Jeremy Laurance: Why we must tackle this terrible stigma

Medical Life

Gordon Brown worries a lot about other people's mental health. He was at it again last week, speaking at the launch of New Horizons, a programme of action from the Department of Health that aims to "improve everyone's mental wellbeing".

But what about the mental health of Mr Brown's himself? Is enough being done to look after that? And here's the odd thing – we aren't allowed to know the answer to this question, or even to ask it. Yet it is perfectly acceptable to ask questions about his physical health.

A couple of months ago, the BBC presenter Andrew Marr asked Mr Brown live on air whether he was taking "prescription painkillers or pills to help you get through" – a question that was inspired by internet rumours that the Prime Minister was on antidepressants.

Downing Street were furious and angrily denounced Mr Marr and the BBC for the question. Yet only days later, No 10 released more details of the PM's medical history. It announced that the Prime Minister had attended Moorfield's Eye Hospital for attention to a retinal tear in his good eye (the one undamaged by the school rugby injury that left him blind in the other eye). The tear did not need surgery and Mr Brown's condition elicited widespread expressions of concern.

Some contrast, no? A putative mental illness is vigorously denied and the mere suggestion of it condemned as an unacceptable slur. A physical ailment, however – once successfully dealt with – is advertised to attract the sympathy vote.

The incident highlights the biggest obstacle to better care of people who are mentally ill – stigma. If you break your leg, there is a problem with your leg. If you have depression, there is a problem with you. A medical record becomes like a criminal record – with the difference that the psychiatric patient can never clear their name.

I wonder what Alastair Campbell would have made of the episode, had he still been in charge of the Downing Street press machine? The former spinmeister has done more than almost anyone to destigmatise mental illness by describing in detail his own experience of depression and demonstrating that it is no bar to high achievement.

Yet even psychiatrists cannot agree how to tackle stigma. An intriguing debate about the nature of mental illness and how it should be described to the public has split the profession and dominates the current issue of the 'Psychiatric Bulletin'.

One view is that mental health is on a continuum with mental illness and that the difference between the well and the ill is a matter of degree. Everyone gets stressed, for example, and what differs is how we react to it. Others disagree, saying this is scientifically inaccurate and that there is a step change that divides the ill from the well, not a continuum linking them.

It is clear where this is going. If there is no hard and fast dividing line between so-called normality and mental disorder, this could encourage a more sympathetic view of those who suffer mental problems and persuade them to seek help sooner whilst also prompting GP services to detect and manage them better.

Unlike the row over Mr Brown and the BBC, this is an argument worth having.