Blue Tuesday: Is there too much work against Blue Monday?

60_jahre_allgemeine_erklarung_der_menschenrechte_3084670759

This bear is leaving home because its owners believe that Blue Monday has a scientific origin. (Attribution)

Yesterday wasn’t Blue Monday. Or to use its full name, Blue Monday (A Normal Day Of The Year Which Was Rebranded Through Marketing With A False Veneer Of Misleading Science). Blue Monday (ANDOTYWWRTMWAFVOMS) became a “not a thing” which happens as a result of holiday sellers, Sky Travel, and public relations company, Porter Novelli, selling holidays and public relating. They invented a formula which supposedly calculates that the third Monday in January is the most depressing day of the year and stuck what looks like a scientist on the front to complete its fancy-dress costume of sexy fake science concept. Needless to say, the average mood of everyone is too complex a thing to calculate with the simple equation being touted. Saying it can is a horrendous misrepresentation of the scientific method, human emotions and mental health. The added scientist, Cliff Arnall, is not a doctor or a professor of psychology. Or of anything. Saying he is is…

It’s difficult to argue with the success of the Blue Monday (ANDOTYWWRTMWAFVOMS) idea as a piece of marketing. On the day itself, the number of companies, including charities, that use the term to promote their products or causes is vast. With the general theme of spending money to improve your mood, Blue Monday (ANDOTYWWRTMWAFVOMS) is used to sell pretty much everything; be that the holidays it was designed to sell, cars, chocolate or financial advice. Perhaps more subtly, some groups have tried to re-purpose Blue Monday (I’ll stop now). They argue that while the supposed science might be a gargantuan heap o’ nonsense, it can still be a day to consider and support those who are unhappy. In addition, a lot of people have put a lot of work into explaining why, as a scientific concept, Blue Monday has the same credibility has half a brick with a picture of Dr Emmett Brown sneezed onto it by a guinea pig. So much so, that the publication of pieces debunking the science of Blue Monday have become as much of a tradition as the shower of gaudy sadverts.

kiara

This dog is more scientific than the formula for Blue Monday. (Attribution).

For the last few years, I have gained the impression that the pieces attempting to counteract the Blue Monday information have become more common than the items using its selling power. If this was indeed the case, the main thing keeping Blue Monday alive would be the valiant efforts to kill it. This could be placed in the Venn diagram of ironic things and bad things. However, whether this is the case is far from decided. While I have seen the same claim from others, my perception that anti Blue Monday work is more common than pro Blue Monday work is just that, a perception. Perceptions are at risk of bias.

Confirmation bias would mean that I might be interpreting information in a way that confirms my pre-existing beliefs. All the evidence I’ve seen shows that confirmation bias exists. The Baader-Meinhof phenomenon (or frequency illusion) would mean something that’s recently been noticed by me, suddenly seems to occur at a greatly increased rate. Once you’ve noticed the Baader-Meinhof phenomenon, you’ll start seeing it everywhere. Finally, the perception that anti Blue Monday work is more common than pro Blue Monday work might be the result of an echo chamber. I’m more likely to associate (digitally or in the great outdoors) with people who hold similar points of view to me. I’ll therefore see opinions the same as mine with greater frequency, and if I’m not careful will come to believe that those opinions are the most common. Everything I’ve seen on Twitter confirms I’m right.

One potential antidote to the plethora of human bias is correctly analysed data. I didn’t have that, so I took to the internet. On 16th January 2017, I searched for the term, “Blue Monday” on Twitter. I didn’t specifically use the hashtag because I wanted to avoid people or organisations using it just to make their tweets more locatable on the specific day. On a separate note, SEX! I then counted the tweets that seemed to believe the effect of Blue Monday, the tweets that actively opposed the effect of Blue Monday, and the tweets that didn’t believe Blue Monday, but wanted to use it to at least gain some benefit. I did this until the total tweets I’d counted reached 100. To be counted, a tweet had to at least hint at belief in Blue Monday or otherwise. It couldn’t just spout a load of a nonsense about sofas and then end with a hashtag. I also did a similar thing with Google (incognito window to avoid the influence of my search history) to count sites, news items, blog posts etc. and place them in the same categories as were used for the tweets. This was also completed when the total links reached was equal to 100. I later checked the Google search o a separate device and found the resulting list to be practically the same.

