Monday, April 15, 2024
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Ken MacIntosh: Psychiatric wards need to separate the mad from the bad


In her first major speech on health since becoming Prime Minister, Theresa May talked last week about the “unacceptable stigma” of mental illness. She outlined plans to introduce “mental health first aid training”, so that employers and educators might be able to identify the symptoms of mental illness in their charges/employees, should they appear, and make early, pre-clinical interventions. As I have previously written for TCW, protracted exposure to the welfare state is anathema to recovery in mental illness, and any attempt made to avoid severing an individual’s links to their premorbid life (in this case, by incorporating employers into the treatment process) is to be welcomed, gimmicky though it does sound.

The idea that the stigma of mental illness will be reduced by broadening public awareness of psychiatric issues would seem to be a reasonable one. Ignorance fuels stigma, so distribute more widely the relevant knowledge. This vision imagines the emollient qualities present in the sanctuary that is the healthcare setting being imparted upon society at large, thus reducing stigma. The reality about stigma is somewhat different. In my experience, there are few places where a severely mentally ill person will face more stigma than in a mental health ward. The place where less stigma is to be found (or not found) is out there in the community. So, in a roundabout way, May is correct in stating that an improved understanding of mental illness in the community will reduce stigma – not because the ambiance of the professionally therapeutic environment will expand into the community, but because more effective early interventions might avoid the need for sufferers to enter the stigma pit that is the mental hospital.

How can such stigma and intolerance exist within a mental hospital? Because nobody is more intolerant of the mentally ill than the mentally ill. And because our notions of what actually constitutes mental illness have radically altered over the years. More and more of the human-condition has been seized by the medical profession and pathologised. Now the ultra-narcissistic are considered mentally ill. As are the very unpleasant. As are those who have surrendered to self-gratification. All of this is exacerbated by fears that the mental wellbeing of our broader society is deteriorating; as I have previously written about here, surveys tell us that young women’s mental health is worsening, as is that of gay men, and manly men, and black men (some of whom are also manly), and students, and schoolchildren, and parrots and other animals.

As such, mental health wards find themselves with two populations – a) those patients who are delusional, and b) those who are ‘calculating’ (the parrots don’t get a look in, which is a shame because some depressed birds might brighten the place up a bit). That is not to dismiss ‘The Calculating’, many of whom are products of dire upbringings, and some of whom have, in part, been shaped by their experiences with mental health services (and others who are just pure bona fide malingerers). But, whatever the reasons for their behaviour, they are often highly intolerant of their more disturbed peers. Some of them will mock the grossly confused, or even exhibit open hostility towards them. I used to wish that we could have two wards, one for the ‘mad-mad’ and one for the ‘technically unwell’, so that those in the depths of psychosis could finally find a place beyond contempt (a genuine ‘safe space’).

Safe spaces, of course, will only ever exist in universities. As it is, when somebody in the community goes ‘mad-mad’ and starts jumping at the sight of their own shadow, terrified as they are by a thousand imagined threats, they are brought to a psychiatric hospital and placed in a dormitory bed next to somebody who has been diagnosed with ‘antisocial personality disorder’ (the technical term for being relentlessly horrible). We replace imagined terrors with real ones, which is one way of stopping delusions.

The ooky-kooky, mad-mad patient-types, as portrayed in the film One Flew Over the Cuckoo’s Nest, barely preponderate on modern acute psychiatric wards. However, when one such individual does find himself an inpatient, he will often, if his behaviour is particularly bizarre, require to have a nurse with him at all times, so that other not-so-mad patients do not take it upon themselves to smack him in the mouth. So I say, go for it Prime Minister. Fight the stigma of mental illness by ensuring that the mentally ill have as little contact as possible with the ‘mentally ill’. Protect our vulnerable and shield them from stigma by, whenever possible, keeping them out of hospital.

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Ken MacIntosh
Ken MacIntosh
Ken MacIntosh is an NHS psychiatric nurse and is married with one daughter. Ken is interested in politics and mental health issues.

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