Monthly Archives: November 2013

Jonathan Trott’s stress-related illness

Jonathan Trott - England

The news that cricketer Jonathan Trott is returning from England’s tour of Australia, suffering from what’s been described as a “stress-related illness,” reminds us of how depression can unexpectedly descend on the most unlikely people. In recent years, athletes from across the whole spectrum of sports, have seemed particularly prone to depression. Perhaps there is something peculiar about the intense, competitive environments in which they operate. The 32-year-old Trott endured a torrid time during the first test in Brisbane as he was twice dismissed cheaply by Mitchell Johnson. He was also the victim of insults from David Warner, who accused England of being “scared” of fast bowling and Trott of being “weak”.  A few months ago, Ellis Cashmore wrote a blog on depression. Here we repeat that blog.

Is depression really an illness?

It sounds a ridiculous question today. Ten years ago, we would have discussed it. Twenty years ago, we would have been suspicious. And thirty years ago, we wouldn’t have heard of the word depression, at least not in the way we use it today to describe a prolonged feeling of despondency and hopelessness. The way we conceptualize depression is largely a result of medicine.

About 54 million people around the world habitually take Prozac, which is just one of several prescription drugs known collectively as antidepressants. Between 1991 – i.e. four years after the introduction of Prozac – and 2001, depression in the USA more than doubled. It seemed more than a coincidence. Before 1986, people were nervous, glum, moody or felt continually down in the dumps. Depression didn’t begin in the early 1990s, but its official recognition as a sickness that could be clinically diagnosed and treated with medication marked the start its medicalization. This refers to the treatment of something – potentially anything – as a medical problem, even if there is little justification. That little justification is: we can treat it. If we have the ability to address any behaviour pattern or unwelcome emotional state with a medical intervention, it becomes a medical condition. Problem gambling and sex addiction, for example, are accepted as medical conditions. Treating them as such precludes any analysis of the underlying cultural conditions that give rise to complex patterns of behaviour that become, in some senses, unwelcome.

So when I hear the likes of Clarke Carlisle, the ex-pro footballer, chairman of the PFA, and Staffordshire University alumnus – and with whom I align myself in his campaigns against racism in sport – talking about depression in football, I have mixed feelings. On the one hand I appreciate that labelling mental states that interfere with normal functioning as illnesses helps remove the stigma once attached to mood disorders. If you manage the symptoms with therapy and drugs, then it serves to de-stigmatize it. On the other hand, it masks the origins or sources of the condition and painlessly negates its social dimensions. Symptoms are treated; causes are identified as within the individual, not his or her surroundings. Medicalization is a dominant force: today, more people are diagnosed with mental disorders than at any time in history. Are we getting sicker, or less “normal”? Or are we just inventing new kinds of mental disorder? The “bible” of psychiatric disorder is a US manual, The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which is used worldwide as a basis for diagnosis, research and medical education. The 2013 edition contains diagnoses of conditions such as mixed anxiety depression, psychosis risk syndrome and temper dysregulation disorder, as well as the more familiar binge eating. Accepting depression as a sickness means subscribing to what’s called a disease model.

Three particularly influential critiques of the disease model emerged in the 1960s and 1970s. They were those of Thomas S. Szasz (1920- ), R.D.Laing (1927-89) and Thomas J. Scheff (1929- ). In his The Myth of Mental Illness (1974), Szasz critiqued both the concept of mental disorder as a disease, or even illness, and the psychiatric profession that perpetrated it. In a different, though complementary way, Laing (1965) located the causes of behaviours that are seen as symptoms of mental disorders in the family, where he saw destructive conflicts disguised as “love” and “care.”

Scheff’s Being Mentally Ill (1966) proposed that mental disorders are the product of social responses to certain kinds of deviant behaviour. Being normal means conforming to an expected standard. Normalcy is a convention: a customary set of protocols and guidelines as to how we should think and act. Deviations are labelled and those who get stuck with a label find themselves unable to shrug them.

In all these and many related arguments, the complexities and diversity of character and content of what is popularly recognized as mental illness meant that it could not be reduced to the status of a disease or straightforward illness. Mental disorder is experienced in the mind, but the implied arena is larger: private conditions are indexed to social processes.

