contributes, and of course perhaps we could both agree that it’s not just about TtoC.  The borders example spans day-to-day language, notions of academic discipline, aswell as political-geographical remits such as nation-states.  Is this really just a UK issue?  Is this even just a mental health issue?

With diagnoses that people have in common in mind, the move towards acknowledging what happened to a person, and of listening to us all unpack our stories as we aim to move forward is something really positive that your article contains.  Similarly, when you say to TtoC  “Help create a world where people don’t bully, don’t abuse, don’t discriminate, don’t place so much importance on career and hierarchy.”  are we really speaking of just one campaign?

By any other name; a move to harmonise the interests within a state in favour of ensuring that all people can work at least part-time if they wish, and no more than an inhumane number of hours if they don’t wish (or are not always able) - would in the context of our debate be a national-level-socialist-movement.  That is not an argument I would shirk, but the extensions to your view do need to be made explicit. 

The relationships between people, or social relations, predate and will outlive TtoC.  Where the history of concepts such as extreme distress and its occasional behavioural manifestation is concerned, we’re right to be clear that we’re well known to be less violent than most (sadly except where self-harm is concerned).  

At the current juncture, the people who put the campaign together and who work enormously hard to try and affect some sort of change, although not all-powerful, I believe have in fact raised the profile of struggle in general and have given a lifeline to many individuals to speak out for themselves and be in a better position to promote their interests after the campaign.  The networks in place and positive affects can’t be judged yet without damaging what is being done.

Very little ever changes overnight, but with the value of discussion based on experience I could tell you all about my roller-coaster ride with TtoC and how the highs and lows are nothing intrinsic or due to any sort of poor strategy or planning, more to do with the scale of what we are all up against, pre-distressed or not. 

I won’t take for granted that anyone has read this far, but just as you say there is a need to promote conversation based on truer categories than psychiatric diagnosis then perhaps we are saying that either TtoC or a new campaign will need to take a major stand on the availability of talking ‘therapy’; talking spaces, alternative ‘therapy’; alterative spaces.. then even that would be open to the major wave of criticism that an advance to new shores enables.  It seems, that when a fresh field is discovered for cultivation, the plough used to loosen the soil of contemplative thought soon gives way to the scythe used to slice through the green shoots of new growth.

If we really were a singular entity as mental health condition managers, or service-engagers, in the most polite way, we would soon be found out as fraudulent if we said that people can only be called ‘ill’ when accused of a crime, when in need of benefits, or when having trouble at work.  I would firmly maintain that the needs of many people are served by TtoC and whole-heartedly disagree with your main contention that the net result of the campaign, within its historical parameters, is negative rather than positive.

Whilst such a bold statement may be open to rebuke, where we may all need to look is in the direction of the sometimes gentle, sometimes bloodied, interplay of individual experiences with larger systems of culture.  The literary critic Raymond Williams, once uttered the refrain that ‘culture is synonymous with meaning’ and although the subjective meaning of the simple word ‘illness’ might be a badge of shame for one, the cultural construction of a common cause could alter human biology in ways that will only be retrospectively understood.

For individual minds to be overwhelmed in large proportion by societal misdemeanours might say more of the type of future campaigns that we should all be interested in forging from nothing, and living through despite everything.  With the exception of the drive to improve the wellbeing of those of us who persevere through almost unliveable anguish as part of a normal day, perhaps it’s not really about a campaign such as ‘Time to Change’, perhaps it really is time to change, everything, in, existence.

Moving on from stigma

Pausing on the concept of stigma to try and build upon ways of knowing about what we need to know, it is worth acknowledging the breadth of approaches beyond any simple or false dichotomy of the world owned by mainstream psychiatry versus it’s anterior and posterior oppositions.  In other words, although we know that even within psychiatric circles there is incredible disagreement there have also been formal currents since the 1960s such as: anti-psychiatry, alternative psychiatry and critical psychiatry.  In fairly recent times, and as noted elsewhere, the Royal College of Psychiatrists have even spent considerable time and effort on various media campaigns aimed at combating stigma.  

A fixed or determinate definition of stigma that people as individuals face might mislead any multi-faceted enquiry more than it assists, as if somehow the thing to be explained was more important than the on-going act of explanation of this, and other (observable) phenomena alongside other things we think to be real but cannot depict in words.  If you want to know more about enquiries into the theme of stigma then Erving Goffman’s 1963 work is widely renowned, referred to, discussed and available.

