This is a bit of a downer to write. As someone who’s written about mental health a decent amount in the past, sometimes in a way that I’m uncertain had a net positive effect, it’s difficult to write about our discourse in a way that isn’t totally positive. I certainly don’t want to discourage people from talking, and writing, and speaking out in a society which is often ignorant or misunderstands the issues. That said, our conversation could be better. It could always be better. Stigma is a huge issue when it comes to mental health, but it’s not an issue which is uniform or which can be tackled simply by talking as much as possible. We need good talk. A diversity of voices, telling their stories, calling out the bullshit, recognising the fallibility of our own beliefs, understanding that not everything can be explained, and that sometimes the invocation to ‘just talk’ can hurt more people than it helps. So here’s some chat about the different types of stigma and the limitations of our current strategy, the one that I call ‘just talk’.
Mental health has enjoyed an increased exposure in British discourse over the last couple of years. I was sitting in a staff room in a school in Leith the other day, getting ready to judge some kids who were going to argue with each other about something significant, and I couldn’t stop staring at the two posters on the noticeboard (in amongst the adverts for teaching unions and exhortations to STAY AT HOME for 48 hours after you’ve had the winter vomiting bug) telling me just how many people have thought about killing themselves and that more people need to talk to their mates about suicide*. When I walk down Edinburgh’s main drag, I’m periodically confronted by billboards reminding me that a man kills himself in Britain every two hours, thanks to organisations like CALM. So many of my friends (and acquaintances, mostly-strangers, frenemies, etc) have written articles about their experiences of mental ill health, told their friends, come out to their families, campaigned for better provision of services for those who struggle every day against chronic illnesses of all kinds.
It’s nothing short of fantastic that there’s increasing recognition of the pain and constant internal struggle that mental illness visits upon the lives of one in four of us every year.
The benefits of talk
But either in spite of this coverage or because of it, we’ve been lumped with a narrative that says that the main issue – possibly the only issue – with mental illness is stigma, and that this stigma can be eradicated if we, as individuals and as a society, are prepared to have a conversation about mental health. It says that talk solves.
There’s an extent to which this is true. When something is totally taboo, nobody talks about it, many people don’t know it even exists, and simply exposing it to discursive daylight can be a big positive. The issue gets more exposure, letting people know not only that a problem exists, but that people they know and love are affected and they should probably take it seriously. It gives (a limited degree of) comfort to those affected: you know you’re not alone, that other people are suffering too, that what you’re feeling or experiencing is a legitimate problem, you’re not just (as it were) going crazy. You might seek help which you wouldn’t otherwise have done, either because you didn’t know it existed or because you didn’t know it was something for you. You might come out to their family or friends, gaining vital nodes in your support network, finally managing to convince yourself that telling others doesn’t simply make you a burden, that a problem shared is, if not a problem halved, then at least a problem rendered less intractable.
This may simply be a result of living in the liberal, coddling (some would say cloying) bubble of university campuses for the last four years, but I reckon I’ve seen an increase in all of the above recently.
The problem comes when we say that all we need is talk, that because everything is getting better with talk, that’s all we need. If we keep talking about it, the stigma will just melt away like the Wicked Witch of the West. But stigma isn’t just one thing, and there isn’t any one conversation-based panacea which can eradicate it in all its forms.
Taboos, misunderstanding, moral opposition
I think stigma comes in three broad forms. First, taboos. Nobody talks about it, people suffer in silence, society at large is unaware that it is a problem or to what extent the problem exists or to whom the problem occurs. This is the kind of stigma that talk (mostly) solves, because something something sunlight best disinfectant.
Second, stigma takes the form of misunderstanding: when we do talk about a subject, but we hold misconceptions in our minds. We might not understand exactly what the problem is, how severe it is, how it happens or to whom. In many cases these misunderstandings arise as a (kind of unavoidable) side-effect of talk. We live in a society which talks far more about sex than we did in generations prior, but as anyone who’s ever ventured into the inner pages of Cosmo can tell you, that doesn’t mean that we understand it perfectly or that there are no ridiculous myths. We talk so that we can get rid of a taboo. A lot of the stories and accounts we produce this way are likely to be simplistic, or unrepresentative, because nobody can represent the whole diversity of human experience, no matter how articulate they are, how brave they are. And because stigma means that such accounts are likely to be few and far between, often we think that the single article we read in the Atlantic is representative in all its detail. And then we talk, and we spread misinformation, playing a game of stigma Telephone, distorting the details and giving rise to all kinds of bullshit.