The terms that come under the rubric of mental disorder are, from this perspective, convenient labels. Once someone gets labelled as suffering from a mental disorder and in need of treatment, whether pharmaceutical or psychiatric (or both) the stigma sticks. This makes it difficult for them to be anything but someone who suffers or who has once suffered from a mental disorder and, in this sense, isn’t totally no

While it may serve the purposes of sport to liken, equate or make mental disorders synonymous with physical illness, we should guard against seeing this as the only way to understand mental disorders. According to many scholars, disordered people are often coping with exceptional social predicaments and their symptoms are more reflections of what goes on outside them than inside them.

Depression and associated mental disorders, even those of the most serious nature, have diverse origins and divergent paths of development. Mental disorders should always be understood in context and conceptualizing them as diseases does not necessarily advance this understanding. Even if it does embolden footballers and other athletes to talk about their problems in public.

More questions than answers …


Q: What did you make of Rebecca Adlington’s breakdown on I’m a Celebrity … Get Me Out of Here!?

A: Many of us suspected that Rebecca Adlington was a pretty self-confident young woman who boasts an impressive record of achievements. She won two gold medals at the 2008 Olympic Games in the 400m and 800m, breaking a world record in the 800m final. At 24, she’s accomplished more than most athletes and retired, if not quite at the top of her game, not far past it. Her media-friendly persona is sure to guarantee her work for the foreseeable future and her latest gig on the itv show seems to be a good launchpad. So I’d imagined she was someone who was comfortable in her own body. She’s not there to be admired for how she looks, but how she performs.

Q: So why did she take a pop at her tv rival, model Amy Willerton, and ask, “why not just be a normal girl?”

A: Obviously, she’s been putting on a brave face for years. Social media hasn’t been kind to her: there have been sarcastic – sometimes callous – campaigns ridiculing her over her looks. You can hardly imagine similar campaigns about, say, boxer Carl Froch, or England footballer Steven Gerrard or cricketer Graeme Swann. None of these have Adonis-like looks. They are, to use, Adlington’s term, “normal.”

Rebecca Adlington

Q: So you could say Adlington has done a disservice to those women who have been arguing for years that we place too much emphasis on physical beauty.

A: And they’d also argue that it’s a particular conception of physical beauty as defined by men.

Q: Has she set back the feminist cause?

A: It’s difficult to be critical when Becky is so obviously upset, but I guess she has disappointed many women. When a woman known for her outstanding achievements dissolves into tears and complains about another woman whose good looks are admired by men, it reminds us just how much importance we attach to superficial appearances. Even a high-achiever who we had all imagined could shrug off her mean-spirited critics as a bunch of jealous no-hopers, has succumbed to what the writer Naomi Wolf once called The Beauty Myth.

Q: Dispiriting then, eh?

A: Indeed. But instructive too. We’ve learned how skin-deep beauty is actually not skin-deep: it reaches right into our psyche, as some might put it. It affects practically everything about us. The body, remember, isn’t just a physical thing, a collection of about 60 billion cells, organized into substances like muscle and tissue, flesh and bone. It is natural and artificial, physical and cultural. We restrain and care for our bodies in order to feel good about our appearance; we work-out and diet in order to improve not just the way we feel, but the way we look.  In other words, we want to believe we look attractive to others.  The often-unstated purpose of cultural imperatives to become fit, healthy and toned is sexual.  An athletic body is a sexy one; a dissipated one is definitely not. We’ve now entered a cultural stage where we have idealized forms of the human body, male and female, to which we are supposed to aspire.  Television commercials, magazines, movies, videos and many other media heave with images of supermodels and hunks, who, three decades ago, would have been regarded as freaks of nature and muscle-bound monstrosities, respectively.  Now many people want to mimic them. Even people like Becky, who most of us admire for doing great things, can be seriously distressed by reflecting on what she believes are her inadequacies. It is, as you say, dispiriting. And by the way: this is an example of the way reality tv shows like I’m a Celebrity … can stimulate great debates about relevant subjects. @elliscashmore


More questions than answers …


Q: The World Anti-Doping Agency (WADA) has provisionally suspended the Moscow Antidoping Center, saying its operations must improve or a six-month ban on the facility’s accreditation will be imposed. They’re also recommending longer bans on athletes who fall foul of drug-testers. What’s all that about?

A: WADA is a kind of service provider for sport’s governing organizations around the world and it regularly checks that its accredited labs are working adequately. If labs are deemed what they call “non-compliant” with WADA’s standards they can have their accreditation revoked.  WADA obviously isn’t satisfied that the Russians are as rigorous as they should be when it comes to dope testing.

Q: Weren’t the Jamaicans recently singled out by WADA too?

