Saturday 10 August 2013

Unconventional Wisdom? Time To Challenge – Tackling Stigma

As the manager of a mental health voluntary service in Powys that provides a mental health information service, I am asked, in the conditions of our funding contracts, to “tackle mental health stigma”.  The dictionary defines stigma as a mark of disgrace. Goffmen defines stigma as an "attribute that is deeply discrediting".  

The Time To Change Campaign has been running across England since 2008.  It has been responsible for much activity from staff and volunteers across the country, all hoping that their efforts, attempting to tackle stigma, are having a positive impact.  You can look at evaluation reports from their work here.   It was no surprise to me when the Time To Change Campaign moved over the border, to Wales, last year.  The Welsh campaign is led by Mind Cymru, Hafal and Gofal.  

For many in Wales, this hailed a truly positive step forward, Comic Relief, Welsh Government and The National Lottery were willing to invest in mental health and stigma.  We were given a national focus for tackling stigma and surely all of those trying to tackle mental health stigma would get behind this campaign, work and stand together.  The campaigners hope that by tackling this stigma we will ensure that more people will come forward to ask for help.  In our mainstream services that often means getting the “right” diagnosis and then the “right” help based on this.

The easier path for me to take, as a manager of a service tasked to tackle stigma, would be to get in line to champion the campaign across Powys, join forces with others and together surely our efforts would have a positive impact.  However, I can not act in this way, because I do not believe that the main idea that underpins this campaign, and others like it (e.g. Saneline’s Black Dog campaign), is sound. 

So what is the bad idea that I think needs to be challenged?  Simply this, the mainstream idea that mental illness diagnoses are valid.  These campaigns use the terms “mental illness” as if diagnosis is the truth for understanding our behaviours, misbehaviours and distress.  The campaigns aim to see “mental illness” normalised and seen in the same way as physical illness.  This very statement implicitly indicates that the same evidence underpins a mental illness diagnosis as, say, a cancer diagnosis. 

My challenge to the idea of "mental illness" as a valid diagnosis comes in the form of the ideas of Thomas Szasz and his articulation of them.  In my opinion his arguments are based on logic and reason and I can never hope to articulate his ideas better than he.  You can access lots of videos of Thomas Szasz via the Internet, but here are two to get you started, should you be interested. 4 minute video highlighting a series of statements that summarise his position here and secondly a 5 minute video where he shares his opinions of diagnosing children with “mental illness” here.

As well as underpinning it's campaign with the idea of "mental illness", Time To Change uses the approach of statistics that tell us things like - 1 in 4 of us are effected by mental health problems.  In Powys, last month, this approach was challenged at an event, as one that in fact increases stigma, by reinforcing otherness.  Melanie Santorini from the Campaign led a discussion in response to this challenge and there seems to have been some agreement there that perhaps a message of “it's not 1 in 4 it's everyone!" would be more useful.  

Whilst I agree that yes potentially “all of us” could find ourselves experiencing mental distress and exhibiting behaviours that could be perceived as symptoms of “mental illness”, I do not think that all of us, or any of us for that matter, could have a "mental illness". 

All of us are living.  All of us will face things in our lives that are challenging to us (e.g. bereavement, sexual abuse, divorce, redundancy, becoming a victim of crime, illness).  Depending on our life experiences to that point, we will respond in different ways to the challenges that we face, and indeed in different ways depending on the timing of these challenges.  For some that response may be hearing voices, for some it is extreme and debilitating sadness, for some it may be behaviours that challenge our place in “normal society”. So I too would challenge the bold “1 in 4” type statements that many of this type of anti-stigma campaign use because I think these statistics are misleading.  They do not challenge us to understand that any of us, at any point in our lives, could find ourselves struggling to cope and that in response to this we may find that our emotions and actions fall outside of our current society’s understanding of normal behaviour.

And of course society's and individuals' understanding of normal behaviour changes all the time.  For example, I wonder whether I would have accepted a diagnosis of “Female Hysteria” as an illness if I had lived 100 years ago and how I would have responded myself to a women exhibiting “symptoms” like "sexual desire" and "a tendency to cause trouble".  Would I too have seen these behaviours as unacceptable, as symptoms of mental illness?  Would I have wanted “to help” this woman behave normally?  Or would I have asked myself whether her response was perfectly valid given her experience and given the constraints within which she had to live? 

