On mental health stigma, and working in a ‘nuthouse’

Quite often, I find myself being quizzed on my job by people I barely know. It’s gratifying that people sometimes find what I do interesting, but, in my experience, it’s often secondary to a problem they have had/someone they know has had. It’s indicative, I think, of the indiscriminate way mental health problems are experienced. There is no protection, really; not money or status or education or any of the things we hope will protect us from the torments of life.

And so it was that I spent a quarter of an hour chatting to some ex-colleagues about my work. Some years ago, I worked in another industry entirely, but I still pop in to the office now and again to say ‘hello’ to my ex-boss. Toward the end of my visit, I got talking to three former colleagues and one person who has joined the firm since I left. ‘What are you doing at the moment?’, one of them asked. ‘Writing m’thesis’, I promptly responded. ‘And what will you be then?’, came the question. ‘A doctor of clinical psychology’, I said. I explained that I was working at a hospital, doing whatever it is that I do and that I am due to qualify in the next few months.  My former colleagues knew that I worked in mental health; the unknown colleague obviously did not. And then came the ‘ooh, how INTERESTING!’ comment, expressed in the worst possible way. ‘What’, she said, ‘is it like working in a nuthouse?’

I am rarely flabbergasted but even I was taken aback. To my shame, when I recovered from the question, I stammered out a deeply ineffectual ‘well it’s hardly a nuthouse’ but I felt like I’d done the people who use mental health services a grave disservice. What I WANTED to say (as I squawked to a friend that evening) was something along the lines of ‘have some bloody respect for people who have experienced untold misery and have demons you can’t even begin to imagine’. Now that’s a bit of a crude statement, because not everyone I see has experienced untold misery and not all have demons (any more than we all have demons, that is). But I was furious at the implication that people who have mental health problems are raving lunatics, locked up for the safety of good upstanding citizens. This is nonsense. People with mental health problems – of whatever persuasion – are not the ‘other’. They’re your parents and friends and bosses and dentists and hairdressers. Notions of Victorian asylums persist, but, when you work in mental health, you get so used to being wrapped up in a woolly world, in which we try to be respectful and aware of vulnerability and the things people have experienced, that it can be rather a shock to encounter a question such as the one I was asked. I don’t think this person had any malign intent; she wasn’t the kind to overtly stigmatise someone with a MH problem, but its not really the overt stigma which is the biggest battle. Yes, it matters that people with MH problems can’t get jobs, for example. But it’s the everyday, insidious stuff which erects the biggest barriers. It’s the casual comments about ‘lazy depressives’ or ‘attention-seeking self-harmers’ or ‘fruitcakes’ , the kind of stuff you hear in the pub, which stops people talking about their own experiences. Interestingly, some of the research indicates that anti-stigma campaigns, which highlight how common MH problems are, actually result in an increase in stigma. Really, it’s the everyday disparagement which needs to be tackled but, if I’m honest, I don’t know you do that. I probably failed, frankly, and I’m still a bit embarrassed by it. If MH professionals can’t pull themselves together long enough to respond effectively to something as relatively minor, perhaps we need to rethink how we tackle something which has a huge impact on the likelihood of people seeking help when they need it. In the UK, we have shockingly high rates of self-harm, suicide and substance use, all of which are often related to unspoken difficulties arising from MH problems. If we could crack the stigma issue, maybe we’d begin to see a shift in these related problems. Sadly, ‘if’ is a big word.


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