The BBC’s ‘In the Mind’ series has completed its first week of programmes and it seems appropriate to write a half-term report on the success, or otherwise, of this high-profile attempt to address the crucial issue of mental health.
Prior to the start of the series, David Brown (the ‘In the Mind’ BBC News Project Initiator) said that the programmes were aiming to ‘make a real contribution to the understanding of issues related to mental health’. So after seven days of news, drama and documentary, how successful has the project been in educating the British public about the causes of, and helpful responses to, human misery and suffering?
A traditional school-report grading format will be used:
E. Very poor
Criterion 1: Balance/breadth of coverage: D
Based on the bulk of the content so far, the average viewer could be forgiven for assuming that mental health problems represent ‘illnesses like any other’, caused by brain defects that can only be rectified by medication or electro-convulsive therapy. Such a premise is misleading, unhelpful and not supported by the scientific evidence.
The introductory information on the ‘In the Mind’ website harboured ominous signs of this subsequent bias. A human brain dominates the logo, a picture that could have been lifted from the wall of any hospital neurology department – perhaps we should be grateful there were no white-coated doctors with stethoscopes swinging from their necks! Charlotte Moore (Controller of BBC TV & iPlayer) proclaims that ‘medical advances mean we have a greater understanding of the brain than ever before, but we are not there yet’, thus mimicking biological psychiatry’s 60-year long battle cry that a revolutionary discovery to explain, and subsequently cure, mental illness is just around the corner.
Medical language, implying that mental health problems are no different from physical illnesses like diabetes, litter the high-profile documentaries. The watching public witnessed Stephen Fry (‘Not So Secret Life of a Manic Depressive: 10 Years On’) and his psychiatrist agonise over the ‘correct diagnosis’ – was he bipolar I, bipolar II or cyclothymic? – thereby perpetuating the fallacy that the right label would help steer them towards more helpful interventions. In a similar ilk, Hannah (an overwhelmed and tormented lady featured in the My Baby Psychosis and Me documentary) after spending a month on a specialist unit, benefits from a major ‘breakthrough’ when the doc decides she’s got bipolar disorder!
Furthermore, these two flag-ship documentary programmes focus almost exclusively on medication with, at best, only fleeting reference to non-medical means of countering human suffering. When the current drug regime is not achieving benefits, the dose is increased as if the correcting of the assumed underlying brain aberration is the only solution. When this fails, Hannah is subjected to shock treatment (electro-convulsive therapy), an approach the psychiatrist describes as an ‘extremely safe’ and ‘most effective treatment’, despite the substantial scientific evidence that casts doubt on its efficacy and highlights enduring memory impairments as a side-effect.
Criterion 2: Awareness raising: B
It is to the BBC’s credit that so much of its recent schedule has been dedicated to the often-neglected issue of mental health. Despite the fundamental flaws regarding the tone and content, such high-profile broadcasts will undoubtedly succeed in raising awareness of the extent of human suffering within our midst.
In particular, the plight of suicide survivors was powerfully conveyed by two personal stories (Life After Suicide and Professor Green: Suicide & Me). And irrespective of the lack of balance in the Not So Secret Life and My Baby Psychosis & Me, many more people will now be aware of the stark challenges presented by mood instability and the anguish endured by some individuals in the aftermath of childbirth.
Criterion 3: Anti-stigma impact D
A substantial body of research suggests that ‘illness like any other’ assumptions about mental health problems, where brain flaws are seen as causal, tend to intensify the degree of stigma experienced by those so labelled. Granting Ruby Wax prime air time to spew nonsense about ‘broken brains’ and the physical essence of mental illness, plus her visible excitement at the prospect of a biological test to reliably distinguish the afflicted from the rest of us, could significantly stymie ongoing efforts to reduce stigma.
Similarly, the correspondent, Fergus Walsh, predicting a revolution in neuroscience – ‘the decade of the brain’ – again misleadingly implies that the primary solution to human suffering will emerge from biological research, an unrealistic notion that will further stigmatise those people identified with a mental health problem.
The shameful lack of reference to environmental factors (childhood adversity, poverty, discrimination, disempowerment) as major contributors to the development of human suffering incriminates Not So Secret Life and My Baby Psychosis in the same way.
Criterion 4: Recovery focus: E
Although the concept of a ‘recovery approach’ to mental health problems can sometimes be corrupted by politicians eager to reduce the cost of welfare benefits, the underlying philosophy is sound and enabling: that each person, irrespective of the severity or type of psychiatric difficulty, can achieve a fulfilling and worthwhile life. Arguably, the most damning criticism of the ‘In the Mind’ series so far is that it conveys a very pessimistic message about the prospect of recovery from mental health problems.
References to ‘bipolar disorder’ consistently implied an enduring condition that would require life-long medication. Pessimistic assumptions of permanent incapacity underpin much of the commentary and risk becoming self-fulfilling prophecies.
A couple of (unchallenged) comments within the documentaries further illustrate the hope-stifling tone of the series. In My Baby Psychosis & Me, the husband of one of the patients says ‘we thought for a long time that we would not be able to have children at all because of Jenny’s illness’, a disturbing remark that either echoes ideas reminiscent of the eugenics movement of bygone years or inflates the likely risk of a person with existing mental health problems deteriorating after giving birth. In addition, a mother of a young woman with a diagnosis of bipolar disorder in the Not So Secret Life documentary berates her daughter’s illness for having ‘ruined any chance of her having a similar life to her friends’.
Maintaining hope of recovery is of central importance when people present to psychiatry, typically overwhelmed and in the depths of despair. By colluding with the pessimistic, hope-crushing messages of traditional psychiatry the ‘In the Mind’ series does a disservice to all those individuals who suffer mental health difficulties.
Photo courtesy of Stuart Miles at FreeDigitalPhotos.net