Can stigma be challenged by evoking stigmatising stereotypes? From the Maudsley to Bedlam

Earlier today, the South London and Maudsley NHS Foundation Trust (SLaM) announced the title of its new Channel 4 mental health series. Filmed over a year, the four-part observational documentary series would take what was billed as an “in-depth and unprecedented look” at “the reality of providing [and receiving] mental health services in the twenty first century”. We were promised “exclusive access” to patients and staff “covering aspects of mental illness you may never have seen before”.

So far, so enticing and, with the prestigious SLaM at the helm, we were sure to be in safe hands. And yet, what title had SLaM chosen for the series? Bedlam.

Yes, Bedlam. That institution dating from medieval times the mention of which evokes images of madmen, chaos and barbaric treatments: just put the word in a search engine and see what pops up. Images of naked people writhing on the floor in crowded rooms, watched over by ladies in crinolines holding handkerchiefs to their noses. Of unhappy people chained to walls – by the neck. Images that play to every negative stereotype – such as dangerousness and unpredictability – about mental ill health.

This post explores my conversation with SLaM over the course of the day, together with fascinating insights from the lovely twitter people on whether Bedlam was a suitable choice for the forthcoming documentary series. Ultimately, SLaM decided that they will publish a statement setting out in more detail the background to the filming as well as what they refer to as “the name issue”.  At present, I’m left with a number of important unanswered questions. Read on to find out more.

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[Update: On Thursday 3rd, SLaM issued a statement – linked below – clarifying their choice of name.]

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My reaction on seeing the title of the new documentary series was: this title has been chosen purely to grab attention, sacrificing stigma-busting on the altar of viewer numbers. So I tweeted to SLaM:

“Curious to know why a documentary series about today’s mental health services has been given a name from the Medieval age. Can we expect footage of today’s treatments to be interspersed with dramatic reconstructions and references to Medieval ones? If so, can we see actors writhing in straitjackets or chained up in baths. Would make for entertaining TV!”

Hey, why not go the whole hog and call it Straitjacket, Chemical Cosh or even Naked Lunatics? SLaM replied, “It’s a reference to our heritage – we can trace our roots back to 1247. Our website can provide more info,” and linked back to the original press release. Indeed, I’d already read this in the press release:

“The title was decided upon both by SLaM and Channel 4. It’s based on the fact that SLaM can trace its roots back to 1247 when the Priory of St Mary of Bethlehem was established in the City of London. The priory, which became a refuge for the sick and infirm, was known as ‘Bedlam’ and was the earliest form of what is now Bethlem Royal Hospital.”

Yes, but … this is a series about modern mental healthcare, not the history of treating mental illness. This was a series which SLaM said they hoped would:

“… help challenge the stigma and discrimination that still exists today and to promote better awareness and understanding of mental health issues.”

Which brings me to the premise of this blog post, namely:

Is it possible to challenge stigma by evoking stigmatising stereotypes? Is it possible to promote better awareness and understanding of mental health issues by conjuring images of medieval madhouses and Victorian lunatic asylums?

SLaM’s view is, it seems, yes. But what did others think? Here are some of the responses I received when I asked the lovely twitter people. They are well worth reading, as they contain some of what Eric Pickles would call “frank advice” as well as hilarious suggestions.

Following feedback from myself and others, SLaM will be publishing additional information about the series and the choice of name. I look forward to reading it because, at present, I have several unanswered questions, based on my personal experience of working with the media. My queries are:

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Queries relating to SLaM:

• Knowledge and consent: Did participants agree to the series being named after a notorious lunatic asylum? When patients and staff signed consent forms to be filmed for a documentary series on modern mental healthcare, were they asked if they agreed to be linked with most notorious lunatic asylum? Were they asked about the name change from modern-day The Maudsley to medieval Bedlam?

• Name choice: How was the series name chosen and by whom? Who – Channel 4 or SLaM – suggested Bedlam as the series name? Who at SlaM had the final say on name choice and – given SLaM said to me that it was decided “after much debate” – how were participants (staff and especially patients) involved in the debate and the decision?

