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.


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.


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

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.


  1. Mental illness and horror have frequently been linked in modern culture. Just consider the films Psycho and Halloween.

    The difference now is that the stigma is realised and people are pushing back. So, just like in the 1970s when there was rampant sexism mainly because no-one thought it was an issue, we are seeing these bubbles of “just having a laugh” without the jokers realising that it is offensive, dismissive and cruel to sufferers of mental illness.


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