Dani Garavelli: A victory for mental illness awareness

With its ripped and bloodied straitjacket, axe and manic expression, Asda’s “mental patient fancy dress costume” was the consummate blend of Jack Nicholson in One Flew Over The Cuckoo’s Nest and Jack Nicholson in The Shining.

Another Halloween costume, this time from Tesco, featured an orange boiler suit with the words “psycho ward” and a Hannibal Lecter mouth mask and seemed to have been inspired by the Silence Of The Lambs.

Both perpetuated stereotypes that have flourished in the public imagination for centuries; from King Lear howling on the moor to Heath Ledger’s portrayal of the Joker in The Dark Knight, mental illness has long been linked with unpredictable and violent behaviour.

That such prejudices persist in the 21st century is shocking enough. But that these outfits could have been approved by buyers from two of the country’s biggest supermarkets came as a huge blow to campaigners who have invested so much effort in fighting the stigma attached to mental illness. It demonstrates how difficult it is to overturn deeply entrenched preconceptions of “madness” and highlights how far the mental health lobby lags behind those fighting discrimination on grounds of race or sexuality in terms of making people understand what is and isn’t offensive.

It is no longer possible to imagine a supermarket okaying a “golliwog” costume, and yet these throwbacks to Bedlam were deemed acceptable despite the enormous damage that could have been caused by having them on sale, both in terms of the reducing tolerance and understanding and in dissuading those suffering mental distress from speaking up.

“These costumes had the potential to reinforce existing stigma,” says Isabella Goldie, head of mental health programmes for the Mental Health Foundation in Scotland, “but the impact seeing them could have had on people who are suffering from mental health problems – that’s what worried me most. They are members of the public too, they grow up with the same stereotypes and may well have internalised them. Imagine if you were feeling low and thinking you should really go and see someone and then you came across one of those costumes – you might decide not to seek help for fear of being judged.”

Yet almost as startling as the costumes themselves was the scale of the backlash against them; within hours of the images appearing on Twitter on Wednesday night, thousands of protesters, many of them with first-hand experience of mental illness, had mobilised themselves into a social media campaign group, deluging the supermarkets with complaints and forcing them to back down. Both apologised and removed the costumes from sale, with Asda promising to donate £25,000 to mental health charity Mind as a gesture of goodwill. Empowered, some went on to tweet everyday photographs of themselves under the hashtag #mentalpatient, explaining – with a hefty dose of irony – that this was what people with mental health problems really looked like.

It was, says Billy Watson, the chief executive of Scottish Association for Mental Health, a watershed. “A social movement of people with mental illness got online and changed the views of one of the largest corporations in the world,” he says. “It was unprecedented.”

Though Watson regrets the costumes ever having been advertised online, he says the renewed debate over attitudes is both welcome and timely, as the much-lauded See Me campaign, aimed at tackling stigma, is to be relaunched in November, with Comic Relief adding £500,000 to the £1 million a year given by the Scottish Government. While previous evaluations of See Me suggest there has been a considerable shift in public opinion as a result of its efforts, with most people now aware that mental illness affects a large proportion of the population (one in four people will suffer problems at some time in their lives), it was suggested more work could be done in taking the message out into local communities. With this in mind, the new programme will attempt to involve those who have experienced mental illness in grassroots work to reduce stigma. “We will be changing attitudes on a micro as well as a macro level,” Watson says.

See Me first launched in 2002, two years after the film Me, Myself And Irene – a comedy about a police officer who suffers a “psychotic” breakdown, resulting in the emergence of an alternate personality – was released and just under a year before he Sun ran its infamous “Bonkers Bruno Locked Up” headline, which caused a national outcry. Much has changed in the interim. Such a headline would be unlikely to run today, and there are now as many newspaper features on support for those who are mentally ill as there are stories calling for greater protection from them.

And yet, as the costumes show, even as understanding has grown, the old stereotypes survive. In workplaces and playgrounds, derogatory words related to mental illness – “crazy”, “bonkers”, “nutter”, “psycho” – are still in common use and there is an abiding public obsession with extreme mental illness, particularly when it manifests itself (or is purported to manifest itself) in sensational crimes such as the Moors Murders or the cinema shootings in Aurora, Colorado.

“Severe mental illness is really frightening to us because it’s symbolic of a lack of control – if we can’t control our own minds, that’s the worst thing of all. And that fear shapes our relationship to it; we demonise it as a way of coping,” says Professor Ewan Gillon, of the First Psychology Centre, who also lectures at Glasgow Caledonian University. “I guess because it’s frightening, there’s also a kind of voyeurism around it. It makes us feel good when we witness difficulty and distress in others because it reinforces our own sense of ourselves as being OK. We may be stressed and feel we’re going mad, but seeing archetypes of mental illness reinforces the idea: ‘That’s not me. I’m normal.’

