Tag Archives: stigma

83. Bandwagon for sale, very low mileage.

A concrete windswept piazza, early in the morning, before the philosophers arrive.

I tried to warn the Liberal Democrats about the negative halo effect that occurs when anyone talks about mental illness in the media. As soon as the talk gets round to mental health, people become upset and change channel, without even knowing why. Not only that but they get grumpy and choke on their pop tarts. The reaction is deeply intuitive, like a brain stem reflex.

The Libs banged on about mental illness affecting one in four of us and needing to be put on the same footing as physical illness services, eliminating suicide etc, just as though they hadn’t read this blog. They didn’t listen and now they are a burned out ruin on the hard shoulder of politics.

Though the halo effect has been known for more than 50 years, this has not stopped a succession of doomed public awareness campaigns such as ‘defeat depression’.

We know that mental health information is perceived as toxic, but no-one has adequately explained why.

Since Shirley Star’s studies of public opinion in fifties USA, the consistent findings have been that people with mental illnesses are regarded as dangerous and unpredictable. Presumably, so too are violent criminals, but they get massive media coverage and scrutiny. Most likely, the ingredient that puts people off dealing with mental health is having to try and understand it. Once you start to think about it, even if you’re in the business, there’s a large parcel of mental work to be done before you can process the information.

For instance, drawing the line between unhappiness and depression, separating personality disorders from illnesses from disabilities, let alone facing the mind brain problem. We’re pretty quickly into Melvyn Bragg territory, but without his panel of expert communicators.

It’s exactly the same for other specialists. A motor mechanic recently tried to explain to me – in some detail – about what had gone wrong with the car’s air conditioning. I remember the phrase ‘wobble plate’, but to be honest that’s the only thing I can tell you about it now. I’ve had to abandon any smug pretensions to knowing my way round a Compressor. Though I will, soon, find an opportunity to say the words ‘wobble plate’, somehow or another.

I’d compare the negative halo to the effect of encountering a protest demonstration in a shopping centre.  First instincts are to avoid it, not particularly in case of violence, but more in case you are called upon to examine a complex issue, like whether a remote area of a foreign country has been shabbily treated. Thinking is the last thing you want to do in the Arndale Centre. But it’s the kind of thing you might do by listening to Radio 4 at about 8pm, alone in your car on a smooth stretch of highway. But then that’s your choice, if you’re in the mood for mental activity.

Outside the police station, a large sign reads PRIDE. I’m going slowly enough to recognise that PRIDE is an acronym – after each capital letter is a smaller word. Subliminally, I perceive the words to be: Pride, Respect, Integrity, Dedication and Empathy. Are these virtues (or sin, in the case of pride) really top of our list of desirable qualities in a police service? Surely, these are not the words you want to hear when the machetes are waving and the AKs start popping.

Having said that, I’ve had no success in weaving an acronym from the words, Taser, Cuffs, Tear-Gas, Smith, Wesson, Court and Prison.

Doubtless the police have their reasons for presenting themselves as social workers, such as the diminished number of real social workers. And obviously they have to try and maintain the moral high ground. Nevertheless, my brain stem reaction to the PRIDE sign was: misguided PR campaign. People are proud of the police because they stand up to horrible people, not because they are empathic. Bad Boys 3 will not be subtitled Good Boys.

The negative halo effect cannot be countered by dressing things up. On the contrary, we are set on guard most acutely by any hint of deception. Very large and fast neural systems are devoted to spotting trickery. It takes a lot of considered reflection to counteract such defences, which means weighing things up carefully. The very thing that stresses out the wobble plate.

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63. Being a do be, not a don’t be.

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Voyeurism can be a problem for creatures that mate outdoors.

 

British psychiatry is a bullet-riddled corpse lying in the gutter, but people are still stopping by, from time to time, to give it another kicking.

It’s in a similar condition to other twentieth century institutions, like organised religion, nuclear power and the Co-op. They are zombies, but they are still staggering forwards, muttering incoherently.

The bullets come from many directions. No new drugs, no new therapies, massive cuts in hospital and community services. Very few medical graduates are coming forward to work in the speciality.

Attacking British psychiatry in 2014 is equivalent to laying into Workington F.C. for finishing bottom of the Conference League (North).

This time, the would-be assassins are a group called the Council for Evidence Based Psychiatry (CEP), who are attempting an anti-psychiatry re-launch, this time under an ‘evidence-based-medicine’ banner.  Some of their argument turns on the (lack of) benefits and dangers of antidepressant drugs.