The results can be seen below. In summary, the pro Blue Monday items were much greater in the number than the anti Blue Monday items. These were both much more prevalent than items trying to re-purpose the day. My perception was wrong, and unfortunately the work to demonstrate that the idea of Blue Monday is anti-scientific rubbish appears to still has some way to go.

blue-pie

Pie part showing the proportion of pro Blue Monday, anti Blue Monday and re-purposing Blue Monday items.

 

One thing to note however, was that out of the pro Blue Monday items, 72% were advertisements. As discussed, these would make the argument that it’s the saddest day of the year so why not buy chocolate/hair gel/happiness? It is unclear to what extent the people behind these believe that Blue Monday was a scientific concept. While their adverts vaguely hint at belief, it’s just as likely that the mention of Blue Monday and its supposed effects are being used as devices to enhance how noticeable their brand is on a specific day. An increasingly difficult task given how common the use of the Blue Monday “brand” is. It seems to me that an advert that went with something other than Blue Monday marketing on the third Monday in January would be the one to stand out.

I’m not sure why efforts to educate people as to the non-scientific origins of Blue Monday are not working or even if they are actually not working in the first place. As discussed, it’s possible people know all of this, but find the term useful for their purposes; whether these are charitable or otherwise. Indeed, some news outlets may be using anti Blue Monday work to join in and take advantage of the temporary interest while maintaining an appearance of credibility. There’s no point in having your cake if you can’t eat it.

Ultimately and unfortunately, it appears that not much can be done about the Blue Monday juggernaut. I might still hold out hope for those valiantly explaining the gibberish behind the claims and even for those re-purposing the day for more noble causes. Judging by the current proportions, these efforts need to increase or change their methods to become more effective. How? I don’t know, although at least I’ve got nearly a year to think about it.

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Stigma and mental health: a one-sided conversation

L0026693 A man diagnosed as suffering from melancholia with strong su

A man diagnosed as suffering from melancholia with strong suicidal tendencies. This is what people thought people with mental illness looked like before they all started looking out of windows with their heads in their hands. 

What is stigma?

Stigma is basically a word for discrimination. Slightly more technically, stigma has been described as a sign of disgrace that is perceived to set a person or group of people apart from others. It’s also a Greek letter, although everyone that uses it in that way is rubbish. Stigma can affect many groups, including people with mental health problems, the elderly, and a third less serious group that I was going to include as a joke, but didn’t because it would increase stigma too much.

The casual use of language stigmatising mental illness is exceedingly common. If you’re a bit angry you might be described as mental or psycho. If you put a book away you might be called obsessive compulsive. Media portrayals reinforce stigma by constantly associating images of violent and homicidal individuals with mental ill health. The Eurovision song contest recently got in on the stigmatising act by parading a person in a Eurovision-themed straitjacket for so called crazy fans and having one of the hosts proclaim “You know what they say – crazy is the new black.” Which is definitely saying like, “Half a cup of thunder makes the bears look at the handbag” and “You don’t have to be crazy to use stigmatising language, but it…oh…I see…I’m sorry.”

Even children’s television seems to have gotten in on the act. A study in the British Journal of Psychiatry found that during just one week’s worth of children’s television, 59 out of 128 programmes contained one or more references to mental illness. Terms like “crazy”, “mad” and “losing your mind” were commonly used to portray that a character was losing control. Six characters were identified as consistently shown to have a mental illness. These characters were almost totally devoid of positive characteristics. Luckily, children aren’t impressionable and don’t learn or pick up attitudes easily.

Does it really matter if people are offended?

In the great scheme of things, not really. Overall, it’s probably not good to upset people, although that largely depends on context. If you’re using abusive language and someone says your awful because of you’re abusive language and this upsets you, then you’re upset doesn’t matter a Katie Hopkin’s opinions worth. If someone with severe anxiety is offended because you’ve told them to “stop worrying”, then that does matter. You’re belittling a potential illness, and ignoring and heightening their distress. We’ll deal with these cases of offence on a case by case basis until we’ve Gervaised the lot of them.

Stigma

I really wouldn’t recommend searching for “prejudice” in order to find images for your blog post.

