A Realist’s Approach to Mental Health Stigma

Current campaigns around mental health stigma tend to focus too heavily on persuading the general public to be more accepting of people with diagnoses by tackling common myths via public campaigns, but there’s little in the way of strategies for managing how those of us who are diagnosed deal with a dominant culture which is often prejudicial and discriminatory while also acknowledging that it isn’t only the dominant culture, but also we ourselves, along with the systems intended to care for us, which contribute to the problem.

While the myths in society do need to be addressed in the interests of social inclusion – though the evidence is that such campaigns achieve little, if anything – this shouldn’t be at the expense of developing an awareness of a community’s shortcomings, along with strategies for addressing them, when it comes to understanding mental health, not least if that may result in improvements.

Likewise, health services, while their very existence is contested, offer solace to many people, while they also stigmatise those they purport to care for with merely theoretical notions of such things as incurable diseases, chemical imbalances in the brain and genetic deficiencies all pointing to some internal and inevitable fault the evidence of which is still to be discovered.

We need a strategy which brings about the best in the stigmatised and the stigmatisers. It isn’t enough to be casually and conveniently dismissive of anyone, sacrificing a comprehensive and constructive understanding. We need to think creatively around how society and psychiatry positions us to think, behave and interact in key ways about certain conditions.

We need to understand how culture works us in order to redress the balance of power at a micro and macro level between ourselves and the societies we’re part of, to recognise that stigma isn’t a deficiency on the part of the stigmatised, but one of the stigmatiser or, better still, of our society and culture, embracing a more empowered way of life accordingly.

What can you do with a toxic brew?

It’s only a cup of coffee, you might say, but I’ve seen people physically shaking with anxiety from Kidderminster town centre’s toxic mix of social problems, excessive caffeine, status anxiety and status envy, concentrated in a small patch of commercial land in my hometown.  It’s linked to what beats the heart of my county of Worcestershire, the British class system, which is a huge factor cross-county, and which manifests itself in numerous ways, from people internalising the dominant ideology of the area to the desire to be ‘posh’ to an almost obsessive desire at times to get one over the other person at varying levels of intensity with a hierarchy based on criteria which would find a better home in a pantomime.  Territoriality also factors into it all as people lacking a home worth living in become obsessed with a commercial area that has so little to offer.  It is, if you’re fortunate enough to be able to see it, quite simply the strangest place in the most backward of counties you can imagine.

Kidderminster is a former market town – an insular town, a town where its reactionary politics are made to look apolitical to the point that people think they’re natural and have no need for an alternative, which would only be seen as a threat, anyway.  The status quo never had it so good.  The local Conservative association had (or still has) its offices in a building called ‘Margaret Thatcher House’.  During a crisis brought about by deregulated bankers, they elected a hedge fund manager to power: a Conservative, not a member of an extreme far-right party, only because that isn’t thought ‘posh’ around here, though the core ideas and way of life betray the diversion.  You get the picture, even though most of the locals don’t.

So, in the context of a politics that likes to individualise rather than see broader issues, there is, of course, no point in trying to help those with shell shock after they’ve been exposed to the place.  There is no problem, they’ll instinctively insist, to any problem they clearly have which you may highlight, having unwittingly learned to erect any defence (partly, again, in the interests of one-upmanship and, well, psychological survival) against the reality that setting up an alternative home in Kidderminster’s town centre represents a significant admission of failure in a great many aspects of life, all the while spilling their lattes all over the place – hands beyond control, minds too easily drawn towards hysteria, all the while almost constantly desperate for something – anything – to prove that maybe hints that they have value beyond the superficial commercial relationships they have there.

I was once close to becoming one of those people until I rediscovered that life was worth living.  That said, revisiting the town centre over the past fortnight has already had an impact.  Years ago, a pretty decent, very likeable fella came to work in the area.  This year he left, widely disliked.  I had tried to warn him in his early days there, but it’s natural not to listen to such things when the reality seems so different to the uninitiated.  In my last vlog, the effects of the place were evident in the video even when merely describing it, the danger being how, like quicksand, the area can submerge you into its ways and the social scene of its bizarre ‘community’ of tragicomic regulars.

