Monthly Archives: October 2013

Movies and Mental Illness: What Do We Do About Stigma? (Updated 12.11.13)

iStock_000009307982LargeI’m a great fan of films and really grateful to the film industry for the entertainment they’ve produced. I’m grateful for free speech, letting everyone have their say even if we don’t like what it is they’re saying. But there come’s a point when we have to just take a step back and see the bigger picture.

Mental illness is extremely common. Most people will experience mental illness during their lives. Sometimes this might be very brief and might not impact too greatly on their lives. A person might have a mild acute adjustment reaction which resolves and allows them to move on with their life

Other people might have more severe adjustment reactions. They might have a Bipolar illness with recurrent Depression, chronic Schizophrenia which may be treatment resistant or be developing Dementia with a severe course. Even for these illnesses the course varies considerably between people. Some people with mental illness aren’t able to speak up for themselves. They might have difficulties with cognition including language and just won’t be able to understand what is happening or to hold and communicate views about these issues.

Movie stars are iconic figures. Watching movies has a universal appeal. They make us laugh and cry, make our hearts race and can make us feel good when we come out. With all of this that the movie industry has given us, there are times when it isn’t so good. There are (thankfully rare) times when the films can be harmful for people with mental illness. There are times when the films are so influential that other organisations base entire events on a single film. These events in turn can be harmful.

Here are some films that in my opinion are stigmatising for people with a mental illness.

1. One Flew Over the Cuckoo’s Nest (1975). In this film one of the main characters played by Jack Nicholson goes into an inpatient unit. He gets into conflict with Nurse Ratched and after a course of Electroconvulsive Therapy used as a ‘punishment’ he undergoes a lobotomy to control his behaviour. One of the other characters in the film kills him to stop his suffering. To add to this the film won numerous oscars, BAFTA’s and Golden Globe Awards. Despite the passage of nearly 37 years the film has had a profound cultural influence. I wonder how many people have refused ECT or coming into an inpatient unit because of seeing this film.

2. Halloween (1978). A boy is institutionalised and emerges after many years to go on a killing spree. The film spawns a number of sequels and is classically associated with the use of a chainsaw mask. There is a description here of how the film was made. The premise of the film is that the main character is the most evil boy in the world. From this IMDB review, ‘After being institutionalised for 15 years, Myers breaks out on the night before Halloween…..no one knows, nor wants to find out, what will happen on October 31st 1978 besides Myers’ psychiatrist Dr Loomis‘.

3. Psycho (1960). Norman Bates, dead mother kept in the house, shower, knife and a psychiatrist that talks about a split personality. Psycho can be short for psychopathy and psychotic leading in my opinion to one of the most unfortunate associations in film history for people with mental illness.

4. The Crazies (1973) and the remake. Crazy is a pejorative label for mental illness and the premise of these films is that a toxin makes people mentally ill and dangerous. Unaffected people must defend themselves.

5. The Demented (2013). In this film the afflicated afflicted become zombies and are the focus of the title. Those unaffected must defend themselves. There is a lot of stigma about Dementia with a number of excellent campaigns to raise awareness. The last thing that’s needed is a film with a title like this.

6. American Psycho (2000). The title suffers the same problem as Psycho and makes an unfortunate links with axes. A title change would be sufficient to avoid this association.

If you can think of other titles to add, just include them in the comments section (there might be a delay of a few days before they are added).

Why tackle stigma in the movies – isn’t this taking it too far. Student nurse Katie Sutton has written this article about typical responses to an anti-stigma campaign. I’ve included some of the themes below.

Free speech – there is a right to express views or establish events even if these are not popular

Speech involves a balance between the right to express views and to consider the effects this has on others.

This is not meant to be realistic

Regardless of whether is realistic, for those with little knowledge of mental illness and its treatment this may inadvertently form a part of their education (about mental illness and its treatment).

How are people being made aware that this is unrealistic?

The financial support for mental health awareness campaigns is counterbalanced by the revenues generated and by and financial support for potentially stigmatising film portrayals of mental illness which may be unrealistic.