However, this isn’t really about people being offended. It’s about the harm that can be caused by language and attitudes. Stigmatising attitudes towards people experiencing mental illness are responsible for substantial additional distress, as well as reduced employment and social opportunities. In addition, stigma can lead to hate crimes, a decreased ability to access appropriate healthcare and reluctance to seek appropriate help (if that help is even available). In fact, the stigma surrounding mental illness has been identified as the primary barrier to providing mental health care and the delivery of treatment. It turns out that if large portions of society hold negative beliefs about a group that aren’t necessarily true, then that group suffers.

So I’m banned from using certain words?

Not at all, but it would be nice if you thought about what you were saying and the impact it might have. Unsurprisingly in a matter involving language and society, there’s a lot of nuance involved. If I privately say “my cat is going bananas” while my cat does something adorable like climbing up the curtains or becoming non-fictional, then I’m probably not doing any harm. If I loudly proclaim to a crowd that another person who is shouting “has gone schizo” then that’s another matter. I don’t know who’s listening, who might be upset and who might avoid social situations or potentially getting help to avoid similar judgement. If you don’t believe in the potential impact of your words in this setting, perhaps you should look at the research, or at least have more confidence in yourself. You can make a difference!

Well, what other words can I use?

I’m pretty sure there are quite a few words that aren’t stigmatising towards people with mental health problems. There’s probably a word for that situation. I’ll check the dictionary. Anyway, a bit of variety in your insults will make you look more intelligent, which is always nice.

Sanakniigu

A good source of awful words.

Why are people so thin skinned?

It’s not really about being offended (as discussed previously), but if we’re talking about people with certain diagnoses then there is evidence that negative terms can have greater impact than in people without those diagnoses. For example, much research has shown that people with clinical depression have what’s called a negative cognitive style. That is to say they’re much more likely to focus on or attend to the negative aspects of any personal experience and to an extent may be unable to focus on positive or neutral aspects. Conversely, other studies claim that this tendency differs across individuals with the depression with some people focusing on negative information, while others pay equal attention to negative and positive information but remember negative information more efficiently than those without depression. Either way, telling someone with this problem to just ignore the bad stuff isn’t helpful. Like telling someone with their foot caught in a bear trap to just walk it off.

I have a mental illness and it doesn’t affect me like that!

That’s good. However, there are other people who it does affect.

Isn’t this just being pedantic about language?

“Just”?!

But you got several phrases regarding mental health wrong!

Probably, and I apologise for that. I daresay I’ll do it again, but I’ll try and do better. Which is hopefully what we’re all trying to do. Not you though. You’re perfect. You’re hair is particularly good.

In fact, a bigger problem is that throughout this post I’ve essentially referred to people with mental illness as a homogenous group. This obviously isn’t true, just as it wouldn’t be for any large group of people. It also potentially marks a large proportion of the population (1 in 4 is often bandied about, although I can’t find a good reference for that figure) as an outgroup. I certainly don’t want to do that, and a large part of reducing stigma should probably be in getting people to consider that the group they’re stigmatising contains as much variety in personality as any group they consider themselves a member of, that that group contains people just as capable of experiencing harm as they are (more so in some cases) and that their words have the power to impact real-world events. Easy done.

Are you finished yet?

Yes.

 

Image credits: Wellcome Library, London. Wellcome Images images@wellcome.ac.uk http://wellcomeimages.org A man diagnosed as suffering from melancholia with strong suicidal tendency. Lithograph, 1892, after a drawing by Alexander Johnston, 1837, for Sir Alexander Morison. 1837-1892 By: Alexander Johnstonafter: Alexander Morison and Byrom BramwellPublished: [1892]

By Ilja.mos – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46665757

 

Does stigma against mental illness increase as people get older?

Want to feel old? Then continue living.

Want to feel old?
Then continue living.

Some say that children are our future. This seems like nonsense given that in the future, all the children will be old people. Are old people the future? This is clearly a facetious point, albeit one with tangential relevance given the trend in Western society for people to live longer. In the United Kingdom, there are currently about 10 million people who are over 65 years old and it is predicted that this number will increase to 19 million by 2050. The phrases “grumpy old man” and “grumpy old woman” may just have to become “grumpy man” and “grumpy woman” simply due to commonality. Or ultimately, “man” and “woman” as grumpiness becomes the ground state. This is rubbish and I hate it.