Making vlogs can be interesting, not least in a therapeutic sense, so long as you can summon up the right frame of mind for assessing your own work, and it was on first viewing of ‘This Toxic Spill’ that I realised the impact the town centre was having on me even after so short a space of time.  The world seemed smaller, restricted, narrow.   The air of possibility that I usually carry around with me had vanished.  I could feel the lack of enthusiasm for things that really matter as things that don’t came into the foreground.But gone are the days where I’d spend almost all my daytime in town, almost camped out, so I lacked the level of stress that involved which would obscure my way out.

As with many psychiatric patients, you can generally gauge the unresolved psychosocial issues the regulars have by the size of the bags they carry for their big day out at the coffee shops in the town.  Mine was occasionally indicative of the trials I was going through, though never as bad as many I’d seen.  But now is not then and, even though I’ve taken my man bag there, it’s been pretty half-heartedly, yearning to get back to my home routine, which is enjoyably productive, rewarding and fulfilling, as are other areas of my life, leading (the hope is) to something interesting further down the line.

Just as importantly, though, I don’t want to lose the defamiliarization I have of the town centre as that process did what it can do at its best, demystifying it and, in so doing, opening up a fresh, perceptive and acute perspective of the place, the county and, beyond that, even the country itself.  There is something to be said about seeing the area you’ve mainly lived in with a fresh pair of eyes, in ways you’d been obscured from seeing in the past, which develops you and your approach to things.  Defamiliarization with my hometown and the majority of the people who inhabit it has led to greater reflection on many things beyond the geographic and cultural, which has led to a degree of personal development I could barely have hoped for.

But what about the place itself?  Trying to address the problems of the area from within the area will probably always result in a fruitless conclusion.  The instinctive tendency here is to deflect it all and say that the area is little different and no worse than anywhere else, despite the evidence, the professionals and key lay people strongly suggesting otherwise.  While appreciating how tragic it is that the regulars’ defences against self-awareness and awareness of the culture that does them so much damage is beyond resolution, I can’t help feeling that life here and elsewhere could be so much better for far more people, but that the extant issues – too often internalised by people who know little better – should be tackled by people who should know better.  It can’t be acceptable that you can drive within 20 miles to the urban landscape of Birmingham and be presented with people, despite that areas issues, whose personalities are as if from another planet, they tend to be so personable and lacking in the superficial charm, hostilities and paranoid approach of Kidderminster’s majority.

But this is not for me to resolve.  The type of tragic figures who haunt the town centre and speak volumes for the county and even the country aren’t yet on the radar of organisations who are currently more likely to target pub dwellers, drug addicts and people as psychologically damaged as the coffee regulars, but without seeing the similarities and the needs these people have.  State institutions won’t touch the place because that would be to admit that the area and its culture has deep-rooted problems, as many professionals and lay people would willingly tell me during my initial spell frequenting the place.  The local press is more interested in tittle-tattle for the local gossips and in promotion for tourism, though let’s hope the tourists always manage to get out before it’s too late.  The locals themselves are so familiarized with what should always be kept at arms length that they can’t ever really be hoped to see the issues.  All that’s left, then, is for social and psychiatric services to pick up the pieces of those for whom the defences are eventually breached.  Surely that’s wrong, but that’s the way the system currently works.

As for me, I went there today at the close of business, even though I didn’t want to.  I’ve got enough to do at home, a decent coffee machine and non-commercial relationships to attend to.  But it’s that witnessing a car crash thing, isn’t it.  The trick is to keep it like that though, as you’ve probably figured out by now, that’s far easier said than done.  And as for it only being about a cup of coffee, I wish someone would tell the powers that be because, ideally, that’s all it really should be.

Madness, Toothpaste and the Two-Percent Problem

Rough guess: between 2-5% of people writing about madness in the media and online know what they’re talking about.  I don’t include myself in that figure, because I’m still developing my thinking and have quite a bit more to learn about the field, but I’m fast getting there.  The thing is, if it’s only 2%, how come?

