Tag Archives: Mental Health Promotion

Inequality, health & the credit crunch.

“life expectancy here in London falls by one year for every underground station you stop at from Westminster to Canning Town”

(Gordon Brown 2008)

I am looking forward to reading “The Spirit Level: Why More Equal Societies Almost Always Do Better” by Richard Wilkinson and Kate Pickett which was published at the start of March. Wilkinson has a long track record of studying and drawing attention to the effect that inequalities may have on public health.  Most famously, Wilkinson’s work played an important role in the development of the report into health inequalities that came to be known as the Black report. This link has a good account of the history behind the Black report as well as the then government’s rather un-enthusiastic reaction to it’s conclusions. 

Despite the fact that we have long had good evidence suggesting that inequality has a powerful effect upon health I would argue that usually, nothing very much is done about it. Usually the most prominent Public health messsage is of the “take care of yourself” variety i.e. Five portions fruit & veg, don’t smoke, drink too much, get fat etc etc.  Whilst there is nothing wrong in suggesting that people look after themselves the argument has always been that this “look after yourself” message is pushed by Governments in preference to actually doing anything concrete about structural inequalities in society. I wonder what difference our recent economic woes & the credit crunch will make to this argument?

We have seen an awful lot of argument and anger over executive pay and bonuses for bank bosses. Whilst I think it is a bit simplistic to blame everything upon these people, I do think it is good that some light has been shone onto this sort of thing & that debate has been started about greed in society. 

Am I being naive in wondering whether some good might eventually come out of this current crisis? – Wilkinson’s book (above) is one of a few things (or this) I have noticed recently that are trying to discuss this issue. I predict that this forthcoming report by Micheal Marmot into health inequalities  which is due in December will get quite a lot of attention. I suppose we will have to wait and see what difference any of this makes.

In the meantime, I will answer my own question – I suspect it is naive to imagine that anything will change – the economy will eventually pick up, the rich will continue to get rich & the poor become poorer & all this will get forgotten about again? – or will it- what do you think?
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Laughing at the lunatic and distracted – it wouldn't happen these days?

I have always found William Hogarth’s engravings fascinating – detailing both the trivia and the drama of ordinary lives in 18thCentury England. Many of them offer commentary on the problems of the day and perhaps also our own times?

In 1735 Hogarth completed a popular series of engravings entitled the “Rakes Progress”. These depicted a young mans debauched journey from a privileged start in life to his death in the infamous London Asylum called Bedlam. This name of this institution has passed into our speech as a term for a fearful and chaotic place. 

The Rake in Bedlam
Hogarth: The Rake in Bedlam

In the foreground of this picture we see the attendants removing the Rake’s chains (although I have read some saying that the chains are just being put on?). In death he is mourned only by the sweetheart he abandoned to pursue a life of drinking, gambling and womanising. As is typical of Hogarth’s work the rest of the picture is full of incident.

The cell on the left shows a “religious maniac”. His face contorts as he sees the shafts of sunlight coming through the bars which he sees as a spiritual visitation. In another cell a man who believes himself to be a king adopts a regal pose – harder to see is the pot he is pissing into. If you remember Dava Sobells book Longitude you will know about the struggle to figure out how to navigate around the world, the man with the telescope has lost his mind in the attempt. Other figures depict depression, a man who thinks he is the Pope and a mad tailor, a reminder of the tailor who measures him for a suit at the start of his progress. Two fashionably dressed women stand out from amongst the inmates.

These ladies have paid to tour Bedlam, this was a popular diversion of the day and a practice that was allowed until 1770 ( See thiswebsite for more details) . One of them is holding a fan to her face and is thought to be either trying to waft the stench from her face or possibly trying to hide the fact that she is laughing at the inmates. It is thought likely that Hogarth himself had toured this institution as it is said that architectural details (such as the bars which divide the “curables” from the “incurables”) are correct. Hogarth was closely involved in the foundation a few years later of the Foundling hospital – which cared for abandoned children. It seems reasonable to me to assume that he would have had a good reason to visit other institutions and didn’t go to Bedlam just to laugh? Whatever his reason to visit though we can be grateful that ideas have changed since Hogarth’s day – or have they?

Everyone is familiar with the experience of meeting a stranger at a party and going through the “what do you for a living” routine. Nowadays I say that  I am a University Lecturer, but previously the revelation that I was a mental health nurse would often prompt a response such as “gosh you must be brave” or a request to talk about the sights I must have seen. If you are a mental health nurse – reflect on this yourself, do people have much idea of what mental health care is like or would their ideas more accurately fit Hogarths image?

Partly this may be due to media portrayals – try entering “schizophrenia” and “murder” into Google or recall the treatment Frank Bruno got from the Sun newspaper in the now infamous “Bonkers Bruno” headline. It is easy to question the press over some of this coverage, especially when the truth is that people with mental health problems are much more likely to be the victims than the perpetrators of violent crime (See MIND information for more details). It would be too easy (if not a little lazy?) to simply blame the press. Perhaps we all enjoy laughing at people who are perceived as different?

For example, I have laughed at some of the X factor auditions – there is an element of slapstick humour when things go horribly wrong but at the same time, being asked to join the laughter at films like this makes me uncomfortable. I have also come across this a few times as well – (whether this film is a fake or not) it is interesting to read the comments underneath.


What do you think? – I think we need to ask ourselves some questions: 

  What do we communicate to people about our work?

  •  What responsibility do we have in promoting understanding about mental health issues?
  •  Are we part of the solution?

…or sometimes part of the problem?