‘What’s the Matter With Tony Slattery?’

(A reflection on the BBC 2 Horizon documentary ‘What’s the Matter With Tony Slattery?’ aired on May 21^st 2020. Available on BBC iPlayer.)

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I usually avoid programmes on what we are encouraged to call ‘mental health’ for the sake of my own ‘mental health’ since they are typically so strongly rooted in the biomedical narrative. But I was hoping this one might be an exception.

Tony Slattery, as my generation will remember, was one of the brightest stars in the Stephen Fry/Emma Thompson/Hugh Laurie Cambridge firmament of the 1990s, with his charm, quick wit and exuberance. But he had disappeared from the scene until an interview with Guardian journalist Hadley Freeman in 2019. He was known to have alcohol problems and multiple hospital admissions for ‘bipolar disorder’, but under Freeman’s sensitive questioning about ‘Where do you think your rage came from?’ another side of his story emerged for the first time.

The interview led to ‘a national outpouring of love’ for Tony’s struggle with ‘this terrible thing (that) still weighs and presses down’. It also led, a year later, to the May 21^st Horizon documentary featuring Tony and his very supportive life partner Mark Michael Hutchinson, which was billed as ‘exploring the link between mental health and childhood abuse’.

So far, so promising. The strong causal link between trauma and subsequent ‘mental illness’ is a much under-explored subject in the media, and this brave man, who up to this point had discussed these agonising events only with his partner, is to be much admired for being prepared to share them with the world. Viewers were unanimous in their warmth and respect for Tony, and in sending heartfelt wishes for his recovery. But for those of us who are less convinced by the biomedical approach, the programme itself was, overall, a severe disappointment. Perhaps its only merit was that it clearly showed up the ‘we are all biopsychosocial now’ narrative for the falsehood it is. Tony had apparently – and fairly typically – spent a whole psychiatric career being labelled and drugged rather than offered the chance to look at his past. Until the very last moments of the programme, we saw him being offered exactly the same again, except this time it was further sanctioned by ‘leading experts’ in the field.

Let’s go through some of the highlights – or lowlights – of the programme. It got off to a bad start with the voiceover repeating the standard ‘one in four of us suffers from a mental illness’ statement – a statistic not based on any evidence and begging all the questions about what a ‘mental illness’ is. We were then told that Tony had never been given a definitive diagnosis. Once this was established (‘never easy’ said the voiceover, setting us up for an exciting adventure into the realms of science), then ‘modern psychiatry’ might be able to ‘provide Tony with some answers.’  While this must have sounded reasonable to the average viewer, others will be aware that that ‘Almost everyone agrees that the old system is no longer fit for purpose’; that even the people who draw up the diagnostic manuals have warned ‘There is no reason to believe that DSM-5 is safe or scientifically sound’; and that, in the words of the New Scientist, we are effectively poised to ‘tear up 60 years of psychiatry and start again.’  ‘Never easy’ hardly covers it. ‘Neither scientific nor meaningful’ would be nearer the truth.

However, the medical narrative continued unchallenged. Tony has been taking ‘antidepressants’ for 15 years. In his words ‘I use them to keep the bleakness at bay’, but there is a part of him that ‘wants to feel what life is like without them’. But before we could explore the ‘bleakness’, Tony’s trusted GP offered him the long-disproved diabetic analogy: ‘They can’t do without their insulin and in the same way you can’t do without your antidepressant medication.’

Next, we met ‘the world’s leading authority on bipolar disorder’, Professor Guy Goodwin, whose role it was to discern the ‘correct’ diagnosis of the condition that might be ‘lurking there’, in his words, as suggested by three previous psychiatrists. It must be somewhat strange to be the world expert in a ‘disorder’ that is not based on any identifiable bodily dysfunction and whose boundaries are not defined by any known genetic or other biologically-based pattern. Although people clearly do experience severe mood swings, the best current research tells us, as the professor must know, that there is no such ‘disorder’ as ‘bipolar.’ However, Professor Goodwin did not reveal these embarrassing holes in the evidence to Tony and nor, presumably, did any of the other professionals he saw over the years.

The medicalising continued. Tony has already learned to use objectifying language about his experiences – ‘bipolarity, co-morbidity, rapid cycling’ and so on. Professor Goodwin encouraged further translation of his feelings into pseudo-medicalese: Tony’s happy time at university was re-defined as ‘You were mainly pretty hypothymic, as we would say.’ And then there were his more difficult emotions: ‘I’ve woken up angry for a long time.’  Carefully avoiding any enquiry about possible reasons for this, Professor Goodwin introduced Tony to the latest ‘bipolar’ diagnostic accessory – a digital mood diary to be completed twice a day.

Tony’s next visit was to a specialist in alcohol abuse. Tony admits to drinking massive amounts to get through the day. He knows he needs to stop. From what I could see, and given the narrow brief, this interview seemed quite useful; Tony was treated with warmth and encouraged to believe that he could, in small steps, start to reduce his reliance on alcohol. However, this goal was rapidly turned into an end in its own right. Tony was clear that he uses alcohol for the same reasons that he uses ‘antidepressants’; without its ‘blunting effects…. you see the bleakness of life for what it really is.’

