We need to talk about stigma within the mental health system. Louisa Harvey.
We need to talk about stigma within the mental health system
‘There’s nothing wrong with you; stop playing games; no one believes you.’
I’ve experienced mental health problems for the past 24 years, and in that time the stigma I have experienced has come, not so much from outside the system as within it. And yet we don’t seem to be having conversations about this issue in the mainstream media.
I was first hospitalised at the age of 17 in an adult psychiatric ward in the UK. It was an inappropriate place for someone still in the throes of adolescence and somewhat emotionally behind due to having suffered in silence for the three years preceding my admission.
Quickly it became clear that I was considered to be a histrionic, attention-seeking young woman whose problems amounted to an individual moral failing, and a refusal to take responsibility. I was not alone. There were other young women my age and we were all subject to the same invalidating experiences which served only to exacerbate our distress.
Our common presentation was self-destructive; we self-harmed and attempted to take our own lives, refusing to suffer silently once our despair had surfaced, the seasons of being able to keep our demons under lock and key well and truly over.
The common refrains we would hear from mental health nurses and doctors went like this: ‘just take responsibility;’ ‘there’s nothing wrong with you;’ ‘you are bed-blocking’ (even though they had sectioned many of us, including myself, and it wasn’t in our power to free up any bed); ‘stop playing games;’ and the worst of all, ‘no one believes you.’
Despite being considered a risk to myself, and lacking mental capacity, these judgements were accusations of mere misbehaviour and laden with mixed messages: ‘you are too ill to make your own decisions,’ and simultaneously, ‘you should stop being willfully disobedient.’ It must be noted that these comments were not levelled at the male patients on the ward, and were not reserved solely for younger patients.
This kind of treatment followed me for years until a desperate attempt to take my own life by jumping from a bridge startled others into taking me seriously. I wasn’t meant to survive. I felt that I was a lost cause and that my inability to just snap out of the madness was a personal failing.
I may not have died, but stigma within the system kills. It is far deadlier than any amount of stigma that one might face outside of the system because these are the professionals we are told to go to for help. Many of my friends who were treated as I was have since taken their own lives because their distress was not taken seriously.
So forgive me if I roll my eyes at the ever-prolific mental health awareness campaigns. Sure, they have their place, and it’s important that we all become more emotionally literate and sensitive to those who struggle with their mental health. But for some, there will be no help because they will be viewed in the same way I was, and consequently may be excluded from services because they are not seen as legitimately ill by those who are supposed to be specialist clinicians.
Over the past nine years my distress has been taken more seriously. This is because my difficulties are now understood to be of a psychotic nature, which can be labelled in biomedical terms and, thus, not my fault. It is not that the system has significantly changed, because I read every day of people who are being shut out of services, but that my suffering is now seen as a bona fide mental illness.
The context of people’s distress is rarely acknowledged, despite the fact that a great percentage of people who experience mental ill health have also experienced trauma. Their emotional and psychological responses to the world and those around them make great sense in the light of their experiences. Further traumatized by the services supposedly in place to treat them, they are frequently labelled ‘untreatable.’
Some critical psychologists and psychiatrists are attempting to address the stigma and injustices within the system, but many have their own agendas in putting forward particular approaches, and may be anti-medication to a fault. I personally believe that drugs are overprescribed, but I also respect that they can help some people some of the time.
Other groups of grassroots activists comprised of people who have experience of mental health services like Recovery in the Bin are emerging, and have important contributions to make in bringing to light the injustices within the psychiatric system, providing critiques of the recovery model as well as offering peer support that has not been co-opted by service-providers in the ways that many peer-led, service-user initiatives driven by mental health teams across the UK have been.
I’m not sure that removing stigmatized diagnoses such as personality disorders (as some are calling for) is enough to change the attitudes of many of the mental health professionals who have prejudices against certain presentations of madness and mental distress. A mere linguistic turn is not going to significantly address the sexist, patriarchal discourses involved in understandings of what constitutes ‘legitimate’ suffering in women and men, and, indeed, who is deemed worthy of treatment.
Change needs to happen at the very beginning of mental health training. I have seen many trainee mental health nurses and doctors who appear to bring compassion and empathy to their placements, only to be indoctrinated by more senior members of staff about who is considered worthy of care and who isn’t.
Of course, I acknowledge that there are mental health professionals who take a much more humane and inclusive approach towards patients, and who are trying to change the system from within. However, there is a clear code in the system that relegates certain sufferers to substandard care, if any. And that’s something we need to talk about.