Stories matter. They have a profound influence on our mental and physical health, and the health of our overall society. Stories told by Government have the potency of a portcullis-stamped seal of approval. One example is the Public Information film, as contagious and hardy as any virus. Just ask those whose dreams are still haunted by the “Spirit of Dark Water,” or the taxi-men who curse our own homegrown “Go Walking” campaign. More recently, Mark Strong’s gruff, sensitive tones have been commanding us to, “Stay Home/Stay Alert, Protect Lives, Save The NHS”.
In this article I will discuss harmful and helpful stories and narratives about mental health and the NHS that have been illuminated by the lockdown.
When I first heard about Coronavirus, I was attending a viewing of Under the Knife, a documentary exposing how successive Tory governments have promoted austerity politics and backdoor privatisation of the NHS. The prevailing story that this documentary dissected was that “competition is good and improves services”. See the film yourself, or read about the effects of NHS underfunding here.
This type of policy promotes under-funding and unfairness across our society, leading to longer waiting lists and less access to mental health services. Under the Knife convincingly argues that opening the NHS up to the private sector creates more inefficiency, poorer quality and less access to health care. These and other human rights have been championed by PPR and campaigns such as #123GP that have a different tale to tell.
Stories and Worries about Coronavirus
Stories about the NHS have changed, for the time being. In the early stages of the Coronavirus lockdown we were told to “Stay Home, Save Lives, Protect the NHS.” That story was successful because it was clear, memorable, evidence-based and appealed to our nobler instincts.
But you can do just as well with a strong motto that is memorable, scientifically baseless, and appealing to our baser instincts. Pretty soon we will be told that we must “tighten our belts” once again to stave off recession - a hard story to stomach while millionaire fat cats punch new holes in their own belts.
Strong stories and narratives can shape society and save lives, but that all depends on who is shaping the story. Like Hercule Poirot scrutinising the charred scrap of a victim’s will, we should ask, who benefits? Like Agatha Christie, we should rock the printing presses and turn our hands to story-telling ourselves – we might be successful.
A survey by the Office of National Statistics revealed that over 8 out of 10 adults (84.2%) said they were very worried or somewhat worried about the effect that the coronavirus (COVID-19) is having on their life right now. I wish I could find someone from the other 15.8% to tell me their trick. The list of worries was topped by wellbeing (boredom, loneliness and stress), availability of groceries and medication, inability to make plans, fears over work, attending weddings and funerals, and family finances.
Many people are concerned over reduced hours at work, redundancy, or closure of their own business. When we worry, we are all in the business of preparing future stories for ourselves, in the (often self-defeating) hope that we will be well-prepared against danger. Perhaps some of this describes you, or someone you know.
Stories about Mental Health
Low mood and anxiety are natural, normal responses to disaster, and should not be pathologised as mental health disorders. But it’s a common reaction to define these phenomena as internal problems or disorders, rather than human responses to hard times.
Lucy Johnston, a Consultant Clinical Psychologist expressed these views here. As fans of Pixar’s ‘Inside Out’ will know, when you are sad it can be helpful for others around you to see your tears. It’s helpful because mental health problems don’t live inside us, like tiny Gremlins tinkering with our inner neural circuitry. They exist outside of us, in schools, families and workplaces, in political and economic philosophies, and the stories we create.
To improve mental health we need to improve these stories. A good place to start is to acknowledge that it is normal to feel depressed and anxious sometimes, that it’s a red flag that we need to connect with others, and that sometimes it is our society that needs fixing not ourselves.
Why would it benefit any government, newspaper or individual to promote the opposite story, that our mental health problems are entirely our own responsibility, or that anxiety and depression are shameful disorders that should be eliminated? Because this viewpoint preserves the status quo. The alternative story says that to help bring others out of distress we need redistribution of power and wealth, systemic changes, change to our institutions, and changes to our addiction to fossil fuels and economic growth.
