There are many things about which it’s claimed “no one” used to speak — sexual violence, menopause, child sexual abuse. Usually, you’ll find that this wasn’t strictly true. Some people did speak about these things. It’s more a case that other people didn’t want them to. Pretending that no one raised the alarm — because these were different times, the past a different country — can be dangerous, not only excusing past inaction, but exaggerating how much progress has been made since. The fact that you are speaking now does not necessarily make you better than “them”. 

It’s a very different matter when it comes to conversations about mental health. How we discuss it has changed dramatically over the past few decades. In the eighties, when my brother was admitted to a psychiatric institution, I couldn’t tell anyone at school. Where I grew up, the local mental hospital was the subject of jokes and fear. “Mad” people were funny but also terrifying. Self-diagnosing oneself with a mental illness would have seemed absurd. If you had a label or lived with someone who had one, you kept your mouth shut. 

In 2007 the “Time to Change” campaign was launched by the charities Mind and Rethink. Its objective was to reduce mental health-related stigma. In one advert from 2011, we saw Dave, who’s “been off for a while with mental illness”, returning to the office. Worried colleagues fear that if they ask him how he is, he’ll literally fall apart — but it’s okay, he doesn’t. Dave is normal, just like you and me. 

The trouble is — you know it and I know it — there’s “mental” and there’s “mental”

This advert always unsettled me. I could see the good intent, and knew that undoubtedly there were people to whom it could apply. What, though, of people for whom severe mental illness meant never working? What about those whose behaviour, appearance and long-term prospects were permanently changed by the side-effects of drugs? There was nothing about this approach to “ending stigma” that made me feel I could be more open about my own situation. It would have felt like a terrible faux pas — oh my god, that’s not making it all look normal! You’re going to scare people all over again!

The trouble is — you know it and I know it — there’s “mental” and there’s “mental”.  Since the era of “Time to Change” (closed in 2021), it has become more acceptable to write and speak about some forms of mental distress, especially if you have the kind of politics, appearance and personality which will defy all the nasty stereotypes. There are certain narratives which have attached themselves to certain conditions, allowing you to describe them in ways which seem safe and non-accusatory. Just using the term “mental health” can be a way of signalling that you are empathetic and non-judgmental when it comes to how people feel. What I don’t see, however, is any significant change in how severe mental illness is understood, or any increase in concern for the utterly archaic way in which it is often treated. 

Last week the DWP announced plans “to send work coaches onto mental health wards to assist with CV writing”. I am not alone in finding this disturbing. When you are not so ill as to need in-patient treatment, it can be helpful to be pushed towards employment, as a way of becoming more outward-focussed (that’s assuming there’s a world of work that will welcome someone who is less “sane-looking” than Dave). To be an in-patient in a psychiatric ward is something else entirely, though. Fear of gatekeeping mental illness narratives runs the risk of trivialising the most serious one. There are times when we have to say “no, this isn’t the same”. 

… this felt more like a mental health-off, a competition to win a political argument on the basis of who can be the saddest

Around the same time I saw this news, I also spotted a tweet from the NHS Practitioner X account: “using a person’s correct pronouns can help improve their mental health”. Can it? It’s always vague what “improves mental health” means in contexts such as this — does it mean it will make a person feel better (which is generally what happens when other people do what you want)? Or is there an insinuation that something terrible might happen if others will not comply? There were many responses along the lines that forcing others to use language that doesn’t reflect their own reality affects their mental health (again, how much? How seriously?). For the record, I think it’s true that there is a relationship between mental distress and being forced to deny your own perceptions. Nonetheless, this felt more like a mental health-off, a competition to win a political argument on the basis of who can be the saddest. Whoever wins, it won’t be the actually mentally ill. 

When you claim something is bad for your “mental health”, you benefit from the hint that it will make you like a mentally ill person — but thankfully you’re not there yet. That people ultimately know there’s a difference is revealed by how offended those who complain about their fragile mental health become if you suggest they might be truly sick or deluded. But why don’t we focus more on those who are? 

Partly, I think, because these are the people who are most at risk in a culture where “telling your story” is the way you win empathy. Openness and paranoia do not go well together. It can be impossible to construct a coherent narrative when all you have is fear. What I’d like, I think, is for those who can speak to do so more clearly. To stop calling things mental health issues when they are things that make us sad or frustrated or irritated. To give direct names to the suffering we do want to talk about. To look critically at mental illness and treatments for those most severely affected (we are too busy de-stigmatising anti-depressants to look at the regimens that may well benefit from a good deal more stigma). 

We are talking about mental health all the time, but also not talking about it at all. In that sense, at least in some ways, we remain stuck in the past.