Horizon

There have been a couple of Horizon programmes over the past 2 weeks (11th and 18th November 2008) revolving around an 'experiment' with mental health issues. I have written about them on the Mental Health Forum and reproduce a version of my thoughts here.

WEEK ONE

First let me try and describe the programme . 10 'volunteers' are taking part; 5 are 'normal' and 5 have a history of psychiatric illness (OCD, Depression, Bi-polar, Schizophrenic, Anorexia and Social Anxiety). 3 Professionals (a Psychiatrist, Psychiatric Nurse and Clinical Psychologist) observe the volunteers undertake a number of tasks and then have to identify who has or does not have a history of psychiatric illness.

In the first programme, last night, the tasks were performing a stand-up comedy routine in a pub, a psychiatric 'card test', cleaning up a cow shed, paintballing and another psychiatric test. At the end they correctly identified the person with OCD, but then identified someone as normal who in fact had a psychiatric history.

I have to admit that in the early stages I came very near to turning this programme off I was getting so  and I still have a lot of problems with it - but to some extent the volunteers are making it all worthwhile. Of course in addition to the problems it is also fundamentally silly - when I am well (and obviously all the volunteers are currently well!) I am completely confident that I could either convince anyone that I have never been depressed, or indeed that I am currently depressed if I wanted too. Any of us who have been through years of psychiatry, psychology, thought and read about our condition could do this. Not that I would want to! And that was my first big problem...

1.) The programme seemed to be suggesting that Mental Illness was something which should be regarded as something to be conquered and hidden. Obviously none of the volunteers was allowed to discuss their condition. Well everything which I want to fight towards in terms of stigma is to be able to say 'I'm a depressive live with it' - not of course happy to be so but accepting and yes, even in a way proud of it. Certainly not something to be hidden. It took me a long, long time to find the personal strength for doing this. But the OCD guy at the end of the programme when he had been 'outed' made exactly this point - he was OCD and out and said he had come on the programme to make that point.

2.) The approach is very behaviourist. This is obvious - the volunteers are watched sweeping up cow-shit or paintballing and their behaviour is observed by the professionals who make a diagnosis on the basis of their observations. The tasks are what makes it good television but also exploitative. Well I would hate both sweeping up cow-shit and paintballing but that has bugger all to do with my depression. It emphasises the external and overlooks what really matters which is what happens inside your head. It is about MENTAL Health after all.

WEEK TWO

I'll try now to get my thoughts into some sort of order having seen the second programme. It seemed to me that there were 3 reasons for making the programme...

1.) To get ratings, as entertainment. This has to be nowadays, as even the BBC is ratings driven. If the programme hadn't sold itself as such it wouldn't have been made. This is is why there was, however they tried to disguise it, a 'game show' aspect to all of it (remember that Big Brother was originally sold as a psychological experiment). I am not necessarily condemning the programme because of that, but it does need to be borne in mind, and there were times when I felt really uncomfortable with this aspect of it, particularly in tasks which were designed to bring out a particular MH issue such as sweeping up the cow-shit or the body image one last night.
The justification for the programme lay however in the following two reasons.

2.) To show that it was perfectly possible for psychiatrists (I am now using the term generically as in fact the 'panel' was 1 psychiatrist, 1 psychiatric nurse and 1 psychologist) to diagnose 'normal' people as 'ill' on the basis of their observed behaviour and to stress the fact, which the psychologist stressed, of there being a continuum of mental health rather than some sharp divide. In this aim the programme succeeded admirably as 2 of the 5 people selected as 'ill' had in fact no mental illness at all. The basis on which these people was selected was wholly behaviourist - how people had reacted to certain tests and social situations. It was an approach which would tend to confirm (it certainly did with me) the worst expectations of psychiatry - that it reinforces and proceeds along very conventional lines of thought as to what is 'correct' social behaviour in terms of things like leadership, teamwork, bonding and so on. So that 'incorrect' social behaviour such as tending to be solitary, nervous of social situations etc. is interpreted as an illness. This is psychiatry as a social tool, a validator and policeman of social norms and has nothing to do with illness. If we flip it we may consider how certain forms of psychiatric treatment may not be designed to help a person reach a situation where they are able to cope with their illness, but to turn them into functioning members of society as conventionally perceived.

3.) To show that it was possible for people to 'recover' from mental illness and live a 'normal' life. In this the programme was much less successful. I know that the participants with a history of anorexia and OCD were successfully diagnosed (given their performance in tests which were very obviously designed to reveal those problems) and both participants spoke as to how they lived a 'normal' life now as did the people with social anxiety, bipolar and depression (a side-note that the programme cheated on schizophrenia, as it said that was one of the conditions but in fact there was no participant with a history of schizophrenia). Certainly the participants themselves were a delight to watch. But obvious questions immediately arose. First the participants were very obviously currently in remission! But beyond this I would imagine (and indeed hope) that the psychiatric screening for the programme was pretty rigorous and so the participants had been carefully checked as to whether their involvement was likely to lead to any problems (if not and anyone does have a problem I hope they sue the a%$e off the BBC). This means that the participants were a fairly carefully selected group.

But the second and bigger problem is conceptual and revolves around the concept of 'cure'. The programme tended to suggest that the way out of mental illness was a 'cure' which would leave the person 'normal'. No details were given as to what continuing medication, psychological help or coping strategies the people were living on and with. Now it is certainly true that for some people a mental illness is an isolated episode which, once 'cured', will never recur. The psychologist in the programme had himself had such an episode. But for others, and numbers of us here, there is no permanent 'cure' in this sense; rather than is the evolution of a coping and containment strategy which may involve many elements of medication, psychological therapy, alternative therapies, but perhaps above all a lifestyle which will avoid situations which would tend to make us ill (not that such situations do not still occur, nor to say that this is ever easy and it is an endless struggle to try and balance having a life with not becoming ill). All of this on-going and permanent struggle with Mental Health issues tended to be avoided by the programme.

In addition there was in the premise of the programme a suggestion that mental illness is something to be concealed. Now I must be fair here. The OCD man, as I commented last week, was magnificent on this - he spoke up for the fact that he would not conceal his OCD. But in general because the programme's premise was that it was possible to 'hide' mental illness the implicit suggestion was that this was the right thing. This goes right against all anti-stigma and discrimination work which is centred on NOT having to hide; to be able to admit to mental illness in the way that one would admit to a physical condition.

Beyond even this there is something else which is a personal belief. A serious bout of depression is absolute hell which I would not wish on my worst enemy; I have lost long periods of my life to it and done and achieved a fraction of what I might if I had not been depressive. But despite all this there are some positives for me - I am a more empathic and sympathetic person, less judgemental; I am, when well, more self-contained, happier with my own company, more contented, more likely to challenge social norms and conventions. All these are gains. I am not saying I would not rather not have depression!!!! But one of the reasons I don't hide it is precisely because I think there are positives. The programme never started to examine these ideas but held a very socially rigid and conventional behaviour as normative and fulfilling.

In some senses I have been overly critical. I am pleased that there was a major programme, whatever its failings about Mental Health. But in another sense I have not been critical enough. Because the big lie of the programme was utterly unsaid or unexamined. This of course was the availability of services. Anyone who comes to this Forum and starts to read a small selection of posts will know just how hard it often is to get decent psychiatric assistance in the UK. The programme's implication was that people just had to walk into a GP and they would get all the help they needed on tap. As if! A balance would be provided by a programme examining some of the many thousands who are desperate for help and unable to access it. The programme's biggest lie of all was entirely off-screen.

tags: mentalhealth  depression