The theme of this year’s World Mental Health Day on 10 October, is ‘Dignity in Mental Health’. According to the Royal College of Nursing’s (RCN) definition of ‘dignity’:
“Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals.”
One of the ways in which those with mental illness are frequently treated with less dignity than those with ‘more obvious’ or ‘physical’ illnesses – though I think the distinction can be misleading – is the way in which recovery is viewed. People tend to view physical illness as something outside a person’s control, to the extent that they cannot simply ‘will‘ the condition away, or spontaneously decide to get better. One tends to assume that a physical illness leads to symptoms which may make it difficult to do certain things, and it would be unreasonable to expect someone to do them (for example, to walk with a broken leg), until they had recovered sufficiently. If someone has a physical illness, unless that illness is terminal, one is naturally optimistic and hopeful of recovery. There is an expectation, even, of recovery – where this doesn’t necessarily mean a complete eradication of symptoms or of a condition, but a restored ability to live a full and meaningful life. Recovery is possible; it is to be expected; and it is probably going to take time and some sort of intervention over and above simply ‘willing it’ to happen.
In contrast, people’s views of recovery from mental illness are sometimes polarized between two extremes. On the one hand, there is the view (rarely stated explicitly, but often implied by well-meaning but nevertheless ill-thought-out words or actions), that someone can ‘just decide’ to get better. That, as mental illness is ‘all in the mind’, if you try hard enough to really galvanize your thoughts, feelings, willpower and strength, all your difficulties will melt away. And on the other hand there is the view (also rarely stated explicitly anymore, but still hanging around from an earlier age), that if you have a mental illness there is something fundamentally wrong with you, and you are ‘doomed for life’, with no hope of recovery and no possibility of a fulfilling or mostly symptom-free existence.
I don’t want to deny that recovery from a mental health condition may mean something slightly different to recovery from many physical illnesses. It may be difficult to define, for example, when someone has ‘recovered’: is it when they no longer meet the diagnostic criteria for a particular condition; or when they no longer need medication or therapy; or when they simply feel well enough, in themselves? It’s also true to say that even when recovered, someone with a mental health difficulty may continue to be susceptible to ‘relapses’, for example during periods of great stress or change. However, although some mental health conditions (but not as many as you might think) may be life-long in that sense, we need to careful that we don’t give the impression that a diagnosis is a life-sentence: not just for the sake of the person being diagnosed, but so that we can start to enculturate ourselves in a way of thinking which aligns our attitudes towards recovery from a mental health condition, much more with our attitudes towards recovery from a physical condition. Recovery is possible; it is to be expected; and it is probably going to take time and some sort of intervention over and above simply ‘willing it’ to happen.
It is important to remember this, too: when people do not recover from a mental health condition, or take some time to recover – they are not suffering from a lack of will, or emotional weakness, or a character flaw, anymore than someone whose physical recovery is impeded by a vulnerable immune system, for example, is suffering from those things. True, some people choose not to take the help available to them, or may choose to continue in behaviours which will lead to a deterioration in their health – but this is true of some with a physical condition, just as it is of some with a mental health condition.
It does not accord someone dignity, to treat them as if they are perpetuating their own misery through choice (or rather by not making a choice to get better). Neither does it accord them dignity to assume that they have no choice but to continue in that state for the rest of their lives. That is a position which robs them of one of life’s essentials – hope. When life seems very bleak, reinforcing the possibility of a life worth living is part and parcel of treating someone as being of worth, and of showing them how much they are valued. To quote from the RCN’s definition of dignity again: “When dignity is present people feel in control“. I hope that on this World Mental Health Day, we can start to think about recovery from mental illness in a way that does not make those with a mental health condition feel helpless: either because they are expected to ‘will away’ their difficulties but cannot; or because they have been made to feel that no change is possible. Instead, I hope that we can try and dignify individuals’ daily struggles with their own minds and bodies, with a response that conveys compassion, understanding, support – and every expectation of recovery and the ability to fully embrace life.