“What that does, however, is to create stereotypes and very unhelpful assumptions around people who are enduring mental health difficulties and that can be very stigmatising.”

The conflicting feelings we have about mental illness are heightened by the mixed messages we receive from popular culture. In 2009, Dr Peter Byrne, a consultant psychiatrist in London who has also lectured in film studies at University College, Dublin, carried out a study into cinematic representations of mental illness. Dividing treatments into different genres – comedy, faking it (as in One Flew Over The Cuckoo’s Nest), pity, and violence – he found Hollywood had an enormous influence on perceptions. More than 50 years after Psycho brought us Norman Bates and his murderous alter ego, he found most people still linked schizophrenia with a split personality, although a split personality is an entirely different condition now known as dissociative identity disorder. Byrne said depictions had not improved in recent years. “If anything, the comedy is crueller and the deranged psycho killer even more deranged than earlier prototypes,” he said, citing The Dark Knight as one of the worst offenders.

Goldie singles out the US TV series The Asylum, which is set in a 1960s institution for the criminally insane, as an example of the reinforcing of stereotypes. But in recent years, these negative portrayals have been interspersed with more nuanced, if imperfect, representations of mental illness; for example, A Beautiful Mind, starring Russell Crowe as mathematician John Nash, which gives a more realistic portrayal of schizophrenia, and Silver Linings Playbook, which centres on a man with bipolar disorder who falls in love with a grieving widow.

Some soaps have successfully introduced storylines about mental illness and, most positively, there has been a spate of TV dramas in which the main characters have mental health problems but are not defined by them, most notably Homeland, where CIA agent Carrie Mathison, who is also bipolar, copes with her condition with various degrees of success throughout the series.

“There are some positive, realistic portrayals and that’s what we want, because when you’re down you lose a lot of hope, you can’t see a future. To see someone on TV coming out the other end [of their illness] can be really powerful,” Goldie says.

The stigma surrounding mental illness has also been reduced by the number of well-known figures who have spoken out about their own experiences of mental illness, with Alastair Campbell giving an insight into his battles with depression and Catherine Zeta-Jones opening up about being bipolar. “You’ve got Stephen Fry, who struggles away, but is a very successful man, a very popular man, who has achieved an enormous amount in his life,” says Gillon. “In fact, a growing number of people are demonstrating that [having a mental illness] doesn’t mean you should be locked away in an institution, that it’s part and parcel of normal and successful living. And their honesty is opening up a path for many others.”

An unexpected flipside to the flurry of celebrities – Frank Bruno, Kerry Katona, Paul Gascoigne, Stan Collymore et al – who are willing to talk about their mental health, is that far from being overly stigmatised, a handful of conditions now have a certain cachet. It is not unusual to hear people say “I’m a wee bit OCD” for example, while, because it is linked to so many creative people, bipolar disorder has become an almost fashionable diagnosis.

On the one hand, this development is positive as it normalises mental illness, but reducing often debilitating conditions to the status of a quirk can diminish the pain those in real difficulty are experiencing. “For me the worry is if you start to say, ‘If I can manage my wee bit of OCD, then you can manage’, that you get that kind of ‘pull your socks up’ mentality,” says Goldie.

“There’s also a hierarchy around mental illness. OCD, self-harm and bipolar disorder may have a bit of a cachet, but you wouldn’t hear people say: ‘I’m a wee bit schizophrenic’. Most people still believe people with schizophrenia are going to be aggressive, unpredictable, look shambolic and be terrifying – exactly like the Asda costume.”

In fact, though studies suggest people with schizophrenia have a slightly raised propensity to aggression, particularly when accompanied by substance abuse, they contribute little to overall levels of violence in our society.

Goldie says the way self-harm and suicide are sometimes glamorised in the media is also damaging for young people, who absorb those messages. “It helps frame the way they look at the world. If you take away the taboo, these things seem to be more of an option.”

That said, progress is undoubtedly being made. While some people continue to harbour preconceptions about schizophrenia, attitudes are shifting. In the first six years of See Me’s existence, the proportion of people who associated mental illness with violence dropped from 32 per cent to 19 per cent.

The impact that last week’s events could make to the ongoing fight against stigma should not be underestimated. The Halloween costumes may have marked the first time people with mental health problems have used social media to instigate change but, says Watson, it’s unlikely to be the last. The #mentalpatient photographs show that ordinary people are beginning to feel confident enough to take a stand.

“Doing what they did, mobilising the whole community to say ‘That’s gone beyond the line and we’re going to do something about it,’ was astonishing,” says Watson.

It seems those who were once silenced by shame are finally finding the courage and the means to make their voices heard. They have already proved themselves a force to be reckoned with.

Twitter: @DaniGaravelli1