Its Just a Bit of Fun

There are lots of creative ways to do similar things without targetting people with mental illness

Having fun is incredibly important and can be done with planning. Why plan something that can perpetuate stigma which can cause suffering for others. It is an equation – not just looking at people having fun on one side but also people with something to lose on the other side.

Mental illness is very common. Most people are likely to develop mental illness at one point in their life. If films such as these perpetuate stigma then people having short term gains (i.e. fun) would find that stigma contributes to their experience if they later develop a mental illness.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

The Halloween Asylum Lives on in the Supermarkets

Jack-O-LanternAfter a campaign about Halloween costumes at supermarkets ended with them being withdrawn I was more than surprised to see ‘The Asylum’ appear prominently in the DVD section in one local supermarket and less prominently in another. To cap it all, the Television series appears to have reached number 4 in the charts when I looked.

The American series does not have a Halloween theme but coincidentally shares the same name as the subject of a recent campaign about a maze at Thorpe Park. So what’s ‘The Asylum’ about? Well I didn’t buy it but just read the blurb

Step inside a madhouse of horror…..terrifying evil lurk around every corner…from alien abduction to demonic posession to a skin-wearing psychopath

Really. Seriously. Number 4 in the charts.

I was relieved to find that ‘The Demented’ had disappeared from the shelf. I thought hopefully it had been tactfully removed. Its description reads

Six college friends …. find themselves fighting for their lives after a terrorist attack turns the local residents into rage infused zombies

and of course ‘The Demented’ is thought to be an appropriate title for this?

Off to see the bargain Halloween films in one local supermarket to find that ‘The  Crazies’ was selling for £3. Its description reads

‘Insanity is infectious’ and one review pasted onto the movie cover reads ‘you’d be crazy to miss it’.

The premise of this film is that a toxin is released which turns people ‘insane’ forcing the unaffected residents to defend themselves with guns.

We’ve talked about events, newspapers and costumes but maybe its time to talk about films and TV.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

 

 

 

Campaigns Against Stigma: Update and A Closer Look at Stigma (Updated 12.11.13)

Jack-O-LanternIn a previous post I wrote about the stigmatisation of mental illness as a theme emerging during Halloween. Here are a few updates.

The story began with a campaign directed at supermarkets selling Halloween costumes with a mental illness theme. The supermarkets quickly apologised and withdrew the costumes.

Although unrelated to Halloween, a tabloid newspaper reported on homicide in people with mental illness. The headline perpetuated a stigmatising association between mental illness and homicide which was quickly challenged by mental health campaigners. I’ve written about this previously here and here. The Lancet article distinguishing fact from myth was particularly helpful in challenging the stigma. Subsequently a petition against the headline has reached 83,773 signatures at the time of writing. The newspaper published a ‘clarification and correction’ of the original story. Paul Jenkins CEO of Rethink, Paul Farmer CEO of Mind and Sue Baker director of ‘Time to Change’ met with staff from the newspaper and summarise the hopeful outcome in this article.

Although it was unrelated to Halloween the stigmatising link was soon reinvoked. Advertisements began for a series of Halloween events – ‘insanitorium’, ‘asylum’, ‘psychosis’ and ‘insanity’. Much of the subsequent discussion and campaigning was directed against the ‘asylum’ maze. Student nurse Katie Sutton did an outstanding job of starting up a petition which at the time of writing has 5503 signatures and went onto radio and television to advertise the petition. The Royal College of Psychiatrists joined forces with Rethink, Mind, Time to Change, The Lancet Psychiatry, The Lancet, Professor Graham Thornicroft, Katie Sutton and @sectioned_ to write a sensitive open letter to Thorpe Park. The response is contained within the above link and states that there are people who hold different views that this is not meant to represent reality and that adults have paid to come to the Park.

Katie Sutton has published an article responding to common retorts to the ongoing campaign and its worth restating here. I’ve also added a few other retorts and suggest some additional responses. (I’ve quoted some of the typical responses and paraphrased KS’s responses).

