In my last post I touched on the 1 in 4 statistic, so often used when discussing mental health. Like most mickey-mouse statistics it is catchy and easily understood, it’s been used globally by the NHS, mental health charities, anti-stigma campaigns and the WHO to name but a few. This widespread use has entered the phase into mainstream discourse. What are the implications of this?
Its worth stating that there is no solid data behind the one in four statistic. I wont go into criticising the study the statistic is based on, for more details see here. The reality is there has never been a longitudinal study into any rates of mental illness or subjective states of suffering. The WHO attempted it, but the results came out as nearly 1 in 2. Regardless of the validity of any statistic we should not need to rely on catchy phrases to reduce stigma about mental illness.
1 in 4 attempts to “normalise” and reduce stigma by putting forward the idea that a quarter of us will suffer from a mental health problem, therefore as it is such a large proportion of the population it must be half-way acceptable mustn’t it? and actually 25% of us are not shouting at trees with tin foil hats on are we? Unfortunately this partitioning off of a quarter of the population just continues to generate and advance the very stigma that the statistic is trying to diminish.
1 in 4 puts forward that if a quarter of us suffer from mental illness, then mental illness is common and if mental illness is common then it is nothing to be ashamed of, but this just reinforces the view that if something is “abnormal” then it is shameful. If it was 1 in 40,000 it would still be unfair and immoral to discriminate.
We can see this discrimination occurring in response to rarer and less understood diagnoses. Most people will have experienced some sort of anxiety or felt down at points, talking about depression and anxiety is much more acceptable than disclosing schizophrenia or a personality disorder. I wonder whether shame is more apparent in people who have been diagnosed with more “severe and enduring” disorders.
1 in 4 also serves to downplay the terrible suffering that some people experience. 1 in 4 implies that it isn’t such a major deal, lots of people encounter it and get by just fine. This undermines the seriousness of the distress and pain people endure on a daily basis and the consequences of this. 800,000 to 1 million people die as a result of suicide every year. Lets have compassion for everyone that suffers and not just because it is “normal” or common.
OrdinaryMadness 
[…] Against the ‘1 in 4’ statistic – a blogger says why she rejects the now familiar statement […]
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I have Dissociative Identity Disorder. My statistic is 9 in 1.
On a serious note, I’ve never liked this statistic. When you’re suffering with a mental illness, it doesn’t matter if you’re 1 in 4 or 1 in a million. You are alone. It doesn’t make it any easier for me knowing that maybe three other people in the room have a mental health issue.
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It’s really hard to diagnose mental illness. If you think about it, modern medicine and other ‘hard sciences’ have been developing for thousands of years. Psychology as a science is quite young and has only turned toward empiricism in the last century. Thus, our understanding and ability to approach physical illnesses versus mental illnesses is radically different: no one would ever ask somebody, “Well, why do you have testicular cancer? You’re a young man, you’re healthy, you have a good life?” It’s because the field of psychopathology is still working to resolve many of the generalizations and misconceptions that have founded the field. For example, in the Freud days people labeled women hysterical when they were mentally unstable, and found many ways to blame these women for their states. When they discovered they were suffering from PTSD, researchers weren’t willing to admit to or publish that information – they didn’t want to expose the horrifying amount of abuse women were experiencing under a patriarchal society.
That being said, our society is divided between ascribing those with mental illness to faulty labels and marginalizing those populations, versus over saturating the diagnostic criterion in an attempt to shed light on a general sense of societal unease. Either way, both approaches have resulted in a poor overall framework to address the underlying issues here. Nonetheless, we don’t know enough about mental illness to rely upon the DSM or our limited research to productively dismantle the stigmas associated with mental illness. I hope that until our general understanding catches up with the reality of the situation, we as a society don’t create a larger distance between those who are suffering and the help they need.
In my opinion, I think 1 in 4 is a phooey statistic – everyone suffers, everyone is ‘crazy’.
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Thank-you for your insightful comment. Give it a 100 years and the way we view and interact with mental illness now will be seen as Dickensian.
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Great post, thank you. The trouble with the ‘1 in 4’ statistic is it’s meaningless. If someone said 1 in 4 people suffer from physical illness I’d ask: What sort of physical illness? Cancer? Chicken pox? A cold? Surely everyone is a bit mentally unwell at times, some more severely. It depends what they have and how badly they have it. It’s the slapdash way the stats are used that demonstrates mental illness is not taken as seriously as physical illness.