Someone who is managing overwhelming emotional pain in this way is unlikely to be able to give it up unless they have other ways of coping and/or have resolved some of the underlying issues. Moreover, this was a clear case of ‘Don’t take your drugs, take our drugs’; no one was supporting his desire to come off the ‘antidepressants.’ But Professor Goodwin was having none of it. Bluntly, he told Tony that the ‘it helps to numb things’ argument was just ‘a get-out clause’ and that it was the alcohol itself preventing any progress. The professor’s version of the expert advice seemed to boil down to ‘You have a drink problem!  So stop drinking!’ Tony, aptly described by Hadley Freeman as ‘open and vulnerable as a freshly peeled orange‘, looked stricken.

With 15 minutes of the programme to go, Tony was introduced to Dr Ciaran Mulholland, a psychiatrist from Belfast who specialises in trauma therapy. This provided the most moving and most pertinent moments of the documentary. The origins of Tony’s rage and pain were clear to see as he spat out the words ‘It wasn’t pleasant being fucked up the arse at the age of eight’. Dr Mulholland was gentle and perceptive as he reassured Tony and suggested that while there were no simple causes, the abuse might have ‘more importance than anything else.’ He encouraged Tony to consider trauma therapy.

But this interlude in the biomedical narrative didn’t last long. Back home, Tony was feeling very low – perhaps as a result of his disclosure – and was struggling to fill in the digital diary. Reminded of his duties by Professor Goodwin, he crumpled and said ‘That makes me feel guilty.’ The documentary ended with a bracing return to diagnosis talk. Tony was deemed to sit ‘on the bipolar spectrum’ without qualifying for ‘bipolar one’, although the treatment implications seemed to have stalled at the ‘take your antidepressants and stop drinking’ stage.

We left Tony and his partner looking slightly more optimistic. Tony has been offered work again and is drinking less. We were not told whether he has been offered trauma therapy. Everyone who watched the programme will be hoping Tony finds the resolution he needs.

Reflection

For me, this documentary raised so many issues beyond Tony’s individual story.  Like everyone, I was deeply touched by his honesty and I sincerely hope he is now getting the trauma-informed support he has needed since he was a desperate, terrified 8-year-old boy more than half a century ago. But it also raises wider concerns.

Tony was abused by a priest, and he turned to a modern-day priesthood for a solution. Both organisations can be equally unquestioning and unquestionable in their creeds, and the potential for re-traumatisation was all too obvious as Tony sought validation and safety, and risked further shaming and silencing. Was he helped, overall, or harmed? As so often in the mental health system, it was hard to work out the balance. However, a number of viewers have reported switching off because of their discomfort not with Tony’s disclosures, but with some of the interventions. Many mental health professionals and service users will recognise the subtle but ruthless exclusion of Tony’s history from the picture, whether by routine failure to explore the bleakness and anger he reported, or more directively, by insisting that he translate it into digital form so that it could be re-defined as a disorder. And yet it had taken a simple, gentle query from a journalist, not a mental health professional – ‘Where do you think your rage came from?’ – to reveal his story. The irony is obvious.

It was a pity that all the professionals we saw were psychiatrists (perhaps because the consultant to the programme was also a psychiatrist.) It meant that we saw both the best and (in my view) worst of this profession, although there are recent media examples of psychologists taking an equally diagnostic approach to the effects of trauma. But this is about far more than a particular profession or particular individuals within it. It is about the continuing uncritical promotion of an unevidenced biomedical approach to distress which, while found useful by some, can also cause immense damage – both through the effects of its ‘treatments’ and through the imposition of a devalued identity and the obscuring of personal stories behind psychiatric labels.

Media examples of alternative perspectives are extremely rare and will remain so as long as those committed to the dominant narrative are accepted as the experts in possession of the scientific truth. While we were given a brief glimpse of a trauma-informed approach, this too was framed through the nonsensical construct of ‘bipolarity’ – as if being serially raped as a child isn’t enough to justify distress unless we posit a deficit in the victim as well. Service users and the general public have the right to more accurate information and wider choices.

I guess I should have known this documentary would fail, in the words of the popular survivor slogan, to achieve the shift from ‘What is wrong with you?’ to ‘What has happened to you?’ because the title ‘What is the matter with Tony Slattery?’ was actually a version of the former question. In the end, we didn’t learn ‘what was the matter’ even within the terms of the programme – his diagnosis remained unclear, although the fact that he was ‘mentally ill’ was never questioned.  But surely, and without in any way denying his terrible suffering, there was and is nothing ‘wrong’ with Tony himself.  From a trauma-informed or even a commonsense perspective, his rage, guilt, hopelessness and desperation, his overwhelming feelings and his desperate attempts to escape them, are all perfectly understandable. We would do better to ask what is the matter with powerful people who abuse, with institutions that sanction it, and with a world that doesn’t want to know about it, and delegates the job of concealing these atrocities to the mental health system, justified by fake science.

Horizon, please do better next time.

References

1. https://www.theguardian.com/lifeandstyle/2019/apr/29/tony-slattery-had-very-happy-time-went-slightly-barmy
2. https://www.theguardian.com/culture/2020/may/11/tony-slattery-this-terrible-thing-still-weighs-on-me-why-after-all-this-time
3. https://www.newscientist.com/article/mg22229681-400-rebirth-of-psychiatry-will-be-slow-and-painful/
4. Frances, A (2014) One Manual Shouldn’t Dictate Mental Health Research.