A: Yes, WADA officials visited Jamaica after several high profile athletes, including former world 100 metres record holder Asafa Powell returned positive drug samples. Dr Paul Wright, Jamaica’s most senior drug tester said somewhat ominously that the country’s recent rash of failed tests might be the “tip of an iceberg”.

Q: Anywhere else?

A: Kenya. WADA said it “very frustrated” by the apparent lack of progress in Kenya. 12 months ago, the Kenya’s government and Olympic federation were considering a task force to investigate allegations of a doping culture in their set-up, but there’s little sign of progress.

Q: Could these countries be suspended from Olympic and other international competitions?

A: Theoretically, yes. But Jamaica dominates the sprint events and Kenya middle-distance running. Russia is strong across the whole spectrum of track and field events. So any athletics meeting would miss them: imagine staging an event without Usain Bolt, David Rudisha or Yelena Isinbayeva.

Q: But if drug-testers really mean business and they kicked those countries out, what would happen?

A: For a start, the television companies would point out that the events would be devalued in their eyes. They wouldn’t attract so many viewers and advertisers would turn away. Then, of course, the big sponsors, like Coca-Cola, McDonalds and Cisco, would complain that their international exposure would be lessened if tv companies lost interest.

Q: But surely the commercial sponsors are at least partly behind the antidrugs policies. After all, they want their products or brands associated with a pursuit that’s all about purity, wholesomeness and goodness. No sport in the world would risk putting them off by going soft on doping.

A: Sponsors rarely say much about this, but it makes sense to believe that many sports governing organizations go to great pains to keep their sponsors sweet. Together with media money, the sponsors’ millions make up the lion’s share of sport’s revenue.

Q: Let me get this straight: are you saying that sponsors are behind antidrugs policies because they wouldn’t want their brands connected with “drugs,” however indirectly?

A: Obviously, you couldn’t prove that, but it makes sense. And you’re beginning to see the paradox: if sport got even more draconian and suspended whole nations, like Russia or Jamaica, from international competition, the corporate sponsors would probably pull their money out anyway.

Q: It is indeed a paradox in the sense that it leads to a conclusion that’s illogical and senseless. So what will sport do?

A: Basically, try to maintain a vigilant watch on sport, but without taking out the big names that bring in the money from the media and sponsors. It’s quite a balancing act.

Q: Does anybody really care if sprinters, cyclists, swimmers, baseball players or whatever are using dope? I mean, we know nothing about whether they are using hypnotists or sleeping in oxygenated tents, or training at high altitude and so on. So if we didn’t know, would it matter?

A: Good question.



They must be worth it



Selecting a celebrity to advertise a product is a science, like astrology or alchemy; in other words, a nebulous, imprecise and uncertain one. The metrics are equivocal. Media visibility (exposure in print, television, radio and online) is a key factor. Hence film and television actors, tv personalities, models, sportsmen and woman, authors, musicians, comics and, of course, reality television figures are obvious candidates. Their visibility is measurable in terms of appearances and namechecks. Beyond that, the science becomes, at best, art, and, at worst guesswork. Celebrities like Beyoncé, Taylor Swift, or David Beckham offer continuity and consistency in the way they go about their business efficiently and reliably: the chances of a scandal erupting around them are slim and they are known to a wide spectrum of people. Not that a hint of indecorum is a bad thing. Sales of Katie Holmes’ high-end ready-to-wear fashion line, Holmes & Yang, increased in the wake of her unsavory divorce from Tom Cruise. “Unsurprisingly, the label has benefited from Holmes’s increased visibility,” confirmed Charlotte Cowles, of New York magazine (July 30, 2012).

Jennifer Lopez, a prodigious endorser of, among others, Kohl’s clothing and lifestyle collection, was caught up in an eighteen month on-off relationship with Ben Affleck in 2003 and 2004. The Latina singer-actor was one-half of “Bennifer” as the couple was known. The tumultuous relationship coincided with a career slump defined by boxoffice flops (Gigli, Jersey Girl) and disappointing cd sales (Brave, Como Ama una Mujer). Becoming a judge on American Idol smacked of desperation, yet it turned out to be a career saviour and, by 2012, at the age of 42, she was, according to Forbes, the most sought after celebrity by advertisers. Idol regularly pulled 26 million viewers to their televisions (i.e. a 9.8 per cent of the total potential audience), most of them in the 18-49-year-old segment advertisers love. JLo used the series as a showcase to premiere music videos and perform singles. “On the floor” went multi-platinum, and the music video amassed over 530 million YouTube views. Mariah Carey must have been enthused by the prospect of emulating JLo when she accepted the offer of becoming a judge on Idol, though the $18 million (£11.6m) one-off fee was a further incentive. Mariah’s advertising file included T-Mobile, Mariah’s …  fragrances and Jenny Craig, for whom she directed a diet plan commercial.

