Mental health in public life: Is the experience of politicians and how we make policy intertwined?

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Many societies are experiencing significant increases in those reporting mental health difficulties and illnesses, but face systemic obstacles in helping their communities’ to deal with these problems. The WHO report on Mental health: New Understandings, New Hope identified mental health as possibly posing the most difficult and acute health care challenge of twenty-first century. The report goes on to outline two major obstacles in delivering effective prevention and treatment: (1) a prevalent and negative social stigma around mental health in many countries (and New Zealand is no exception to this), and (2) under-funding and under-ambition in relation to mental health policies. It has been argued by some (e.g. Finder, Weinberg and Geddes, 2016) that these two obstacles may be inter-related because of the existence of a dominant and systemic political culture that makes it very difficult for politicians to openly discuss mental health issues in a manner that can then influence the policy response in a way that help to close the clear gulf between supply and demand for services that currently exists.  Could it be that this crisis is mental health care, or the apparent failure of democratic politics to mount an effective policy response is actually related to a far deeper and entrenched element of how we actually ‘do’ politics? If this is the case, then we also need to consider:

  • What are the key psychological stressors and strains that modern politicians experience that may impact on their mental health? 
  • How does our dominant political institutional framework and culture facilitate the channeling or  expression of this stress? 
  • How might this combination of psychological stressors and politicians, operating within the currently dominant political institutional framework and culture influence the policy-making process? 

Recently, an 18-month project exploring the politics of mental health through a focus on the mental health of politicians in four countries (New Zealand, the UK, Canada and Australia) has revealed how the nature of modern politics - where the dominant mode is competitive representative politics with an increasingly aggressive 24/7 media environment, augmented by a social media backdrop with covert actors seeking to influence agendas - ensures not only that the psychological stressors and strains on politicians are intense, but that the stigma associated with such mental health concerns prevent politicians from acknowledging the existence of these stressors and asking for support. Occupational psychology research suggests that working within aggressive, low-trust, high-blame, secretive and highly partisan political cultures is unlikely to be good for anyone’s mental health. 

Politics is difficult and stressful. Like many other professions, it takes place in the public spotlight. It also requires the reconciliation of incompatible demands and goals that must be fulfilled in the full knowledge that a range of audit and account-demanding authorities will be looking to review performance. But unlike say teachers, doctors or police officers for example, politicians are exceptional in that there is no agreed  ‘job description’ or ‘person specification’ for a politician in any of the countries studied. Partly, this is due to the complexity of the role. There might be some kind of manifesto from the previous election that indicates the role and targets of members of the Government, and to some extent, backbenchers in the governing party in the Parliament, but that definition is pretty loose, at best. So, this is a potential source of stress for politicians. 

Another source of stress is the difference between winning an election and wielding political power. Winning an election is very different to the challenges of compromise and deal-making when it comes to governing. At the level of political culture, three particular stressors have been identified.

Expectations

 The is the idea that politicians must inflate the public’s expectation about what they will achieve if elected to office and this creates subsequent pressure to deliver on these commitments. Actually, the reality is that limited resources and / or capacity to deliver - with often far less ability to exert meaningful change than the public assumes. Politicians have less ability than imagined to push through meaningful reform, due to the fragmentation of the modern state and the diffusion of responsibility across a vast range of agencies, boards, commissions and other statutory bodies. This extent of this expectations-capacity gap and the psychological pressure that it exerts on politicians is completely unknown. It should also be noted that these pressures are also coupled with often little professional support or induction, and politicians having to learn by osmosis. 

Distrust

 The public appear to like democracy while disliking politicians - which tends to create a low-trust environment, augmented by 24/7 demands of modern media (both official and social media), with a focus of sensationalism and negativity. The dominant form of the modern media is to focus on micro-analyses and rolling sound-bite news, and we transition from print, to online blogs, and now to Tweets. The issue then becomes that the complexity of public problems usually gets lost in dramatic micro-facts and disconnected commentaries resulting in the public’s impression that there are in fact simple solutions to complex problems in modern society, and that politicians are ‘failing’ to implement these. This isn’t an argument again ‘keeping politicians on their toes’, but it does relate to some need for proportionality and balance. In some sense, an individual can only endure so much pressure before they begin to reconsider their profession against its personal cost, or perhaps cost to their family. There are well-documented negative impacts of being subject to too many accountability demands - where  people spend so much time trying to engage with and pacify potential critics that they can’t actually focus on the core tasks which need to be done, which then in turn leads them to be seen as ‘failing’. The key insight in political memoirs and autobiographies is that for most politicians, political life is a professional life spent under attack, and this can lead to hight levels of substance abuse, depression, and relationship difficulties. Harassment of MPs is now a commonly reported experience and is likely to be associated with fear and vulnerability, and changes to lifestyle such as increased security precautions and reduced ability to socialise. The toxic environment for politicians has also been intensified by anonymous social media accounts, including threats of rape and murder. 

