Some reflections on Bedlam

Bedlam on Channel 4 has been the most talked about programme regarding Mental Health that I can remember.  Certainly the development of social media has had a major impact on this.  Do read @mentalcapital ‘s blog on the social media reaction for further insight into this: http://mentalcapitalblog.wordpress.com/2013/11/15/bedlam/ …

I have been impressed with certain aspects of the programme, notably the individual’s courage to share some very difficult moments of their lives with the watching public.  There are, I’m sure, a number of ethical dilemmas involved in filming someone who is deemed to “lack capacity” but there is no time/space to go into this here and in reality I’m not the best one to do that.

I think the way that the programme makers have involved the families in the filming is encouraging, although sadly, I’m not entirely convinced that this reflects how services often approach working with families of people with mental health difficulties.

The professional’s, I think, largely come across positively and appear as caring and genuinely concerned.  The Social Worker on last night’s programme seemed to be trying his best to do the best by the people he was seeing as were the psychiatrists I saw in the last episode.  I don’t necessarily agree with the way Dominic was spoken to about staying in hospital and it appeared in many ways to be a de facto detention, but overall the psychiatrists I’ve seen came over pretty well.

Someone noted to me on twitter that merely showing people in this way will reduce stigma, I’m not sure it will.  It will raise awareness but that’s different (see my previous post on that topic), will it help people see that we all can have mental health difficulties?  Will it combat stigma, just by looking?

Bedlam, as a hospital has a history, which is why there was concern over the title. For example:

rakes progress bedlam

This is a scene from ‘The Rakes Progress’ the moralistic account by William Hogarth of what happens when you chase money and forget who you are (one of many interpretations).  In this, the final scene,  we see Tom Rakewell ,in the foreground, in Bethlem Hospital (Bedlam) having shackles removed, whilst clawing at his head.  He is being held by 2 staff members whilst (we think) his ever loyal partner (do look up the engravings/pictures they’re wonderful) tries to comfort him.  We also see people in their rooms seemingly in distress, we see people acting as a musician and a priest.  Someone hides behind a door and then, in lighter colours we see two ladies of a ‘higher class’, with fans looking around.  This is what used to happen, people would tour Bedlam for a day out, looking at the ‘insane’.  They’re whispering and watching.

I know, we’ve moved on a long way from here in many ways, but do the people watching still exist, except now they don’t have to leave their sofa’s?  People peering in on the ‘insane’ with wonder or pity?   At times it feels like that, especially on twitter.

The main area I felt was missing and one I really hoped this programme would introduce, which I believe would really move us forwards, was that of getting to know the person and how their difficulties came to be.  Lloyd was a great example, what we learned first of Lloyd was his experience of hearing a voice, a lady who talked to him, often positively.  There had been “no mental health problems” up to around 6 years previous when Lloyd, we are told in passing (actually whilst the Psychiatrist was in the lift), suddenly experienced hearing the voice.

And that was it.  The psychiatrist was clear that there were life stressors and that it is possible to have 1st episode psychosis at any stage of your life.

Couldn’t Bedlam have explored or explained this a little more?  Maybe there was a link there? Maybe Lloyd, after experiencing some significantly stressful life events, including the death of his mother and loss of his girlfriend started to experience this voice?  Maybe it didn’t just come out of nowhere, maybe it makes sense when we know about Lloyd, maybe it would have made sense to the watching public?

Tamara’s ‘Persistent Delusional Disorder’ was clearly rooted in reality.  There were bedbugs in the flat.  Anyone’s who’s experienced them, (I have whilst travelling years ago) will know that they are horrendous, they bite you all over and it is extremely uncomfortable.  I’ve seen people in real distress due to bedbugs.  You lie there, waiting to feel them and then you feel them when they’re not there.  I’m not surprised it really stressed her out.  I’m not denying that her distress and thinking became more problematic for one second, but it was rooted in reality and some social interventions (moving house/ treating house) may well have if not eradicated, possibly reduced the propensity for Tamara’s problems to take hold so vehemently.  But again, her irritation and upset was, I believe, entirely understandable in the context of her life.

This approach to understanding people’s problems was missing from the other programmes too, Dominic’s diagnosis changed, from Bipolar to Borderline Personality Disorder so he got different treatment (therapy) and things started to look up.

Let’s be clear about this, Dominic didn’t change one iota.  What changed was the professionals understanding of his difficulties.  He had always had the experiences he had, they didn’t suddenly appear in his history.

But knowing the history made them see Dominic differently, could that have also been true of the watching public?

As a Clinical Psychologist a significant part of my role is to help people understand.  Understand why they are feeling the way they do, why they

‘suddenly started to hear voices’

‘felt like there was no other way than an overdose’

or ‘why they can’t bear to be in a foster family’.

Also true of working with families:

‘why their child cuts herself’,

‘why their son believes he’s such a bad person when he’s a wonderful son’

‘why their adopted daughter is so convinced they don’t want her when they love her with every fibre in their body’.

