Nick Johnstone: Blue notes

Anyone who has followed this column since it started nearly a year ago will know that its purpose is to show what it is like to live with depression, panic attacks, alcoholism and anxiety. I have been trying to challenge the taboos, stereotypes and stigmas of mental illness, to take people who haven't experienced any kind of mental illness - either themselves or via someone close to them - inside the mind of someone dealing with these illnesses on an everyday basis. I'm putting myself out there to try to make the world a better place. Call me naive, call me a dreamer, but I still believe that it is possible to make a difference. That is why I am a proud member of the National Assembly Against Racism, the Burma Campaign UK and Free Tibet. That's why my wife and I sponsor three little girls in Central America.

So imagine my horror last Tuesday when I opened my copy of G2, where this column finds a good fortnightly home, to find an article about self-harm called "Cut it out, please" written under a pseudonym (very brave, I must say) by "a doctor in an inner-city NHS hospital". It billed itself as a reaction to the recently published report by the National Institute for Clinical Excellence (Nice) which advocates better NHS treatment of self-harmers at care points such as A&E. Instead, it was a bigoted attack on self-harmers, who are apparently, in this doctor's opinion, suffering from an "illness" but not entitled to the same treatment as "an elderly lady" at risk of "bleeding to death". This buys into the oldest taboo in the medical book: that which says a mental illness does not carry the same urgency or merit as a physical one. Surely, any patient arriving at an A&E unit with a potentially life-threatening condition deserves to be treated in a standardised way, whether presenting symptoms of mental or physical illness.

Although I wrote a comment piece criticising the Nice report in the Guardian four days prior to the anonymous doctor's ignorant rant in G2, I now see that despite its heavily flawed content, it is a necessary report. There is a problem within the NHS when it comes to self-harm. The anonymous doctor epitomises it. Why are healthcare professionals so poorly trained when it comes to self-harm? What on earth would make a doctor - a doctor, for God's sake! - say: "It is hard not to get frustrated: people who self-harm do have a choice, although it may not seem like it at the time. They could not do it, or they could do it and stay at home to deal with the consequences. Just please don't lacerate yourself, come to hospital and then complain about it."

When I read this I was so angry and upset, I didn't know what to do with myself. Briefly, I wondered if there was even any point in carrying on with this column in the face of such bigotry and ignorance. But that is like saying there is no point in carrying on the fight to end racism.

Reading her article as a former self-harmer, I felt humiliated, judged and belittled. Since when do self-harmers have a "choice"? Self-harm is a morbid symptom of many different mental illnesses. Who has a choice in any illness? Does a patient with a broken leg choose not to be able to walk? Of course not. No one who has been through the hell and misery of self-harm could say that it is a matter of choice. It is a symptom of an illness. Surely they teach doctors that in medical school, don't they? Evidently not.

Then my favourite anonymous doctor went on to say that the way to solve slow treatment times at A&E might be to stop treating self-harmers. Why doesn't she go the whole hog and put a billboard outside the hospital she works at that screams: Self-harmers not welcome! Your illness is not recognised here. Most self-harmers are isolated, ill and desperately in need of understanding, compassion and medical help. But according to this doctor, it's not her problem. Whose is it then? She says it is "society's problem". Excuse me, but isn't the NHS one of society's biggest institutions?

As long as there are doctors out there like her with such deep-rooted prejudices and taboos about mental illness, then the problem in the NHS is bigger than any Nice report is going to solve. It is time the NHS organised proper education about self-harm for its staff. Doctors cannot see self-harm as the sole remit of psychiatrists. It's time it was everybody's problem. Illness is illness and call me old-fashioned, but last time I checked, a doctor's job was to treat illness.

www.nickjohnstone.com

Thanks to guardian.co.uk who have provided this article. View the original here.