Fear of the strangers who live in darkness at the edge of town

MIND, the National Association for Mental Health, has fallen on hard times, as erstwhile supporters send their donations to Bosnia and Rwanda. None the less, it was able to present its annual pounds 1,000 book award at the Barbican last week for a work which enlarges public understanding of mental or emotional distress. It went this year to Michael Ignatieff's Scar Tissue, a moving novel about neurological disease, ageing and bereavement.

Even more boldly, Mind announced that it was to set up a new award, to go to the journalist providing the most sensitive and informed coverage of mental health issues over a year. Some of the audience reacted wryly to the announcement, letting it be known that they thought the idea nuts: those working in the field argue that mental health issues are treated very badly by the media. Mind has recently prepared a damning paper on the matter, and so has that growly old watchdog, the Glasgow University Media Group.

The charge is that newspapers and television associate mental illness with rampant sexuality and violence. The majority of rapists and murderers (including Robert Black, found guilty this week of murdering three schoolgirls) have no history of mental disorder, but they're presented as mad fiends and monsters, leaving the impression that 'mad' people are necessarily dangerous and providing an excuse for the Psycho school of reportage: 'Crazed axe killer . . . staring eyes . . . Ripper-style attack . . . long history of . . . allowed to roam free hunting innocent prey.'

The catalogue of media misreporting is long. Schizophrenics, who, research suggests, are 100 times more dangerous to themselves than to others, are mentioned only in the context of a Hungerford massacre or Peter Sutcliffe. Reports on community care projects and housing initiatives focus not on the support these can offer but on the Nimby protests of neighbours. Mental patients are imagined to be roaming the streets or sleeping in Cardboard City when, in fact, 90 large psychiatric hospitals remain open, out of 130 in the early 1960s. Documentaries salaciously 'display' mental cases, rather as Bedlam used to charge a penny admission on Sundays to see its inmates. Serial killers dominate the headlines.

Mind's objection is not only to inaccuracy and Gothic sensationalism but also to the reinforcement of public fear and hostility. Mental illness has always been more difficult to sympathise with than physical illness because it's harder to see. We like to believe it is a foreign country where 'people like us' would not expect to go.

Often the language used is precisely that used against foreigners: Nimbys whinge about their homes being 'our little bits of England', under threat from aliens. Even the practitioner Oliver Sacks speaks of the mentally ill as 'travellers in strange lands'. This may be true of the exotic cases in Sacks's The Man Who Mistook His Wife for a Hat, but it doesn't describe the humdrum kingdom where many of the mentally ill live - inert, withdrawn, numbed, melancholic.

Mind minds about all this. It has even drawn up guidelines for journalists. Like all pressure groups, it sometimes rattles its lid too clamorously. Yes, there is an unbroken line from sanity to insanity; but there are gradations, and some mentally ill people are dangerous. Yes, most of us are a bit mad some of the time and quite mad now and again; but as well as crises of 'emotional distress' (the favoured new euphemism) there are also long-term cases of mental disorder. Yes, we have been ruled by mad kings and by the end of the 1980s some thought we even had a mad Prime Minister; but we don't have to be as foppish or cynical as Thomas Tryon, who wrote in 1689 that 'the world is but a great Bedlam, where those that are more mad lock up those that are less'.

Mind rightly thinks newspapers could be more responsible in the words they use about mental health. But there will never be a consensus on correct usage. It isn't only that the experts can't agree: the rest of us are horribly fascinated by madness (like Lear, we fear it happening to us: 'O let me not be mad, not mad, sweet heaven'), and richly inventive in the perkily distancing words we use for it: barmy, bats, bonkers, cracked, cuckoo, doolally, gaga, harpic (as in the detergent's slogan: clean around the bend), loco, loony, mental, nuts, screwy. The terms can be affectionate about those to whom they don't apply: 'Good luck you bonkers loonies' ran a Daily Mirror headline to its student exam revision guide; or there's 'loony left' and 'motorway madness'. But once such language is used wittingly, the warmth drains from it. Look at the slang for mental institutions: booby hutch, bughouse, funny farm, loony bin, nut hatch. Bugs are low on the evolutionary scale; hutches and farm are places where animals are kept; a bin is for rubbish.

This kind of language grew out of a culture in which the mad were banished or confined. Michel Foucault's contentious Madness and Civilisation shows how the leper colonies of the Middle Ages became the mental asylums of the Enlightenment: institutions no less stigmatised and inducing a similar dread of infection. By the end of the 19th century, the asylums were there at the edge of every major town, their dark towers and high walls like the masts and rigging on medieval ships of fools. As children, we learnt to fear these places as shaming and punitive. In my village, the nearest institution was called Menston; 'You'll end up in Menston' was the rebuke for all forms of daft behaviour.

But adults have to put away childish prejudices. The spirit of our times is, at best, about tearing walls down, not building them up. And the need to understand mental disorder and admit its place in our culture has never been greater. Last Tuesday, before the Mind Book of the Year award, a delegation went to Downing Street to present a petition for improved community care. Its case is simple: the government programme isn't working, not because it's wrong to bring some of the mentally distressed into the community, but because the facilities for helping them are under-funded. What's needed is more crisis centres, 24- hour counselling, tighter controls on drug dosages, less use of ECT, statutory rights to after-care.

Among the delegation to Downing Street was Jayne Zito, whose husband, Jonathan, was stabbed to death by Christopher Clunis, a 'released' mental patient, in 1992. Jayne Zito is in effect campaigning on behalf of the man who killed her husband, because she believes that a better community care system would have averted the tragedy. Her slogan might be the reverse of John Major's 'we must condemn a little more and understand a little less'. She is trying to bring a rational understanding to the sad world of mental breakdown. It won't bring her husband back, and it doesn't make lurid headlines. But she would have the backing of Edgar in King Lear, who knew that 'the mind much sufferance doth o'erskip / When grief hath mates, and bearing fellowship'.

Neal Ascherson is on holiday