Sometimes it’s staff:

‘why the young person seems to ‘switch’ so quickly and get angry at them.’

‘Why they do themselves such harm’

‘Why they assaulted us’

It’s not everything, but understanding, I think, breeds empathy.  You have to know the person and their life to really understand their problems.  Then you can move forwards, with them.

A good example is Post Traumatic Stress Disorder.  If you just see the person struggling with it you don’t understand it in the same way as if you know what they’ve been through, you need to know the ‘T’ to understand the ‘D’.

People may look at Lloyd or Dominic and think “well that’s nothing like me so I’m ok”, but what happened to them can happen to anyone.  Lloyd lost his mother.  Dominic was hurt and abandoned by people (we were told snippets).  This could be you, me, anyone.  Tamara had had many difficulties and to top it off her children had been removed from her.  Is it surprising that they struggled to cope? I don’t think so.

There was, I feel, an over emphasis on medication in inpatient and community settings.  I don’t disagree that medication is very important for some people, but even if it is, there are always things that can be done to help people, not necessarily ‘therapy’ but support in moving forwards, not just managing.  There was little sign of that last night.

I for one don’t want the watching public to think that the only hope for you if you have difficulties with mental health is medication, just a balance would be good to see.

Some people say that in acute care medication is the most important tool.  I disagree and I work in inpatient care.  It can be very important and it can be very helpful I don’t doubt that.  But helping people feel safe is way more important and that is not done by medication alone.  It’s done by the staff (should be) and the team, to use ways of interacting and helping to try to help the person in distress feel safe.  That was missing.  Nurses that I know do more than administer meds, a lot more.  Clinical Psychologists like me also work with acutely distressed people.  I would’ve liked to have seen some balance in there.

Last comment on stigma and understanding.  Lloyd was scared that he ‘didn’t know his own mind’ that he might do those horrendous things he read about in the paper.  This was desperately sad and deeply frustrating.  Lloyd has enough on his plate than worrying about losing his mind completely and harming someone.  Why? Because he had the same diagnosis.  Paranoid Schizophrenia.  Will it help him worrying about that? No. Do all people with paranoid schizophrenia harm people?  No, of course not.  Does he know that, no.  Do people watching?

When people say ‘what does it matter that 2 people can have the same diagnosis without having a single symptom in common’ (true for paranoid schizophrenia)  there is your answer.  If we use labels to explain people this is what we get. People are not labels.  We need to help people understand the person without putting them into a box.   The problem here is that some boxes are so big lots and lots of people fit in them but they’re so different.

The words we use to describe people matter, the way we talk about people matter.  Whether they are accessing services or not.  Whether it’s the media, mental health services or the public.

Understanding is more important than labelling.  When we see that on a TV programme regarding people with mental health difficulties then we will have come a long way.

When the narrator says “treating those who are mentally ill with humanity as people like us”  as if this was a realisation that the programme had come to, he got it wrong.

People with mental health problems are not “like us”.  They are “us”.

We all need to get better at seeing that.

Over to you.

Dr Gordon Milson

Other very good blogs that I’ve read on Bedlam include:

http://fightingmonsters.wordpress.com/  Very reflective on the detention issue and other underlying issues.

humamunshi.wordpress.com 

Very good on the dramatic element and how it fits with the stories of the individuals.

Both are excellent in my humble opinion.

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8 comments

  1. Excellent thought provoking reading. I know many mental health nurses who freely admit athey feel like all thetydo on inpatient wards is hand out medication. They desperately want to spend therapeutic time with their patients but are so overstretched and under staffed that it just isn’t possible. It’s so sad.

  2. There only seems to be discourses about discourses. Knowledge can’t capture me:)

  3. Unless you experience ‘BPD’ yourself, you have very little idea. I though BPD was a diagnosis that meant exclusion from therapy for most sufferers?

  4. That’s a rhetorical question by the way. Feel free to delete any ‘flak’ if you can crush your own compassion;)

  5. Thanks for mentioning my blog 🙂

    Here are my thoughts on Bedlam: http://www.time-to-change.org.uk/blog/huma-munshi

    it is very difficult to use mental illness for the purposes of entertainment. Mental health is a journey and this not often captured on screen. I would also say that many of us with mental health problems can function, despite the pain we feel – this is hardly ever discussed. Our illness does not define the entirety of our experiences.

  6. Very true, I have been in hospital for months a decade ago, but most people would never know; only a few people like family know. I was even studying for a degree in English Literature whilst in hospital (I didn’t finish it).

  7. Looking at the Hogarth picture you can see the bourgeois manners in the ‘ladies’, compared to the disheveled and chaotic behavior of the residents. The economic and social status of different people is exaggerated; the whole picture is shot from within the mind of status and manners. Has anything changed from today; quite alot, but the attitude of ‘decent’ society is still a bit scathing. Taking clothes off in a picture sometimes means shaming; Rakewell is being reduced by being unclothed. All in all, it shows how status is tied up with the moral excellence of being wealthy which is still around today.

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