JLo and Mariah are among an elite of celebrities whose name or image adds value to a brand and, in turn, make products move off shelves. And you imagine L’Oreal considered Adele (above) in the same league when the company offered her £12 million to appear in its advertising a couple of weeks ago. The big surprise was: she turned it down. This is an exceptional occurrence nowadays. A huge endorsement contract is almost a membership card to the A-list, and Adele would have become one of the highest paid advertisers in L’Oreal’s stable, which includes the likes of Cheryl Cole, Eva Longoria and, of course, Beyoncé. Of all the endorsers used by L’Oreal, Beyoncé is perhaps most closely associated with the brand and its signature tagline “ … because I’m worth it” (a slogan dreamt up by Ilon Specht, of McCann Erickson, in 1973 and which is now recognized by 70 per cent of consumers.

But seriously: does anyone else in the world believe Kim Kardashian or any of the other celebrities are sincere when they advocate, recommend or vouch for a cellphone? Sharon Osbourne is hardly likely to shop at Asda, particularly after that same supermarket chain paid her millions to appear in its ads in 2005. Is anyone in the world unable to spell out the motive behind celebrities’ behavior (clue: five letters beginning with “m”)? Adele earned over £11m last year, so maybe she doesn’t need the extra cash.  Is anyone so absolutely, completely and utterly gullible that they are prepared to accept the word of a well-paid mercenary when they part with their hard-earned cash? We’d probably like to say the answer to all these is an emphatic no! On inspection, though, we probably conclude that it’s no-ish. I’ll explain what I mean in a later blog. @elliscashmore

Corrie and the right-to-die, part two

An Audience with The Croppers


When I wrote on Coronation Street a couple of weeks ago, Roy Cropper was traumatically conflicted: his wife Hayley, who has been diagnosed with terminal cancer, had expressed her wish to determine the circumstances of her own death and asked her husband to support her. Roy (played by David Neilson, above) treasured every remaining second he had left with his wife and couldn’t find it within himself to condone her decision. Their long and engrossing discussion ended with neither partner fully understanding the other’s perspective. It was an absorbing plot development that, in typical Corrie style, engaged the viewer in a wider contemplation on euthanasia and the moral right of an individual to take control of his or her own life. The damaging effects on their loved ones was reflected in Roy’s anguished response. Now the narrative has moved on and the soap’s scriptwriters have once more excelled in deepening the conundrum. Roy has accepted a new challenge by agreeing to support Hayley’s decision.

His change of heart has been occasioned by the death of Hayley’s friend and fellow cancer patient Jane. Much to Hayley’s annoyance, the ever-protective Roy had inadvertently shielded her from the death, but the couple attend the funeral. Here Roy talks to Jane’s two sons, one of whom is satisfied his mother died peacefully, her pain relieved by morphine. Her younger son disagrees and says his mother’s mind was so addled, she didn’t know who was at her bedside. Hayley’s fear is that, should she opt for palliative care, she too will become confused and lose cognitive powers to the point where she will deliriously return to her former self, “Harold.” Hayley (played by Julie Hesmondalgh), as viewers will know, is a transsexual.

Both Roy and Hayley have assumed Jane and her husband found comfort in their faith, but, again Roy is given pause for thought when he discovers Jane’s husband Jeff is, in fact, not a believer. Jeff merely pretended to be religious for the sake of his wife. He finds no contradiction in this; if it made his wife feel comfortable in his final days, it was justified. Shortly after the funeral Roy announces he has changed his mind and will support Hayley in her wishes. Later, it transpires, he hasn’t actually changed his mind, but he intends to support Hayley nevertheless. He confides to Anna, who works for him in the café, that he truthfully can’t understand Hayley’s wish to take her own life, but has lied to her only to give her succour for her remaining months. So he plunges himself into a new dilemma: is he right not just in lying to his wife but in betraying one his most deeply-held principles – the sanctity of human life? If Hayley doesn’t change her mind, Roy is implicated in a pretence that will surely overpower him over the coming months.

