Marion Janner on substance abuse, stigma and sense of self.
Note: this post was written before the transmission of the Why Did You Kill My Dad? documentary.
This is a very difficult blog to write, stimulated by the programme on BBC2 tonight, (follow the link to watch it on BBC iPlayer).
Firstly there’s the unusual problem of it being inappropriate this time to rabbit on about my dog, Buddy. The issue is inescapably complex, fraught, widely debated and relatively well-researched. Balance is crucial, and this blog post's contribution will probably be through irritating or infuriating people with highly diverse opinions, equally.
Some might think that it’s not very balanced to comment on a programme I haven’t seen. Very Mary Whitehouse (for those of us old enough to remember the excitement of electric typewriters being invented.) But I’ve read a long and multiply-upsetting by the film-maker, Julian Hendy, about his father’s killing; an understandably highly emotive, provoked and provocative piece, so I’ve got a rough idea of what’s to be unleashed.
Before even getting to looking at anything substantial, there’s the language hurdle. Referring to people as ‘service-users’ is generally OK, but in the context of mentally ill people killing ourselves or others, it’s ridiculous.
As Paul Farmer says in Mind’s press release: “The common thread in all the cases in this programme is the failure of mental health services and other agencies to work together to engage people who have complex multiple needs…”. Because Paul covers the most important factors around safety so well, I won’t duplicate these within the three aspects the blog covers: substance abuse, stigma and sense of self. (So nothing about sun, sea or sausages.)
Research in 2009 about the relationship between schizophrenia and violence revealed that it was the additional element of substance abuse which was the primary factor. Why then is this crucial aspect so under-represented not just in media accounts but also within the mental health field? (Interestingly, the newspaper article by Julian Hendy did say that the mentally ill man had a history of excessive use of drink and drugs.)
Statements about ‘the media’ are almost as problematic as those about ‘the mentally ill’ or ‘the Middle East’. The Daily Mail is not The Guardian, blogs are not the BBC. (Er, unless they’re the BBC’s blogs.)
How ‘balanced’ is it reasonable to expect different media sources to be? Is there a difference between the responsibility within a short news piece and a lengthy article in a colour supplement? Should journalists and broadcasters be conscious of the stigmatising impact of concentrating mainly or exclusively on the exceptional? Or is putting each story into its own immediate context without sensationalist language and images sufficiently professional and ethical?
And what degree of responsibility, if any, do those of us with mental illness have in challenging stigma? It’s hard enough just getting through each day, trying to access the services we need and cope with medication side-effects we don’t need. (Oh. And bringing up our kids, earning a living, trying to get our dogs to eat out of a bowl rather than insisting on being hand-fed. She’s such a scamp, that Buddy.)
There’s an interesting issue with anti-stigma campaigns arguably over-looking or denying the legitimacy of concerns about the behaviour of mentally ill people. Many of us who spend time on inpatient wards talk about how unnerving it can be when those around us (and we ourselves) are behaving in a highly ‘unconventional’ or unpredictable way. These extremes of behaviour don’t switch on when we’re admitted and off when we’re discharged so there are plenty of times when people see us in a disturbed and disturbing state.
Perhaps there’s a parallel between the disproportionate, stigmatising effect of the media concentrating on the exceptional and newsworthy, and anti-stigma campaigns avoiding the painful reality that mental illness is often characterised by some of us being irrational and behaving in ways which seem or are highly risky?
A fundamental marketing rule is to start where your ‘consumers’ are. This applies at least as much to ‘social marketing’ campaigns. So if the majority of people you’re hoping to persuade have a particular view (eg mentally ill people are worryingly unpredictable), however unreasonable this may feel, it’s essential to recognise and address it in all its complexity.
Explaining that mental illness is very common and that only a tiny minority of us are dangerous is analogous to telling smokers that cigarettes could kill us. That’s certainly true, but health promotion has moved way beyond that in recognising the complexities and individualities of people’s addiction.
Finally, how do programmes like tonight’s affect our sense of self? I’ve absolutely no idea because there’s four hours to go until it’s inflicted on me. But I’ve seen similar programmes and, beyond the obvious about the gut-wrenching tragedy for the individuals left bereaved, they make me feel a bunch of very painful things about my own illness and about me.
My naughty internal twins, Guilt and Inadequacy, usually start dominating, and their companions Despair, Distress and Frustration tend to soon join in. It’s shame by association, helplessness by overwhelm.
I do have murderous compulsions but because of my particular illness, borderline personality disorder, I am fortunate that it is entirely self-directed. People with gentler conditions (and of course others with BPD), will between them have the full array of responses but it’s very hard not to internalise the stigma that the whole ‘mental patients are violent’ imposes.
Perhaps the programme will turn out to have at least elements which are both factual and constructive.
Marion Janner, founder of the campaign