1. Its been going on for 8 years, why respond now?

KS: The campaigners have only just become aware of it

Additional Responses that I would suggest

Why shouldn’t a response take place at this point?

It is only now that social media platforms and surrounding infrastructure (e.g. charities) can support an effective response

2. ‘It’s just a bit of fun to scare people’

KS: Using simulation of mental illness as a form of entertainment is ethically wrong

KS: There would likely be a different response if people with physical illnesses were targetted in this way

Additional responses that I would suggest

There are lots of creative ways to do similar things without targetting people with mental illness

Having fun is incredibly important and can be done with planning. Why plan something that can perpetuate stigma which can cause suffering for others. It is an equation – not just looking at people having fun on one side but also people with something to lose on the other side.

Mental illness is very common. Most people are likely to develop mental illness at one point in their life. If rides such as these perpetuate stigma then people having short term gains (i.e. fun) would find that stigma contributes to their experience if they later develop a mental illness.

3. ‘Why do you want to ruin Halloween for everyone?’

KS: The target is one of the rides, and the aim is to make the world a better, safer place for everyone.

Additional responses that I would suggest

Halloween is not the target here. It is directed at the entertainment delivered by a small group of organisations which in some cases is just one aspect of the entertainment delivered.

If Halloween continues to be celebrated in this way without challenge such events and potential stigma could continue to increase in the future.

4. People don’t really believe that patients with mental illness are dangerous

KS: responds with studies published by or reported on by the National Mental Health Development Unit, Mental Health Cop and @mentallyjaded.

Additional responses that I would suggest

Stigma occurs in direct and indirect ways. Direct ways are easier to measure – they come out with behaviours towards people with mental illness or attitudes (e.g. expressed in surveys). Indirect stigma is more difficult to detect and involves inaction and avoidance where action and contact are needed e.g. services, communication, support. Events of this nature have the potential to influence people in both of these ways.

There is also something I refer to as self-directed stigma in which people who develop mental illness anticipate how others might perceive them. As a result they act differently to how they might if they didn’t hold this self-directed stigma e.g. they may choose not to come into hospital. Again events of this nature have the potential to influence this.

The combination of direct and indirect stigma as well as self-directed stigma can act in concert to result in general and more specific inequalities for people with mental illness. If events such as this contribute to stigma then it may influence such inequalities.

5. There are other similar attractions

KS: There are distinctions between other rides and the one considered

Additional responses that I would suggest

The attractions must be considered individually.

This is even more reason to challenge this. If Halloween continues to be celebrated in this way without challenge, such events and potential stigma could continue to increase in the future.

6. Its not meant to be a realistic experience

Open Letter response: Events such as these are creating culture.

Additional responses that I would suggest

Regardless of whether is realistic, for those with little knowledge of mental illness and its treatment this may inadvertently form a part of their education (about mental illness and its treatment).

How are people being made aware that this is unrealistic?

The financial support for mental health awareness campaigns is counterbalanced by the revenues generated and by and financial support for potentially stigmatising events and media portrayals of mental illness which may be unrealistic.

7. Its based on a horror film not real life

KS: The origin of the theme does not matter and there is artistic license

Additional responses that I would suggest

Let’s take a closer look at the films

8. You haven’t experienced it how can you know its stigmatising?

KS: All that is needed is a misrepresentation of mental illness

Additional responses that I would suggest

There is enough material about the maze available including footage and reviews in addition to the material about the theme to draw conclusions about stigmatisation.

9. The actors aren’t being described as patients

KS: The context is clear

Additional responses that I would suggest

The Asylum is culturally associated with people with mentally mental illness. Where are alternative associations being made in this case?

10. This is political correctness taken to an extreme

KS: The response by the supermarkets suggests that this is not

Additional responses that I would suggest

This is free speech.

Why is there pressure against people pointing out stigmatisation – does this happen with the reverse i.e. that its just a bit of fun

11. There are people with mental illness who do not object to this

KS: There is still a need in society to represent people with mental illness who do object to this.