The history though, of attempts to understand what appears now as another spectre looming over the known human world, commences prior to this I believe; but let's start with the simple contention from chapter 2 of Rogers & Pilgrim’s ‘Sociology of Mental Health and Illness’ that from the 17^th century, largely European notions of other-worldly demons are used gradually less and less to explain and account for mental turmoil.  Where medical explanations arise, Foucault’s ‘possibility’ of psychiatry can be inserted, and as we reach the 19^th century Rogers & Pilgrim note that

“The early days of psychiatry in the 19^th century were heavily influenced by eugenic considerations- [and] it was assumed that a variety of deviant conducts could be explained by a tainted gene pool in the lower social classes.”

Class may be beyond our remit for this post, but needless to say that all actions do have a social context just as various factors in diagnostics in turn feed into living statistics and are almost impossible to remove from the historical process by an observer.  Jean-Paul Sartre is one individual whose existential inclination is said to try and look at the connections of socio-economic structures with the inner lives of individuals. 

And of his ilk?  Please do be aware of the critical theory embodied in the 20^th century Frankfurt School of Max Horkheimer, Herbert Marcuse, Theodor Adorno, Walter Benjamin and so on; in as much as their materialist Marxian-Freudian enquiries can help us.

To come at things from the perspective of an individual is difficult.  The synthesis of materialism and idealism is elusive in the real world just as in all of our small but ever expansive minds.  When it comes down to disagreements over the connections between individual words, such as illness, in relation to what we can detect and what we know too; then perhaps a step back is needed. 

My take on the theme is that the hypothetical spectrum from wellbeing to illness, if seen as a continuum, raises the question of at what point the balance is tipped towards illness?  The continuum may be a helpful way of viewing things, but the spectrum that ends in ‘illness’ may raise objections from many.  Psychoanalysts perhaps, may be amongst those who adhere to the view that we are all neurotic to the extent that may make us ‘ill’ someday, or some days- or neurotic some days at least.

In a token defence of the continuum model above, perhaps we need to point not just to the medical model but to the legal status of certain loose definitions of insanity in order to say, that with the best of intentions, we could temporarily conclude that nobody is ever ‘ill’.  The late Thomas Szasz, most famous for his ‘Myth of Mental Illness’ (1960), went to great lengths to challenge the 'illness' model.  

It does seem that in many circumstances his message can be accepted.  But think then, of the terms ‘not very well’, or ‘poorly’ and ask if these are any better for a person with visible signs of unknown malaise?  Terminological substitution is all that happens in some circles.. Not to mention the hermenutical extensions of known physical ailments being definitionally non-existent by the same logic that Szasz applies.

The previous point about legal status is relevant because if both a psychiatrist, or series of psychiatrists, in conjunction with various legal agencies such as healthcare assessors (for state benefit purposes) or perhaps employment tribunals or even courts of law, deem a person to be ‘ill’ and we deem them be ‘not ill’ then there is a problem.  Although a dialectical model of logic can say that they are perhaps both ‘ill and not ill’ the real world may have trouble keeping up. 

One cannot both reside in prison and be geographically free to roam, or work full time and volunteer full time simultaneously- unless of course we extend this example to ridiculous lengths.  Similarly, one cannot both be sacked and quit, although compromises could be sought.

It would seem reasonable to surmise briefly that we are very much on structural terrain which is non un-politicised.  The once feminist contention that the ‘personal is political’ can illuminate a world-view where high-politics (of statecraft and macro economics) perpetually disengages from the low-politics of body and interior aspects of mind.  We can’t really say that just because it's flawed to view issues of mental health in individualised terms that individual circumstances and even thoughts are irrelevant.  Even a utilitarian could agree that if enough people have neurosis or psychosis then there must be substantial shifts in accommodation of need.  

Where language is concerned R D Laing once pointed out the concern of a lack of adequate terminology to describe those nether regions of the brain which we all tread through each day and night.  Where misnomers such as ‘illness’ abound, is it currently better or worse to take away the one thing that may protect the rights of a potentially vulnerable individual?  Ah, I hear you say, ‘but if it feeds back into our self-understanding and is used as a basis to disable parts of the brain chemically over time, are we not all, well, kind of doomed?’