• Name choice: What other options were considered and why were they rejected? Why was the documentary – whose working title was “The Maudsley” – renamed “Bedlam? The team behind the series has produced other fly-on-the-wall documentaries with enticing but non-stigmatising titles such as 24 Hours in A&E, The Audience, Inside Claridges and The Year the Town Hall Shrank. Why is it only their series on mental health problems that gets a salacious title?

• Timing: When did SLaM know that Bedlam was Channel 4’s preferred choice? SLaM said to me that, “It [the choice of name] was decided quite late in the day after much debate.” But was it really the unspoken agreement from the outset that Bedlam would be the series name of choice? Did SLaM know this when the August press release went out? Did they know earlier but not let on because the controversial name might have put off staff and patients from participating?

• What will the impact be on SLaM’s reputation? Will trust in SLaM be damaged or enhanced by this collaboration with Channel 4? Will patients and staff feel stigmatised – or honoured by the association?

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Broader queries arising from the debate:

• Is all publicity good publicity? There is no doubt that Bedlam has stigmatising connotations for people experiencing mental distress, their families and mental health staff; but is this a price worth paying for getting the subject a TV audience? Do the ends justify the means?

• What lessons can be learned about engaging positively with the media? Are NHS trusts savvy enough to get what they want from TV companies in deals like this or do they get manipulated and suckered into doing more than is wise? Is working with TV always going to be a pact with the devil and about getting what little gains you can? When you lay down with dogs, will you always get up with fleas?

• What is the best way to exploit valuable brands like “Bedlam” and “Broadmoor” for maximum positive impact? On Channel 5 at present is a two-part documentary series, Inside Broadmoor, which has been criticised as using every mental illness stereotype in the book. But would a psychiatric hospital get airtime without the hook of a brand name like Bedlam or Broadmoor? And if, using them as a hook risk plays into the zombie apocalypse/dangerous and unpredictable narrative that exists around mental illness, can they be used productively at all?

• Is mental ill health too boring for TV unless it’s presented in a dramatic way? Is the only way to mental health problems portrayed on TV to provide a hook – like thirteenth century madness and torture? Do TV production companies consider audiences capable of only being interested in a topic if there is jeopardy, conflict or a journey; and, if so, how can that reality be made to work for the mental health lobby?

• Can a good programme get its message across despite a bad title? National anti-stigma campaign Time to Change says a good story can be weakened by poor image choice; it therefore follows that a good TV series can be weakened by poor title choice. Is it really possible to challenge stigma by evoking stigmatising stereotypes?

• What does the future hold for mental health documentaries? Will patients and staff in future be happy to participate in such programmes, knowing a stigma dump-and-run could take place?

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These are questions I am pondering and perhaps SLaM’s promised update on their new documentary series will answer some of them. I hope so.

My reservations about the series first arose when I saw the initial press release back in August. I assumed – because of the use of stigmatising language – that it was written by someone in the public relations team who was away the day the mental health awareness training was given. But, even so, someone approved it for publication. For instance, the initial press release makes these gaffs:

• References to “the mentally ill” and “those who suffer with mental illness”, both of which are advised against in the Time to Change guidance on use of language around mental health issues.
• Presenting a false dichotomy of what it’s like to manage a mental health condition: “Many people manage their illness with medication; others walk a daily tightrope with the possibility of relapsing at any time.”
• Referring to “manic depression”, a diagnostic category which was superseded decades ago.
• Describing Lambeth Hospital’s accident and emergency department in lurid terms: “In a postcode with the highest rates of psychosis in Europe, this is the Accident and Emergency of mental health … For our staff it’s all about risk management … Getting it wrong could have tragic consequences.” This is the zombie apocalypse narrative of mental illness.

Was the person who signed off this press release involved in the decision to call a documentary series on modern mental healthcare Bedlam? I don’t know. But it will be interesting to see what the documentary looks when it’s broadcast at the end of the month. Especially since the production company behind it also brought us a documentary from another residential setting with a long history … namely Claridges.

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See below for further related links.