Fear of appearing hypocritical

 The very essence of democratic politics make it very hard for politicians to simply ‘stand up and tell the truth’. A realistic approach is to perhaps accept as Turner and Hogan say that democratic politic is a ‘worldly art (2006), in which inconsistencies will have to be tolerated, transparency has its ultimate limits, deals have to me made, and confidences are kept. The reality is that truth-telling is a complex concept due to the existence of multiple and often incompatible loyalties, and having to make decisions on imperfect or incomplete information, and having to compromise to move towards an intended goal. The modern world is a messy place, where politics ‘as theory’ runs into politics ‘as practice’, meaning that there is a likely to be a pressing need to compromise on some high principles in order to produce some degree of positive change. So, the psychology of politicians somehow has to manage this gap between public ideals and political reality. One may try to manage this is two possible ways. The first is a strategy of radical candour: this means that politicians seek to strive a new bargain with the public leading to an acceptance that politicians sometimes have to do things they would rather not do. However, the current political culture means that this is a difficult conversation to have, meaning that more often, a second route is taken; one of management. The result is that spontaneity and straight-talking becomes impossible, and it is only through psychologically distancing oneself through the creation of an alternative persona that this gap, this stressor, can be managed. So, one can see where what Canadian Politician Michael Ignatieff calls ‘self-dramatisation’ comes to be at the core of modern politics. A politician invents themselves a persona for public consumption - yet can still be debilitated by the pressures of high public expectations, limited capacity, public distrust, social media fury, and media intrusion. But the impact of living a political life through the constructed alternative persona has the potential to be a highly unsatisfying and potentially damaging experience: Here is Michael Ignatieff again:

“As you submit to the compromises demanded by public life, your public self begins to alter the person inside. Within a year of entering politics, I had the distorted feeling of having been taken over by a doppelgänger, a strange new persona I could barely recognise when I looked at myself in the mirror…. Looking back now, I would that some sense of hollowness, some sense of divide between the face you present to the world and the face you receive for the mirror is a sign of sound mental health. It’s when you no longer notice that the public self has taken over the private self that trouble starts.”

The political culture 

If we contrast and compare two different patterns of democracy - the power-hoarding majoritarian democracies such as those based on the Westminster system, versus power-sharing consensual democracies, we see very different value systems come into play, with potential consequences for mental health and well-being. The values under-pinning those Parliaments following the Westminster-type system tend to be explicitly muscular and aggressive, prompting a ‘politics as war, adversaries as enemies’ mindset. With an emphasis on negativity, this political culture that veers towards belligerence, intransigence and confrontation is also reflected in the actual physical design of opposing benches in the architecture of these institutions. It’s notable that many political memoirs from individuals who have served in such institutions often speak of ‘bear-pits’ and ‘blood sport, with dominant themes of fighting and survival. New entrants into elected roles can report feelings of loneliness, lack of role clarity, the feeling that somehow other people are being instructed into the ‘rules’ in ways that they are not, and a willingness for political opponents to capitalise on otherwise harmless and human mistakes. But it is not just the new entrants: significant levels of stress have also been found in experienced parliamentarians, reflecting the dominance of  an adversarial political tradition. The additional pressure to appear competent, knowledgeable and fully coping at all times in itself can become a key source of stress. Acknowledging these sources of stress, admitting personal failings, or understanding a need for support is culturally defined in such a context as an example of weakness that will most likely be exploited by political opponents and the media. This style of political system values strength above all else in terms of both its politics and its politicians, leading to a highly stressful and unrealistic environment. 