Without wanting to become sarcastic, I believe that the development of the human brain has taken more years than the development of neuroleptic medication.  In conjunction with-  and in opposition to-  other brains, our adjustments to the world continue on (despite recent headlines made elsewhere. In fairness, David Attenborough does acknowledge our on-going cultural evolution article here).  It seems plausible perhaps to say that if alcohol, caffeine, nicotine and other substances are included, most people use drugs of some sort. 

Where prescriptions are concerned, the proportion of us on powerful mind altering substances may or may not rise but; and excuse the purposeful double negative- this can’t have no long term effect.  The impossible magic pill to fix or regulate all aspects of necessarily organic and dynamic brain chemistry is a matter for stories and films alone, but if we carry on as we are,  without it one day we are truly damned.

Disney's Mickey Mouse as the Sorcerer's Apprentice

 

During recent times, it has been brought to our attention that the chair of the Diagnostic and Statistical Manual IV committee Allen Frances, has decided, for his efforts and sins, that medication has too large a role.  Now that DSM V is about, this leading US psychiatrist has made a significant statement.  It does need to be noted that more prescriptions are made in the US than in Europe to date, but areas for hope should always be incorporated into monologues and hopefully discussions too.

Practically once more, a good friend of mine once said that ‘society has the work:fun ratio all wrong’. Depending on how one sees both work and play, there are certainly issues to do with emphasis on economic (narrowly conceived) output (measured finitely and rationally) in relation to specie-al wellbeing.  Either as individuals or not, with enough of us in play, it may be necessary to move beyond complaining of unfairness based on historically subjective notions obtaining objective status against which present notions of equity are deemed too subjective and narrow..- and on towards some more rigorous conceptions.

Considering the wide reach of serious ‘mental health issues’- in the UK and beyond what does the future of health care look like?  What roles and space for talking and communication can be in-built and do we all need therapy?  Furthermore, what is a reasonable working day or week now, given consistent difficulties for some and also the lack of full employment for all amidst recurrent issues of growth, which regularly falls below David Harvey’s recent assertion that capitalism requires growth to be maintained at around 3% of gross domestic product in order to survive.

It’s not possible to extend this much now, but needless to say that of course, everyone struggles sometimes.  All I would suggest is that fighting illusory or real mental demons is different (if not separate) to having practical based problems.  The point is also, examples such as psychosis now brings increased problems for some people - and even if you conquer your great inner personal challenges you are then required to exist and compete in an imbalanced social world where the battles you have fought may mean next to nothing to anybody else.

Time to Change the debate

If concentric circles seem to ripple outwards from common misconceptions of benevolence some of us are left asking whether the fault lies with the would-be ‘do-gooders’, that is, in the act of benevolence itself, or with the enormous obstacles that they are faced with. The quick act of considering this short quote..

“It is just as foolish to fancy that any philosophy can transcend its present world, as that an individual could leap out of his time or jump over Rhodes.”[Hegel, Preface to The Philosophy of Right (1821)]

... will give a clue that my own view is that we are on deep rooted and enormously complex terrain whereby ancient wonders of the world are as likely straddled by one person than small charities (for example Time to Change and Time to Change Wales) can decisively interject on the panoramic reach of a world view which favours many things ahead of densely concentrated lived-experience and the necessary changes to everyday life which our current fascinations with the indefinable area of mental health presage. (Pause for breath).

An interesting question to commence with might be how many people have mental health concerns? For one, I don’t expect to find a definitive answer, or to overcome the continual reproduction of stigma and discrimination as part of existing and remade social relations. Given recent counter-edicts that I have been following (see the Powys Mental Health Blogspot or the following blog in at least two places Discursive of Tunbridge Wells and here) the themes are known to be numerous. But if the limelight that a few TV adverts (my favourite is this one), posters, radio slots, interviews, the odd celebrity and some necessary rhetoric casts an uneasy shadow on the other already-dispossessed who will claim that our common heritage of ‘mental distress’ can't and shan't ever be labelled as ‘ill’ (regardless of what we may sometimes do or not do, say or not say, need or want); then there is a problem.

