The worst piece about mental illness on the internet
It is murky here on the internet and it’s good practice to read most things twice just to make sure you’re not being had. But I’ve been through Brendan O’Neill’s ghastly piece about mental health (“You are not mentally ill”) four or five times now, and unfortunately I think he means it.
O’Neill published his piece on Medium, although commissioned at least two similar articles (“How Prince Harry is failing the mentally ill”; “In defence of the stiff upper lip”) for Spiked Online, which he edits. Between them, they lay out a brave agenda with a clear target: apparently mental health awareness campaigns need to stop.
According to O’Neill, the recent attempts to improve mental health in this country have simply gone too far. Despite overwhelming evidence accrued by scores of clinicians across the world over several decades, the way to better mental health is not, as is generally considered the case, to talk about it. It’s actually specifically to not talk about it. “We shouldn’t ditch the stiff upper lip; we should rehabilitate it,” O’Neill (no medical training) says.
O’Neill has been tipped over the edge by the royal endorsement last week of the Heads Together campaign. While he graciously accepts that “William and Harry had a horrendous experience early in life”, he steadfastly is not “buying the idea that their mental-health campaign is brave or necessary”. O’Neill insists the UK is now one big orgy of mental illness celebration, where the mentally ill are deified like idols and it’s Christmas every day for anyone lucky enough to be employed in treating mental illness. Only by taking a hard line against these mental health awareness despots can this plague of goodwill, understanding and progress be halted.
Of course, only the princes themselves will know how much bravery they actually needed to join the Heads Together campaign, but given that a) the general idea behind almost all mental health awareness campaigns is to reduce the impact of eminently treatable conditions, and that b) the first step on the path to achieving this is diagnosing them early, but c) suicide is the biggest killer of men under 45 in the UK, I’d say their campaign is “necessary”.
Thankfully much of O’Neill’s bluster can be dismissed immediately as it is simply, objectively wrong. We needn’t dwell, for instance, on the claim that what is now called “bipolar disorder” is the same as “feeling up one day and down the next — which used to be called ‘moods’.” Similarly, despite what O’Neill says, you actually can’t “boost your standing in respectable society by having a mental illness”, and his insistence that he can’t remember the last time he “met a student who didn’t claim to have a mental illness of some kind” has to be a lie.
It’s also not true that “anyone who raises so much as a peep of criticism of campaigns like this runs the risk of being branded a heartless bastard”. As much as O’Neill seems to revel in the idea of being a loathed agitator, this is just ignorance rather than heartlessness.
But let’s take a look at some of O’Neill’s other claims because maybe they have the potential to be convincing, even if they are also dangerously wrong-headed. Before we do so, though, I want to introduce an analogy that I think is pretty useful. I apologise in advance if it is too crude.
[Begin analogy]
If you wipe your arse and see blood on the tissue paper, there’s an exceptionally high chance you are not seriously ill. You may have rubbed too hard with scratchy paper and caused a cut, or there’s a pretty good chance you’ve got haemorrhoids. But the NHS is far from alone in advising: “You should always get rectal bleeding checked to rule out more serious causes.”
Those “more serious causes” include anal or colorectal cancer and the only people who can determine whether it’s worth investigating further are medical professionals. There’s only a minuscule chance that that’s what you’ve got, and there’s good news too: both are a “type of cancer that can be cured if detected early”.
No doubt the actual process of checking this out is going to be something you’d rather not do. You’re going to have to tell a doctor, possibly someone you’ve never met before, that you’re bleeding from your arse. You’re going to need to show it to him or her and might end up with a finger poked up it as the diagnosis is made.
You could say there’s a stigma attached to shoving your arse in a stranger’s face. But if you’re bleeding, you have to bend your stiff upper lip because it might save your life, and comfort yourself in the knowledge that doctors look at arses every day. The very least you’ll get is some decent dietary advice, the names of some manufacturers of softer toilet tissue or an appointment at the piles clinic. Mind at rest, your incredibly common complaint will be taken care of — and you should think yourself lucky you live in 2017. It would have been much, much harder to have done all this in 1954.
Doctors treating colorectal and anal cancer — much like those specialising in breast cancer, prostate cancer, or any kind of potentially fatal illness — want as many people as possible to know about the disease, to be able to recognise its early symptoms, and to get those symptoms looked at as soon as possible. This is called “awareness” and it’s the basis of all campaigns that have saved millions of lives. Awareness gives professionals the best chance possible either to rule out something sinister or to cure whatever ails. No one ever died of too much awareness.
But back to the matter at hand. End analogy. Some untreated mental health disorders kill people, just like cancer can. Both are potentially life-threatening conditions. And just as it is very far from the case that most people who notice blood on their toilet tissue die from it, most people who feel their mental health may be suffering in ways they can’t control can be treated incredibly quickly.
One of the other articles on Spiked actually mentions this — although it scoffs incredulously as it states: “Apparently, ‘ending the stigma around mental health’ equates merely to talking about your problems.” Yes, that’s exactly it. You’ve hit the nail on the head. And why wouldn’t you want to do something so simple?
