Making 'madness' more about all of us

July 12, 2002

Rufus May believes his openness as a 'mad' psychologist helps his students break down barriers in mental health

You could say that I have had two careers in psychiatry. The first was fairly short-lived: I spent 14 months as a psychiatric patient and was given the label of schizophrenia. I managed, however, to avoid a long-term dependent relationship with mental-health services, somewhat against the odds, and a few years later decided to go back to school to study to become a clinical psychologist. My ambition was to contribute to a force for change in mental-health services so that services promoted holistic recovery rather than encouraging long-term pharmacological and services dependency.

Entering education, I felt my experiences as a patient would enrich the academic understanding of mental-health problems. However, I soon became aware that knowledge about my psychiatric history might count against me. Fearing discrimination, I chose to keep quiet about my past, but what leapt out at me was the lack of imaginative ways to make sense of the confusion and the recovery processes of mental illness. Much of mental-health teaching involved a passive presentation of fairly one-dimensional medical perspectives of clinical problems. This teaching style seemed merely to add to the foreboding "doom and gloom" that traditionally hangs over the subject. I have, therefore, spent the past three years, alongside my work as a clinical psychologist, developing teaching strategies to make learning in mental health a more inspiring experience.

While there are pockets of innovation, most undergraduates are taught a fairly limited view of psychiatric problems that does not acknowledge the expertise of personal experience or that beliefs about mental health in society are a contested area. An inclusive style of teaching that involves service users' experience and conveys the wide range of perspectives on this enigmatic subject is still rare.

For me, the key to good mental health teaching is to transcend the tradition in academia to depersonalise the subject matter and take an "objective" stance. For example, in my degree I learnt how to write passively without using the word "I". Inevitably in mental health, such an approach leads to a very distant and cold discourse. Good teaching about mental distress and recovery is about recovering the validity of personal experience. Good teaching manages to combine the personal and political with relevant research and to consider the competing perspectives that are a core part of thinking in mental health. The best place to start is to encourage students to work in small groups and to reflect on their own wisdom on questions such as what constitutes wellbeing and what helps people to deal with adversity. This helps students to engage with the subject matter and also overcomes the "them and us" barriers in mental health that assume the observer is normal and the observed abnormal and that tend to alienate all involved.

Guest speakers who are willing to discuss their personal journeys in psychiatry can also help to bring the subject alive. I encourage students to challenge me and, in general, to take a critical stance. This is important given the traditionally one-sided discussion of mental-health problems and their solutions.

I use a variety of mediums to stimulate discussion. Madness and the emotions are perhaps more authentically covered in popular music than in academia. Pop songs can help to trigger reflection and debate. For instance, listening to excerpts from soul songs that depict different versions of male identity from the "sensitive man" to the macho "I'm a man, baby" can help to stimulate discussion about masculinity and mental health.

The media is legendary in the way it stigmatises madness and distress and associates them with dangerousness and degeneracy. Taking an analytical look at contrasting images presented in the media allows students to think about how their perceptions of mental health are formed and the reasons for them.

It is also important to look at the economic and political interests that shape thinking and practice in mental health. Drug companies are powerful stakeholders in mental health with their need to market new notions of illness and remedies in a jar. Their promotional efforts impinge on all of our conceptions of sadness and insecurity. We also need to to present the history of social exclusion and its role in "madness".

There are some signs of change in mental-health teaching: the Learning and Teaching Support Network on Mental Health in Higher Education recently held a meeting that brought together a range of opinion on the way forward, and it is seeking funding for local and national training events.

Moreover, people across society are beginning to "come out" about their experiences of madness and distress. An increasing number of students are willing to discuss their own experiences of distress and confusion, and there is a growing emphasis on giving better support to students with mental-health needs. My openness as a "mad" psychologist is indicative of this climate change.

This shift to a more inclusive approach to mental-health teaching is a challenge to lecturers who have traditionally adopted a removed approach to the discipline, denying their own personal wisdom on the subject. By reflecting on our personal experiences, we get away from the "them and us" thinking that has perpetuated one-dimensional thinking in teaching in mental health.

Rufus May is a clinical psychologist working in Bradford. He lectures at Liverpool University, the University of East London and University College London.

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