The BBC Horizon series’ “two-part special” on mental health concluded last night, making the programme’s hidden message clear.
The final result was that the expert panel identified only two out of the five participants who had previously been diagnosed with mental illnesses.
They correctly identified the man with OCD in Part I, when he freely admitted to disliking a task that involved a lot of dirt. In fact he was able to perform the task, and he might have gone undiscovered if he had kept his mouth shut. It turned out that he is proud of having OCD, and was pleased to be identified.
They correctly identified a woman who had had a past eating disorder, when they gave her a specialized test that specifically detects cognitive distortions to do with body image (body dysmorphic disorder). So although this woman had completely recovered from her illness, in the sense that she was no longer having treatment and the illness no longer affected her life, she had not had effective cognitive therapy for that specific feature.
They failed to identify the other three — a man with social anxiety (who nevertheless seemed very social), a man who had been bipolar in the past, and a woman who had been depressed in the past.
The message of the programme seems to be that if you ever have any kind of mental illness, you will have it for the rest of your life. You can never be cured.
Near the end of the episode, the voiceover said:
Three wrong diagnoses in a row. After a whole week of observation, the panel have identified just two out of five disorders. Alongside Yasmin, two more people with clinically diagnosed illnesses remain undiscovered in the group. The panel have completely missed them.
But in fact only two people out of the ten had clinically diagnosed illnesses (OCD and social anxiety), and the panel identified just one of them (OCD). Yasmin and the other two had all recovered from past illnesses.
Furthermore, the man who thought he had social anxiety has either recovered too, or the diagnosis is very questionable. No one with social anxiety whom I have ever met could possibly have participated in a programme like this in the way he did.
The message of the programme is that recovery doesn’t count. Once you have a mental illness, you are trapped in it forever. All mental illness is incurable. One of the participants who was not ill herself saw it this way too:
The people with mental illness have got themselves into this program knowing that their mental illness will come out on camera.
The experts seemed very surprised by all of this, in an amiable kind of way. The programme’s other message was that mental health experts don’t know much.
The implications of this are pretty strange. Suppose there really is a widespread delusion, shared by some TV producers and mental health professionals, that mental illnesses are always incurable. Could that make treatment for mental health problems more difficult to obtain?
Coincidentally, a couple of GP bloggers wrote today about difficulties obtaining treatment for mental health problems. In My patience is at an end, The Jobbing Doctor writes about mental health referrals being delayed and diverted. In Pillars and posts, GeePeeMama writes about crap crisis teams and depressed psychiatrists:
…the psychiatrists’ lives must gradually be becoming more and more depressing, having to see hundreds of people who, let’s face it, are just being contained and managed and not actually treated, and not seeing the hundreds more who might bounce out in 6 months or a year, grateful and happy and better.
If “mental illnesses are always incurable” is a meme, how does it survive? Clearly it’s a self-fulfilling prophecy to some extent, because in mental health trusts where it is widely believed, staff will see little point in trying to help patients recover, and that will mean that patients really don’t recover.
Does it confer an advantage? Perhaps a widespread belief in the meme makes it easier to justify spending most your time with patients who are easy to manage. So you get a system that rejects difficult patients (who might be curable) in favour of easy patients (who remain chronically ill). Perhaps, in a system like that, the professionals are less stressed, feel less exposed to risk. Perhaps that’s how this meme is beneficial to its hosts, and survives.