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• My Storify stories of tweets and other links

  • From “The Maudsley” to “Bedlam”: the evolution of a programme name – including the discussion with SLaM that led to them deciding to issue a statement explaining the background process and decision on what they refer to as “the name issue”
  • Bedlam – discussions on the TV programme name – After I posted my initial Storify, I asked the lovely twitter people what they thought of the name “Bedlam”. In this Storify story is the long version of the discussions that ensured.
  • What do the lovely twitter people think about Bedlam as a name for a programme on modern mental healthcare? – Don’t take my word for it – what do the lovely twitter people think? This Storify story shows just the comments people made in response to this query – some hilarious!
  • What does mental illness look like? The head clutcher – on the harm done by the use of stereotyped portrayals of mental health problems

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• South London & Maudsley NHS Foundation Trust

  • Bedlam – Our new Channel 4 series – this afternoon’s announcement about the title name (2nd October)
  • SLaM and Channel 4 make groundbreaking documentary series on mental health – More information about the documentary series is contained in this initial announcement (22nd August)
  • On twitter: @MaudsleyNHS
  • Website: SLaM
  • Update: Bedlam – Why did we choose this name for our Channel 4 series – Statement from SLaM on Thursday 3rd October clarifying the reasons for the name choice
  • Update: Bedlam, our new Channel 4 series – SLaM e-news edition dated 14th October (which includes a link to this blog)

 

• Time to Change

  • Guidance on image choice in stories with a mental health element, from the national anti-stigma campaign in – “Some really strong stories that may include great content and have educational value can be weakened by the use of an innappropriate image.” Why shouldn’t the same be true of TV? In other words, a really strong documentary that may include great content and have educational value can be weakened by use of an an inappropriate title.
  • Guidance on language use around mental health issues (which advises against using such phrases as “the mentally ill” and people “suffering with” mental illness, as used in the August SLaM press release)

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• Mental health on TV – some portrayals this year:

  • Inside Broadmoor – Channel 5‘s current 2-part documentary – “This remarkable two-part documentary special marks the 150th anniversary of Broadmoor, home to Britain’s most notorious killers. With exclusive and unprecedented access to Broadmoor’s archives, this film unfolds the extraordinary history of the world’s most famous and feared hospital. Why was it originally created, and what has it become?”
  • My Mad Fat Diary –“Set in the mid-90s at the height of Cool Britannia, this six-part drama is based on Rae Earl’s real-life diaries. It takes a hilarious and honest look at teenage life through the eyes of Rae, a funny, music-mad 16 year old who, despite an eccentric mother, body image and mental health” – Channel 4‘s drama series which opens with Rae being discharged from psychiatric hospital after months of treatment. Covers self-harm.
  • It’s a Mad World – A season of BBC Three films looking at a range of mental health issues affecting young people in Britain today, including:
    • Don’t Call Me Crazy – 3-part series filmed over a year at a teenage inpatient psychiatric unit
    • Football’s Suicide Secret – “Clarke Carlisle investigates the dark side of professional sport: depression, addiction and suicide.”
    • Diaries of a Broken Mind – “Using handheld cameras, 20 extraordinary young people with a range of health disorders from OCD to schizophrenia show us what life is really like as they navigate the rocky road into adulthood.”
    • Rachel Bruno: My Dad and Me – “26-year-old Rachel is the daughter of Frank Bruno, the ex-heavyweight boxing champion who is one of Britain’s most famous sufferers of bipolar affective disorder.”
    • Failed by the NHS – “26-year-old Jonny Benjamin, who has schizophrenia and depression, investigates why many young people with mental illness are failing to get the right treatment from the NHS.”
    • Extreme OCD Camp – 2-part documentary – “6 British teenagers and young adults living with OCD embark on a unique, life changing week-long treatment course in the US, where course leaders use exposure therapy to enable their participants to confront their fears.”
    • Inside My Mind – The science behind mental health problems
    • Free Speech – Young people debate whether modern life is driving us mad

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• Additional links:

  • Image search for “Bedlam” – the results of this search are not how I perceive modern inpatient mental healthcare (and I’ve been on the receiving end of some of the worst of it)

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