Does '1 in 4' actually reinforce stigma?
I was recently offered the opportunity to go on BBC Radio 4’s All in the Mind to make what I consider to be a vital point about a fundamental flaw in the way our society is campaigning against stigma in mental health. I wanted to argue that by using the headline statistic ‘1 in 4’ to refer to all people who have mental health problems, campaigners are more likely to reinforce stigma than reduce it.
This is for two simple reasons. Firstly, by using a single statistic for mental health collectively, something never done with physical health, it is being implied that mental health only applies to a minority, albeit a substantial minority, of people. This is a category error, treating global mental health as if it were the equivalent of specific physical disease and therefore a sub-category of health rather than an aspect of all health. Secondly, by using statistics in this way we reinforce the false notion that people either have or do not have mental health conditions in a binary fashion. By doing this we encourage people to think ‘I am not the one with the mental health problem; I am one of the normal majority, the 3 in 4’. By using figures in this way we exclude the more valid proposition that mental health is always an issue for all people and that we are all on a spectrum of mental health throughout our lives. We are never entirely free of the same anxiety, panic, despair, obsessionality, self-dislike, emotional insecurity, grandiosity and suicidality to which some people are more prone (usually because of more extreme or painful life experiences from childhood onwards). By reporting mental health phenomena as ‘binary’ rather than as ‘continuous’ we are not only perpetrating bad science, we are undermining our own worthy humanitarian objective.
I was given the chance to debate these issues in the studio at BBC Broadcasting House with Sue Baker, the director of ‘Time to Change’, a programme dedicated to ending mental health discrimination, led by the charities Mind and Rethink Mental Illness. Presenter Claudia Hammond and her producer Fiona approached the subject very professionally and I felt that I was given a platform to get across something I felt passionate about and that was perhaps not easy to articulate in a short space of time. I believe (perhaps because of my own grandiosity!) that I won the debate and that Sue had no real answer to my points, saying that she agreed with me in principle at but felt that the public were not yet ready for such a powerful message. I still cannot agree that ‘baby steps’ are what is needed to change attitudes, and I believe strongly that even baby steps need to be in the right direction.
My contribution was pre-recorded, and certain things were cut out, primarily for reasons of time. For example, I had made the simple point that in 30 years of NHS practice I never saw anyone who sought help with a serious mental health problem who didn’t also mention other people in their lives whose mental health was more concerning and yet were not seeking help at all. Where were these other people included in the statistics? Were we also counting in these figures the not negligible number of powerful people in our society, in our businesses, schools, hospitals and other organisations that bullied others and exhibited signs of ‘personality disorder’? Were we only counting people who could accept their need for help when these were usually mentally healthier than those who didn’t? I also didn’t have time to say everything that I felt was relevant, such as the fact that men don’t seek help as easily as women… where is gender in crude statistics such as ‘1 in 4’?
On the whole I had a very positive experience of contributing to the programme, which was broadcast on 11 November. Some previous radio experience helped me to be more comfortable with the technology and familiar with studio etiquette. In particular I was grateful to Claudia and Fiona for giving me the chance to put across a more positive and normalising vision of mental health campaigning. I was allowed time to read out a list of mental health issues that include all of us – four in four – and I would like to conclude by reiterating the list here.
If you ever:
- Got rejected, neglected, hurt or badly misunderstood by the adults responsible for your care when you were growing up
- Experienced favouritism or bullying at home, school or work
- Felt like an outsider
- Looked in the mirror and felt unattractive
- Got betrayed or hurt in a love relationship
- Comforted yourself with food, drink, drugs, betting or other activities
- Experienced traumatic loss of someone or something much loved
- Pretended or fantasised that you were much more adored, important and special (as a good or bad figure) than was true
- Felt terror of death, failure or obscurity
- Doubted the point of your own existence or wished that you weren’t there
- Got devalued or put down because of your looks, accent, class, nationality, race, gender or religion
Then you are indeed suffering from a mental condition. It is called the ‘human condition’.
Martin Seager is Honorary Consultant Psychologist with the Central London Samaritans
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