Challenging ideas in mental health
Challenging ideas in mental health

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Challenging ideas in mental health

1.1.2 Boundaries of difference

One of the things that language does is define and give a name to differences between people – to delineate the boundaries that separate them. In the mental health field, the ‘mad’ are at one end of the social divide that separates the ‘normal’ from the ‘abnormal’. They are ‘the other’, a point made in the article by Perkins in the previous section: ‘To be mad is to be defined as “other”’.

This is a recurring theme in the mental health field. In the following passage Abina Parshad-Griffin, who at the time was the Chair of the Mental Health Action Group for the Disability Rights Commission (DRC), reflects on ‘otherness’ and what it means to be ‘the other’:

I could use different aspects of who I am that make the whole of me, as a kind of through-the-looking-glass. And I can give an example: being mixed race, if I had to fill in different forms in various countries, I’d have to tick different boxes. So in South Africa, I would have been ‘coloured’. In America, I would be ‘black’ because one drop of Black blood makes you ‘black’, and excluded. In South America, I could possibly be ‘mixed race’, or I could even pass for ‘white’ when you have the hierarchy of colour coding. But guess what I’m called in England or the UK? ‘Other’. And it’s that otherness that is part of my identity, and I believe that mental health discrimination is that otherness which is sometimes indefinable. But you pick it up – this overt and covert discrimination. I call it ‘psychophobia’: fear of mental illness. And there are certain conditions. Like somebody asks me, ‘What do you do?’ And I say, ‘Schizophrenia.’ You know that’s going to be a conversation-stopper and you will also know that it’s going to be associated with violence, with antisocial behaviour, which is not at all the case. That’s rare.

(Disability Rights Commission, taped conversation, n.d.)

To be ‘other’, in many instances, is to be on the wrong side of the boundary. The fact that Parshad-Griffin is mixed race gives her an officially designated category of ‘other’ in the UK. In addition, of course, her experience of mental distress reinforces her ‘otherness’. To be regarded as ‘other’ is to be treated differently, which often means prejudice and discrimination. ‘Otherness’ comes into play at all levels, but especially, it seems, when mental distress triggers ‘psychophobia’ in the people around. Although Parshad-Griffin’s situation also features ‘double discrimination’ (Baxter et al., 1990; Wainwright, McKeown and Kinney, 2019) because of her dual heritage, in many ways it is typical of the experiences of people who have periods of mental distress. Psychophobia leads to prejudice and discrimination. This may be something you have experienced yourself or have witnessed first-hand.

Being seen as someone with mental health problems may result in discrimination, often of a severe kind, as many people have found to their cost. The experience of being on the ‘other’ side of the mental health/distress boundary may be accompanied by unemployment, breakdown of relationships, low income and poor housing. For Black, Asian and Minority Ethnic (BAME) groups, the ‘other’ that is associated with racism is distressing and can directly contribute towards their experiences of mental ill-health. This is illustrated in the work below from the Black British artist Ashley Straker. In this piece, they graphically depict the emotional exhaustion experienced as a result of the COVID-19 pandemic, while also simultaneously dealing with racism and news about the injustice of Black people being killed. As indicated in the artwork, these stressors are a lot to ‘carry on your shoulders’.

This is an illustration of a black teenager holding on his shoulders items such as Black Lives Matters protests, a ‘Stand against racism’ sign, and the NHS.
Figure 2 ‘There is a lot we have to carry on our shoulders’.

Activity 2: David Harewood: Psychosis and Me

Timing: Allow about 20 minutes

In a BBC/Open University co-production, British actor David Harewood (MBE), reflects on his past experiences as a young Black man sectioned under the Mental Health Act (i.e. detained for treatment without his agreement). In the following clip he discusses his experiences with clinical psychologist, Dr Chanelle Myrie.

Watch the clip now. Then write your answers to the two questions in the text box below.

Download this video clip.Video player: Video 1 David Harewood: Psychosis and Me
Skip transcript: Video 1 David Harewood: Psychosis and Me

Transcript: Video 1 David Harewood: Psychosis and Me

DAVID HAREWOOD

I'm starting to wonder how much of my psychosis was connected to the racism I was dealing with. And if my experience is shared with other young Black men.

TEXT ON SCREEN

Black men in Britain are ten times more likely than white men to be diagnosed with a psychotic illness and four times more likely to be sectioned. Sources: Government Race Disparity Audit/NHS Mental Health Act statistics.

CHANELLE MYRIE

There are lots of reasons why young Black men are being sectioned more. One reason is that Black men come to the mental health system later than their white counterparts, and that's for fear of being hospitalized, fear of being stigmatized. They arrive at hospital at crisis point, really.

DAVID HAREWOOD

Let me just-- I'm going to go to for my bag here-- I want to look, show you my records from 30 years ago.

CHANELLE MYRIE

Oh, wow.

DAVID HAREWOOD

See, look at this, I mean, this is like-- this is what a doctor wrote-- lively, bit of a clown, but sly underneath.

CHANELLE MYRIE

That's awful.

DAVID HAREWOOD:

It's awful.

CHANELLE MYRIE

Absolutely awful.

DAVID HAREWOOD

Very hostile and angry, shouting, fighting, given diazepam with the help of six policemen. Do you think that authorities consider us more dangerous?

CHANELLE MYRIE

I do, and I definitely think that there's a story that exists for how Black men are seen in society and that influences people's perceptions. Images of Black men as violent, hypermasculinity, so I think when a Black man presents in crisis sometimes people's ideas about what Black men are like overshadow the person that's actually in front of them.

DAVID HAREWOOD

So you think all those negative connotations, all those negative, all that negative language, plays into that--

CHANELLE MYRIE: It can play into your perception of yourself. Exactly, exactly. And the ideas of who you want to be, and who you can be.

DAVID HAREWOOD

I guess that's the part marginalization plays of images of self. If everybody you see on TV is white and all the police are white, all the heroes are white, it can subtly seep into your--

CHANELLE MYRIE

Yes, that's exactly it. So I think sometimes it's referred to as the everyday struggle, which is just what life is like for a young Black man. Experiences of marginalization, oppression, discrimination. And I think that actually things like that, experience like that, can have a cumulative effect in the development of psychosis.

DAVID HAREWOOD

It's good to hear that what happened to me wasn't just as a result of my individual issues, problems, but that there are factors at play in people that look like me.

End transcript: Video 1 David Harewood: Psychosis and Me
Video 1 David Harewood: Psychosis and Me
Interactive feature not available in single page view (see it in standard view).
  1. Why is it thought that young Black men are sectioned more often?
  2. What are some of the factors, described as ‘accumulative effects’ in the clip, that contribute towards the development of psychosis for young Black men?
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Interactive feature not available in single page view (see it in standard view).

Discussion

  1. Myrie explains that Black men access mental health services later than their White counterparts. This is due to the fear of being hospitalised and the fear of being stigmatised. As a result, they arrive at hospital or services, already at crisis point (i.e. when they are extremely distressed).
  2. The cumulative effects include the everyday struggles frequently experienced by young Black men. For example, their experiences of marginalisation, oppression, and discrimination (including ‘double discrimination’).
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