Bedlam, Stigma, and Twitter as an Indicator

15 Nov

Over the past three weeks I’ve been watching Channel 4’s ground-breaking new documentary series Bedlam. I’m going  to concentrate in this post on the way the series has been followed on social media, especially twitter, and the lessons that might give for anti-stigma work. Other bloggers have concentrated more on the content of the series.

In the three programmes so far we have seen very different contexts of mental health and mental health services bound tightly together by a kind of high definition authenticity which has shown the reality of the situations people face, and challenged both the public, and people with lived experience of mental ill health.

Personally I applaud the boldness of the series, and the courage of the participants and recognise this as a leap forward in what is offered in mainstream TV about mental health. Documentary is supposed to shock and awe and this has, in unexpectedly painful ways for me. It showed reality in rawest sense. The big question is, has that shock and awe moved us on in stigma terms, or upset and shocked too much?

I watch a lot of mental health television. Often it’s with an eye towards how the programme does in relation to addressing stigma and discrimination, and with many programmes historically not doing well in that regard, the experience has often been uneasy from my perspective of someone so steeped in mental health personally and professionally.

Dual Screening – Twitter feeds and TV Together

The programme uses and promotes the hashtag #bedlam , openly inviting ‘dual screening’, or following the programme and twitter feed simultaneously.  It has been very interesting to take part as a ‘dual screener’ viewing the ways in which the programme and the tweets have interacted to emphasise points, to disagree, and to distress in different places. To draw a  science analogy, it reminded me of constructive and destructive interference, where colliding waves can either cancel each other out, or increase in pitch.

With the first screening of Bedlam, my heart lifted and then roared with empathy and pride at the courage of the people telling their stories, and the way that the programme addressed the more difficult areas of mental health to communicate to the public, such as the effect of unwanted intrusive thoughts. The way the stories were presented seemed different for me too. The programme didn’t seem to be highlighting an individual or individuals for entertainment or scrutiny, but more I felt telling a thematic story with the assistance of several personal stories.

In the first week the majority of the twitter stream was positive, with empathy and pride expressed by those with lived experience, disclosures of personal experiences that were similar, and relief and delight that these topics were being featured. Of course, there were also some heartless and unpleasant contributions. The stream felt positive though, and I would describe it as a ‘safe space’ with a strong vibe towards collectivism against stigma.

The second episode of Bedlam was different. Showing the reality of acute assessment wards and crisis was always going to be a challenge. What the programme did was bold and real. But like the realisation that HD cinema meant a distortion in perception due to ‘hyper-reality’ of scenes, I wonder if a similar effect might have been in play with the second programme. I found it deeply distressing. Distressing on an empathic human level and distressing as a person who has lived experience as both a service user and carer. It was distressing enough that I felt the need to get a hug, smile at my baby daughter, and watch a cooking programme to help me step away.

Last week the twitter feed had a much greater proportion of negative, offensive and discriminatory tweets. It had far fewer rallying cries, positive stories, and collegial empathic disclosures. In week one it was a safe space, in week two, in my opinion, anything but.

Many of the frequent twitter commentators on mental health decided not to comment on the programme, or said that they weren’t going to watch because they anticipated it being difficult.

The main stories featured included Dominic, a man with teenage children who had a bipolar diagnosis and made two suicide attempts during the period covered by the film, and Rupert, an imposing black man who was reportedly being assessed ‘because of being more of a danger to others’.

Both stories were candidly told, pulled no punches, and featured both the complexity and dilemmas faced by patients and by staff in assessing and managing risk and the decision to detain or not. Importantly the stories also showed the impact on family in Dominic’s case. Critically, at the end of the programme all of those featured updated sections, where all had made progress, but none were ‘cured’, showing clearly the reality of recovery as a journey for most. That said, the word recovery wasn’t used.

The response on Twitter to these stories was highly polarised. There were some lauding the courage of staff, Dominic and Rupert, and their families. There were many expressing deep interest in mental health, saying how important the piece is, or expressing sadness at people’s experiences. And there were many tweets expressing highly upsetting stereotyped views about dangerousness, fear, competence, and capability.

There were highly offensive racist perspectives about Rupert, and very difficult and judgemental tweets about Dominic. There were also a lot of responses decrying these.

Most upsetting of all for me was that there were increasingly tweets that showed that the programme was disturbing to folk with mental health problems watching:

“It’s basically inevitable that my bipolar will land me in a psychiatric ward one day and watching #bedlam makes me so nervous about it”

“Watching #bedlam with my folks is making me feel very horrible”

The third programme, shown last night, discussed community mental health, concentrating on the experiences of three people with long-term mental health problems, with a particular emphasis on the boundaries between treatment home or in hospital. The personal stories were strong, and it was good for instance that one person who was shown being sectioned in the programme, was later shown at home and markedly improved. There were still a lot of ‘sharp edges’ shown and not placed in context.

This was very well picked up on the twitter feed, which was different again. With last night’s episode, I would describe the commentary as more critical of the depiction of mental health treatment shown, than of the programme per se.

There was a lot of discussion for instance about the decision to concentrate on medical interventions and compliance with medication. Several people felt that there was a missed opportunity to feature recovery and hope more centrally, and to feature self-management. Critically, some also felt the case studies used increased social distance, making a distinction between ‘them and us’, potentially contributing to ‘othering’ of people with mental health problems who were described at one point as ‘your neighbours, living among us’.