What with the fact that psychiatry is heavily about engineering conformity to norms along with what I wrote last time about the copycat element of ‘self-harming’ not to mention the placebo effect involved in anti-depressants’ successes, I can’t help but link in the success of orthodox psychiatry’s powerful position with studies pointing to poorly considered conformity to authority and status.

Indeed, the success of neo-Kraepelin psychiatry’s smoke and mirrors can be equated with the way the toothpaste brands used to sell us their products on TV, with an actor dressed in a lab suit using pseudo-scientific phrases about whiter than white.  What with bio-reductionist psychiatry flying in the face of science, along with the disempowered helplessness of people persuaded by the constructed pathologizing of much ‘normal’ behaviour, not to mention more transgressive thoughts and acts, I have to wonder whether psychiatry’s success in pulling the wool over most people’s eyes is down to little more than disempowerment by misinformation and conformity to what’s seen as a higher order.

It’s easy to stereotype dissenters when you’re living within the confines of traditional psychiatry.  They must be scientologists, they’re in denial, they’re dinosaurs compared with our modernity, and so on.  But, because I’ve been on both sides, now, it should be easier to see the terrain of this debate in better ways.  Going on my own experiences (and having transformed them), then, I’ve often rebelled against the system only to find myself, once medicated, at the disempowering extreme of complete conformity to the norms and values of the system and my locale – both fairly reactionary and conservative – which I’m not ordinarily instep with philosophically.

In your conformity, though, you also face abandoning any argument that risks true analysis and clarity of the true state of affairs by putting such questioning and doubt down to illness in the face of what can be the overwhelming opinion of those around you, especially on mental health wards, not to mention online, in the media and, well, in society in general.  You fail to even begin to realise that there are many ways of perceiving and acting around popular conceptions of causal factors and mental states, pathologized and decontextualised or otherwise.  Sometimes, in desperation and the absence of any understanding of the possibility of better alternatives, you may want to believe in something – anything – and traditional psychiatry increasingly fits the bill, backed by limited perceptions and blatant falsehoods almost everywhere you look.

You maintain what many in the system have long experience of – inadequate reasoning, poor problem-solving skills and other common features of problematic relationships – to reject good arguments and laud the bad, especially when these come in the form of the sales techniques of toothpaste manufacturers.  You sacrifice empowerment over even information by surrendering your mind and senses to the wit of people who don’t tell you the truth about iatrogenic effects, causal factors, how psychiatry really conducts itself across the board from research to treatment, diagnostic irregularities, and so on, but instead give an air of authority and prestige in making many declarations about things of which there’s no certainty on the one hand and make-believe on the other.

This isn’t to say that people who advocate neo-Kraepelin psychiatry are bad people.  I’ve yet to meet anyone in the system who, at some stage, I didn’t think went into the service of people to help them.  But the fact that their work is based on a belief system that flies in the face of reliable science means that what you’ll often find – in the rare moments when there is the chance of effective debate – is the very type of reasoning errors and bogus stunts that can look so reasonable to those who often know little better because of their past exposure to similar ways of arguing: for example, shooting the messenger, giving incomplete evidence, not engaging with arguments when you don’t have the evidence so you don’t have to admit it, ‘Crucible’ logic and the prestige suggestion so heavily involved in also selling toothpaste.

That, by my very rough estimate, merely 2% of people in the media and online actually know what they’re talking about when they discuss madness, could say many things to many people.  To me it isn’t a sign of an open and shut case according to popular opinion (though I could easily become derogatory in arguing that).  Instead, it says that there’s a societal problem around norms, prestige and empowerment (not to mention professional, financial and political interests) which needs an overhaul in radical and creative ways.

Earlier today, I read a tweet by a prominent psychiatrist apparently debunking a theory about madness.  He was wrong in fact and dubious in his casual populism. The temptation was to engage him.  I didn’t bother, partly because of the reasons outlined in this post, but also partly because, despite everything, I didn’t want to just in case I was had, as I also buy toothpaste based on the dubious claims of actors in lab suits.