Anyway back to tackling stimga.  The option that I perceive to be the easier one and the one that looks to most people, it seems, like the right thing to do (i.e. act in the name of these campaigns), I am afraid is not one I can take.  I have tried here to explain why.  I think that action, effort and good intentions based on underpinning ideas that are wrong, will produce unforeseen bad consequences. Eleanor Longden clearly articulates the consequences she had to face when her experiences where seen through a “mental illness” lens in this 15 minute video.  

So even though this is not the easiest path for me to follow, I can not support this campaign directly.  A close friend of mine often uses the following quote – I hope he is right...

“The truth will set you free, but first it will make you miserable.”  James A. Garfield

So how do you think we should be using our funding to tackle stigma?  What do you think about these campaigns? What do you think we could do to tackle stigma i.e. the disgrace, the badge of shame that we attribute to our mental distress?

There are many people out there, across Powys and indeed across the world,  challenging the medicalisation of distress and the conventional wisdom surrounding mental health, in our society and within our mental health services.  I would love to hear your thoughts and ideas.  You can comment on this blog, follow me on twitter @powysmh, get in touch with me here or keep up-to-date with events we are running on our website.  Why not join us at our free conference on Sept 19th.  Jacqui Dillon is to be our main speaker to help us continue with this debate.  I hope to hear what you think ...


  1. OK Laura, this point I'm sure will be raised time and time again and firstly, it is accurate to say that there are certain things that are done in the name of reducing stigma (and discrimination, the other main focus of Time to Change) that do not tackle their root causes and may in fact reproduce them as entities.
    However, although I agree with the majority of what you say perhaps their ought to be more emphasis in your post on cooperation and the positive impacts of initiating a conversation from a very difficult starting point?
    There are times and places where referring to 'mental illness' does have some validity- although your point that this is not universal, absolute or trans-historical is essential. For example, if I go to my employer and present the need for some time off to settle my mental, physical, emotional and other needs back to a manageable level for work purposes then the difference between the severity of some experiences that may have warranted a diagnosis and other forms of distress may need shorthand to be recogniseable.
    As for the campaign, consider the following question. Is a dis-ease of 'mind' made better when configurations of circumstance that are regularly life-shattering or fatal are talked about outside of specialist circles and known to be fairly common- or not?

    1. Hello - yet again thank you for reading and commenting.

      I take on board and fully support the importance of co-operation and starting a conversation. In a way this blog is one way that I am hoping to do some of this, but your comment amongst other conversations I have had over the last few weeks has reiterated to me the need for us all to talk more in an open and safe way.

      I would like to try and develop more ways for us to talk to each other, as you say from often very difficult starting points, I hope to have more news soon on this, but hopefully in the meantime the DIY Futures event on 9th Oct and the Powys Conference on Sept 19 Shaping Services (details from me or our website) will provide some opportunity for debate.

      I do, I think, understand your point, about how sometimes it seems that referring to 'mental illness' is the only thing to do. All I can do is continue to bring my truth to this debate and others will hopefully bring theirs. You might be interested in an online debate that happened last night at The Big Mad Experience entitled “Is it time to change the language of ‘mental illness’? and storified at

      Take care Laura

    2. Hi Laura,

      Thanks for your efforts and thanks for engaging with a random individual!

      I like this blog and find it very worthwhile.

      I believe that we all need to reflect a little more on the Time to Change debate. I will have a look at the above link a little later on but in the meantime want to clarify that I am still wondering about the appropriate use of the word 'illness', an otherwise semantically incorrect term.

      Perhaps using the term can increase compassion and tackle the sort of ignorance that deems the content of another person's head totally irrelevant? This, in my simple view, would represent an advance or a 'step forward'.

      Whether that usage simultaneously means that we are taking 'two steps back' is a moot point, and not an area for firm conclusion.

      I welcome the search for truth, and accept that you are challenging yours to a greater extent than I am challenging mine by my acceptance of occasional defeat, or slippage by use of the word 'illness'.

      However, please be cautious in aiming at what would be for most of us, a pyrrhic victory.

    3. Dear Philip - thank you for engaging with me and thank you for showing an interest in our blog. It certainly helps keep us motivated when we get people's comments/ideas and we check stats on a regular basis to try and make sure what we are doing is looked at and it seems to be ...

      I doubt very much to see any great shifts in my life time, though, but still I think that the important thing really is that we/others are at least having this debate and challenging our own and others ideas, and reflecting - I hope that this is positive for us all - all questions seem to lead to more questions ...but I for one enjoy the debate ...

  2. When overcoming mental health and substance abuse , it is very important to get help and have a support system.

  3. A very good article providing 2 alternative approaches to tackling stigma. Really worth a read if you are interested in this subject.
    When the Ads Don’t Work - stigma