One concern in an ageing society is mental health care. There are an increasing number of older adults in need of psychological care and it has been identified that cultural and organisational aspects of mental health care in later life present some of the main barriers to quality services. Stigma can be described as a sign of disgrace setting a person apart from others and Erving Goffman, defined stigma as “the process by which the actions of others spoils normal identity.” Stigma against people with mental illness can result in a lack of funding for services, and difficulty gaining employment, a mortgage or holiday insurance. Feelings of shame from perceived stigma can also cause people to delay seeking help or even deny the existence of their symptoms. Stigma surrounding mental illness has therefore been identified as one of the primary barriers to providing sufficient mental health care.

It seems obvious that attitudes and perspectives change throughout life with identifiable trends. The perspectives of a 20-year-old are unlikely to be exactly the same as those of a 90-year-old, whether this is due to differences in lived experience or due to age itself. So perhaps attitudes towards people with mental health change as we age. If attitudes towards people with mental illness improve as we age, then great. Let’s see why and see if we can use what we learn in anti-stigma interventions for younger people. Older people really are the future. Someone should write a song. If attitudes towards people with mental illness worsen and become more stigmatising as we get older then not great. Nobody should write that song. Not even if it contains the line “Oh. Think twice. Just another day for you and me with prejudice.” However, at least if it is known that stigmatising attitudes against people with mental illness worsen with increasing age then interventions against stigma can be targeted towards older people. Why? Because of the reasons we’ve discussed e.g. stigma is bad and causes bad things to happen to vulnerable people.

To investigating these issues, a study was carried out with the aim of determining whether stigmatising attitudes towards people with mental illness increased with age. This study will be described here.

Method

Three surveys were given to German citizens aged over 18 years in 1990, 2001 and 2011. Individuals taking the surveys were selected randomly and once they had provided consent, were interviewed face-to-face.

Data were collected through face-to-face interviews. This picture probably isn't representative of that process.

Data were collected through face-to-face interviews. This picture probably isn’t representative of that process.

During the interviews, participants were presented with short stories describing either a person with schizophrenia or major depression. The stories did not specifically state the diagnosis of the person, although the symptoms described fulfilled the criteria set out by the World Health Organization’s (WHO) Diagnostic and Statistical Manual of Mental Disorders (DSM) III. During the 1990 and 2011 interviews, the sex of the individual within the story was varied at random. However, during the 2001 interviews, only responses to stories describing a male with mental illness were recorded. As a result, only responses recorded in reaction to stories containing males were included in the analysis. Once again, there doesn’t seem to be much that men won’t try to take control of.

Stigmatising attitudes against people with mental illness were measured using a social distance scale. That is to say, the participants’ willingness to engage in various everyday activities with a person with a mental illness was measured. Such activities included working together, being a neighbour, recommending for a job and letting them take care of a small child. Willingness was rated on a scale of 0−5 and combined across all activities into an overall social distance score out of 28. A higher score indicates a higher desire for greater social distance, and potentially greater stigmatising attitudes.

The effects of age, birth-cohort (group that was born at a similar time) and time period on social distance (the measure of stigmatising attitude against people with mental illness) were then analysed. Maths was involved. What are the chances?

Results

Participants

  • 7,835 participants aged 18 to 93 years
  • 3,925 participants heard the story describing the person with symptoms of schizophrenia and 3,910 heard the story describing the person with symptoms of major depression.
  • Age groups included were 18 to 30 years, 30 to 39 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and equal or over than 70 years.
  • The number of participants within each age group were reasonably evenly matched, with slightly fewer within the equal or over than 70 years population.

Effects

Age

For both illnesses described, there was a significant effect of age, with a higher social distance score with increasing age.

Social distance scores and therefore attitudes towards people with mental illness become more negative (higher social distance scores) with growing age.

Attitudes towards people with mental illness become more negative (higher social distance scores) with growing age.

Cohort

Cohort only appeared to have an effect in relation to the story describing someone with symptoms of major depression and not regarding the story describing someone with symptoms of schizophrenia. People born in later years showed lower social distance scores towards the person with symptoms of major depression, regardless of the effects of age or time period.

Time Period

Time period effects were examined for 1990, 2001 and 2011. Time period appeared to have a significant effect on social distance, with people from more recent time periods displaying higher social distance scores against people with symptoms of mental illnesses.