Coronation Street excels in dramatizing what might otherwise remain abstract moral conundrums and giving them a form we can all find both stimulating, yet accessible. Roy will doubtless struggle with a decision that he regards as brave; yet is it? Perhaps there would be more courage in maintaining his genuine stance and seeking to dissuade his wife from taking her own life? His torment will reflect that of countless others. Cancer, like other terminal diseases, takes more than one victim. Those who love, cherish and care for the sufferer themselves suffer in multiple ways. The celebrated itv drama has included many, many arresting storylines in its five decades history; this one is arguably the most poignant and provocative of all.


The dignity of simple faith

Philomena offers a finely-judged debate on belief and forgiveness

“Do you believe in God?” Philomena asks Martin Sixsmith in the new movie Philomena. “I always thought that was a difficult question to give a simple answer to,” answers Sixsmith, “do you?” Philomena answers without pause: “Yes.” Stephen Frears’ film is based on Sixsmith’s book The Lost Child of Philomena Lee (2009), which is his account of his attempt to track down Phiolmena’s son, who was taken from her when she was 22, and the child six. She kept it a close secret until the fiftieth anniversary of her son’s birth and then told her daughter, who managed to interest former BBC journalist Sixsmith in writing a story.

The film tells of Philomena and Sixsmith’s odyssey, which is sometimes mournful, sometimes funny, occasionally heart breaking but consistently thoughtful.  Much of its power derives from a debate between the two central characters about the existence of God.  Philomena is an unquestioning Roman Catholic, whose unshakable faith is both a source of personal strength and the cause of her torment. Sixsmith describes himself as a sceptic and, as the film progresses, becomes evermore forceful in his reminders that evidence of a merciful God is hard to find. It’s a kind of running discussion that might have forced the two apart, but in the event it actually draws them closer together.

Philomena Lee was born in Limerick in 1933. Her mother died when she was aged six and she was brought up by nuns until she was eighteen. The nuns, the Sisters of Mercy, shielded her (and we presume other girls) from the facts of life and, within months of leaving the convent, Philomena had a brief sexual encounter and became pregnant. Disgraced, she was entered into another convent in Roscrea, Tipperary and made to do penance by working in a laundry. For three and half years, she was allowed to see her son for an hour a day. Then, without notice the child was sold for adoption. Philomena, then 22, signed a document not just giving up all claims to her son but undertaking never to attempt to see him again at any future time. After her meeting with Sixsmith, she began a search that took them both to Roscrea, then to Washington DC and back to Roscrea.

In the film, Sixsmith, played by Steve Coogan (who also co-wrote the script) initially regards Philomena as a misguided believer; he explains his cynicism by reference to his trade. Journalists are taught not accept something as true just because someone says it is, he tells Philomena, as if to point out that having faith is exactly the opposite. Religious believers never ask for evidence, corroboration or inferential proof: they just accept truth as it is revealed to them by their faith. Sixsmith’s journalistic training inclines him to see religion more as a consolation for grief and anxiety rather than an aid to understanding. Irritated by Philomena’s convictions, he points out that, if God is behind all natural disasters, he claims more victims than terrorists. When she tells him she wants to visit a Catholic church for confession, he despairs. The Church separated her from her child and, in his eyes, bears responsibility for all her sorrow. So she has no need to feel guilt. Once a Catholic himself, he rarely misses a chance of mocking the concept of guilt as decreed by Catholicism. Toward the end of the film, when Philomena and Sixsmith confront Sister Hildegard, the nun who chastised the young Philomena and who they believe was responsible for the boy’s adoption, they find her unyielding and unrepentant. Now in a wheelchair, she tells how she has remained true to her vow of chastity. Sixsmith’s fury gets the better of him and he shouts: ““I think if Jesus visited now, he’d tip you out of that fucking wheelchair!”

Philomena takes some comfort in her ability to forgive Sister Hildegard and the other nuns who were complicit in the sale of her son. Sixsmith announces that he can’t and won’t forgive them. It’s a beautifully judged scene, full of nuance and ambivalence. You’re left wondering whether Philomena is just a kind-hearted, but simple-minded woman, or a mother whose unbreakable faith has somehow elevated her to a level from where she can dispense moral absolution and feel no malice. Her faith is intact.

Dame Judi Dench, who plays Philomena has said: “I can’t imagine myself being in that position and being able to forgive, … “I don’t have the scope of humanity that Philomena has.” Coogan acknowledges that his script criticises the Roman Catholic Church as an institution; but it dignifies people with what he calls simple faith. “It’s not a polemic, because an attack would have been too simplistic, and very easy to do. Of all the things that happened in the Church, people who have simple faith are often forgotten, and we wanted to dignify those people.” @elliscashmore