ProjectMIND

So, #MHAW15 is drawing to a close…it has been been great for ProjectMIND. We had the opportunity to spread our message far and wide and ask question’s to you in order to get you thinking about mental health. The future prospects for mental health awareness are looking up; people are slowly but surely paying attention - the stigma is wavering, we just need to be persistent! Let’s not wait for an occasion, we can raise awareness next week too!

I now think it’s time to look back at human development and how this has contributed to the stigma of mental health. Renowned psychologist Helen Campbell kindly wrote us an article entitled “Living with the enemy?” to explain this below. It’s lengthy, and dark at times but is certainly enlightening, informative and useful in enabling us to understand the formation of stigma. Enjoy!

- Kahvan

Living with the enemy? By Helen Campbell. MBPsS.   Humans developed as pack animals; not in the modern sense, as beasts of burden, but as mammals who lived in packs of roughly between eighteen and twenty-eight.  Too small or too large a pack was a threat, but so long as circumstances were favourable, they coped by sharing and by helping one another.  An undersized group might struggle to survive, and serious illness could wipe out a group or leave the remaining survivors to seek shelter in a neighbouring or extended family group if they would have them.  In times of plenty overpopulation meant that the environment might become exhausted of natural resources in the following season.  Social pressures would develop as people competed for status and resources and eventually there would be a split, with a few young people leaving the group to find a new one.  Young people might marry into neighbouring groups, but might move many miles to seek a mate.   Groups were affiliated into tribes, and most had periodic tribal meetings for the cooperative negotiations of lands, marriages and to share their identity and understanding of the world they lived in.  We still see many aspects of this behaviour in human life today. Success depended on living effectively on the land they controlled as a territory, hunting and gathering food and finding what safety they could from the climate, and from one another, in a nomadic circuit of their territorial land.  Very few humans still live this life, and those who do are considered a nuisance by those who often take land and resources they assume to be ‘available’ which have been the territory and wealth of nomads for possibly thousands of years.  It does not help to be different in modern human society, but in fact, it never has.   All pack animals operate a system of elimination of the weak in order to preserve the strong.  In favourable environments it is possible to support those less favoured in strength or abilities, but when times are hard, just like other species, humans can be very practical in order to survive.  The weak or those who do not fit in and cooperate are marginalised (pushed to the edge and not supported) or possibly driven off or killed.  Humans always have, and still do, practice infanticide.  Historically babies who did not meet the criteria set by the group were exposed (left out to die or be killed by animals) and the stories of wild animals raising abandoned children are not fantasies, we know of children living today who have been adopted into animal packs by monkeys or dogs.  In our society we manage infanticide by abortion, and it is strictly controlled, but it is still an accepted aspect of human life.                                                               In a human pack the weak or needy were not seen as the enemy, but they were a threat to the survival of the group.  Those who would or could not contribute and cooperate in the group’s activities were marginalised or evicted, and survival outside the protection of society was difficult and unrewarding.  It is not surprising that most of us developed with a will to be similar to our peers, be accepted and join in, it is what allowed us to survive.  We are in no doubt that, when push comes to shove, the shove will be hard and there may be no going back.  We who are not accepted become the enemy, we are being told to keep our heads down, make no demands and don’t rock the boat, because the boat only has a few places, and our seat is not guaranteed.  Essentially this is the basis of the bullying behaviour which is the sad trademark of most human societies; school not the least of them.

But where does that leave those who have limited abilities or do not fit the expected criteria of what people in our society should look like, talk like and behave like?  There have always been oddballs, misfits and the unfortunates who were born or damaged to become imperfect.  In early groups a misshapen baby, if it survived at all, would be exposed. If problems emerged as the child grew it may be stigmatised (marked as unsuitable) and, unless defended by the parents, might ‘disappear’ or be sent away.  If the existence of the individual became a problem it would be dealt with in a way we would see as harsh, but for the group may be a matter of survival.  Misfits must still contribute in some way, and must not become a burden, or they would be driven out to fend for themselves.  When selecting partners for children such individuals were unlikely to be mated.  Without protection they were not given a place in the boat. When humans learned to grown their own food they settled down next to their gardens and started to build modern societies.  The pack life changed over time to a hive-like existence where we are all interdependent on one another.  We no longer do the same few tasks to survive; we do different things that collectively meet the needs of all involved.  This means that the weak and vulnerable can survive among us, with whatever resources and rights we choose to bestow on them, and will thrive just so long as we can be bothered, and while those more capable will protect and defend them.  Not so different then, all things considered, but with a much better survival rate. 

All societies have vulnerable individuals, and many ways of dealing with them have developed, some more useful than others.  It is very unusual for those who are weak or ill to enjoy the security and comfort that people in our culture do.  We have welfare systems that care for them, support them and help them enjoy life to the best of their abilities. The sick are healed or supported until death, and it is not seen as their own fault that they are a burden; nor are they seen as unsuitable mates unless there is a rare problem that science cannot resolve.  However the way we deal with those who have psychological weaknesses or problems is less satisfactory.  Although the boat today has many seats, and nobody expects to kill or drive away the mentally ill-fitting or illmade (except for a few regimes who do not speak about it much), the plight of the psychological misfits is much less clear-cut. 