Conclusions

The authors concluded that over the life-span, social distance scores and therefore attitudes towards people with mental illness become more negative (higher social distance scores) with growing age. The effect of cohort seems to differ across disorders, although only two sets of diagnostic criteria were examined within this study. People from more recent time periods tended to display higher social distance scores (and therefore potentially more negative attitudes) against people with symptoms of mental illnesses.

The authors state that the findings of increasing negative attitudes towards people with mental illness with increasing age is due to a tendency for conservative attitudes to grow with age and to the preference of older participants to prefer familiar social partners who are less likely to trigger negative feelings. It may also have been the case that as the person featuring in both stories was of working age, social distance score may have increased with age simply due to a perceived age difference between the participant and the person being described.

It’s ultimately concluded that stigma against people with mental illness in old age is amplifying burden in a population that is already vulnerable to social isolation and that this is likely to contribute to more negative health outcomes.

Limitations

No “control” story describing a person without symptoms of mental illness was included as part of the interviews.

No “control” story describing a person without symptoms of mental illness was included as part of the interviews.

Only one story was presented to each participant. Attitudes recorded may therefore represent those held towards the individual within the one story with that particular set of symptoms rather than stigma towards people with mental illness as a whole. Having said that, people with mental illness represent a highly varied population, you know, because they’re people, and asking a study to narrow down one particular set of attitudes towards this entire population may be too much to ask. However, it may have been useful to include responses to more than one story, describing symptoms of more than one recognised mental illness diagnosis to attempt to capture attitudes to a broader range of people.

No “control” story describing a person without symptoms of mental illness was included as part of the interviews. As such, there is no baseline score for social distance score and how it changes with increasing age. For example, it may be that social distance score increases with age due to the greater risk of social isolation that has been reported with age. There is no way to determine from these results whether attitudes relate specifically to people with mental illness.

As the study was conducted solely in Germany, the attitudes concerning people with mental illness that were revealed at most may only hold in similar cultures e.g. Western industrialised countries, or at least just within Germany. Further study across varying cultural groups would be required to determine whether the attitude trends identified exist cross-culturally.

The study doesn’t mention the composition of the participant population in terms of sex. This seems an oversight given that only stories featuring males were included and attitudes regarding gender and/or sex from different genders and/or sexes can be highly complex. In addition, we can’t necessarily assume that the participant population was approximately 50% female and 50% male, as the study includes people across a wide range of ages. In Western cultures, with increasing age, the proportion of males tends to decrease. However, as it stands, there is no way to determine whether the attitudes towards the person with mental illness within the story were influenced by the sex of the person described or the sex of the participant.

There seems to be no attempt to describe whether participants in the study had any history of mental illness or any experience with people with mental illness. This would undoubtedly affect attitudes towards mental illness. The authors state that the effect of contact could not be included as information regarding this variable was not consistently elicited. Given how common mental illness is, it could be argued that with increasing age, probability of encountering someone with experience of mental illness and/or experiencing it personally increases, and examining how this interacts with attitudes and increasing age is vital for future studies.

Summary

Take two of these twice a day and stop being prejudice. Seek doctors' advice if you're a member of UKIP.

Take two of these twice a day and stop being prejudiced.
Seek doctors’ advice if you’re a member of UKIP.

The findings describe how attitudes towards people with mental illness become more negative with growing age. However, the limitations of this study mean that this cannot be stated from these results with any degree of certainty.

Ultimately we do know that stigma against people with mental illness is a real problem with real negative impact in terms of mental distress and various life and health outcomes. While more research is needed to examine whether stigma towards people with mental illness increases with age and if so, why, the growing proportion of older people within Western societies means that tackling stigma in more elderly people may be a priority regardless.

References

Schomerus G, Van der Auwera S, Matschinger H, Baumeister SE, Angemeyer MC. Do attitudes towards persons with mental illness worsen during the course of life? An age-period-cohort analysis. Acta Psychiatr Scand 2015;1−8 [PubMed]

Sartorius N. Iatrogenic Stigma of Mental Illness. BMJ 2002:324:1470−71 [PubMed]

Comedians Are Not Psychotic

Comedy mask outside a theatre. There's also a tragedy one. This isn't proof of anything sciencey.

Comedy mask outside a theatre. There’s also a tragedy one. This isn’t proof of anything sciencey.

