The BBC’s science documentary series, Horizon, has come up with a “two-part special” on mental health. But is it a documentary, or is it reality TV?
Part I of How Mad Are You?, broadcast yesterday, introduced a kind of game show format — ten members of the public versus three mental health professionals. The professionals’ task is to work out which five people are mentally ill, and which five are “normal”, without using any of their usual diagnostic methods.
In place of diagnostic methods, they get to observe the participants in various situations and unusual tests.
Yesterday they challenged two of the participants. They got one right, saying he had OCD, and they got one wrong, saying she was “normal”. (She denied being normal, but she has not yet revealed in what way she is ill.)
Inverted political correctness
One of the odd features of the programme is the way it inverts a common form of political correctness. There is a theory that it is bad to describe, say, a man who happens to suffer from schizophrenia as “a schizophrenic.” This is supposed to be because saying “a schizophrenic” seems to define the person by his illness. The man happens to suffer from schizophrenia right now, but he might not have suffered from it all his life, and he might recover. So it is better to describe him as “a man with schizophrenia,” making it clear that the man and the schizophrenia are separate things.
This was always a little daft. It was always OK to describe a man as “a plumber” even though he was not always a plumber in the past and he might not always be in the future.
But in this programme there is a definite feeling that having a mental illness defines your life, even if the language used is the politically correct kind. Dan, who has OCD, experiences what he describes as a constant white noise in his head, causing anxieties that he can only control by rituals. There is no suggestion in the programme that he could be cured — that the white noise and all the rest might be made to go away. Yet he only developed OCD twelve years ago, so he has certainly lived much of his life without OCD, and he could live the rest of his life without OCD if he ever had effective treatment.
“I’m here to fly the flag for people with OCD,” he says to the professionals. The CBT and medication he has had are allowing him to maintain his illness, allowing his illness to define him. He seems to enjoy having OCD. It gives him a certain celebrity status. He gets to take part in a TV game show.
CBT is mentioned several times, but only as a method of coping with persistent symptoms. The real aim of CBT, to address the underlying cause of those symptoms so that the symptoms disappear, is never mentioned. So these people, who are said to have had (or possibly had) CBT, have in fact only had failed CBT.
It is certainly true that there are failed CBT practitioners around who only teach coping methods and never attempt real therapy. Like sending a man with a broken leg to limping classes, they assume that mental illness cannot ever be cured, that a broken leg can never be properly set, splinted, and healed.
This idea, that CBT fails to address mental illness, leads to criticism of CBT as only a kind of mental sticking plaster. It’s very disappointing to see CBT presented in this way in mainstream media. I suppose someone who had OCD for a while, and was cured, does not make a very interesting subject for a TV programme.
Part II of the programme, next week, will reveal who has mental illness and who does not. The ability of the professionals to diagnose without diagnostic tools will be exposed.
So it’s too early to say what the overall messages of the programme will be. But the early signs, making mental health into a game show, portraying mental illness as necessarily permanent, and portraying CBT as merely a collection of coping strategies, are not encouraging.
[To read about Part II, see: Incurable]