There were far fewer out-and-out discriminatory tweets this week. What there was though was a consistent outpouring of ‘this makes me sad’ tweets. Empathy, rather than sympathy is what anti-stigma work needs from people looking on.

What could this mean for anti-stigma work?

In terms of what programming like this might mean for anti-stigma work, it made me think. Certainly there has been a huge step forward in the past eighteen months in willingness of mainstream programme makers to address mental health and show programmes. There is clearly an appetite to learn and move forward, which anti-stigma programmes and those with lived experience should hope to benefit from. We need to learn by doing, and gauge opinion and form ideas for further programming on the back of knowing what consistent strong programmes does for stigma. We do know though from evidence in arts programming that care must be taken about reinforcing negative stereotypes.

It has been interesting to see the commentary in the twitter feed mature with the passing weeks, and for me there is a research imperative to see whether this kind of instant discourse is helpful in anti-stigma work, in terms of the messages, their reach, and the effect on the ‘silent reader’ of seeing what can be very challenging content without filter.

A key question for me remains how far the programme, in addressing some of the most complex aspects of mental health in such a raw way, addressed discrimination and self-stigma.

My instinct is that the programme will have opened many eyes, and the series as a whole will energise people to stand up and join a cause.

For some though, I suspect stigma and self-stigma will have been exacerbated. Certainly if the twitter feed is anything to go by that may be the case. The number of ‘mad, bad and sad’ tweets from some quarters is disturbing.

Can we play a percentages game like that with anti-stigma work? Is it OK to move some people forward at the cost of moving some people back? What are our ethical obligations in terms of consent and filming people in crisis? These are all questions we can only ask and answer in an environments where programmes like this get made, aired, and learned from.

Twitter is a microcosm. Like comments sections on newspapers and YouTube it draws people two have polar views. But people read it, especially people with mental health problems who because of self-stigma may seek negative reinforcement.

I would like to see large scale polling research around programmes like this, to gauge their effect on attitudes and behaviour. The anti-stigma movement could benefit from approaches taken in political campaigns around major speeches to gauge the effect on viewers. I hope that Twitter is only a concentrated view of a wider public opinion, but without data it is hard to know.

The other thing that occurs to me is that if we are going shift our anti-discrimination work to a rights based focus, we are going to need to learn that changing minds might lead to resistance from those whose minds most need to change. Perhaps we need to look after ourselves better, choose better which battles and discourses we get into to make sure we stay safe and strong. There is something I feel, and perhaps others with lived experience share. I feel the need almost to ‘stand guard’ over programmes like this, to watch out for stigma and engage it.  Perhaps we also need to understand better through research the effect of watching twitter streams and seeing live ‘opinions’ on self-stigma.

We have a lot to learn from other movements, where struggles for equality and rights often result in horrific backlashes even from the establishment…Stephen Fry’s recent ‘Out There’ programme on homophobia was gut wrenchingly authentic, and many accounts of the struggle for civil rights are disturbing to watch and no doubt trigger memories in the viewer.

Somebody said on twitter last night that ‘the programme wasn’t targeted at people with mental health problems’ and to some extent I think that’s true, it was a hard watch. But, if we want to build a social movement where empathy and compassion enable people to stand together, then programmes must bring together people more.

Bedlam has given much food for thought. There are huge positives, but also huge questions that only future programming, future research, and future engagement can answer.

This piece is written in a personal capacity.

3 Responses to “Bedlam, Stigma, and Twitter as an Indicator”

  1. Marina November 15, 2013 at 3:01 pm #

    I am always puzzled by discussions about stigma. I have had past contact with mental health services because of persisting emotional problems and alcoholism (all now resolved). My only encounter with any issue even faintly related to stigma came when I was required to give a report from my GP to a new employer. I declined and my boss made some vague remarks about me having a medical, but once I (quite untruthfully) filled in a questionnaire, the issue was utterly forgotten about. Interestingly, when I discussed the issue with my very sympathetic GP , he speculated that an employer would be far more worried about the drinking problem than the ‘depression’.
    The irony was that in fact I was not at all competent or capable of holding down a job at that point and I personally doubt if any support could have made me so.Though my health has hugely improved, I still would not take on any stressful position.So I have some sympathy with employers over the sensitive issue of employing someone with mental health problems.
    Otherwise I can’t say stigma has played any role in my life at all. I suspect that for many people with mental illness the big problems are ineffective treatments,poor support in the community,poverty and homelessness.I wonder if ‘stigma’ has become a popular cause because it revolves around image,so lends itself to media representation.However, any discussion of mental illness cannot simply revolve round perception, and has to engage with the reality of illness and what it does to peoples’ lives. The big struggle of my life was just getting well. I know because of my past I simply am different to people who haven’t been through such experiences and vulnerable in ways they are not. Mercifully, most of the time this is not an issue I have to think much about. And I tend not to tell people about my history (apart from very intimate friends), not because I am ashamed of it, but because it really isn’t the most interesting thing about me.

    • chrisosullivan November 15, 2013 at 4:59 pm #

      Thanks for this. For sure, stigma means different things to different people. Personally I think that the systematic, structural inequalities that people with mental health problems often face (leading to the poor community support, poverty, and homelessness you highlight) are the challenges that amount to the discrimination people face. We need to address these, as well as talk about ‘stigma’…even though they two things are the same.

Trackbacks/Pingbacks

  1. Some reflections on Bedlam | Clinical Psychology and People - November 15, 2013

    […] 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: https://mentalcapitalblog.wordpress.com/2013/11/15/bedlam/ … […]

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