Mind and Meaning: Changing perceptions about mental illness proves a difficult task
The producers creator, Mel Brooks. Photo: Frazer Harrison, Getty Images
Monday May 04 2009
Who ever thought that a musical about Hitler would be performed on our stages, let alone that it would be funny? Yet The Producers, soon to be performed in Dublin, is crackingly funny and clever, proving that topics normally considered out of bounds as entertainment, need not be when handled sensitively.
So too with mental illness. A new musical that has broken another taboo, Next to Normal, recently opened on Broadway and deals with the crumbling of a family as they struggle to cope with the delusional beliefs of their mother, who has a combination of bipolar disorder and a traumatic past.
Written by composer Tom Kitt and lyricist Brian Yorkey, it is described as a "pop-rock score". Tackling difficult topics in this manner might imperceptibly and gradually break the silence and fear around mental illness.
Closer to home, similar strides have been made. Before Christmas, a surprising development in the reality-TV genre was the series How Mad are You?, screened on the BBC. It took 10 volunteers to a castle in Kent where they remained for five days. During their sojourn they cooked, worked and ate together and had to rise to challenges that included performing stand-up comedy, taking psychological tests and cleaning cow sheds.
The difference from other reality-TV shows was that five had diagnosed mental illnesses, the other half did not. Those with mental-health problems had diagnoses that included bipolar disorder, obsessive compulsive disorder, eating disorder and others.
The stated aim was somewhat vague and grandiose, but it was to identify if there are traits or features of mental illness in all of us. At the conclusion of the week three mental health experts, a psychiatrist, mental-health nurse and psychologist, were asked to identify those who had mental illness and those who had not. They could not.
It would be tempting to see the obvious conclusion as simply that there is no difference between those with mental illness and those without, and while this is manifestly true, a more in-depth examination of this is warranted.
Writing in the New York Times, psychiatrist, writer and resident scholar at the American Enterprise Institute, Sally Satel, argues that this experiment proves more about the benefits of treatment than about differences between those with and without mental health problems.
She points out that: "Such a soothing fiction distracts from the true reason the experts were stumped. It is not because people with psychiatric problems are indistinguishable from others. The experts floundered because the participants' most dramatic symptoms -- immobilising depression, agitated mania, relentless hand washing and so on -- had been treated and were under control."
If her conclusion is correct then this is a pessimistic and an optimistic message; pessimistic because up to 60pc of those with mental-health problems who are receiving pharmacological treatments do not adhere to this and non-adherence is the most common reason for readmission to hospital.
On the other hand, optimism should prevail in the knowledge that there are now interventions that are effective in treating the vast majority of those with mental illness.
There have been many well meaning anti-stigma campaigns, but even the most comprehensive, such as the Changing Minds Campaign, sponsored by the Royal College of Psychiatrists in London, or similar initiatives in the US, have only had a short-term impact on attitudes.
While knowing somebody with a mental illness also has a positive effect on attitudes, reaching the public at large is problematic. The stigma of tuberculosis, ingrained in former generations of Irish men and women, only disappeared in the 1960s after effective treatments had been discovered.
Satel concludes: "No matter how sympathetic the public may be, attitudes about people with mental illness will rest upon how much or how little their symptoms set them apart."
Like it or not, she has a point.