None of this criticism is new, and like all negative campaigns, this one will fall victim to the ‘negative halo effect’ that surrounds mental health information. It’s guaranteed to make people hop channels. The media won’t be interested unless one of the following crops up: colourful brain scan, or samurai sword.

Like progressive rock, anti-psychiatry belongs to a former era. CEP might just as well attack any other long demised evil empire, such as the Soviet Union or the Barons, or Marlborough Man. They could still be yelling ‘Judas’ at Bob Dylan for ‘going electric’ in 1966. They are probably still worried about the fuel tanks on the Ford Pinto.

To be fair, there is a lot to be critical about in modern psychiatry. Many of the points made by CEP are manifestly true, much as the programs ‘grumpy old men / women’ make accurate observations about modern life. It’s easy to criticise and there’s so much to be critical about. But what is the aim? To rant and rave, or to get more resources for non-drug treatments? To do that, the battle has to be fought in the context of public attitudes towards mental health problems.

Back in the middle of the last century, some very creative and brave researchers attempted to find out what ‘ordinary people’ knew and felt about mental illness. There were a number of milestone studies, such as those by Shirley Star in Chicago, Cumming and Cumming in Canada, and Gatherer and Reid in England.

These studies found that people tended to stereotype the mentally unwell person as dangerous and unpredictable. They were slow and reluctant to consider someone to be mentally ill, but once they did, they tended to avoid that person. The aim of these researchers was to reduce stigma by designing public education programs. Sadly, no-one is paying attention to what they found out, which basically, was: 1. ‘stay positive’ and 2. don’t attempt to pretend that mental illness does not exist – people are hard-wired to believe that it does.

Attempts to alter people’s attitudes toward mental illness failed because of the negative halo effect. In the case of the Cummings, they were eventually forced to leave town, hence the name of their book, ‘Closed Ranks’.

The researchers attributed this to an attempt to advance the notion that mental illness was something that could happen to anyone. People just wouldn’t accept that.

Interestingly, now it is the psychiatrists and nurses who are closing ranks. The worry is that what remains of the mental health industry will turn in on itself, similar to police departments, such as the West Midlands Serious Crime Squad or LAPD after Rodney King.

One sign of this is the Royal College of Pyschiatrists’ accusing itself of institutional racism, following in the footsteps (smaller size, obviously) of the Metropolitan Police. Another sign is the defensive sort of response service users get from NHS Trusts in response to queries.  There are odd attempts at ‘whistle-blowing’, but in the NHS, that’s basically a one-way ticket to the Ecuadorian Embassy.

Closing ranks is not the answer, nor is smashing the system. Everyone knows that Psychiatry is the Cinderella specialty. The neglect, in all its forms, including poor quality treatments, is down to negative public attitudes. The Turning Away, as Floydians would put it. The solution, so obviously, is better media coverage.

Here’s an example of a positive strategy: in Liverpool, The Readers Organisation has been pursuing positive mental health by setting up Reading Groups for people with Depression*.

Results have been very promising, although the evidence base would doubtless fail to satisfy the CEP. Probably they will start to identify victims of literature instead: ‘Hi, I’m Charlie. I’ve been catatonic since I read Silas Marner’.

It’s already been shown that reading challenging literature causes bits of brain to light up in bright colours. Surely its time for a controlled trial of Wordsworth versus Prozac?

Although ‘ECT versus Titus Andronicus’ was turned down by the Ethical Committee.

 

 

*An investigation into the therapeutic benefits of

reading in relation to depression and well-being: http://www.thereader.org.uk/media/72227/Therapeutic_benefits_of_reading_final_report_March_2011.pdf

40. Holding’em, folding’em – or going nuclear.

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A man must know his limitations.

Some days you’re the windshield, some days you’re the bug, according to Mark Knopfler. When tackling a large outfit like a utility company, be assured, everyday you’re the bug. And when tackling the NHS, they are the Louisville Slugger and you are the ball, as Mark would put it.

Sometimes it pays not to fight on too many fronts at the same time – just ask Hitler.

One of the battles not to fight is with a large corporation. Private or public sector, it doesn’t matter, don’t tangle with it unless you have unlimited resources, a firm of lawyers and preferably an enforcer who works through ‘unofficial channels’ e.g. by re-arranging peoples kneecaps. And I don’t mean an orthopaedic registrar.

For example, though I should know better, I am locked in a pointless battle with Ovo Energy, which will only end one way. Every time they read the meter they record the night as day and the day as night, essentially adopting the world view of  a nocturnal creature. They purport to be a green outfit, and I suspect they are trying to be fairer to owls and badgers, who cannot at present benefit from Economy 7.

Large organisations are groups of thousands of people, with massive resources. You are one person with very little time and money, even if Erin Brockovich is your favourite movie.

There are several ways that people get hurt when they interact with large organisations, but the main effect is that of learned helplessness. Even Kim Kardashian can’t get British Airways to accept they have taken items out of her bags. Veteran complainer Clive Zeitman resorted to sending British Airways’ mouldy strawberries to their CEO by courier service*. As a result his daughters were invited to Heathrow to inspect the catering facilities. Personally I’d have suspected they were walking into a trap, like Clive might receive them back, also by courier, but not in one piece.

You might get an apology – but does an apology on behalf of a vast organisation actually mean anything? Customer relations usually frame an apology in a twisted way like ‘We are sorry that you feel unhappy and dissatisfied with our service’. The implication is that your feelings of unhappiness and dissatisfaction are your problem and relate to poor early life experiences.

They might as well add, ‘we hope with adequate therapy you manage to resolve your issues with your over-involved yet emotionally detached  mother.’

You might get carried away and become a single issue fanatic and pub bore. The organisation might even have you designated a ‘vexatious complainer’, which means they acknowledge your letters but don’t otherwise respond to them (no change there then).

And finally, having gone too far, having got personal with some hapless call centre employee, having bogged yourself down in nitpicking details, you are consumed with guilt and remorse and you realise you have turned into a monster. For instance in suggesting that there is really only one essential item in the meter readers’ toolkit of skills.

Worst of all, it might turn out you were wrong all the time. I have checked that meter so many times. I have taken photos of it and mailed them to Ovo. My dream is to get an eminent person – Desmond Tutu would be ideal – to visit the house during the day and observe the meter’s steady advance as I turn on all the appliances, then sign an affidavit as follows: ‘I Desmond Tutu, Archbishop and veteran human rights campaigner, winner of the Nobel peace prize in 1984, solemnly confirm that Reading One is Economy 7.’ How you like them eggs, Mister Ovo? [ovo=egg, gettit?]

Instead of signing, Desmond would probably advise me that the relationship between the strong and the weak, the big and the small, is far more complicated than a simplistic perpetrator / victim scenario. Butterflies should take care not to break the wheels.

As a participant in Capitalism, which is the only game in town, it is better to regard yourself as playing a game rather than conducting asymmetrical warfare. The paradigm of gaming means you choose your opponent wisely and play when it suits you. If you lose, its only a game (sucker).

Why do people hate large organisations so much anyway?  Perhaps there’s a limit to the amount of ‘putting you on hold’ people can take, even with Vivaldi in the background. It is very difficult, even for an able -bodied, able-minded person, to penetrate the ‘choice architecture’ that creates a force field around organisations. How difficult must it be for a person with impaired abilities to deal with ordinary issues like trying to minimise energy costs?

Is there such as thing a Corporate Psychiatrist? I don’t mean a psychiatrist who wears a smart suit, drives an Audi and carries a Blackberry, because there are none. No, I mean someone who can diagnose and treat ailments that affect large companies.

For instance, the power companies suddenly became incredibly unpopular and possibly evil.  Could that be seen as a kind of disease process? I have a friend who works for an energy company, who assures me the industry is not evil, not particularly profitable and not guilty of the various price-rigging allegations that are being promoted in the media. He hasn’t tried to sell me any energy yet, but I accept he might be working a long con.

My theory is that society has a certain quantity of Stigma within it, which is probably a constant total. Now that Stigma cannot legitimately be attached to disability or minorities, it has had to go somewhere, and seemingly it attaches itself to arbitrarily and lazily designated villains-de-jour, such as banks, newspapers or power companies.

If there is hope, it probably does not come in the form of EDF, but I am hoping that nuclear electricity will boil my kettle faster, so I am changing over. We are heading toward judgement day for the meter, as two giant companies slug it out in the cellar. Desmond, you could have stopped this.

https://elt.oup.com/elt/students/englishfile/dyslexicfriendlytexts/ef_int_reading_8a.pdf?cc=us&selLanguage=en