How to hack a mood

I got into a steamer of a mood earlier yesterday, a proper cynical, loathing/self-loathing one, and the sort which could linger for weeks at an earlier stage of my life, leading to consequences that could also easily lead to a vicious circle where it was necessary to form a lifestyle to adapt around all that, with often long-standing consequences. Yesterday’s lasted about 20 minutes.

I’m firmly of the conviction – and I’m not alone in thinking this – that there’s a whole heap of people walking around society doped up, where the issues they need to deal with are obscured to them, charging around in the back of their minds, largely inaccessible and often leading to subtle, long-term alterations of character at best or extremely bizarre behaviour at worst (a situation bioreductionist psychiatrists are only too willing to ‘treat’ by medicating individuals even further).

I once was one of those people, tortured by what I didn’t understand and couldn’t really see. That was until I was put on a medication that didn’t sedate me (though it still had unacceptable side-effects). This, along with a more outward-looking approach from Relate, the relationship counselling organisation, reintroduced the notion of context and was the catalyst for re-educating myself about moods so that yesterday’s lasted for as short a time as it did.

Yesterday’s was a combination of the medication I’m on kicking something off – I could feel the increase in physical anxiety that had no psychological input – though thoughts would develop that I had to subsequently deal with, even though that wasn’t a big deal. It isn’t, these days, because, between my two past spells in hospital, I developed the work I did with Relate (which was roughly in line with what had always been my approach prior to psychiatric involvement) and sought reasons for why I’d often been behaving bizarrely for over a decade, where the moods came from (there’s always reasons, despite many people claiming there aren’t) and what I could do about it all (incidentally, it was a bit of a revelation to me when, in 2011, I first realised that medication could induce physical reactions you’d normally associate with negative mental states but where there were no thoughts whatsoever that could have led me to them. In other words, the meds that are supposed to deal with psychiatric symptoms were producing physical reactions that were giving me them instead).

Nowadays, that process is pretty natural, an almost automatic process where one reason will trigger me off into seeing another in another now-automatic process of putting it all together to make sense of it all and so mastering it to the point where I’m empowered in relation to the mood and its causes, which then transforms the mood into something far more realistic, balanced and manageable.  From there, I can pick up the pieces of where I left off without psychological residue: no dramatic consequences, no bizarre behaviour, no need to endure weeks or even months of angst. It’s a more flexible and creative approach, a critical, including historical, awareness that works for me, at least. It needs a fair degree of honest accuracy (warts and all, but all in context) but once it develops into a habit, it’s yours for life.

I still get into moods. I wouldn’t be human if I didn’t and some moods are useful in many ways that aren’t widely acknowledged. But the ones I find unacceptable are the more involving negative and debilitating ones which lead nowhere and, with me, are usually a consequences of meds I have little choice but to take (even though my view is that I’m largely having to take them because of initial psychiatric incompetence, social factors and, now, a physical dependency). Those meds still have an obscuring effect, so it takes me time to recognise and act upon even the deepest moods even now, but these days I do and do so pretty quickly. Even where sometimes there’s a course of action you’d like to take to ideally work around the mood that isn’t open to you, accepting that and working on something else instead is part of dealing with the mood, too.

The really important thing, though – and again, most people should know that I’m certainly not alone in thinking this – is that such an approach is available to everyone, if they want to use and benefit from it.

Is there anybody out there?

Apparently, I’m in the best shape I’ve been in during all my involvement with psychiatric services. This stint in hospital lasted five and a half weeks. It could have been two. My decline was rapid, but so was the turnaround and, because problematic ways of thinking and behaving didn’t have a chance to bed in, normality’s returned and the work needed to get there was minimal. As a consequence, too (thinking long-term), I’m starting to pick up the pieces from a better position and that bodes well for the times ahead.

