Open letter to the BBC concerning ‘Casualty’.

I rarely watch ‘Casualty’ and I imagine I have missed many diverse and powerful storylines. However, the two episodes I have recently watched have been notable for their irresponsibly negative handling of mental illness.
In series 31 episode 2, a pregnant woman is so distressed by the noises in her head that she wants a premature delivery. She and her husband are aware that she is showing symptoms of schizophrenia and are doing everything they can to keep this to themselves so that she will not have to go to a psychiatric hospital.
In series 31 episode 8, a young man is suffering from paranoia. His girlfriend wants him to have treatment and is ready to leave him because she finds it so hard to cope with the stress.
These stories are similar in structure and resolution. For both couples there is (in the words of one script) ‘a happy ending’. The cause for celebration is that the patients have serious medical conditions. The woman in episode 2 has ‘superior canal dehiscence syndrome’ and will need surgery on her skull. The young man in episode 8 has ‘systemic lupus erythematosus’ which can lead to organ damage. These diagnoses are apparently massively preferable to a psychiatric diagnosis, so much so that the patients, their loved ones and the hospital staff can relax in the knowledge.
The underlying premise of these stories is clear: a psychiatric diagnosis is shameful and devastating.

It's good news!
It’s good news!
He's not weird, he just has an incurable disease!
He’s not weird, he just has an incurable disease!

I quote here some of the key lines from the scripts.

Episode 8.

Doctor to nurse: ‘Speaking of happy endings, I’m pretty sure that the root cause of Steve’s symptoms is physical, not psychological.’

Nurse to girlfriend: ‘Do you believe in happy endings?’
… and the doctor informs the patient and his girlfriend (who is not going to leave him now because he does not have a mental illness) that he has ‘Systemic Lupus Erythematosus’…
Doctor to girlfriend: ‘His immune system is attacking itself…’
Girlfriend: ‘It’s actually a condition?’
Doctor: ‘Yes, a condition. A very rare one but a condition nonetheless.’
Patient: ‘and is there a cure?’
Doctor: ‘No … there are no guarantees.’
Patient: ‘I never thought I’d be happy to hear I have a disease.’
Girlfriend (smiles as if she has been given a present): ‘I’m sorry we’re smiling but it’s nice to know.’

Episode 2:

Doctor: ‘It’s incredibly rare. But it means psych can stand down.’
Nurse beams.

Patient: ‘Am I going to the psychiatric hospital?’
Husband: ‘No, you’re not.’

Patient: ‘So it’s not schizophrenia?’
Doctor: ‘Well we’ll need to keep you monitored. But a couple of operations and you should be fine.’
Husband: ‘Thank you.’
Doctor: ‘Well we like to get to the bottom of things.’
(All-round beaming)

The diagnoses given have different implications in individual cases, just as psychiatric diagnoses do. But the basis of these stories is that there is a strong general preference for a disease you can see on a scan or on your skin. Even if this means you need surgery on your skull.
By being so unambiguously pessimistic about the possibility of mental illness, these episodes reinforce outdated stereotypes. Many viewers will not see anything odd in these scenes; if you have not been inundated with complaints then the size of the problem is clear. The fear and disgust associated with mental health problems which have no physical excuse is entrenched. And perhaps many viewers with mental health problems found that their self-esteem and confidence dropped as a direct result of these scenes.

The BBC has done some good work, for example here and here, on changing attitudes to mental health problems. I don’t know how these stories made it onto the screen.

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