Have you ever faced stigma? It is likely that you will have.
I have faced stigma for trying my best to stand up for professional values. I was an NHS psychiatrist for 25 years until I retired a few years ago. Given this career, the subject of stigma is an important one: an issue that psychiatry is always trying to address. Before I retired, I wrote and submitted this paper as an Editorial for the British Journal of Psychiatrists: The other side of the fence: Iatrogenic stigma. My paper was rejected by the psychiatrist reviewer and criticised for containing “anecdotal” material. For me, this kind of said it all.
My website Hole Ousia has been around a long time. It is where I share all sorts of stuff covering a very wide range of subjects. I do not seek followers for my website or spend any time in promoting it. I prefer just to enjoy creatively sharing explorations and findings in the world at large. I deliberately do not separate out the Arts and the Sciences [the so-called “two cultures”].
A small fraction of the material that I have shared on Hole Ousia relates to the use of social media. Much of this relates to general use but some of it relates to the use of social media by professionals, and in particular, given my career in psychiatry, its use by mental health professionals.
I was once on Twitter [before it became ‘X’] but closed my account in December 2015. I did so reluctantly because I had made a number of new friends through the platform and enjoyed the benefits of sharing ideas and learning about new research. However, I also faced stigma, which came from a number of directions including mental health professionals. I recall one British psychiatrist, who has long been one of the most influential on Twitter/X mock my interest in the humanities. This psychiatrist did so by using unpleasant language about my appearance in a photograph that I had shared. Sadly, this is not unusual on social media and I was able to cope with this. However, I began to notice a pattern: unpleasant comments about me such as this were not confined to just one mental health professional. When I shared my difficult long term experience of an antidepressant, that I had been prescribed for anxiety and then found unable to stop, I routinely had responses tweeted to me that I was “scare-mongering” or “pill-shaming”. Some of these comments came from very senior UK psychiatrists. Some of the comments were much more personal and occasionally loaded with language that was more than unpleasant. Aware of this issue, a former President of the Royal College of psychiatrists, Professor Wendy Burn, a prolific user of social media herself, stated: “What is the point of all this nastiness?”
Social media is not all bad. It can provide vital support for marginalised groups. It is also a platform where lived experience can be shared. One example relates to lived experience of psychiatric medications beyond the short term. Had it not been for social media and the work of the likes of Adele Framer, Marion Brown, Stevie Lewis and Ed White, testimonies would not have been gathered to highlight a significant problem. Prevailing psychiatric approaches would have continued to disbelieve those like me who were experiencing harmful consequences of their prescribed medication. Being disbelieved is a manifestation of stigma. The mental health profession needs to do better. Far better.
It does not help wider understanding when social media discourse becomes polarised. Let us be honest, we are all subject to group behaviour even if we are not aware of it. Groups on social media support one another but may also egg each other on. Short-hand labels [and yes labels is the right word] such as “anti-psychiatry” or “the antis” are routinely used by some mental health professionals to describe a swathe of individuals, including those living with prescribed harm [see examples below]. Increasingly, at least for some mental health professionals, defensiveness is ousting judgment. Compassion and openness to wider understanding too often lose out.
For the record, I need to say here that I do not “hate” psychiatry as one senior psychiatrist has said of me. As a doctor and psychiatrist I did my best to raise ethical issues when I encountered them in practice. I found speaking up about issues such as these was not always easy. My intention was only to try and ensure patient welfare was put first and I still had good working relationships with my psychiatrist colleagues.
So, you may ask, why am I writing about this now? After all, I don’t use social media. The reason is that many people continue to be in touch with me describing their experiences of comments made on social media by some mental health professionals that causes them distress and fosters stigma. Occasionally I have had people write to me to say that they were left feeling suicidal because of such comments. So yesterday, on Hole Ousia I shared these two old posts [copied below]:
I should not have been surprised that re-posting these elicited an immediate unpleasant response of the kind described above. I remain disappointed that some mental health professionals continue to behave in this way on social media.
I am of the view that professional core values matter. Departure from such values risks erosion of trust that patients have in professionals and could cause lasting reputational damage to British psychiatry.
‘VILE ON’:
Prof Rob Howard, 14 February 2022: “‘Vilegate’. What’s going to happen next?”
Prof Rob Howard, 14 February 2022: “[Vilegate] is far better than Bollywood“
Dr Annie Hickox, 4 March 2022: “That is one of the most vile things I have had the misfortune to encounter on Twitter, Rob” [sarcasm]
Prof Rob Howard, 4 March 2022: “I have a reputation to maintain. As do you, Annie”
Dr Annie Hickox, 3 April 2022: “I’m the vilest. @ProfRobHoward is only the second vilest”
Prof Rob Howard, 3 April 2022: “I am so disappointed. Always runner up”
Dr Annie Hickox, 3 April 2022: “Try harder”
Prof Rob Howard, 3 April 2022: “I think vileness has to come naturally. You can’t force it”
Prof Rob Howard, 12 June 2022: “This, I’m afraid is Vile Cake Talk”
Twitter contributor #1: “Utter FILTH. I love it.”
Twitter contributor #2: “We shall be suspended from Twitter. We are Vile and Proud”
Dr Annie Hickox, 12 June 2022: “The Vile Bodies Club continues to grow apace”
Dr Samei Huda, 25 July 2022: “I’m mediocre at being vile”
Prof Rob Howard, 25 July 2022: “You are too modest”
H-A-R-M:
Contributor #1, 15 April 2022: “Now we’re going back to prescribed harm again”
Prof Rob Howard, 15 April 2022: “Don’t rouse them whatever you do
Contributor #2, 15 April 2022: “Don’t wake the dragons”
Prof Rob Howard, 20 June 2022: “It makes me uncomfortable because I struggle to spell it.”
Contributor #2, 20 June 2022: “H-A-R-M”
Prof Rob Howard, 20 June 2022: “You’d think I’d have got it by now.”
Contributor #2, 20 June 2022: “Maybe we should get it tattooed on you!”
Prof Rob Howard, 20 June 2022: “No space left.”
Contributor #2, 20 June 2022: “We will get you an antipsych to follow you round and ‘help’ you remember.”
Core Values for psychiatrists [framework of the Royal College of Psychiatrists]:
