As a former mental patient, I find being asked to ‘embrace my diagnosis’ far more offensive than words like ‘bonkers’
Mentally ill people can be troublesome but at least the rest of the population does not have to think about them much. The system is effective in that respect. No one need know, for example, that 10 per cent of adults in Scotland are on antidepressants. The disturbed do not spread their disturbance.
Whenever the subject of mental health surfaces in the media, progress is reported, unless there’s been a murder. While ‘bipolar’ has become a fashionable term to describe one’s own interesting self, and celebrities lay claim to mental difficulties without fearing loss of face or income, the main thrust of the psychiatric profession’s publicity wing is the fight against ‘stigma’. The message is that the psychiatrists understand the predicaments — bipolar affective disorder, schizophrenia and so on — and are treating them correctly. The only snag is that some people, including some sufferers, still think that they should be ashamed of being thus ‘ill’.
Yet the people who are best placed to comment on the system are precisely the people who least want to think about it ever again. Former mental patients, released back into society, in general want to forget their unhappy experiences, make a new start, avoid the subject. They — we (Peter Smith is a pseudonym) — might have railed at our treatment while confined against our will in a hospital, but when released, pale and mumbling and shaky, we have nothing more to say. I am only able to make any sort of comment here because, seven years after my last sectioning (marvellously expressive term), and four years since my last pill, I finally feel free of the psychiatric profession in whose clutches I had been wriggling since 1989. My views might be unrepresentative but all current and former mental patients that I have met broadly share them; and many psychiatric nurses would agree.
And where we agree most heartily is with the view that this anti-stigma campaign, which exhorts us to embrace our diagnoses, is pure bullshit: doomed to failure, dishonest, sentimental. It is useful only as a distraction from the fact that, actually, when it comes to the mysteries of the mind, no one knows what they are talking about. How, pray, do you remove stigma from that malodorous man on the bus, dribbling and barking obscenities at the moon? How do you de-stigmatise a sectioning? This normally involves several health service professionals, an ambulance and a police car arriving at your home and removing you from society for an unspecified period on the say-so of one psychiatrist. Armed robbers are arrested with more respect.
The mad — i.e. those whose behaviour is thought to present an unwitting danger to themselves or to others — will always be looked at askance. When the Sun changed its headline about Frank Bruno’s difficulties in 2003, from ‘Bonkers Bruno locked up’ to ‘Sad Bruno in mental home’, we felt insulted. It took a dozen policemen to restrain him! He was bonkers! He was not ‘sad’ and he was ‘locked up’. The first headline faced facts; the second pussyfooted: and if there is to be real progress, the pussyfooting, the sentimentality, must cease. Some people lose the plot so completely that their behaviour gets out of control, they need to be confined and they are rightly called crazy.
Those of us who have been crazy — and I was certainly that — do not mind the jocular and colourful terms. Nor do we object in retrospect to the rough treatment and the imprisonment: the law’s the law and society must be protected from nutters on the rampage. What we object to is the application of terms — the labelling, the pigeon-holing — which purport to tell the whole story and demand that we surrender our individuality. ‘Manic depression’ has become ‘bipolar affective disorder’; ‘paranoid disorder’ is now ‘delusional disorder’. The names seek to persuade us of their compassion and absolute authority, and they are always changing. But mental disorder involves multiple aspects of an individual’s being and history and cannot be labelled or treated in the same way as physical illness. My mania was a response to circumstances and, to an extent, a choice; it was inextricable from my peculiar personal trajectory and an absolutely individual catastrophe. It is possible, though not proved, that my genetic make-up let it flourish but it was — I am certain — a response, a reaction (to an accumulation of confusion and misery) and, in a way, an expression of wellness, as a cough in seeking to expel alien matter is an expression of wellness.
The response to my response was confinement and pills. When deemed well enough I was set free but the doctors kept checking that I was taking my pills. Lithium, my basic pill, felt like clingfilm round the self; there was no fineness or subtlety about what it suppressed; it was in no way an attempt to treat my disorder and, I think, fostered further rebellious outbursts. Recovery was not an option: I was branded but that was OK because I was quiet.
Recovery did come when, fed up and bewildered, I found a wise man with whom to talk. ‘Words are the healers of the sick temper,’ wrote Aeschylus — perhaps too long ago (the fifth century bc) to be taken seriously by modern psychiatry, but so it proved. At last I was considering myself as an individual not a specimen. The wise man prompted and listened; the healing words were my own. Cautiously, gradually, I withdrew from pharmaceutical dependence, and emerged ordinary.
Or as ordinary as most people — which is to say: not totally sane. Everyone is mad, more or less. ‘Perhaps,’ wrote Samuel Johnson, ‘if we speak with rigorous exactness, no human mind is in its right state... There is no man whose imagination does not sometimes predominate over his reason...’ Dr Johnson is perhaps too rigorous here, but the point is made: there is a spectrum of sanity and no one has a fixed position on it, neither for life nor in the course of an average day.
It might help if this were acknowledged. The raving loony in the bushes does not belong to a discrete category of sub-human. He is one of us. His lurid behaviour frightens children and is justly stigmatised but we should share the stigma, for he cannot be madder than the world which gave rise to him. It might even be worth listening to him. But sooner or later, unless he calms down, he will be locked up, labelled, dosed up and instructed to embrace his diagnosis.