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Oh completely. Thats exactly right. Sometimes I feel we live in the stone age with this.
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The shouting at trees part made me LOL (…maybe I’m just yelling at the ants ON the tree…). I try to do my part in normalizing mental illness by speaking openly about it to people who I interact with on a regular basis and I mention it on my Facebook frequently. That’s actually why I started my blog, too.
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This is true I think. I have a diagnosis of Bipolar (1 – for the who are into such things) and people think they get it, but are shocked with the idea that being in the manic phase is as dangerous if not more than being in the depressive phase. They seem to think it is a joyful thing. Plus, of course, trendy (trust me, not trendy to be refused college based solely on dx – I know because they withdrew an unconditional place based on insurance issues. Not trendy to be catatonic, or broke, or genuinely paranoid or…. OU get it)
One on 4 is meant to normalise, but, what IS normal when it comes to brain and mind function?
Accepting of the differences, and ability to step in when they are dangerous, but not to assume it is ALL dangerous.
I am lucky, and old, so I am more or less in control of my worst excesses, but…
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Accepting of difference is key I think. Sorry to hear you’ve experienced discrimination.
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I totally agree with this and it’s something I’ve tried to explain to mental health professionals themselves but they seem clueless. Mental health is so personal and stats are stats, they are the least emotional thing to attach to such an emotive topic. My diagnoses haven’t helped me reduce the stigma I face most of the time, and ‘attention seeking’ is how I’ve been told I am and resulted in me feeling ashamed and guilty. It’s not been taken seriously and we need far more education on this. If it’s as pandemic as the stats say, why haven’t we got more support in place?! I could write a rant, hey wait, you may have triggered the creation of a post! Thank you for writing this and keep going, you’re writing is fantastic xxxx
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Excellent post. I certainly agree with you and share most of your sentiments here. I’m really glad I found your blog. Great perspective and very thought provoking. I will continue to read your work!
All the best.
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I think the relevant statistic would be on how many people, on encountering moments/periods/episodes of depression or anxiety seek help — or don’t seek help. We all have those moments/periods/episodes — it is hard to avoid in a world of such uncertainty — how do we move through the ‘shame’ of feeling these things to asking for help? It isin’t about the ‘1 in 4’, it’s about how do we perceive/derive value in asking for help.
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Exactly, so many people could be suffering and just not coming forward.
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I completely agree with you on this. People speak of inequality problems in society but one that is often undermined is the inequality between mental health problems and physical health problems. It’s really not taken seriously enough. Even reaching out for help is significantly more difficult, I wrote about it here if you’re interested: https://waveringparisian.wordpress.com/2016/03/13/the-trouble-of-seeking-help-2/ Great post!
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Good post. The NHS needs much much more funding to bridge the gap. Dave! Sort it out.
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This is a really insightful post and has expressed really well some things I felt were just beyond my grasp to explain. So thanks for writing it.
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No probs, thanks for reading and commenting.
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I agree with you wholeheartedly. Having experienced anxiety and depression for years before I was finally diagnosed with Bipolar Disorder II and speaking for myself, there was shame even before I had a “label” …who the hell wants to feel the way we all do on a consistent basis. The fight is so hard emotionally, physically, and obviously mentally. Our diseases are definitely a big deal no matter how “normal” some experts/society categorize them.
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Absolutely. Did a diagnosis reduce or increase the shame you felt?
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I have wondered, at times, if the stigma originates from the idea that people with mental illness are assumed to be of the worse cases. And I think people tend to assume that mental illness is “in the mind” and society has always been taught that the mind is the strongest asset a person has, so if something is “in the mind”, then it follows that it can be controlled.
Granted, I recognize these are assumptions, but I think they are probably more common than 1 in 4, so it tends to outweigh that reality. Granted, it doesn’t make it right, but it is what it is.
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Agreed, the mind is seen as “who you are” If that is “disordered” then what does that mean?
Quite why people think that the mind can be controlled without any help is beyond me. I manage my neck pain with a lot of effort every day with help from a physio… If I wasn’t taught mindfulness I don’t know where I would be and even with mindfulness I’m not controlling my mind I’m just reacting to it much less.
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