I’m Coming Out
On November 27th 2013, my husband sat me down and gently pointed out to me that I was in the middle of a nervous breakdown.
You're probably looking to read some kind of punchline now, something flippant like "writer's block had driven me nuts." But there isn't one. Just that cold, stark fact. The previous 18 months had been difficult for my family. My husband had been dismissed from his job unfairly and gone through the tribunal process, with all the union representation and legal fees that entails. Because our family home was part of the contract we were told that we and our young children had to leave within 6 weeks. Throughout those 8 months, I was still working for the same employer as they tried to make my life harder and harder, hoping I would just give up and leave so they wouldn't have to pay a faithful employee of 18 years redundancy. I held out. They paid. But the pressure was immense.
And all the time I held strong. I went to work and smiled brightly for the very people who were trying to dismiss my husband, I remained steadfast In the face of workplace bullying, my friends gave me support and I was more or less OK. I continued to work my day job while blogging and writing for newspapers. I had it under control.
Until I snapped. And I still don't know exactly what triggered it. I just knew that suddenly I wasn't Me any more.
Like a dying star eventually collapses under its own weight and becomes a void, my personality collapsed and I became... nothing. A walking bag of bones and fat and sinew, moving automatically through the world while the real Tania disappeared somewhere, shrunken and defeated. The simplest of tasks - phoning the gas company with a query, going to my son's nativity play, a visit to the supermarket - became huge, seemingly insurmountable hurdles. My husband would ask me how I was feeling and I simply didn't know how to answer because I felt nothing. Dead inside. When you're that low, you can't even work up the energy for the "I'm fine" lies that come so easily to the moderately depressed, the lies that would save embarrassment. I spent my days watching black and white movies and knitting mindlessly. I lost 40 lbs because I forgot to eat. To cut a long story short, I have a very good GP who got me on medication straight away, and although it took a couple of months I'm-feeling-much-better-now-thanks-for-asking.
So why am I telling you this? On a science blog, a blog that I hope will one day be, let's face it, a calling card, a portfolio of my science writing for future editors? Not terribly professional, is it?
Because I believe we should be able to talk about mental health in the same way we discuss physical problems. I hope that one day, saying "I had a nervous breakdown" should be no more momentous than saying "I had a really bad dose of the 'flu last year". Except not so bad, because at least mental illness is not infectious.
Sometimes I have wondered if people realise that. People leave you alone when you're going through a bout of mental illness. Very few people, only those who have experienced mental illness themselves and know the isolation, ask how your treatment is going or whether things are looking up in the same way they would if you were undergoing chemotherapy. In one situation you are the the brave fighter to be boasted about, in the other, something embarrassing to be swept under the carpet. Mental illness still carries enormous stigma. I know many people in my position who would not be writing so frankly because they fear it will lose them friends or harm their future career prospects.
The Time to Change campaign has recognised this, the "s-word". Stigma. Like many similar campaigns in different countries, for the last few years here in England Time to Change has been both monitoring people's attitudes to mental health and trying to figure out how to change them, so we can at least talk about it openly.
I confess that while the mentally ill side of me does a happy dance at this, the epidemiologist in me balks at such a massive task. When you do any kind of population study that involves an intervention, you want a clear and measurable result which shows The Thing You Did (and nothing else) Leads To That Result. How do you even begin to measure the effect on people's attitudes of a social media campaign such as Time to Change? How do you judge if it works, if it's value for money?
Time to Change is a classic complex public health intervention. Sometimes it's only truly simple to measure the impact of major public health campaigns from a distance - for instance, it now seems incredible to think that a doctor would recommend smoking for a sore throat. Or that we once thought it was fine to drink a few pints then drive home and, while we were at it, not wear a seatbelt. Yet all of those examples show a massive shift in public attitudes. But none of this happened overnight. Campaigners were in it for the long haul.
The Time To Change campaign, launched in 2007, faced the huge task of both defining what it would claim as a "success", and who would be monitored to define any kind of attitude change to those with mental illness. All good studies need specific outcomes. Writing in a recent special supplement for the British Journal of Psychiatry about the campaign, Claire Henderson and Graham Thornicroft pointed out the three big-but-specific aims of Time to Change:
- To significantly increase public awareness - a 5% positive increase in public attitudes towards mental health problems, teamed with a 5% reduction in discrimination by 2012
- 100 000 people to have increased knowledge, confidence, and the assertiveness to challenge discrimination by 2012
- The provision of greater opportunity - 274 500 people with a range of mental health problems to come together, break down discrimination and improve their well-being by 2012
It was hoped that the campaign would reach up to 30m people, from the general public through to members of professional medical bodies, providers of mental health services, medical students and employers. The media campaign had three stages addressing three particular areas of mental health stigma. Stage one addressed how common mental illness is. According to a recent editorial in The Lancet mental disorders account for 22.8% of the UK's burden of disease compared to cancer at 16.2% and cardiovascular disease at 15.9%. We are not alone, and more importantly we are contributing to society and leading meaningful lives - from the actor in your favourite soap, to your bank manager, to your friendly local epidemiology blogger, we get along just fine and you often wouldn't know it unless we choose to tell you.
The second stage of the media campaign attempted to address prejudice about mental illness. No, if you met me chances are I would not have pencils up my nose, underpants on my head and say "wibble" or only if I'm at a Blackadder convention, anyway. I am far more likely to be a victim of violence than violent. I am ill, yes, but I take medication to deal with it and I cope. Sometimes I will have days where I don't want to get out of bed, but there are also days when I will be the life and soul of a party. Pretty much like you, in fact, except my lows may be lower.
The final stage of the campaign was based on encouraging behaviour change among the public, getting the message across that we can all help, most importantly by maintaining our social contact with friends as they go through rough patches, and by socialising in general. As well as a social marketing campaign, Time To Change organised events to promote social contact between people with mental health experiences and those without.
So far, the results of the Time to Change campaign have shown mixed success, as is almost inevitable from such a big, long term campaign.Over the next few posts I'll be looking at how we even begin to look at measuring the effects of these large scale interventions, what questions we decide to ask to define "success" and what end results we choose to measure. Our choices in designing such studies in epidemiology and the social sciences can have huge effects on what we see at the end, and whether our studies reflect an accurate picture. I used to be a chef before I was made redundant and went back to university. Designing a large scale public health campaign or study is much like cooking a meal - you have to choose the best ingredients you can afford, pay careful attention to each step of the recipe and always remember who you're cooking for.
As I said, I lost my appetite for a while. Now I'm ready to open the recipe book and start cooking.