But this goes against the trends. By now, I should be a cabbage and it’s strange to think of how mad I’ve been in the past. Re-entry to normality’s not been an easy ride, but then the way psychiatric services blasted away my mind for over a decade was hardly a walk in the park. Now, though, I should in theory be able to come off meds completely, but it looks like I’m physically dependent on at least a small dose of them, which is a problem – you’re never told the full story about side-effects and most people who should know haven’t a clue – but one I think I’m prepared to live with. All-in-all, I think I’m philosophically and psychologically where I would have been had I never entered the psychiatric system at all.  At last, I’m grounded in a reality that’s both comprehensive and coherent.  My world and my place in it make sense, so I can take things from there and actually get more enjoyment from life.

This time it’d been two years since I’d been hospitalised, a time during which I increasingly focused on ideas I’d had before psychiatry had ‘persuaded’ me against them – most notably, the importance of context in our lives. Psychiatry, as I’ve written before, makes a good show of considering context, but it can’t help betraying its true philosophy in singling out the individual for ‘treatment’. There is no such thing as society, sort of thing, as even the left ultimately champions decontextualisation when talking about ‘mental health’ with just about every bogus and ill-informed stunt in the book.

I’d spent a long time thinking about my experiences in the system and now and again views buried in the back of my mind would emerge and chime with the sociological approach I’d once had. But it was a gradual process of picking apart my life from a number of angles – sociological, psychological, economic, historical, cultural, etc. – and informing this further with research which grounded me in a better sense of the world as it is, my place in it, and how to manage the relationship between the two – not how psychiatry had led me to believe in how things were and should be.

Psychiatry stigmatises while persuading its advocates that the public at large are the great stigmatisers. According to psychiatry, the ‘mentally ill’ are chemically or genetically deficient – a set of theories with no scientific basis whatsoever, which are put forward and adopted as fact throughout the system for all sorts of bizarre reasons. Tragically misguided campaigns formed on their basis spring up all over the place with campaigners failing to grasp why their attempts are doomed to failure (during this last spell in hospital I even had to politely tell a psychiatric nurse this as he reeled off a list of theories about ‘chemical imbalances’ while I told him that there was nothing whatsoever in the field of science to substantiate his beliefs. He wouldn’t have believed me). Indeed, so wedded are campaigners to the false assumptions of psychiatry that the wider public are done a great disservice in being singled out for doing essentially what the campaigners are doing themselves and often to themselves. You can’t win. But then, no-one can, faced with the hook and crook power grab psychiatry’s historically pulled off that blinkers so many people to the true state of affairs.

I know all this sounds as if I’m bitterly anti-psychiatry and ranting about a system out of mere dissatisfaction but a bitter-sweet moment came when I realised that, although all my thinking wasn’t original and I wasn’t some sort of pioneer – there’s plenty of people who’ve reached similar conclusions about the ‘system’ – at least I wasn’t alone.

Moreover, I’m not anti-psychiatry at all. As I see it there are three schools of thought in this area: anti-psychiatry, critical-psychiatry and pro-psychiatry. I fall into the middle category, seeing psychiatry as needing urgent and thorough reform, if not a complete overhaul, but still seeing it as an important option in assisting people at the extremes of thought and behaviour who wish or need it, so long as that’s accompanied by an understanding of what people’s full options are, aside from how we’ve been culturally conditioned to think.

The pity is that the three schools of thought don’t seem to interact and learn from one another. Learning of them and their approaches has opened up options to me that I hadn’t been made aware of by a system supposedly acting in my best interests. Psychiatry’s a powerful system and it seems highly unwilling to risk relinquishing its power – personal attacks on critics are only the tip of the iceberg of how badly it reacts to its philosophy being questioned, something that should ring alarm bells for even it’s most blinkered advocates.

It doesn’t and yet psychiatry’s a very broken system. Again, I’m not alone in observing this, but what came as a surprise to me during this spell in hospital was that many of the people working in that very system also see a need for thorough reform. In researching the subject, I’d come across evidence that there are many senior psychiatrists who are calling for change, but I still saw things stereotypically in an ‘us versus them’ scenario. So I was taken aback by how passionate many people working in the system were in their calls for change.