“Successful comedians display symptoms of psychosis, study says” went the headline. “Psychotic traits in comedians” said the title of the study the headline was referring to. “Bang” went the foreheads meeting the desks of many psychologists, psychiatrists and humans who’d thought for five seconds about what this headline could do for science, psychology, psychiatry and mental illness stigma.

The scientific study, which in this case is apparently Latin for “press release based on a journal article”, states that the popular belief that creativity is related to mental illness is borne out in comedians, who showed higher levels of psychotic traits than actors, who both showed higher levels of psychotic traits than “normal” people. The word normal was the article’s rather than mine as obviously actors and comedians (and by association people with traits of mental illness [?!]) aren’t “normal”. At least the authors are thematically consistent with their description of their research methods and their conclusions.

Is this what the research really suggests though? Spoiler alert 1: Bananas release an enzyme that causes other fruit to go off quicker so keep them separately. Spoiler alert 2: No. No, this isn’t what the research really suggests. This isn’t going to be a painstaking dissection of the research. This isn’t the place for that kind of analysis, the research isn’t particularly hard to critique and I’ve got important slamming my hand in a car door to do. This will be a brief look at how the headline changes as we look at the research and what can be inferred from it.

The authors claim that humour often involves the ability to compare normally incongruous frames of reference. For example chickens don’t normally have complicated reasons to cross roads, elephants shouldn’t be wearing Grouch Marx’s pyjamas, Michael Gove is somehow a politician in a position of power. Thinking in people with schizophrenia is often characterised by disorganisation of thought and speech containing ideas that are not logically connected or “word” salad in one of its more extreme forms. In a leap worthy of when Indiana Jones walks across that canyon to get that magic cup, it’s then argued that because humour can involve comparing disconnected ideas and schizophrenia can involve disconnected ideas that comedians are therefore more “psychotic” than people who aren’t comedians. They chose poorly.

Obviously not all comedians have mental distress indicative of schizophrenia of another mental illness. This is where the O-LIFE Personality Scale comes in. As well as being a song by Des’ree, the O-LIFE (Oxford-Liverpool Inventory of Feelings and Experiences) Personality Scale is a measure developed from the idea that symptoms/characteristics of mental illness exist on a spectrum and therefore traits which may predispose individuals to schizophrenia can be identified in non-clinical populations. In other words it looks for traits that everybody has that aren’t symptoms of mental illness but potentially would be if they were substantially exaggerated. It’s a bit like saying that people who really think dusting is important could have obsessive compulsive disorder if this trait were amplified.

A vacuum. Science hates these.

A vacuum. Science hates these.

New headline 1: Professional cleaners display symptoms of obsessive compulsive disorder.

New headline 2: Successful comedians don’t display symptoms of psychosis but would do if the traits they possessed were very much exaggerated. You know, like with most people.

The O-LIFE questionnaire through getting you to answer YES/NO questions on around 160 questions (versions vary) gives you a rating in four different personality traits, identified as aspects of schizophrenia (or as the study more broadly calls it, psychosis. The two are not the same, but that’s an argument for another time.)

  • Unusual Experiences: tendency for magical thinking and to experience perceptual distortions.

“I believe in telepathy and sometimes think I hear people telling me telepathy isn’t real.”

  • Cognitive Disorganisation: distractibility and difficulty focussing.

“I never listen to them though because….oooh biscuits!”

  • Introvertive Anhedonia: reduced ability to feel social and physical pleasure.

“I wish to be alone to eat my biscuits. Your presence makes me uncomfortable.”

  • Compulsive Nonconformity: tendency to impulsive, potentially antisocial behaviour.

*Punches potential biscuit thief. Wanders of to watch Derek Acorah for 2 minutes.*

In terms of the O-LIFE (Ooooooh life! Oh life, doo do do doo) questionnaire, the higher your rating in these four areas, the more you possess traits related to psychosis. I’d rather have a piece of toast.

The study asked online for people from online comedian agencies, comedy clubs, comedian associations and comedian societies mainly in the UK, USA and

Australia who said they were comedians to complete the O-LIFE questionnaire.

New headline 3: People on the internet who say they are comedians might have traits similar to psychosis if the traits they said they had online were exaggerated.

