During a 2019 episode of the popular TV show Britain’s Got Talent, the hosts, Ant and Dec, surprised the audience. ‘In the last 15 years,’ Dec said, ‘there has been a staggering 48 per cent rise in anxiety and depression amongst British children. But something as simple as talking together and listening to each other can build our mental wellness.’ The time for listening began immediately, with the hosts announcing an awkward, minute-long pause to the show. Signs asked viewers to ‘use our silence to talk to each other’. So ITV’s ‘campaign for mental wellness’, named Britain Get Talking, was officially launched. ‘See, wasn’t hard, was it?’ Ant said after the silent minute was up. And then the show went on.
It is a widespread assumption that silence in mental illness is intrinsically harmful, an idea that has been drilled into us by countless mental health problems, or are not being properly heard when they do speak about that issue. Literal silence, by contrast, is when someone physically doesn’t speak. Britain Get Talking urges us to fight both kinds of silence.
Both of these silences can be harmful for people with mental illness. Mental health stigma can coerce them into suffering in both literal and metaphorical silence for fear of how others would react if they told them about their struggles. Such imposed silences can be reinforced by other people’s failure to talk about, or be open to conversations about, mental health – that is, by their metaphorical silences. Ant and Dec were trying to help people with mental illness who suffer in imposed silence by creating a space, however brief, in which they feel comfortable opening up, and in which their family members or friends encourage them to do so.
But it’s a mistake to think that all silences in mental illness fit this mould. As one person with bipolar disorder told me, there is a rainbow of silence in mental illness. Some come in darker colours, indistinguishable from the storm clouds of illness or stigma. But others are bright, beautiful, and offer relief from the tempest of distress. And many others fall somewhere in between.
As a philosopher of psychiatry, I also used to think of silence in mental illness as a shorthand for harm. Not only am I steeped in the common mental health slogans, but also in Western philosophy, an intellectual tradition that tends to equate speech with flourishing, and silence with misery. These ideas are particularly prevalent within my subfield. Within philosophy of psychiatry, the silence of people with mental illness is often assumed to be a symptom of epistemic injustice – a kind of wrong in which social marginalisation or prejudice undermines an individual’s ability to share or gain knowledge.
But, while examining how people with bipolar disorder navigate the epistemic injustice they face, I began to doubt the one-sided denigration of silence. I glimpsed the rainbow of silence.
For people with mood disorders, being silent is a vital and often hard-won resource
So I decided to have a closer look at silence in mental illness. My research has explored first-person experiences of literal silence in a category of mental illness known as mood disorders. This category includes some of the most diagnosed psychiatric conditions, including major depressive disorder or what is often called clinical depression, and bipolar disorder, an illness characterised by periods of high activity and energy known as mania as well as periods of depression. From a silence perspective, mood disorders are particularly noteworthy because, during episodes of