Does the wider public or those ignorant enough to unwittingly campaign for more stigma believing they’re challenging it have any awareness of all this? It seems not, as I was once one of those people and even wrote a dissertation partly dealing with challenging stigma, without once questioning the basic assumptions of psychiatry or that my approach would encourage stigmatising processes as much as anything else. Just as it’s frustrating to now watch most campaigners unwittingly chase their own tail, it’s also a great tragedy that there are people throughout services working so hard and to such a high standard in the face of a deeply damaged system with little realistic hope for the kind of substantial and effective reform in the near future that would see their efforts as rewarded as they deserve them to be.

For me, personally, these ideas and my experiences of the fallibility of the system, along with alternative approaches, have ultimately proven more productive than passively accepting the singular approach of one failing discipline. We live in a context that influences us, where we need to reform ourselves but also the world around us, while adapting to things as they are. Not only are there people who believe that I’m in better shape than I have been during my time in psychiatric services, but I feel better than I have during all that time, also, however difficult it was to emerge from the mire. It’s difficult to put myself in the mindset I experienced for so long, I went in so deep and at times didn’t look like coming out. But I did and it’s given me the conviction that the same can be achieved for anyone.

As for services themselves, even within the pro-psychiatry model, they’ve declined shockingly even during my 15 year time with it. Nursing staff consumed with paperwork didn’t train to be clerical workers, but that’s what most have become, with implications for those in their charge. The stigmatising social effects of diagnoses remain, but without the knowledge that they’re only theoretical and highly disputed. Social services on offer have diminished so people have even fewer places to go for therapy or even to just spend time interacting with others. Therapies that can help aren’t widely on offer while other potentially successful approaches aren’t usually considered at all. Spaces even on confined wards have become fewer, squeezing people at different levels together – with the inevitable personality clashes – as they’re ‘needed’ for yet more office space, as decreed by (as far as I can tell) centralised senior managers who understand little about the needs of people in the system.

I hear calls for improvements in ‘mental health’ care from all sorts of quarters, but they’re usually misguided and betray a shocking level of ignorance when you consider the positions many of these people hold in society. Yes, services need to be improved, but in the right way, not just more of the same because the same doesn’t work – currently, psychiatry is flawed from top to bottom, its assumptions are wrong and its practises are ineffective. Moreover, the ideas needed are relevant for everyone, not just those who enter psychiatric services, with the promise of improvements on a societal level on offer, if people would just look.

That the upper echelons of psychiatry are unlikely to risk their unjust power being challenged by calls for thorough reform doesn’t bode well, but my approach is working while theirs didn’t, never really has and never really will. That there are people with a good understanding of the issues is helpful, but that they’re still being sidelined isn’t. It’s time the bulk of campaigners did their homework, but maybe part of the problem is that, if they were going to, they would have done so by now. That said, I remain optimistic, but only in the longer-term.

The Social Media Documentation Project

The Social Media Documentation Project makes good information about social media both accessible and usable. The project isn’t just about tools and services, though. It’s also about the thinking behind them and how to make the most of the new media. The project exists to enable people to effectively use existing online social networks and even build their own by looking to increase our knowledge and key skills.

The project is intended to be informative and well-written, concise yet comprehensive and comprises three elements:

Wagwan? http://wagwan.org Wagwan? deals with the ‘social’ in social media. Most of us could do with improving our psychological and social skills for real life. But it’s also the case that we need these skills to make the most of social media, otherwise we are in danger of losing out on what the social web has to offer us. Wagwan? is a health and well-being Q&A site designed just for that purpose, to openly discuss better ways of thinking and relating to others.

Nagwan! http://nagwan.org Nagwan! concerns the ‘media’ side of social media. Many of us would benefit from brushing up on our technical and communication skills so that, when we do use social media, we can hold our own. Nagwan! is a forum-based site specialising in bridging the gap between those proficient in social media and people hoping to make more out of the social web but who may only have a rough idea of what they want to do, if they have an idea at all.

The Social Media Documentation Project http://tsmdp.org Tying it all together – the ‘social’ and the ‘media’ – is The Social Media Documentation Project. Wagwan? and Nagwan! are both quite dynamic, so the wiki provides a more static place to draw material and conclusions from contributions to the other two sites.