It is surely a good thing to get something potentially damaging out in the open early, to nip in the bud what could become a far bigger problem. Why on earth would you advocate keeping quiet, maintaining a stiff upper lip, not telling anybody that you feel slightly ill, allowing a problem to fester and grow into something potentially far more serious, when it can be treated immediately with nothing more than a decent chat with a mate? You’d never tell someone to man up if they said they were bleeding from their arse. Why would you do that if they say they’re feeling mentally unwell?
Lots and lots of people still find it incredibly difficult to go to a doctor when they know they’re going to have to drop their trousers. And lots and lots of people still find it incredibly difficult to admit that they feel there’s something going on in their mind that they can’t deal with. But awareness — conversation — invariably helps. Every mental health expert in the world will tell you that.
O’Neill, however, knows better. Citing no evidence beyond the fact that there are a lot of books in Waterstone’s about mental health, he says that there’s actually no stigma attached to mental illness anymore. This is offensively, catastrophically wrong. If you talk to absolutely anybody involved in the treatment of mental health issues, or who have suffered mental health issues — even the “genuine” ones that O’Neill accepts exist (and more on that appalling claim in due course) — there is still enormous stigma attached to mental health. Unexplained gaps on CVs vastly diminish job prospects. Common parlance routinely uses words associated with mental illness as derogatory terms. People still stand beside graves of their closest friends and say, “I never knew there was anything wrong with him. He seemed all right to me.”
It is as plain as day: these things happen because there is a stigma around mental illness. People die rather than mentioning it. People also still die rather than telling their doctor that they are bleeding from their arse. There’s a stigma still around that too.
Difficult to believe, I know, but O’Neill isn’t done. He has other claims that are demonstrably untrue. He says, “The other really bad thing about the mental-illness fashion is what it does to mental-health services: it clogs them up. It distracts the attention of doctors away from those who are genuinely in need: the clinically depressed, the schizophrenic, the suicidal.”
In other words, having insisted that awareness campaigns are bad for mental health services, O’Neill heroically comes to the defence of mental health services, who routinely insist that what they need most is more awareness. OK. But let’s not be unfair. He actually says that it’s fine for people who are “genuinely in need” to sit in the waiting room, but they had better bloody well actually have colon cancer because we’re sick and tired of people coming in here with their piles or their anal fissures or their bad diets or their Tesco Value bog roll.
Perhaps O’Neill is especially gifted and can immediately separate “genuine” mental illness from whatever he considers to be fraudulent mental illness. On the other hand, perhaps this is just unmitigated nonsense. There is simply no truth to the claim that people talking about “having a shit day” on Twitter means that people with schizophrenia aren’t being adequately diagnosed or treated. People whose bloody tissue indicates piles get sent to a piles clinic; people whose bloody tissue indicates colon cancer get that treated elsewhere. It’s really very easy to separate the two — so long as they’re both examined.
I daresay some people show up in doctors’ offices with “blood” on their toilet paper who forgot that they ate beetroot salad washed down by Ribena and Guinness the night before. But no doctor is going to condemn these obscene time-wasters for showing up. The doctor will instead send them on their way with a reminder to come back immediately if the symptoms persist.
I’m going to be more fair to O’Neill than I really want to be and try to pick out the kernel of a point from his rantings. I think actually there might be two. What I think he is trying to say is that 1) there are sometimes a few people who embellish the extent of their temporary psychological suffering, typically on social media, and 2) the term “mental illness” is sometimes too broad to be useful as it cannot immediately differentiate between its two extremes (untreated, unpredictable schizophrenia at one end, for example, and someone on Twitter saying they’re depressed after running out of milk at the other).
But even if you accept these points (and there’s definitely an argument to be had on each of them), these are tiny — absolutely minute — observations on a vast and complex subject. There is no way that anybody who is serious about the treatment of mental health issues considers over-reporting on Twitter to be a significant factor in their work. It would be absurd to complain about it. It’s a vanishingly small part of the job.
Further, the fears over the blanket term “mental health” represent a minuscule point about linguistics. The insistence that mental health campaigns are actually to blame for the rise in mental illness is a gross contortion.
What actually seems to be O’Neill’s principal issue is that he is irritated by some people on Twitter. That’s about it. And as a way of rounding on what he considers to be overdramatic tweeters, he’s belittling the torment of millions of people, potentially making far worse — possibly fatally worse — as yet undiagnosed conditions, and undermining the work of thousands of professionals attempting to combat a real and growing problem.
It may be true that social media encourages narcissism and solipsism and that cyber-life promulgates new stresses while magnifying others in ways that sociologists haven’t yet been able to map. But that’s a separate issue from the mental health awareness campaigns. The people involved in Heads Together, much like those at Rethink Mental Illness, Mind, Time to Change the NHS and others take a real problem and attempt to solve it. These campaigns are not “inviting” people “to think of themselves as incapable” or “to build their personality around being pathetic”. They’re being told that even if things are shit, they need not always be. Talking about mental illness improves the treatment of mental illness. This is not a matter of opinion. It is a fact.
Is this the worst thing that’s ever been written on the internet about mental illness? Well, it’s either this or it’s Brendan O’Neill’s piece.