“Actors” were recruited in a similar way through acting agencies, clubs and so forth. The sample of people saying they were comedians consisted of 523 individuals (404 men and 119 women) The control sample consisted of 364 people saying they were actors (153 men and 211 women) and the “normal” control group consisted of 831 people (246 men and 585 women). It should be noted at this point that there is clearly a big discrepancy between how many men and women are in each group and the men and women studied were different in terms of O-LIFE personality traits in the comedian, actor and control group. However they did their statistics all up in it and there was no interaction between sex and being a comedian that affected O-LIFE score so this potentially massive confounding variable gets ignored. Do men who claim to be comedians rate their own personalities differently to women who don’t? We’ll never know.

We do know.

New headline 4: More men than women say they’re comedians and also rate their own personalities differently. Information is used unwisely and incorrectly for jokes and “banter”.

A tragedy mask at a theatre. It's sad because of badly communicated science.

A tragedy mask at a theatre. It’s sad because of badly communicated science.

The much flouted results were that people who say they’re comedians had significantly higher ratings across all four personality traits than people who don’t say they’re comedians. This seemed to particularly be the case for Introvertive Anhedonia and Impulsive Nonconformity. The authors noticed these were opposites and claimed that this means comedians were more likely to have personality traits a bit like bipolar disorder. Spike Milligan was wheeled out which proves it.

New headline 5: Mental illness is common so it’s not that shocking that some comedians have mental illnesses.

The conclusions seem to be that these traits allow comedians to be creative in a way that leads to comedy. It seems reasonably logical to assume that you have to think slightly differently when trying to be funny than when you’re not, and that comedians can identify that they do this kind of thinking more often. Does this mean that comedians have psychotic traits? No. You’ll note that none of these new headlines are particularly good or attention grabbing. Does the headline that comedians have psychotic traits fulfil this function? Yes. Did they get my attention in that manner like some sort of chump?

New Headline 6: People who identify themselves as having a creative profession rate their own personality as having creative traits. Nobody is shocked until they claim it relates to psychosis which it doesn’t. I write about it like a chump.

Relatively Stigmatised: Mental illness stigma and its spread to family and friends.

I assume they're laughing at a picture of a "stereotypical" family in the book they're all reading.

I assume they’re laughing at a picture of a “stereotypical” family in the book they’re all reading.

(Originally written for Time To Change and available here: http://www.time-to-change.org.uk/blog/mental-health-carers-relatively-stigmatised-david-steele)

“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.

Crazy talk: The language of mental illness stigma

I worry this may be the actual fate of some reality TV contestants.

I worry this may be the actual fate of some reality TV contestants.

 

It’s time to deface music! At the time of writing it was that time of year again. The musically talented and untalented alike had swum upstream (been selected in advance by producers) to spawn (sing a bit on television while people frown/smile at them).

Every Saturday night, millions of televisions blurted the selection of noises, shapes and primary colours that compose Cowell’s Cavalcade of Corporate Crooner Culling into the living rooms of the UK. The name of the particular programme has been changed for many reasons, i.e. x number of factors. During the initial stages of this singing and pointing competition the less-talented among the hopeful masses will be accused of a great many misdeeds. A simple internet search reveals contestants being referred to as dim, attention-seeking nutters, delusional, circus freaks, mad-as-a-box-of-frogs and violently breaking down.

The more astute among you may have noticed that these are intended to be derogatory terms belittling people for not using their vocal cords properly while some music is playing. Additionally these derogatory terms almost universally refer to mental illness in some fashion.

During the 2012 Paralympics, Channel 4 is showing a programme hosted by comedian Adam Hills. (The Last Leg with Adam Hills. It’s a pun, please don’t be wrong-footed. That was another pun (a much worse one). One section of this programme involves Adam discussing with Alex Brooker what you can and cannot say about the Paralympics: a frank discussion about the taboos inevitably involved when discussing disability.

Primarily their advice revolves around the content of speech. “Just don’t be horrible” – a seemingly simple piece of advice that needs to be tattooed backwards across the heads of whoever is writing THOSE comments on YouTube.

Hills and Brooker state that you probably will say the wrong thing and not to panic if you do. An example of such a wrong thing is given (source mercifully not provided): “In the Paralympic equestrian events, is it the horse or the rider who is disabled?”

The point is not to control what you should and shouldn’t say but rather to create an environment where people at least think about what they’re saying before being horrible or downright offensive.

