Tackling stigma

Piers Morgan really gets my goat. I suppose I should be grateful to have one of the many Twitter accounts he’s blocked over the years. But as someone who works in mental health, Morgan’s relentless stigmatising rhetoric, including his recent attack on gymnast Simone Biles for speaking openly about her own mental health, is something I just can’t keep quiet about (I even dedicated my first book to anyone affected by his nasty nonsense).

Sadly, Morgan isn’t alone in his desperate game of mental health baiting. There are many others who seem to get a kick out of attacking those of us who have experienced mental health problems. And I should know – I’ve been there, worn the sweaty anxiety t-shirt and kickstarted the legal proceedings for a discrimination case.

However, even though mental health stigma is still a huge problem, the Government de-funded the Time to Change campaign - leaving the rest of us scratching our heads and wondering how we can continue to fly the flag. And so, as a writer of fiction and non fiction who continues to write about mental health stigma, I’m here to say we’re all in exactly the right place to make a difference.

There are lots of books that explore mental health – that’s certainly nothing new. But perhaps one thing we could do to look at in more detail is mental health stigma.

It might feel counter-intuitive portraying stigma in our work, but as a societal issue that is still very much a problem in its own right, we should face it head on. I spent some time working with script researchers for soaps such as "Coronation Street", "Hollyoaks" and "EastEnders" on behalf of charities such as Mind and Recovery Connections. One point I was always keen to make was that seeing stigmatising language on soaps was perfectly acceptable – providing the context was appropriate (i.e. was it challenged? did it demonstrate the impact of stigma? was the character using stigma proven to be wrong?)

I think it’s the same with literature. We shouldn’t shy away from showing the consequences that stigma can have. We can safely create situations from which to convey powerful messaging.

One thing I think is important to remember about mental health portrayals is that we are portraying an illness – not a personality or character. We shouldn’t tip toe around a mental health problem – we can’t hurt its feelings by showing it warts and all. It’s an illness, not a human being. 

Mental health problems suck – big time! My anxiety disorder has seen me exhibit all manner of unfortunate behaviours (retching, diarrhoea, sweating…crawling on my knees down a public street – yeah, it’s not pretty). So to show these kinds of realities in fiction isn’t doing a disservice to anyone experiencing them. I found it refreshing recently reading Last One At The Party by Bethany Clift in which the protagonist talks of panic attacks and the dodgy stomach business came up rather than the usual, more palatable ‘hyperventilating into a bag’ scenario. This, of course, isn’t stigma. 

There’s a really simple way to avoid accidental stigma – focus on the person first, and the illness second. But of course doing the research is invaluable. I work with the fabulous charity Action on postpartum psychosis and we recently received a manuscript from author Caroline Corcoran for her upcoming book, Five Days Missing. Caroline had clearly researched the topic of postpartum psychosis, but, understanding the power of storytelling, she wanted to run it past us to make sure everything was representative and responsible.

To portray the impact of stigma, I think it’s important, as mentioned previously, to get the context right. To illustrate my point, I’ll use a well known fairytale. If Prince Charming called Cinderella a ‘crazy bitch’ because she was seeing pumpkins turn into horse-drawn carriages it would be problematic, because we are encouraged to like and trust the prince. If, however, her nasty stepsisters insulted her, we’d get that they were jealous that Cinderella was going to get her leg over.

Other techniques used to challenge stigma include the ‘unreliable’ narrator - The Girl on the Train is a great example. How could we possibly believe ‘an alcoholic’? Well, we soon learn the truth and challenge our own assumptions, andat the same time come to understand why somebody might turn to alcohol to self-medicate against trauma.

Once we’ve tackled the vile messages that come from the mouths or fingertips of Morgan and Hopkins in our writing, does it end there? Not really…

Not everyone who uses mental health stigma has an agenda like the aforementioned desperados. Some simply haven’t had the experiences that would enable understanding. It’s not right to publicly shame any individual who uses stigma accidentally (e.g. Twitter person: Oh my God I’m SO OCD I’m just like Monica from "Friends"). They’re not trying to attack anyone. But they are using stigma and mis-using language. So a sensitive approach or direct message wouldn’t go amiss, explaining why their comment could be damaging. An example in literature and screen where mental health language has been mis-used relates to the character of Villanelle of Killing Eve fame. So many fans described her as ‘psychotic’. But psychosis is a mental health problem that can make the person experiencing it immensely vulnerable. Villanelle was psychopathic - and violent. BIG difference. Confusing the two isn’t helpful when, as we know thanks to research by Time to Change, psychosis is still one of the most stigmatised of mental health problems.

As authors, editors and publishers we have so much power to affect change and to do so safely and responsibly. But even more significantly – we can do so in an engaging way. We can encourage empathy in our characters and distrust in our villains. We can encourage somebody to pick up a book and learn about mental health through our creative stories – somebody who might walk straight past a book entitled A Book About Mental Health.

And, importantly, we can use our platforms and words to hold those who should know better to account – through open challenge or simply the refusal to publish stigmatising (often dangerous) content.

Lucy is a writer, blogger and commentator on mental health and addiction stigma. Her first novel, The Twenty Seven Club, explores the media’s impact on our understanding of mental illness and why we should always put people before labels through humour and nostalgia. You can find her on Twitter at @lucyenichol