Additional responses that I would suggest

Society helps people to express their views – although there is not a consensus the scale of response in petitions and other forums suggests that significant numbers of people object to this.

12. There are bigger things to worry about

KS: Stigma works on many levels and affects mentally ill people as well as services delivering care to them.

Additional responses that I would suggest

For people working in mental health or people with mental illness or having friends or family with mental illness these can be very important issues.

As mentally mental illness is very common it has the potential to be important to everyone.

13. Free speech – there is a right to express views or establish events even if these are not popular

Responses that I would suggest

Speech involves a balance between the right to express views and to consider the effects this has on others. The campaigns and petitions here have involved a dialogue. The core aspects of these campaigns/petitions have been conducted in a civilised way which allows others to make up their minds.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

Study Suggests Sleep May Clear Toxic Metabolites News Round-Up October 2013 4th Edition

There is a nice write-up of two studies at the Alzheimer’s Research Forum. The first study suggests that a better quality of sleep reduces the risk of developing Dementia of Alzheimer’s Type in people who have a gene that increases the risk of Dementia of Alzheimer’s Type. In our genome we have a lot of a genes. There can be many different versions of a gene in the population – these are known as alleles. One allele of the gene for the ApoE lipoprotein increases the risk of Dementia of Alzheimer’s Type 3-4 fold above that of people with other versions of the gene. The researchers in this study used sleep actigraphy to investigate sleep. The gold standards for investigating sleep has been an approach called overnight polysomnography which usually takes place in a sleep laboratory and includes techniques such as Electroencephalography. Actigraphy involves the use of sensors attached to the body (e.g. wrists) to detect movement and other measures. This is a relatively low cost approach and has been quickly gaining ground.

The researchers found that if people in the study had the ApoE4 allele and they had a good quality of sleep, their risk of developing Dementia of Alzheimer’s Type was increased 2-fold instead of 3-4 fold (relative to those with other alleles). The researchers also looked at the brains of people who had died and found that better sleep quality was linked to a lower density of neurofibrillary tangles. Neurofibrillary tangles are another structure found in the brains of people with Dementia of Alzheimer’s Type and are thought to play a central role in Alzheimer’s Disease.

This type of result also gives us insight into another debate – genes versus environment. A longstanding debate is whether our fate is determined by the environment or by our genes. There are various ways our environment can impact on sleep e.g. noise, stressors and so these results might show one route through which the environment might modify genetic determinism.

The other study examined in the above write-up is one which looked at sleep in mice. The ancestors of rats diverged from the ancestors of humans approximately 75 million years ago during the Cretaceous era. This means that the results might not be generalisable to humans. The researchers injected mice with traceable compounds that were taken up into the brain. They found that the compounds were removed from the brain twice as quickly in sleeping mice compared with mice that were awake. The same applied with Amyloid Beta – the precursor of the Amyloid plaques found in Dementia of Alzheimer’s Type. Furthermore the research linked the removal of these compounds with the glymphatic system. Remarkably the glymphatic system’s function has only recently been confirmed and has some similarities to the lymphatic system (the lymphatic system has many functions including acting as a transport system in the body excluding the brain).

There is an interesting MedWire News write-up of research linking two genetic pathways to Bipolar Disorder. The genes code for proteins involved in synapse formation and an enzyme. The enzyme is thought to be influenced by mood stabilisers while the synapse forming protein is associated with increased excitation of neurons.

There is an interesting MedWire News write-up of a meta-analysis in which researchers looked at cardiometabolic risk factors in people with Schizophrenia. There were 185, 606 people with Schizophrenia included in the meta-analysis and the control subjects across the studies totalled 3,900,000. The data showed that the people with Schizophrenia in this study were 4.43 times more likely to have abdominal obesity than the control subjects. Furthermore they found that the risk for Diabetes was doubled relative to the controls.

Researchers in this PLOS One study looked at the instructions for authors for Psychiatry Journals. The researchers were particularly interested in specific instructions for registration of clinical trials. On the basis of their findings the researchers commented on areas of good practice and recommended stricter enforcement of publishing data on trial registration.