Any person with mental health issues, be they temporary or permanent, can live comfortably in our society if they have people willing to act as advocates.  These may be family or friends, social workers or official guardians appointed by a court.  The advocate can make sure that the individual can access the diverse and often confusing system of medical and psychiatric support, welfare benefits and resources available.  They will need to be educated, informed and determined, but resources are available and new technology has enabled support groups to make more information and support available than ever before.  A vulnerable child in the UK can expect to go to a mainstream school if they can cope with support, can live independently as an adult and will be able to access what they need from professionals trained to provide for them.  That is not to suggest that the system is perfect, it is not and there will always be more demand than the resources supply, but compared to other societies ours is well prepared and well resourced.  So why is it still such a stigma to be marked as mentally ill?  Why are the mentally ill seen as unsuitable mates and why do people who are fundamentally opposed to abortion still prepared to make an exception for those with illnesses with psychological impact?   

Many medical professionals who deal with children are aware that those old attitudes to mental and physical misfits are alive and well in the modern world.  While it is considered antisocial to shun the physically malformed, it still happens, and people are able to understand distress that the birth of a malformed child can cause in a family.  Reactions to babies born with illnesses of the nervous system are even more pronounced.  Many nurses have personal knowledge of cases where babies are rejected by one or both parents, by siblings or extended families, or are seen as an embarrassment to the family.  It is still common to conceal misfits, and I have heard several reports of the smothering of children which have been recorded as ‘cot death’ or Sudden Infant Death Syndrome rather than as murder.  The fact that humans still regard it is understandable, if not defensible, is a clear sign of our more unforgiving origins. Not all problems are obvious at birth, but reveal themselves as children grow up to be different from their peers.  Mothers of children with mental differences can be faced with rejection by other mothers, by organisations where the behaviour of the child cannot be accommodated, or even by the father.  It is common for estrangement of the parents to arise when a parent cannot accept or will not support the child.  It is too easy to say this is wrong; it is a behaviour embedded in the human character that permits families to expose or dispose of children that would pose a risk to the survival of the family as a whole.  What we might see as a glitch in the modern human was surely one of the factors that enabled society to develop at all.  But how do we deal with these traditional and intrinsic attitudes in a culture where to be mentally limited or different is no longer a threat to life?  Why does mental illness still carry blame, stigma and potential danger when we are able to accommodate individuals without risk of social disaster?  And how can we help people to understand these changes and what they can mean for the individual and their family? 

What is it that drives the behaviour of those who shun the ‘miss-made’ or ‘broken’ in society?  To some extent it seems that these reactions are inbuilt, an evolutionary factor that still operates today; but understanding the mechanism that makes it shape behaviour may help us to deal with it more effectively.  Most of us fear what we do not understand.  We assume that anything unknown is potentially dangerous, and are cautious about it until we have reason to accept it as safe; indeed the very absence of such protective fear is seen as abnormal.  When we see someone who looks or acts differently we see a potential threat.  We do not even need to see that behaviour.  The mere warning of threat from others will set us up to search for abnormality and any behaviour we could see as deviant we will interpret in that way.  This means that the very suggestion of psychological weakness is a source of anxiety.  We may feel that the person is unpredictable, unreliable, unsupportive and ultimately unworthy of inclusion in our family, community or business.  They are marked, will be carefully watched, discounted and when possible, removed.  Their best hope is to shape up or ship out.  Nothing changes, or could it? 

It would be unrealistic to suggest that humans will never again need to use their early survival instincts, the violence or disruption of our habits make them as important today as they have ever been.  In a war zone it is statistically more dangerous to be a woman than to be a soldier and nobody, in time of war, has time to take care of the weak and mentally limited.  Hitler recognised this and, with considerable social support for his eugenics program, developed a system of ‘humane euthanasia’ by gassing those with inherited mental disorders.  This was done initially in busses with exhaust fumes, and later with carbon monoxide in clinical gas chambers.  Although not all were handed over willingly, many of the patients had been sent to the clinic by their own families.  It was proposed that exposure at childhood was more humane than making people live with the burden of mental illness.  It is easy for us to shake our heads and disapprove, we need to recognise that early humans would have criticised us for letting it get to that stage.  It is simple fact that in human and all animal societies, the weak live only as long as others who bother about them keep them alive. 

There will be those reading this who grow angry that I seem to defend euthanasia and infanticide when in fact I do not support or defend either.   Rather I believe that by recognising that they have old and practical applications, we can understand and counter them in our own society.  We are blessed to live in a time and a place where there is hope for everyone, and the goodwill to share through the welfare system.  Medicine and psychiatry are working to explain and to solve human problems, and we have enough, in theory, to make sure that everyone gets at least the basics they need for a secure and happy life.  How then can we address the problems experienced by so many people who have to deal with stigmatism, marginalisation and the fear of others who cannot face their own feelings? 

The most dangerous thing for the mentally limited or ill, and for their families, is discomfort; the discomfort and low level anxiety of other people that comes from unfamiliarity and uncertainty.  The fear of difference, of members of the out-group, of uncertain intentions, unpredictable reactions and behaviours and of not knowing what to do about the needs of the different; that anxiety leads us to avoid, to shun and to deny.  If we wish to change things we need to challenge ignorance, educate regarding the true nature of mental problems and help people understand how the anxiety they feel can make life difficult for others without ever intending to.  If we can just get people to relax, to take a fresh look at mental health issues and accept that society can deal with it effectively, we can make a difference.  And society can cope with different needs as long as we all agree that it is a priority and make the commitment to help, be it directly or indirectly through our taxes.  There is no need for us to fear, marginalise or deny people who have different mental needs to us.  In fact, by becoming more well-informed and sophisticated in our understanding of mental wellbeing we can all benefit from living in a healthier mental and emotional environment.  We can all benefit from a more accepting society.