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How do we understand mental illness?
How do we make sense of complex mental phenomena?
How do we comprehend the experience of people who might have mental illness?
How do we interpret the acts of people labelled as mentally ill?
These are all vital questions for those of us who seek a world where people with lived experience of mental illness are treated as equals with others. They are vital questions, but also difficult ones. For some people their personal experience of mental illness may shape their understanding. People diagnosed by a medical professional gain first-hand knowledge. Their carers will probably also gain knowledge too.
But this would seem to be only a relatively small percentage of the population.
Perhaps we have to turn to the realm of culture. The stories we tell about mental illness; the people in narratives burdened by mental and emotional phenomena. Take the great works of that master of the human heart, Shakespeare. Hamlet would probably be diagnosed with melancholy depression today. Lady Macbeth, washing invisible blood from her hands, with delusions or obsessive-compulsive disorder. An aging King Lear with dementia. The character of Poor Tom in King Lear would probably be diagnosed with schizophrenia. And so forth.
These stories are powerful. But probably the strongest force shaping our society’s understanding of mental illness is the mass media: films, newspapers, television, radio and social media1.
The unfortunate truth is that the mass media more often than not presents stigmatised pictures of people with mental illness2. Let us count the ways…
Firstly, the mass media tends to focus on severe mental illness, such as schizophrenia, bipolar disorder or delusional behaviour, to the exclusion of (far more common) illnesses such as depression or anxiety. One suspects that, were they asked what are the most common mental illnesses, the majority of the population would not nominate anxiety and depression.
Second, when an act of senseless violence is done, the question of the accused’s mental health always arises. News reports are quick to report that the authors of violence had “mental health issues”. This portrayal of people with mental illness as violent is fundamental, and fundamentally flawed. People with experience of mental ill health, even with serious delusions, are far more likely to be the victim of violence than its perpetrator.
Thirdly, people with mental illness are often portrayed as insensible; as living in their own worlds and not amenable to rational discussion or behaviour. They are irrational and criminal.
Fourthly, people with mental health concerns, be they mild or serious, are not portrayed through the lens of recovery. That is to say, our mass media does not promote pictures of people who recover or overcome – or even simply manage – mental distress. Can you think of a story in the mass media about someone who overcomes or manages their mental illness?
Finally, the mass media does not focus on the social forces that may lead to mental ill-health; forces such as poverty, traumatisation, genocide, dislocation and social, economic or political breakdown.
Sure, there are some artifacts of the mass media that do not paint such a negative picture. Films like ‘One Flew Over the Cuckoo’s Nest’ humanises people in a psychiatric ward. ‘A Beautiful Mind’ presents a genius with a serious experience of schizophrenia who comes to manage his delusions. ‘Silver Linings Playbook’ portrays a more serious, or accurate, picture of someone with bipolar illness.
With all these forces at work in the mass media, it is no wonder that people with mental illness are stigmatised. The sad result is negative treatment of these people3. Mental illness is not recognised, or is recognised as recalcitrance, weakness of will or character defect. The role played by social factors in the development of mental illness are under-emphasised. Treatment for relatively mild mental illness is avoided so as to avoid the potential of stigma. People living with mental illness may internalise a sense of self-stigma. And, ultimately, people with mental health concerns can only lead less rich and fulfilling lives.
Dr. Richard Schweizer, Policy Officer at One Door Mental Health firstname.lastname@example.org.
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Dr Richard Schweizer