Neuroscience

brain.1Dr Stoet, Professor Keith Laws and colleagues have published a new study in BMC Psychology examining the question of whether men or women are better at multitasking. The researchers administered a real world task and a more abstract task and concluded that men and women performed similarly on the tasks. There were some exceptions with women in the study performing slightly better on a task in which they formed a strategy to look for a key. You can try the task at a link in this BBC write up.

Evolutionary Psychiatry, Evolution & Culture

Evolutionary PsychiatryThere has been a lot of research published on Neanderthals recently. Neanderthals were a distinct hominin species which contribute between 2 and 5% of DNA to the modern human genome. Differences between the human and Neanderthal genomes reveal several genes that are linked to diseases and so there are various reasons why understanding Neanderthals will help us understand health and illness in humans (nevertheless there are overwhelming genetic similarities between Neanderthals and humans and the gene differences represent a tiny part of the respective genomes).

Evidence from Gibraltar suggest that this is the last home of the Neanderthals. Research by Dr Matt Pope and colleagues however suggests that the Neanderthals were living in Jersey as recently as 47, 000 years ago. A recent finding in Spain suggested that Neanderthals ate herbs based on an analysis of dental tartar and were possibly using these for medicinal purposes. In a more recent response to this Professor Chris Stringer suggests that these dental findings may have resulted from consumption of animals that in turn had consumed these herbs. This possibility relates to how the food is processed. Professor Stringer argues that these patterns of consumption are hallmarks of cold adaptation. Indeed Associate Professor John Hawks suggested that Neanderthals were using animal organs as cooking vessels similarly to the way in which Haggis is prepared. However Professor Stringer does not discount the possibility of medicinal herb use. These discussions also hold relevance to models of hunter-gatherer societies which underlie many evolutionary theories of illness.

Appendix

News Round-Up 2008-2011

News Round-Up 2012

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

The Royal College of Psychiatrists Writes Open Letter to Challenge Stigma (Updated 25.10.13)

awarenessThe Royal College of Psychiatrists along with journal editors, other charities and blog/twitter mental health campaigner @sectioned_ have joined forces to write an open letter to Thorpe Park about ‘The Asylum’ maze. This is a profound letter which explicitly outlines the reasons why the maze is stigmatising. The letter addresses injustices including those that happened in older Asylums and how this relates to perceptions of the Asylum maze.

Care of the mentally ill in the UK and elsewhere has been transformed for the better and so too have the approaches to challenging stigma.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

New Helsinki Declaration for Research Published News Round-Up October 2013 3rd Edition

JAMA have published the new version of the Declaration of Helskinki’s ethical principles for medical research.

Mental Elf reviews the Cochrane Review of Fluphenazine treatment for Schizophrenia in this post.

Researchers investigated various social neuroscience methodologies for use in trials for people with Schizophrenia. One approach in particular appeared to have advantages for use in research.

In a widely reported study, researchers identified a compound which stopped the development of Prion disease in a model with similarities to Alzheimer’s Disease. However it will be interesting to see the results of clinical trials.

Duration, severity and age were risk factors for developing psychosis in Parkinson’s Disease in this study.

Neuroscience

brain.1Neurons appear to fire backwards during sleep in rats – in this study!

Donald Hebb’s theory of how synapses form and strengthen has been central in Neuroscience for a long time. There is competition now from a new model which suggests that neurons form synapses when electrical activity falls below a threshold.

Awareness

awareness14th-20th October 2013 is Dyslexia Awareness Week.

Evolutionary Psychiatry, Evolution & Culture

Evolutionary PsychiatryThere have been some big announcements in the field of human evolution on five skulls found in Georgia. The skulls date back 1.8 million years and are viewed as a variation on Homo Erectus. The crux of the debate is whether this means that many other species were simply Homo Erectus (due to significant variation in form) or that other species are still viable (e.g Homo Rudolfensis).  As usual Associate Professor John Hawks has an excellent summary of the findings and is able to offer a balanced perspective.

