Thinking more about care, compassion, and empathy

Two of my favourite ways of helping people think through an issue, problem or idea is to say either ‘let me reframe this’ or ‘let’s change the narrative’. They are slightly different approaches, but can lead to the same outcome. The reframe approach is useful in a 121 conversation; changing the narrative works well with a wider discussion. Both can help shift a mindset. Reframing can help a person see a situation, issue, or relationship from a different perspective. The ‘frame’ in which the person views a situation, issue, or relationship, will determine their view, and often their behaviour.

A month ago, J and I went to look at the wonderful annual display of snowdrops at Lytham Hall. For a few weeks, sweeping drifts of snowdrops cover much of the woodland grounds of the hall. Every so often was to be found a picture frame set on a post, through which you were encouraged to take the best possible photos of the snowdrops. It was a great idea, but eventually these were the only photos we took, and perhaps we lost sight of the other wonderful things that were there to be seen.

Narrative is similar. It provides a choice of what events to share and in what order to share them. In so doing, the narrative become a specific representation of the story, rather than the story itself. Re-ordering the events will result in creating a new narrative of the same story. The use of narrative in some circumstances might give rise to the accusation that the ‘true story’ is being hidden. I don’t agree with this view. I think changing the narrative doesn’t change the ‘true story’, it’s simply that a narrative will often convey the truth of a story indirectly.

Last week Mel Stride (the Secretary of State for Work and Pensions) was attempting to change the narrative around mental health and employment. The prevailing narrative has been around nurturing and supporting folks’ mental health and wellbeing. What Mel Stride was challenging was the idea that whilst it is good that society has generally taken a more open approach to mental health, perhaps we are in danger of over medicalising the normal everyday challenges we all face. His concern was that people were now ‘convincing themselves they have some kind of serious mental health condition as opposed to the normal anxieties of life’. He was saying this in the context of the rising UK benefits bill for people signed off work because of a mental health problem.

There are 2.7 million people not working because of health problems. One in three 18 – 24-year-olds (Generation Z) now report they have or are experiencing a common mental health problem. One in five 18 – 24-year-olds with mental health problems were unemployed and workless or ‘economically inactive’, as the jargon puts it. Whilst this is not a situation anyone would like to find themselves in, it is also not good for society economically or socially. Which is why Mel Stride was attempting to change the narrative around what mental health might actually mean.

Whilst I don’t agree with this Government’s proposed reforms to the welfare system, I do think there is a need to perhaps revisit how mental health and wellbeing are conceptualised. We all have mental health.  We don’t all have mental illness. Yet if you were to consider the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), originally published in 2013, as being the absolute authority on what constitutes a mental illness, then perhaps we all do.

I have long argued that the DSM-5 lacks validity, and is often based upon evidence not underpinned by empirical research. At its last revision (which took some 10 years), some really challenging additions were to be found that reframed familiar everyday behaviours and experiences. For example: Disruptive Mood Dysregulation Disorder (what my Mum would describe as us children getting a strop on); Video Game Addition, a psychological addiction to playing internet games (two of my grandchildren visited yesterday and like many young people, were constantly on their mobile phones playing such games and watching video clips); Minor Neurocognitive Disorder (I have this! Going upstairs for something and then getting there and not remembering what you came upstairs for). Binge Eating Disorder and Nicotine Dependence Disorder were also additions that illustrate how far pathologising everyday life has come. All of these ‘mental disorders’ have their respective recommended treatment approaches.

Changing the narrative for me is not about adding to these diagnostic labels. It is not about saying Generation Z just need to toughen up and become a little bit more resilient (like people of my generation were, allegedly). It would not be about altering the current work capability assessments to reflect a changing digitally-powered employment environment.

Changing the narrative for me would be to recognise that all folk need hope in their lives. Hope that the world can become a more peaceful place. Hope that their life has meaning, ambitions are achievable and not blighted by limited access to education, poor housing, unsupportive communities and cost-of-living challenges. Hope that folks’ experience with everyday life struggles are recognised as being unique and needing a person-centred response, not a formulaic and process-driven one. We can do this if we (and policy makers) choose to change our narrative, where the story being told and shared, is about care, compassion, and empathy. Failure to do so fails the very generation, who will be there to provide our care and support, as we enter later life. And I for one, don’t want that.