Despite the first paragraph of this blog being about mental illness, I’m not trying to conflate being disabled with being mentally ill. Rather we should note that while people increasingly take care about the language they use to describe the disabled, the same luxury is often not afforded to those with mental illness.

You would correctly frown (I don’t know how you’d incorrectly frown, possibly a problem with your corrugator muscle) about someone with a stubbed toe saying “I’m a little bit crippled”. But you wouldn’t pay the slightest attention to someone tidying their desk saying “I’m a little bit obsessive compulsive.”

I can almost hear the cries of political correctness gone mad. Except if political correctness really had gone mad, we wouldn’t be allowed to use the phrase, political correctness gone mad. Possibly you’d be forced to say political correctness had become a little bit obsessive compulsive.

The casual use of language stigmatising mental illness is exceedingly common. Stigma can be described as a sign of disgrace setting a person apart from others. Erving Goffman, defined stigma as, “the process by which the actions of others spoil normal identity.”  For those with mental illness the stigma experienced can result in a lack of funding for services, difficulty gaining employment, a mortgage or holiday insurance. Ultimately, feelings of stigma cause people to delay seeking help or even deny they have symptoms in the first place.

Casual language used to describe mental illness is decidedly negative. He or she is described as going mad, mental or psycho. Media portrayals reinforce this with images of violence and homicide associated with mental ill health. It was rare to see a discussion concerning the recent shootings in Aurora, Denver, without comments about the shooter’s mental health status.

Even children’s television seems to have gotten in on the act. One study in the British Journal of Psychiatry found that out of a sample of one week of children’s television, 59 out of 128 programmes contained one or more references to mental illness. Terms like “crazy”, “mad” and “losing your mind” were commonly used to denote losing control. Six characters were identified as being consistently portrayed as mentally ill. These characters were almost totally devoid of positive characteristics. I’m not sure if one of these was SpongeBob Squarepants.  Why would a porifera even need trousers? Some sort of body dysmorphia ?

The sign “You don’t have to be crazy to work here but it helps” has become so common that it’s a cliché. People describing themselves as “a bit mad” usually mean that they’ve worn a sparkly hat at some point. Terms like mentalist, psycho, bonkers, insane and barking are thrown around like loose pennies in a conversational washing machine. Look at Terry, the mentalist. He’s bonkers. He’s so drunk he’s gone outside to punch the thunder for annoying the moon. Mad!

An argument could be made that these terms, while technically describing mental illness are not being used to specifically refer to mental illness. Rather they are referring to behaviour which they consider a little out of the ordinary. We can refer to this argument as Gervais’s Gambit. The problem is that if this language is making people with mental illness feel stigmatised, ashamed and isolated then the amount of thought behind it as it is used casually is largely irrelevant.

If you are so attached to using a word you don’t want to put any thought behind it before you use it that’s fine. I am more than happy for you to take your dictionary on a romantic weekend away if you promise to use your technical definitions in private without hurting anyone. “But nobody I know has complained about me using this language.” Well no, perhaps the people you know with mental illness are too worried you’ll call them crazy and laugh at their inability to sing.

And you will know somebody with mental illness. With estimates of one in four (most likely higher) people being affected it would defy statistics if you didn’t. And only Benjamin Disraeli is allowed to defy statistics. Ultimately people are not going to stop using these terms stigmatising mental illness. It could be argued that at least one comment I’ve made during this article does just that. They are as entrenched in language as the saying of “lol” is instead of actually laughing. As a side note, shouldn’t people who say lol instead of laughing, write it as lolol to describe laughing?

Like the thought that should go into that distracting parody of text speak, it would be enough that people thought about what they are trying to express and whom they will hurt. Especially as it’s likely to be someone close to them. You can still make your jokes and use the words, but consider whether another word might do and who you may hurt beforehand. Perhaps then we can move towards a frank and honest dialogue about mental illness and away from the disgrace and stigma.

The Royal College of Psychiatrists along with mental health charities Mind and Rethink Mental Illness have produced a video explaining more about mental illness discrimination and how you can support the proposed mental health (discrimination) bill.

That and some consideration before you describe your busy weekend as mental, would go some way to reduce mental illness stigma. I don’t think I’m crazy to think that would be a good thing.