There is a fascinating piece on Marmoset communication. Our lineages diverged about 40 million years ago. Marmosets are very vocal and researchers think that understanding their communication might help to answer questions about our own communication. In particular when Marmosets vocalise to each other there is an approximate 5 second pause before responding. Additionally the Marmosets display turn taking during vocalisations as is the case in human conversations. In the article above there is speculation about why such turn taking exists.

There is a very interesting piece here showing photographs of how cats and humans might see the same scene based on physiology.

Appendix

News Round-Up 2008-2011

News Round-Up 2012

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

Halloween 2013: Is the Stigmatisation of Mental Illness Becoming A Commercial Theme? and How are People Responding in Social Media (Updated 22.10.13)

Jack-O-LanternHalloween is thought to have evolved from an ancient festival celebrated across the world – the festival of the dead. The theme was based around remembering and celebrating the lives of the dead. Later developments meant that Halloween was associated with ‘lost souls’ and even ‘evil spirits’ and the Jack-O-Lantern was thought to ‘ward off’ these evil spirits. The cultural associations of Halloween can be seen as many and varied. In more recent times the popularity of Halloween has been supported by commercial enterprises providing Halloween associated events and merchandise.

Why is this Relevant to Mental Health and Illness?

The reason that I am writing about Halloween here is that in the UK in 2013 a mental illness theme has appeared and widespread concerns about stigmatisation have emerged. The discussion began in September 2013. A number of Halloween costumes with a mental illness theme (e.g. hospital inpatients) were being sold. The details are neatly summarised in this post with links to other articles.

What was the Issue with the Costumes?

The costumes included a ‘mental patient’ and an outfit for someone on the ‘psycho ward’. One of the costumes came equipped with a meat cleaver just to avoid any ambiguity. The combination of the costumes and their descriptions communicated a simple message about mentally ill people on inpatient units. Most people with mental illness who receive treatment will get this in primary care and a smaller proportion in mental health community services. Inpatient assessment and treatment is reserved for the most complex cases.

For some people, coming into hospital is a difficult decision and perceived stigma is one of the contributing factors. Stigma comes in many forms. A quiet conversation amongst friends or colleagues at work might be the mildest forms of stigma. Big companies on the other hand play a vital role in society and are widely trusted. When costumes such as these appear in retailers with established brands it sends a powerful message out and some may see this as validating stigmatising views.

For those that haven’t thought much about mental illness and inpatient treatment such costumes may even provide ‘education’. A meat cleaver may link ‘inpatients’ with ‘threat to life’ and ‘danger’. In fact inpatient treatment is associated with people who are at their most vulnerable and require a supportive, trusting environment. For me, its difficult to understand how there can be such a disparity between reality and the images portrayed with the costumes above.

What was the Social Media Response?

In the cases above the social media response was incredible. Key players were charities Rethink and Mind through their websites and Twitter accounts. However the response worked because of widespread support. One poignant and powerful campaign on Twitter was #mentalpatient where people with mental illness shared pictures of themselves. The pictures revealed the truth about mental illness – that it can affect everyone. Instead of the strait-jacketed meat-cleaver wielding man we see women and men, casually or smartly dressed, young and old, relaxed and smiling into the camera. The ‘ plastic mask’ had slipped and instead we saw ourselves looking back at us – a powerful truth about mental illness. We didn’t need a special costume – just a large mirror so that people could reflect as they walked past.

The Response to the Response

There was a happy ending to the story. The shops responded quickly with an apology, removed the costumes and even contributed to charity. People worked collectively, negotiated and the shops responded to what people were saying. The process of challenging stigma appeared seamless in retrospect.

Intermezzo

With the challenge of the Halloween costumes in the stores finished it wasn’t long before the next event. This time it wasn’t related to Halloween but it helped to reinforce a link that had been there with the costumes. Two reports were published – ‘The National Confidential Inquiry into Suicide and Homicide‘ and ‘At Risk Yet Dismissed‘. One of the tabloids printed a story based on the report linking mental illness and homicide in the headline. I initially wrote about that story here. Subsequently I wrote about a very popular petition in response to the original tabloid article which at the time of writing has 82,869 signatures. The Lancet Psychiatry has just published a very nice editorial challenging the ‘myths’ around these studies with the facts.