I’ve read a number of articles about men’s mental health which can be summed up like this: “men make up 75% of all suicides, men are taught emotional stoicism, societal support for men with mental illness is inadequate and they are unlikely to seek it, suicide provides them with a unique form of control over their lives so they kill themselves. If we talk about male suicide, break down stoic norms of masculinity, and encourage people to get treated/seek help, then we can solve this problem.” At best, these explanations, however well-intentioned they may be, are incomplete. They don’t account for the diverse reasons that men choose to take their own lives, they don’t give any reasons for the gender gap, and they don’t give any real reason that talking about the problem would help solve it for those men who have sought help and found it ineffectual.
At worst, this is actively unhelpful. Why? Because of what and whom it excludes. The men for whom suicide is compelling not because it provides them with control, but simply because they can’t push the thoughts of death out of their head. The men who have sought help and found it wanting. The men who have been through every avenue of treatment, had counselling, been given prescription drugs, and still find the everyday weight of living unbearable. The women who may also feel unable to seek help, who may also have been socialised into not expressing their negative emotions, not being a burden on others. The people who have been talking about their mental health for years, to friends and family and doctors and counsellors and strangers and who still find themselves unable to pull themselves out from under their duvet until 3pm because their head won’t stop screaming at them that they’re worthless and life is hopeless and everything would be better if they had never existed but, failing that, at least they can remove themselves from the world now.
We don’t just need talk to eradicate this kind of stigma. We need good talk. We need complex, intricate accounts of personal experience, coming from a diversity of sources, and a recognition that no one person’s story can perfectly substitute for everyone’s (or anyone’s). We need active efforts at myth busting: recognising the differences between self-harm and suicide, the diversity of reasons (or lack of reasons) that people suffer from mental illness and its consequences, the spectrum of efficacy along which ‘help’ can fall. We need to clarify that sometimes these things resist explanation, that they can’t be explained, and that if that is your experience then that is also legitimate, and that you shouldn’t feel pressured to provide a perfect explanation of why you feel this way. We need to understand that sometimes just talking can be harmful, if it comes from a position where you don’t have the lived experiences or insight to contribute in a way that doesn’t homogenise and simplify the conversation.
The third kind of stigma I call moral opposition. This is where there’s not just a misunderstanding of an issue or trait, but viewpoints and discourse which make life actively worse for those affected. Because it’s active opposition rather than passive ignorance or misunderstanding, this kind of stigma is both important and really hard to tackle. In terms of mental health, moral opposition commonly occurs in a few areas, usually those which are also the most misunderstood. Suicide, self-harm, harmful narratives surrounding ‘willpower’ and ‘positive mental attitudes’: all suffer at the hands of self-righteous op-ed pieces and articles shared by those people you used to know in secondary school who have turned out a bit racist and really like the LAD Bible. I still cringe inwardly when I remember being interviewed about my experiences self-harming on BBC London, talking about it as part of a constellation of symptoms and a coping mechanism and a sign of a deeper problem, only to be cut off and told that they ‘couldn’t endorse it’. I thought just talking would help, and I was really wrong, and it really hurt.
Such deep-rooted stigma can only really be tackled by presenting complex, informed and relatable narratives in places where large numbers of people are likely to read them. Achieving this combination of factors is nigh impossible without serious influence. It’s not a problem which can be solved through ‘just talk’, but we can mitigate against it. For every column of bile about the way the internet is encouraging teens to self-harm, there needs to be a clamouring of voices calling out the lies. It’s difficult and tiring and emotionally knackering, but informed communities can help to stem the rising tide of effluent, even if we can’t drain it altogether.
*(As an aside, it’s really strange just how much adverts like that can affect you as a person who regularly thinks about that kind of thing (don’t worry Mum and Dad, not in a serious way, I’m ok) and how that makes you so aware of all the other adverts about alcoholism and cancer and sexual assault and how much they must invade the consciousness of people for whom those are salient).