Of course there are many different angles of approach and places of emphasis. The medical model of mental illness (sic) enjoys an enormous power base but even a small child could recite that there is a difference between an individual pancreas say, which if deemed deficient will need insulin, and millions upon millions of human brains that if deemed individually deficient and at fault, still communicate with other ‘brains’ and are developed, fed and maintained by more than the processes that occur within any one person’s skin. Whether it is accurate to say that the human brain is more complex than the furthest unknown reaches of the universe I do not know. But if we don’t yet understand one brain then the task of engaging with and altering amalgamated human action is even more difficult. Perhaps though, if we made the journey to the experimental collider at CERN in Switzerland and all put our heads in there some interesting results would follow?

To say that stigma (and discrimination) can’t be effectively quashed by a UK civil society campaign is a fair point. But not to laud the efforts of the small team who; are on finite contracts, have a fixed budget and who must fulfil ‘interesting’ ways of statistically measuring results in order to satisfy funders, for at least trying? Perhaps make up your own mind.

The larger picture, I would argue, brings us onto the question of the frequency of mental health concerns both in the UK and beyond. This, to have any relevance to a meaningful debate, has to sketch amongst other concerns the explicit points of the relationship including places such as the UK to the wider world and some central implicit aspects from known and recorded human history. Combined with individual perspective(s), I hope that we can honour the spirit of previous debates that I have witnessed that have stemmed from the Time to Change claim that ‘1 in 4 of us will have a mental health problem at some stage’through to the counter claim, that if extended too far, says that we’re all imminently and immanently at risk of meltdown of an apocalyptic scale.

That claim, just in case you’re wondering, is that we all have a mental health problem comparable with severe and often life-ending conditions. My innocent side hopes that although we all have on-going health and wellbeing concerns I would rather conclude less than‘1 in 4’ than more. Even this though, risks over simplifying the richly interwoven individual and social tapestry which we are all part of. A diagnosis may, or may not, be proof or otherwise of the severity of a person’s distress by comparison to another person who doesn’t have a diagnosis. By the same token, scientific, quasi-scientific or the science by proxy that modern psychiatry embodies, even during its most exact moments, will never be the pinnacle of knowledge that well-used philosophy happens to be. To be clear, science is a branch of knowledge, not knowledge in itself. Psychiatry may or may not be deemed science in turn, which is something to bear in mind when working out the sort of hierarchy that an attempt to challenge orthodoxy might entail some days.

Whatever view you find most endearing and whichever ones sit most comfortably with your own known or unknown position in space and time, we may safely conclude that we don’t really have accurate ways of describing those things that go on in our heads when we can’t sleep, or if and when psychoses or deep depressions take hold. Not to be a pessimist, but one can also paint a picture of a universe which is thought to be contributed of mostly dark matter and dark energy (neither of which we really know too much about) and of a human history which is, at the bare minimum, nine tenths unrecorded in any way whatsoever. From here, the idea that we are particularly different to pre-historic incarnations of ourselves that lay beneath stars and wondered about what was in them, and what was above, may either soothe or frighten. Language for one, has surely moved on greatly since then, as have the internal neurological receptors that register acute verbal signals in meaningful and emotive ways.

But even with highly sensitive measuring devices carried around with us at all times, most of us ought admit to regularly using imperfect ways of describing things which we don’t really understand. With possible danger around every modern city corner if you believe certain news outlets, it might be better to say that paranoia is a very sensible default position to assume. Similarly, although voice-hearing may have a long and rich history of incorporation in other cultures or that can be normalised within other spiritual currents, the small percentile who are pathologised for admitting to it these days might be the only ones who truly give time and effort to exploring every deep, dark corner; every nook and cranny within their own mind-space for the sake of functioning normally alongside others.

But, over time, how many people have had mental health issues that we can compare to the things we recognise today? And how many people in ‘non-western’ spaces have comparable or worse conditions than we know of here? Similarly, how do large scale known historical events such as wars, the spread of markets, industry and technology feed back into these questions? If indigenuity were to be a thing of the past, and modernity were to crumble around it’s already bowing edifices; what would a healthy post-modern mind and body be like on the whole? Perhaps these are the directions change is already occurring in and that we need to begin to acknowledge in more than tacit ways over the coming days, weeks and months.