However the link had been made again – mental illness was linked to danger, to homicide even though people with mental illness are more likely to be the victims of crime than members of the general population.

Deja Vu

It was therefore with a little surprise that I learnt about some further Halloween themed events. There were a variety of events to choose from – ‘asylum‘,  ‘insanitorium‘, ‘psychosis’ and ‘insanity‘. Included in these events, we see the return of the ‘mental patient’, a journey into the psychiatric ward and there is even an appearance by a chainsaw – just to avoid ambiguity. Tickets for one of the events are already sold out. The social media responses are neatly summarised in this post.

Halloween and Patients on Psychiatric Wards – Why the Link?

The theme throughout all of this (with the exception of the tabloid article) is that psychiatric inpatients are an appropriate theme for Halloween. Clearly I fundamentally disagree with this and so do a great many other people. Indeed not only do a lot of people disagree with this but they disagree very strongly with this. I can’t see that the theme has anything to do with the festival of the dead. There may be another link with morality however. The Jack-O-Lantern wards off evil spirits. The theme of the costumes and the events is permeated with images of blood and dangerous weapons with an air of foreboding. Why should such links happen at Halloween – perhaps it is because a link is being made with morality – the issue of good and evil.

Morality and Mental Illness – Wasn’t this Association Debunked in the Nineteenth Century with the creation of Psychiatry?

Johannes Reil coined the term Psychiatry in 1808 laying the foundation for the investigation and understanding of mental illness. Despite the gains made over the last two hundred years, there still appears to be a considerable gap between the professional and public understanding of mental illness. While there is a well informed segment of the general population there also appear to be strong prejudices that must be borne in mind. Forensic Psychiatrist Dr James Knoll has an excellent article on the public’s unfortunate association of mental illness and evil.

The Business of Stigmatising the Mentally Ill

One point out of all of this is that events, newspapers and costumes are commercially driven. People in charge of the commercial apparatus are in a position to make profit from those at the periphery of society and in so doing further stigmatise these people. If stigmatising ventures prove popular and profitable because they satisfy general prejudices then society has a reinforcing mechanism for such stigma – the ‘commercial stigma machine’.

The Commercial Stigma Machine

The commercial stigma machine runs something like this. Newspaper links mental illness with homicide – homicide is linked with evil. Dramatic headlines are popular and attract more readers. Sales go up. People make the link between mental illness and evil. Halloween originally representing a festival of the dead has become more commercialised, linked to ‘fright nights’ and ‘evil’. Halloween costumes and events are profitable but a theme is needed. People are more likely to want themes with established links to evil. With the reinforcing stories in the tabloids the link to ‘dangerous’ inpatients is made. Inpatient themed costumes and events satisfy that link in the context of the media coverage. Obviously I view such links as nonsense but this hypothetical scenario may well explain the pervasive theme of mental illness during Halloween.

Society’s Stigmatising Discourse

In the nineteenth century, asylums were built on the periphery of society – people with mental illness were effectively segregated from others in society. Discourse in society happens on many levels and through various media. As well as the arts, mainstream and social media the discussions happen in every walk of life. The stigma produced by the ‘discourse’ described above segregates those with mental illness from others. Countermeasures are needed to integrate those with mental illness in the discourse. Social media campaigns are an important step in this process.

A Proposal

So for Twitter users one proposal is simple – to use the hashtag #endhalloweenstigma.  However there is other work of a much deeper nature that needs to happen to address these issues in the longer term.

Update

The hashtag #Asylumno has been the central tag used in the twitter discussion.

@sectioned has written an open letter here

BBC article here

Get Surrey article here

Guardian news article here

Metro article here

BT article here

Airgates article including responses from several organisations

Rethink statement

Mind statement by Sue Baker director of ‘Time to Change’

Petitions here and here

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