The Daily Mail and The Telegraph featured adverts for drinkable sunscreen so I looked for evidence that it works.
Here it is:
I couldn’t find any. Because it’s water.
Here’s a picture of a goldfish instead.
Too much sun exposure without the RIGHT protection can harm the skin and increase the risk of skin cancer.
Here’s some information about skin cancer.
Here’s some stuff about the drinkable “sunscreen.”
Stay safe.
I’m going for a lie down.
I assume they’re laughing at a picture of a “stereotypical” family in the book they’re all reading.
“You’ll be fine as long as you can avoid going native.” These were the words spoken to me when I said I might be interested in psychiatry. If we were being unkind (and possibly correct) we would say that this statement belies evidence of stigma against mental illness and those who deal with it professionally. It even hints at the idea that mental illness is somehow contagious or catching. Who knows how such an “infection” could be spread. Be careful when sneezing while depressed I suppose their advice might be.
If we were being more forgiving we might decide that this person was merely showing a concerned attitude, highlighting the difficulties inherent in having a mental illness and in being responsible for the health needs of those experiencing it. Either way, this brief conversational snippet can be used to highlight not only the stigma against those with mental illness but the spread of that stigma to those that care for them.
Stigma can be described as a sign of disgrace setting a person apart from others. Erving Goffman, noted sociologist, defined stigma as, “the process by which the actions of others spoils normal identity.” It is common for people with mental illness to feel invisible or that their needs are not being met. They feel people assume they’re “benefits scroungers” and that they should “pull themselves together”. Casual language used to describe mental illness is decidedly negative. He or she is described as going “crazy”, “loony” or “psycho”. I haven’t seen the film, Psycho, but I suspect the emphasis isn’t on hugging. Media portrayals of mental illness reinforce stigma with images of violence with mental ill-health.
Family members of those with mental illness are affected with so called “courtesy stigma” or stigma-by-association. But when thinking about courtesy here, think less about opening doors for others and more about unnecessary guilt. Many relatives feel it necessary to hide the mental health problems of their nearest and dearest. In one study of 156 parents and spouses of people experiencing a first-admission to hospital for mental health problems, 50% reported making efforts to conceal their relative’s illness from others.1
Secrecy can act as an obstacle to presentation and to the treatment of mental illness at all stages. As such when social resources are mobilised, people with mental health issues and their families may be removed from potential support. It follows that poorer outcomes are likely.
Depending on the illness and its severity, the help and support provided by friends and family can be of great importance when it comes to successfully treating mental health problems. But families must remember there’s only so much they can do and that their own lives are important. Families must realise they are not to blame, that it is ok if they feel stress when a loved one has a mental illness. As such stigma by association must be reduced to aid this process. The Royal College of Psychiatrists and Rethink Mental Illness has some great resources for aiding families of those with mental illness with this in mind. So does Mind of course.
Logically an increase in the accuracy of information available would be an ideal way to reduce courtesy stigma. If it was widely known that stereotypes such as that of the “violent mental patient” or the “neglectful parent of a mentally ill child” were false then it would seem stigma could be reduced. However research on reducing mental illness stigma, highlights the importance of what information is used.
In one study participants who were told that mental illness had a genetic basis were more likely to assume that people with mental illness were dangerous compared to individuals told that mental illness was explained by social factors. Additionally those told mental illness had a genetic basis were more likely to stigmatise the families of those with mental illness.2. If we are going to use an information-based approach to reduce mental illness stigma we are going to have to be very careful about what information is used.
Ultimately then we can see that while it is obvious that those with mental illness need support and would benefit enormously from stigma reduction, the same can be said of family and friends who will be providing the majority of this support. The familial and social networks of individuals with mental illness are the backbone of their support and we mustn’t let stigma create an invertebrate system of isolation for these caring individuals.
References
1. Phelan, J. C., Bromet, E. J. & Link, B. G. (1998) Psychiatric illness and family stigma. Schizophrenia Bulletin, 24, pp115–126.
2. Read. J. & Harré. N. The role of biological and genetic causal beliefs in the stigmatisation of “mental patients”. Journal of Mental Health. 2001. 10 (2), pp 223-235.
“That’ll be £10 please. You’re ill because of your bad choice in furniture.”
The greatest griefs are those we cause ourselves – Sophocles
I’m sure Sophocles thought he was being quite clever when he said the quote above. It’s one of those sayings (like most sayings touted on Facebook under a picture of a heroically sad cat) that sound like they should mean something but don’t. The worst things that happen to us are the things we do to ourselves. This isn’t necessarily true. If an imaginary gentleman called Fred stabs me in the toe without provocation, then I think I can fairly correctly blame Fred for causing a major grief in my life. Bastard, no wonder he’s imaginary. The quote is especially surprising given that it comes from Sophocles, a man who wrote several plays about Oedipus. Oedipus accidentally killed his own father and married his own mother. When he eventually found out the truth, he wisely dispensed with appearing on Jeremy Kyle and blinded himself. Subsequently Oedipus’ family were said to be doomed for three generations. In conclusion we have three generations of people with terrible things happening to them that weren’t their fault. Good work Sophocles. Sophocles wrote several tragedies where awful things were generally fated to happen to people. Fated. In that the people involved couldn’t help it. Perhaps Sophocles would have been better off saying, “the greatest griefs are those caused by uncontrollable forces of nature and destiny.”
