Intolerance

Stephen Fry’s programme The Not So Secret Life of a Manic-Depressive: 10 Years Onhas aggravated a group of senior academic clinical psychologists. Professor Richard Bentall has received a lot of support on Twitter for blogging an open letter to Stephen Fry, which you can read here.

Essentially, Bentall feels that Stephen Fry, who is President of MIND (one of the UK’s leading service user mental health charities), has somehow promoted a decontextualised, biomedical model of bipolar disorder and that he should change his (supposed) ideas about the nature of his mental health problem in order to come in line with the conceptual framework that Bentall and other researchers have developed.

The open letter made me watch the programme. It is about the experience of service users diagnosed with bipolar disorder. The content comes predominantly from the service users themselves, their families and a few of the mental health professionals involved. There is no expert opinion, and there is no mention of causation from Stephen Fry or anyone else. There is a fair bit of talk about medication, particularly side effects. There is no mention of clinical psychology at all. This would be a problem if the programme purported to be a scientific overview. It does not. It is about lived experience. There is no implication that the participants have disclosed everything. Why should they?

Richard Bentall and I have been friends for over 25 years. Colleagues have sometimes suggested that I should keep my distance because he has persistently attacked psychiatry in the press, but I like him. We are much the same age. He does good quality empirical research. I like debate, and I like people who challenge my own ideas. Challenge is one of things that make science interesting. Talking with Richard is always interesting.

My father, now aged 88, takes a keen but amateur interest in my writing. He looks out for my friends’ articles in the national press. He phoned me up one day and said that he had read an article in the Guardian by Richard Bentall.He wanted to know why it said exactly the same things as I say, until the last paragraph, when Bentall concluded that psychiatry does not work, whereas I conclude that it does (when done properly).  So I discussed the matter with Richard, and the only explanation we could find was that he is a clinical psychologist and I am a psychiatrist. I think his attacks on psychiatry are sometimes immoderate and lack the rigour of his scientific work, but in discussion we have no disagreements.

It follows that I accept most of the evidence cited in Bentall’s open letter. However, despite the support he has received, I think he was entirely wrong to write it. Stephen Fry and other service users have every right to talk in public about their disorder without mentioning everything that may be helpful and without making disclosures about everything that someone else thinks is relevant. If we are serious about listening to service users and learning from lived experience, we should accept diversity, including opinions we do not like. Mental health professionals have to listen to views that are different to our own without immediately telling people that they are wrong or suggesting that we, the experts, know best.

It is offensive to suggest that Stephen Fry has done something damaging and stigmatising by making a programme that fails to mention a particular point of view. The offense is aggravated by Richard Bentall’s assumption that their shared public school experience accounts for Fry’s problems. In medicine, this kind of speculation about someone else’s mental health would be regarded as unethical.

At some point, public intolerance and condemnation of a person with lived experience of mental ill health because they disagree with you becomes bullying. This observation will upset Richard Bentall, but he has had a national and international platform for his ideas for a long time. I strongly feel that the open letter was unnecessary and inappropriate.

Peter Kinderman (President Elect of the British Psychological Society), Richard Bentall and other colleagues have followed up with an open letter to the BBC, which you can read here. Essentially it accuses the BBC of showing bias by broadcasting Stephen Fry’s programme without representing their opinions. It demands ‘balanced’ coverage of mental health issues. It is very similar to Conservative Party attacks on the BBC for ‘bias’. It may succeed in supressing dissent from their orthodoxy. In fact, Peter Kinderman and other clinical psychologists have had extensive coverage their ideas on the BBC for many years. Quite right, too. Peter Kinderman even hosted a reality television series featuring participants with mental health problems a few years ago.

Two years ago, a book was published called Mental Health and Poverty. I was a co-author. It was concerned with the evidence on the social origins of mental illness, especially psychosis, and the public health implications of that evidence. We argued that social inequality and adversity, especially childhood exposure to urban poverty, could be addressed, and that doing so would be likely to have a significant effect in reducing the number of people developing serious mental health problems as adults. We acknowledged that the evidence on biological and social factors is hard to reconcile. We suggested that it would take a paradigm shift to allow all of the evidence to make sense, not just at the level of rhetoric, but to an extent that would create a proper scientific consensus. The book is not a work of radical anti- or post-psychiatry. It is a work of social psychiatry. Until recently the psychiatric journals showed a skew towards publishing biological findings. This has been changing. In any case, irrespective of editorial policies of the journals, social psychiatry has been the mainstream stance of UK clinical psychiatrists for the whole of my long career.

Clinical psychologists and psychiatrists are not natural enemies, and we should not be attacking each other or service users. We should be the allies of service users and carers. Some people with mental health problems prefer help from clinical psychologists, some from psychiatrists, some from both and some from neither. We should not brow beat service users for departing from our orthodoxies, whether biological, psychological or social. We certainly should not attack people like Stephen Fry when they fail to agree with us. He is one of the public figures who have shown great courage in opening up debate about mental health to the point where it is now high on the political agenda.

Service users are seeing their services deteriorate. Their benefits are being stripped away. The pressing need is for all of us to fight to preserve or develop good quality services that people with mental health problems find helpful, and to speak with one voice about the measures that will improve public mental health, alongside physical health. The academic whose work is most important in this regard is neither a psychiatrist nor a clinical psychologist. It is Sir Michael Marmot. Read his blog here.

Postscript: a co-incidence

Richard Bentall sent Stephen Fry a copy of his open letter before publication.

On 15th February 2016, Stephen Fry announced in his blog that he was closing his Twitter account. Here is part of what he said:

“…let us grieve at what Twitter has become. A stalking ground for the sanctimoniously self-righteous who love to second-guess, to leap to conclusions and be offended – worse, to be offended on behalf of others they do not even know. It’s as nasty and unwholesome a characteristic as can be imagined.”

Richard Bentall’s open letter was published on 19th February 2016.

Erratum: When initially posted, this blog gave the date of Richard Bentall’s open letter as 19th January 2016 owing to a typing error.  I corrected the date as soon as this was pointed out to me.  I do not wish to imply that Richard Bentall drove Stephen Fry from Twitter and I apologise to Richard Bentall if this impression was given.