TALKING ABOUT TALKING ABOUT MENTAL HEALTH – THE Q&A (PART 1)

 

As I mentioned in my previous post, the Q&A at our Skeptical Soapbox was as good as each of the talks.  An opportunity for the speaker to think on their feet and demonstrate that they know their stuff.  Here I will share some of the questions I was asked, and my responses:

“You said that we shouldn’t assume that the woman in Tesco’s was still suffering from a mental health problem, and that the cashier was wrong to refuse to serve her.  But how would you know that someone in that position wasn’t mentally ill and/or vulnerable?”

The simple answer is that I wouldn’t. You can’t tell if someone is mentally or physically ill by seeing them in a supermarket queue. But I would consider whether or not I thought it appropriate to say something. The cashier’s heart may have been in the right place; not wishing to take responsibility for the customer coming to harm. However, a person’s agency must be respected. Of course, anyone may end up self-harming or indulging in unhealthy behaviour, but it would probably happen with or without our “permission”. And that’s the key point: the cashier was refusing the customer permission to carry out a normal, adult task. Even if someone is mentally ill, it doesn’t mean they’re mentally incapable. I would suggest that the cashier’s response could have done more harm by dehumanising and infantilising the customer. It’s all about assumptions. Sure, I can’t assume that a person doesn’t have a mental illness, but I’m damn sure that I’m not qualified to diagnose other people’s ailments.

“What if I’m worried about a friend’s mental state; should I say something?”

This is a difficult question to answer; it depends on so many variables, many of which will be unique to your friend and the relationship you have with them. But broadly speaking, you need to judge the situation carefully to decide if you should say something, and how to say it. It’s pretty safe to advise that you should be discreet about it, however you choose to phrase it. It might be a good idea to arrange a day out, or a coffee, or something, with your friend – don’t make your questioning the focus of the day, but also make sure that you will have the time and space available to sit down and chat. Perhaps mention that you’re worried about something in their behaviour, and ask if they’ve spoken about it with anyone else.

Your friend’s reaction could be anything from relief, to fear, to defensiveness, so you’re really just going to have to do the best you can based on your own judgement.  Hopefully if you’ve handles it ok thus far, you’ll be able to work through it.  Your friend might need advice and support, and the best thing you can do is stand by them while they’re dealing with whatever issues they have.  Talk with them, stay in touch, invite them round for a cuppa, let them know that you understand what they’re going through.  And if you don’t understand, educate yourself.  The Mind website is an excellent source of information for people with mental health problems, those who are close to them, and anyone who wants to learn about mental health.

Things to NOT do:

Don’t try to diagnose them.  Talking about symptoms and what they might indicate is ok, but there is a line between suggesting that they may wish to consult a doctor, and deciding that you are the doctor.  Even if you are a qualified psychiatrist, (you will know that) there are serious ethical implications for offering your opinion on the mental health of friends and strangers.

Don’t gossip about it behind your friend’s back.  Even talking about it with close mutual friends with a view to looking at ways to help can backfire.  Your friend is the one with the (potential) problem.  They need to be at the heart of this conversation.  Interventions are a great way to alienate people and ruin friendships – no-one wants to be “surprised” by everyone sticking their oar into their private life.

Don’t avoid them.  They might be really difficult to deal with as a result of their illness; they really cannot help this.  From the outside, your friend might seem lazy, rude, aloof, anti-social, but if you were to experience their life you would come to realise that sometimes “being a bit flaky” is the best they can muster right now.  They are going to need the support of a good group of friends – their behaviour is likely to isolate them (through no fault of their own), and if you can help keep some semblance of normality and stability in their life, you are doing them a huge service.

Don’t smother them, but don’t just “leave them to it” either.  If you’re repeatedly checking if they’re “OK”, or doing things on their behalf because you’re worried they’re “incapable”, you are going to come across as condescending with no respect for their autonomy.  Again, mentally ill ≠ mentally incapable.  There are going to be times when your friend just needs a break, though.  Offering to perform specific tasks like cooking dinner one evening, or helping them tidy their house, not only helps them to keep on top of managing their life, but shows that there are people they can rely on, even when things get really bad.  And who doesn’t relish the opportunity to put their feet up and forget their troubles?

“The racist woman on the tram: obviously her behaviour was objectionable, but she just seemed out of control – like it would be reasonable to assume that she is mentally ill.  What do you think about that?”

The problem is the perception of associating mental illness with being out of control. There are many reasons why someone might behave like that, and yet our go-to explanation is “mental illness”. It might look like she has a mental illness; maybe she does. But she doesn’t need a bunch of strangers providing a running commentary on her behaviour and thought processes. Sometimes we are right in our armchair diagnoses. But sometimes it’s just better to keep one’s mouth shut. It’s worth returning to Slide 4, the one that states “There is no mental illness in DSM V or ICD 10 Ch 5 that lists racist abuse as a behavioural characteristic. Period. It does not happen.” – the author of this post goes on to say:

“My point is this: yes, a mental problem can lower inhibitions so that a person’s attitudes will inevitably be expressed at least verbally but also in their more general behaviour.  For that to happen, though, those attitudes must already be there to be expressed.

The other stuff is actually immaterial: what is relevant here is her attitudes and what allows them to be expressed so candidly.  With or without any mental illness, those attitudes are already there.”

And so, she might be out of control, she might well have a mental illness.  But that’s not what’s important here; we don’t need to invoke mental illness to condemn this woman’s actions.  What if she was irritable due to having a sprained ankle, and she launched the same tirade?  We wouldn’t link her behaviour to the physical injury, would we?

“Do you think the culture of scrutinising ‘benefit scroungers’ is contributing to the trend in people ‘diagnosing’ other people’s mental disorders?”

It’s definitely a contributing factor, but also related to this culture of Diagnosis By Internet is the fact that we are more aware these days of mental health conditions among the general population. It’s great that the average person has a better understanding than they did even ten or twenty years ago, but there’s a long way to go, and it neatly illustrates the point that a little knowledge can be a dangerous thing.

Back to the original question: is it the strivers vs. skivers mentality that’s fuelling this particular fire? Well, yes. The focus on whether a recipient of disability benefits ‘deserves’ it or not has been perpetuated by the media and the government, so that we end up with stories like this, this, and this. People expect to see evidence of hardship or disability. If you have an invisible illness, the options seem to be:

a) assume the person is lying;

b) find some physical evidence of their disability to make it easier to process.

I often find myself caught in a loop of over-explaining and apologising for taking up people’s time, because I’ve learned to make my struggles identifiable if I want any allowances made for me.  That’s another assumption about mental health that needs to be thrown out – that one must be struggling 24/7, with visible indication of said struggles, in order for people to consider one’s needs.

“What do you think is the solution to better educating the public about this topic?”

This may seem a surprising answer, but the tabloid press and soap operas are the best place to start conversations. These media have a far greater reach than science communicators, or possibly any other broadcaster. But specifically, they are accessible to an audience that skeptics are very rarely able to capture. The mass media is great for raising awareness of controversial topics like HIV/AIDS, teenage pregnancy, domestic abuse, etc. Seeing something on the TV or in the newspapers generates conversations, which is the first step to achieving wider understanding. As intellectuals, we may scoff at soaps and The Sun, but those are the outlets we need to target to communicate with those who will derive the most benefit. We might spend hours on YouTube watching science documentaries, but the average citizen does not.

 

There were more questions, too many for one blog post, and I also can’t remember all of them.  But I was asked some further questions by email, which I will respond to in my next post.

 

1 thought on “TALKING ABOUT TALKING ABOUT MENTAL HEALTH – THE Q&A (PART 1)

Leave a Comment