Other stressors exist, such as those associated with leadership, or the temporal stressors of having to deliver on pre-election commitments within relatively short timescales governed by the electoral cycle. At a more individual level, many more stressors exists, such as;

  • Lifestyle: Life as a politician is all-encompassing and making room for any ‘headspace’ is difficult. It means long, unsociable hours, working away from home, not seeing your kids and family, and frequent work-related travel. As well as being experienced through physical symptoms that are significantly higher than the general population, political life is often experienced in the strain on family life and family relationships. 
  • Control: Political life is very difficult to control - even one’s own diary - and politicians have very little in the way of a formal job description against which to gauge their performance. 
  • Skills: The skills required to operate as an effective politician are generally learned on the job or through osmosis. There is very little professional support, and this alone can be highly stressful. 

In this blog post, I’m not going to comment directly on what has happened in New Zealand politics in recent weeks. But we can start to discern the types of stressors and strains that make the political career unique in its ability to interfere and intrude on almost every aspect of everyday life, and how it may become a lonely and hazardous experience. The idea that politicians are at once expected to be superhuman and yet ‘normal’, to be strong and determined, yet passionate and flexible, to be ‘statesmanlike’ yet also relaxed, political not not partisan, authoritative but not condescending, word preference but not scripted, confident yet not arrogant, intelligent but not nerdy, good-looking but not vain, family-friendly but not work shy, amateurish but also professional, not unkempt or exhausted but equally never allowed to be off-duty or on holiday when a crisis erupts. These kinds of conditions are not exactly conducive to promoting good mental health. Indeed, they are far more likely to increase the probability of mental health struggles, if not illness. 

Although the UK’s All Parliamentary Group of Mental Health report in 2008 on Mental Health in Parliament recommended cultural change within Parliament and for members to speak openly about their experiences with mental health, it has only achieved limited success, despite the establishment of an All Parliamentary Group on Mindfulness in 2013. For example, even in a Parliament of 650 MPs, only six have publicly admitted to having experienced mental health challenges. For those that did talk about their experience, there was an open admission that admitting these challenges meant that they had taken a big risk that might negatively affect their future in politics. In fact, the discussion of experiences of mental illness can easily become a line of attack rather than discussion and support. The mere fact that mental illness carries such a stigma means that it is almost impossible to have an open and constructive debate. 

However, there are more encouraging signs from other countries. In August, 1998, the Norwegian Prime Minister publicly announced that he was experiencing a depressive episode and needed a break away from front-line politics. He returned to office two months later and received support for making mental illness more publicly acceptable. Indeed, he was subsequently re-elected and served a second term as Prime Minister from 2001-2005. The fact that he was willing to acknowledge his own mental frailty served as a a key source of his public support. He went on to call for politicians to do more to ‘normalise’ mental health issues by talking openly about their own experiences. Much more recently in New Zealand, the MP Chloe Swarbrick in 2018 has publicly disclosed her ongoing experiences and history of mental health issues. 

It is worth noting that this Norwegian Prime Minister’s experience did occur in a parliamentary democracy, but one which is fundamentally different to that in New Zealand, Australia, Canada and the UK. Norway has always embraced a strong element of consensualism in terms of their expression of democracy, rather than the majoritarian, ‘winner takes all’ emphasis in the four countries listed above. The MMP system in New Zealand gives potential for more a more consensual politics to emerge in time, but only if the opportunity can be grasped more purposefully. 

These snippets suggest how majoritarian, confrontational politics might undermine mental health crises that may emerge for those that serve as members in these parliaments, and how they can respond to the needs of the residents and citizenry that they serve. However, what any kind of analyses of the data reveal is that we actually know relatively little about the metal health of politicians.  We also don’t know how the psychological strain of political life is experienced by husbands, wives, partners, friends, children and personal staff in ways that have never been acknowledged or studies. This becomes even more important to understand if politicians cannot express the frustration or pressures of office through professional channels, it becomes even more likely that their personal networks and relationships may feel the effects of these strains. 

The difficulties in addressing these stressors - at all levels from how political institutions are run and the wider culture of political and media engagement, to individual stressors such as the punishing lifestyle and potential skills gaps means that there is a high risk of strains emerging as mental health difficulties. If fear of stigma or possible political retribution means that these difficulties remain hidden, then they become blocks to effective broader mental health policy responses to help to address a much wider problem for the citizenry at a population level.

Declaration of Interest: Dr Sarb Johal was a List Candidate for the New Zealand Labour Party in the 2017 General Election, and is a Registered Clinical Psychologist.