Stories in Hiding
Subtler childhood stories exert great influence, and most forms of therapy attempt to unearth and exorcise these glitches in our machine code. Therapists hope that vampiric core beliefs such as “I am unlovable,” “I am stupid,” or “boys don’t cry” will crumble and burn when dragged out of their psychic crypts and into the sunlight. This approach is itself a narrative – fix your bad thoughts and irrational beliefs, fix your behaviours, and fix your mental health.
Community Psychology suggests that because we live in a psychologically unhealthy society, fixes at an individual level are not always enough. We also have to unearth the destructive economic and political narratives that promote humiliation and shame, fear and distrust, instability and insecurity, discrimination and inequality. Amidst the pain and confinement that we are all experiencing, there is also an opportunity to expose and break free from myths about austerity and the benefits of NHS privatisation.
Austerity is a narrative. The trickle-down benefits of economic growth based on GDP and productivity is another form of narrative. The benefits of competition and efficiency in a privatised NHS are yet another narrative, exposed as dubious by Under the Knife.
As a by-product of the response to Coronavirus, the inability to sustain services and find money to fund the NHS has been exposed as yet another mythical narrative. We must continue to promote the new narrative that change is possible and money is available when a crisis such as Covid-19 is identified.
We need an organised community response that will alleviate austerity ailments, fix our poisonous addictions to growth and fossil fuels, and ensure adequate funding for public services.
Our collective Mental Health needs a systemic, society-wide boost to its immune system. Individual therapy – like exercise - can be transformative. But it is only part of the equation if our world remains psychologically unhealthy, riddled with inequality, discrimination, poverty and isolation. The link between inequality and mental health is well founded. We need an organised community response that will alleviate austerity ailments, fix our poisonous addictions to growth and fossil fuels, and ensure adequate funding for public services.
We need systemic changes that will reduce health inequality and poverty, promote community cohesiveness, protect and empower minorities, improve housing, urban renewal and provide green spaces for all.
Many times in history we have seen seemingly impossible hurdles overcome by unified effort. The Moon landings, the abolition of slavery, women’s suffrage, the creation of the NHS and the Good Friday Agreement come to mind. All of these endeavours seemed unlikely, up until they happened.
Similarly, the public’s reaction to coronavirus and adherence to lockdown has saved thousands of lives. A new social contract has been written up overnight that governs our behaviour down to the side of the road we choose to walk or run upon. These extraordinary actions should remind all of us of the power of social action. Too often it seems that the obstacles we are up against are insuperable and that any effort is a waste of time – the type of self-defeating story that is often at the root of depressed societies and depressed individuals.
There is much to dislike about the Government’s response to Coronavirus. But the new narrative of the Coronavirus lockdown also shows that when the message is clear, the danger is presentable, or the opportunities are rich, we can change society instantly. What can we do to keep up this momentum?
What Can We Do?
Proper funding and training for GP Counsellors in Primary Care, the focus of the 123GP Campaign, would be an excellent start. It’s inspiring to see the work of this campaign in lobbying Stormont and making sure that the voices of service users and families are heard. In the midst of this upheaval, the case for enhanced mental health funding and overall NHS funding is greater than ever.
We should keep the pressure on government, capitalise on renewed public support for the NHS, and trumpet the pitfalls of overseas health systems that prioritise profit and private interests over patients. Similar investment in urban regeneration, education, and housing is long overdue. The austerity narrative is dead and should not be allowed to regenerate.
Like careful gardeners, we should also take care to sow and cultivate the stories that matter. You can achieve this through lobbying, activism, writing to your MP, signing petitions, and engaging with the media.
Coronavirus will run its course. The vast majority of us will be physically unharmed, while saving lives through social distancing and staying at home. Some of us will feel the pain of bereavement, the claustrophobic grip of anxiety and panic, and the misery of financial pressure and redundancy. These are natural responses to a natural disaster, not psychological disorders. Counselling and therapy will help many of us to recognise the inner strengths and outer supports that will help us cope through this crisis.
But when the dust settles and life returns to normal, we should remember that life in Northern Ireland was not normal in the first place, that there was and is an ongoing pandemic of austerity and inequality. This will be overcome by making your voice heard in community activism.
When this is all over, we’ll no longer have to stay home. But we will still need to save lives and protect the NHS.