Katie Hopkins probably thought she was being quite clever when she decided she knew how to fix the National Health Service. Katie Hopkins proposes that those who eat, drink and smoke too much should pay more towards any additional NHS care they require. The delightful Katie then goes on to state, “Frankly if you don’t care about your body or your health, then as a taxpayer funding the NHS, nor do I.” Katie Hopkins must be a very wise individual, with years of research into healthcare, economics and politics to come to this conclusion. A cursory glance reveals that in fact Katie Hopkins is a former and repeated reality TV contestant. (The Apprentice, that celebrity in the jungle one and nearly Big Brother if you must know). To be completely fair she did study Politics and Economics at the University of Exeter. As such it seems we should rank her opinions on the matter alongside those of Fictional Fred the Toe-Stabber, who I have decided studied the Economics of HealthCare at the University of Toe-Stabbing. If it seems harsh comparing the opinions of an existing human to a fictional one, remember that the existing one was described as difficult to get along with by other contestants of The Apprentice. A situation not too far removed from being described as “a bit green” by Kermit the Frog.
Ultimately it doesn’t really matter who Katie Hopkins is (a fact the BBC should quickly realise) as unfortunately her opinion is not an uncommon one. Member of Parliament and practicing GP, Phillip Lee had an opinion about doughnuts. According to Dr Lee, patients who have doughnuts for breakfast should pay for their prescriptions if they develop diabetes. This was widened to a more general point that people of this generation were less stoic than previous generations, some vague hints that people should pay for illness resulting from their “lifestyle choices” and an astonishing quote on his desire to save money by getting GPs to dispense drugs. According to Dr Lee, there is no need for pharmacists to be involved because “it’s like counting Smarties.”
The last point can be dealt with fairly quickly. Pharmacy and pharmacology is a varied and complex field which takes years of training prior to being allowed to practice. Counting Smarties it isn’t. Although admittedly an ability to count is useful. Perhaps Dr Lee thinks medicine comes from sweet shops.
We also run into problems when deciding on how to charge people for illnesses they have been judged responsible for. Should people pay for medical problems resulting from obesity if they have an unhealthy diet? Lee and Hopkins would say yes. Should smokers who get lung disease pay extra? Again Lee and Hopkins would say yes. Heavy drinkers should pay if they get liver disease? Again that would seem to be a yes. But how much do you have to drink before you pay this premium? How much do you have to smoke or eat? Not everyone who drinks more than they should gets liver disease for example and the amount you have to drink before you’re at risk varies for what is likely to be genetic reasons. How is this accounted for? Does someone who injures themselves falling off a horse have to pay more? After all they decided to go horse riding. If anything choosing an equestrian hobby is more of a “lifestyle choice” than diabetes. The clue being that having diabetes isn’t a lifestyle choice. Should someone who slips getting out of the shower because they chose not to buy a suitable bathmat have to pay more? You buy the wrong mat, you pay the health cost Lee and Hopkins might shout. And so we see that this system of judging others’ responsibility becomes complex and untenable. The number of injuries resulting from throwing stones in glass houses alone would be ridiculous.
Can people have responsibility for their own health? Of course they can. People should try not to smoke, not to drink too much, exercise, try to avoid being stabbed in the toe and so on. Should they be punished if they don’t do these things? I’d say if they become ill then that’s “punishment” enough. Diabetes isn’t a walk in the park, especially if you develop foot complications. The myriad other complications of obesity, smoking and the like are awful to have and live with. To charge people on top of this seems unnecessary. It is likely to be argued that the NHS doesn’t have enough money to pay for all these illness and that those who have caused their own illness have a moral responsibility to make up the difference. Putting aside for one moment that people who are said to be ill because of overconsumption of a certain good whether it is food, alcohol or smoking have already paid extra in the form of taxation on those goods, moral responsibility in this area is difficult to judge.
In terms of enacting this strange financial justice we run into another problem. Many health problems and factors considered health risks increase with poverty. So suddenly people would be more likely to have to pay more when in fact they have less money. Julian Tudor Hart, former GP, noticed this tendency for good medical or care to decrease as the need of the population served increased in his Inverse Care Law and that this especially tends to be the case when medical care is exposed to market forces. Put simply, in the system proposed, people who need medical care most are least likely to get it. If you have to pay extra for treatment and you have no money then you’ll have to stay home (if you’ve got one) and be sick. Perhaps I’m fussy but this seems like a bad thing.
Moral responsibility is the division of actions into those that are good or bad and the attribution of praise, blame, reward or punishment to the agent responsible. It is beyond the scope of this already too lengthy blog post to decide whether the broad spectrum of health acts fall into the simple division of good or bad. Is one glass of one morally wrong? Two? Eight? I’d argue that none of the options are morally wrong although eight is certainly worse for you health wise. That isn’t really the point. The point is that it’s too complex to decide and allocate financial responsibility and ultimately it is not for the health service, doctors, nurses or any health care professional to be judge, jury and financial executioner for health problems patients don’t want and almost certainly didn’t consciously choose. The NHS may be having financial difficulties but applying judgment and discrimination through the weapon of accountancy does not seem to be a viable or ethical way forward. Aneurin Bevan when spearheading the formation of the NHS did so under the belief that treatment “Should be based on clinical need rather than ability to pay” and this to me seems the only morally responsible option. But what do I know? I’ve never been on reality TV.
Delight Through Logical Misery 