March 12, 2021

Back in the days when they were still speaking to one another, the Cambridges and the Sussexes collaborated on a short video made for the mental health campaign Every Mind Matters. Over moody black and white video, cut with shots of celebrities staring meaningfully into the camera, Meghan Markle describes a suite of online self-care resources that offer a “new way to turn things around” when “we feel stressed, low, anxious, or have trouble sleeping”, while Princes Harry and William assure us that “everyone knows that feeling, when life gets on top of us”.

“Everyone”? Yes, that’s the claim. And that includes members of the royal family. Markle used her Oprah interview to tell the world about the depth of unhappiness she experienced when she was pregnant with her son Archie.

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“I just didn’t want to be alive any more. And that was a very clear and real and frightening constant thought… I went to the institution, and I said that I needed to go somewhere to get help… And I was told that I couldn’t, that it wouldn’t be good for the institution.”

Thrust into a (frequently hostile) media spotlight, estranged from her father and sister, and living far away from her mother and old friends during her pregnancy, it’s not surprising that Meghan felt distressed. What is surprising is the implication that she was disallowed from accessing psychiatric care, given Prince William’s particular interest in mental health as a campaigning issue, and the fact that Prince Harry has spoken publicly about his own mental health difficulties. Prince Charles, Princess Margaret, and Princess Diana were all known to have seen therapists.

The younger royals — and now Merkle — have been enthusiastic participants in this broader discourse on mental health, which relies on a definition of mental illness that is both expansive and depoliticised. Everyone is encouraged to be more emotionally open in reaction against the ‘stiff upper lip’ adopted by the queen’s generation — but little attention is paid to the issues of wealth, class, and access to scarce public resources.

Rather than seeing disclosure as the first step towards seeking treatment, this newly popular model understands disclosure to be a form of treatment in and of itself — in fact, the more public the disclosure, the better. Jo Hemmings, a self-described “media psychologist”, spoke on LBC radio on Tuesday to honour Meghan Markle’s own efforts in this regard, saying that: “it was extremely healthy to share it with the entire world” because “she needs the world to listen to her… she’s just taking talking therapy to its extreme”.

She has been described as “brave” by the White House Press Secretary, Jen Psaki. And the mental health charity Mind tweeted out a statement acknowledging that although “opening up in this way can be really difficult… when high profile people talk about these experiences, it helps to break down the stigma around mental health issues.”

And yet it’s not at all clear what negative consequences Markle was risking in speaking about her history of depression. One of the very few public figures to have questioned her account, Piers Morgan, received more than 41,000 complaints to Ofcom, was immediately rebuked by his co-host, and has since stepped down from his position at Good Morning Britain. It seems that, on this issue at least, the public are determinedly sympathetic towards Markle.

Not all disclosures of mental illness would be greeted with such (almost) unanimous support. Historically, celebrities who have confess to having recovered from common and invisible mental health problems like anxiety and depression are far better received than those whose displays of illness are more public and alarming – think of Britney Spears shaving her head, Michael Jackson bleaching his skin, or Tom Cruise jumping up and down on Oprah’s sofa.

In a 2018 Guardian article about her own experiences of mental illness, the journalist Hannah Jane Parkinson writes of a very particular style of “opening up”:

“In recent years the discussion around mental health has hit the mainstream. I call it the Conversation. The Conversation is dominated by positivity and the memeification of a battle won… it tends to focus on depression and anxiety, or post-traumatic stress disorder. It is less comfortable with the mental illnesses deemed more unpalatable – people who act erratically, hallucinate, have violent episodes or interpersonal instability.”

The Conversation shies away from conditions that are disturbing, destructive, and very clearly not curable through disclosure alone. In some rare instances, there are forms of mental distress from which people never recover, and to which the only solution is heavy medication and institutionalisation. The Conversation doesn’t know what to do about those.

Instead, the focus is on those forms of mental illness that are really just extreme manifestations of universal forms of emotional distress, like sadness and worry. Imagine the response if Markle had confessed to suffering from paranoid schizophrenia, or borderline personality disorder, or if her perinatal mental illness had manifested, not in an urge to hurt herself, but instead an urge to hurt her baby. It is one thing to admit to a depressive illness that is now passed. It is quite another to admit to a permanent condition that is liable to produce frightening and poorly understood symptoms like psychosis.

But only a small minority of psychiatric diagnoses fall into this category. In England, Mind reports that 1 in 4 people will experience a mental health problem of some kind each year, overwhelmingly either depression or anxiety, and although there is little evidence to suggest that antidepressants work better than a placebo, more than one in ten people are now taking them. For Conversation enthusiasts, these figures should be understood as positive — a sign that we are finally “opening up” about private suffering, and thereby waking up to the true prevalence of mental illness.

But few proponents of this approach ever pause to reflect on whether this kind of radical openness actually does lead to improvement. Given that suicide rates in the UK have reduced only slightly in the last 40 years, and have actually increased in the US, while rates of non-fatal self injury have shot up, it’s certainly not obvious that the new model is any more effective than the old one.

And while the expansiveness of the Conversation may potentially serve to destigmatise, it also serves to obscure. This week, the journalist and mental health campaigner Bryony Gordon described mental illness as a “great leveller”, affecting prince and pauper alike. But while it is of course true that the highly privileged do sometimes experience mental illness, this is a category of disease that is closely tied to societal conditions that both create and aggravate distress — and the Conversation, with its preference for talking therapy over material change, cannot accommodate that kind of analysis.

When we lump together depressed duchesses and schizophrenic homeless people into the same category of “the mentally ill” — a category that, in any given year, will apparently contain fully a quarter of us —  precise analysis becomes impossible. A graphic on a government website reporting that “50% of people seen sleeping rough had mental health needs”, for instance, is now unintelligible. Does this mean that half of rough sleepers are in urgent need of being sectioned? Or would their problems be solved by relocating to California and “speaking their truth”?

A key participant in the Conversation, Heads Together — an organisation spearheaded by the Duke and Duchess of Cambridge and intermittently supported by Prince Harry — aims to “tackle stigma and change the conversation on mental health”, with the solutions presented all orientated around deliberately uncontroversial forms of education, generally through digital means.

Which is unsurprising, given that Prince William, as a future head of state, is required to maintain political neutrality. So although his campaigning work is no doubt sincerely meant, it is also obliged to be anodyne. It can’t mention issues like class or government policy. It can’t even demand increased funding for NHS services. It is necessarily limited to platitudinous statements which do destigmatise — albeit in a very limited way — but which also flatten and distract. The public response to Markle’s disclosure is entirely in keeping with the Conversation, which — with celebrity and royal assistance — has succeeded in normalising a very narrow band of mental illnesses, but has also stripped away any semblance of political critique.