According to Theresa May, the main problem with mental health in this country is stigma. This is convenient. If it were a lack of trained professionals, or excessively long waiting lists for treatment, or too much pressure placed on mentally ill people to return to work, any solution might prove expensive. Thankfully, tackling stigma is, by all accounts, cheap.
Speaking to Sky News’ Sophy Ridge, May claims that “it is always wrong to assume that the only answer to [mental health] issues is about funding.” She is of course right. One could, theoretically, spend endless amounts of money on institutionalising every severely mentally ill person in this country and it is extremely doubtful that all this would be for their own good. Throughout the late eighties and early nineties, much criticism of the Thatcher government’s Care in the Community seemed to me “we don’t want these maniacs walking our streets” masquerading as “we’re only worried about a loss of resources.” A welcoming, understanding outside world is both less costly and more valuable to many mentally ill people than a hospital bed.
Having spent time as a patient in a psychiatric ward, and having friends and relatives who have done the same, I am under no illusions about the impact of being a deeply distressed, deluded person surrounded by many other deeply distressed, deluded people. My own response to this was: 1) to get more distressed and deluded, 2) to smuggle alcohol into the ward until I got transferred to A&E, 3) to run away and sleep on friends’ floors rather than ever go back. I fared a lot better with outpatient treatment. Crucially, however, this treatment was available in Oxford, where I was living at the time. In Cumbria, where I had first become ill, the options were either to become so terrifyingly ill people were forced to find a bed (even if said bed ended up being, as mine was, across the border in Scotland), or to struggle on with no formal support network at all.
As Hannah Jane Parkinson writes in The Guardian, with May’s current approach to mental illness, plus the precedents set by previous Tory governments, “we are in danger of being lulled into security by the walls of stigma surrounding mental health being brought down, while the help available washes away.” It’s all very well to “tackle stigma” (although as Parkinson points out, it is not as though David Cameron did not suggest he was doing this, too). It cannot become an excuse for suggesting that under-resourcing does not need to be tackled, too.
Except that’s precisely what it does become. That’s how stigma works in today’s political discourse. It’s a vague, free-floating miasma, creating bad thoughts and lazy misconceptions about something that isn’t so bad after all. There is no broader structural reason for mental health stigma, no way in which the squeamishness, embarrassment and fear surrounding mental illness might be related to the time, effort and resources needed to deal with it. It’s just pure irrationality.
May focusses on mental illness in schools and the workplace because presumably that’s how she sees most mentally ill people: as functioning cogs in the capitalist machine. But what about those who can’t work? Is this all a question of stigma, too? I am aware of how people look at severely mentally ill people when they are not behaving “normally” in public. I am also aware of how campaigns to make mentally ill people appear “just like you and me” do not necessarily help those who fail to live up to the prescribed standards for “you and me.” This is about stigma but it is also, fundamentally, about time and care. And it is also about money. These things are not unrelated (not least because the current government has been complicit in stigmatising those who cannot earn due to any sort of illness).
Treating stigma as a self-contained phenomenon shifts the focus of debate from what we, as a society, are doing to others – how we are neglecting them, exploiting them, hurting them – to second-guessing what others are thinking and telling them their thoughts are bad. I’ve seen this happen with women’s issues, too. We are told that femininity is stigmatised, sex work is stigmatised, housework is stigmatised. If only we stopped thinking such negative thoughts about these things, they wouldn’t be a problem. Except the problem here is not stigma itself, but the exploitation of women’s time, work and bodies. Thinking good thoughts about exploitation does not make it any less exploitative, nor does it end the implicit stigma of being a member of an undervalued class.
Stigma cannot be tackled without a clear-eyed examination of why certain people are stigmatised. I can’t help thinking this almost always comes down to what others want from them or what they don’t wish to do for them. Stigma serves a purpose and exploitative governments thrive on it. Ending it will take more than telling others what to think.
Image: Waterford District Lunatic Asylum on John’s Hill in Waterford. National Library of Ireland on The Commons.