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"It's OK to not be OK." A phrase I've seen a lot lately: on well-meaning leaflets and posters, in think pieces and, inevitably, as a hashtag (the fact that it's the title of an acclaimed Korean drama has probably made it especially salient right now).
Is it, though? OK, I mean. The only good answer to this is that it might be. It depends very much on your definition. When it comes to mental illness, people presumably mean that it is OK to talk to others about your problems, that you should neither be shamed nor punished for doing so, and with this I fully agree.
But talking about mental illness isn't a cure, and more than conversation may be needed. There are many well-meaning campaigns that encourage disclosure of illness; the problem is that they're not always followed up by the resources necessary to actually help people. And, to be honest, not everyone is kind. Some people will talk about their problems and be met by embarrassment, hostility and even indifference.
From the perspective of mental illness, what does it actually mean, to not be OK? On social media there is a broad acceptance of some types of mental illness, and often a great deal of sympathy. But much, although not all, of this is directed at those who can ask for help, those who may indeed be very ill but can and do get better. I should know, being one of them - my health may not be perfect between episodes of illness, but there is no doubt that I can function at a high level. I have talked and written about my illness to raise awareness, and also to inspire hope. When I was first unwell, I thought I might not get better. But now I know that I probably will, even though the risk of recurrence will always be a cloud in my life.
I want to give people hope, but realistically I cannot give them reassurance. There is no guarantee that their illness will follow the same path as mine, so all I can do is put my story out there and listen to others. As a psychiatrist I can give facts and figures; as a person, I can only tell stories and show what might be possible.
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There are people who won't recover from their mental illness, or will do so only partially. They are the tragedy of psychiatry and the ones who people cross the road to avoid. Not because they are dangerous but because they are different - inappropriate, loud, oddly dressed, talking to things we can't see. Schizophrenia and its variants are illnesses characterised by psychosis, which can mean loss of touch with reality, hallucinations and delusional beliefs. It can be treated with antipsychotic medication, and some people will get better. But some won't respond or will continue to relapse, and they may develop other symptoms like apathy and lack of motivation. What it must be to live in such a world, where no one can understand your experiences, or even believe you?
© Photograph: Johner Images/Alamy'Many of us experience mental ill-health, but some more than others.'
There are others. I see those addicted to drugs and alcohol, and many don't get better despite talking about their problems and even reaching out and getting help. One day last week at work, we were talking of all the many we have known who are now dead. I know we have helped others, but it is still heart-breaking. It wasn't OK for many of them and they are often received with disgust when they ask for help, particularly if they are still drinking at the time. Yet that's the whole point. Some people cannot ask for help and understanding, and are dependent on the kindness of others.
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It is OK not to be OK if you ask for help in the right way - and sometimes if you are the right person. It is less OK if you make others feel uneasy. What can be even worse is when people can't actually help you, and this also applies to professionals. It's very difficult for doctors, nurses and others if they feel they cannot do anything. Sometimes it can be easier to blame the patient as this absolves them, and it happens, particularly when people behave in difficult ways or harm themselves.
I think that I will answer the question with this: it's OK not to be OK, but this still isn't OK. In other words, it should be OK to admit to difficulties, but that doesn't actually negate or solve them. Talking to people can be very therapeutic, it's true, but it doesn't cure serious mental illness. Sometimes I think that all the energy encouraging people to talk might be better channelled into improving the help and services that people need to get better, or to live with their illness. What's the point of talking to someone, only to find that you will have to wait a year for treatment and therapy?
It is never OK for people or their families to experience serious mental illness and they should not be stigmatised by this. But I think there is still a great deal of variation as to which illnesses are deemed acceptable, and that we have to recognise our reactions to the full range of problems. There seems to be an inbuilt fear in humans of that which is other or different; this is well recognised in many spheres, including psychiatry. I'm not sure that we can eliminate this - it may well have been protective in times gone by - but we do need to recognise it, and to look within ourselves. Stigma feeds on denial and ignorance, and the hiding away of that which is less acceptable.
Many of us experience mental ill-health, but some more than others. These people need well-resourced recognition and support, rather than platitudes. I think they already know they're not OK.
Rebecca Lawrence is a consultant psychiatrist
In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978