This post, co-authored by Jae Ryeong Sul and Dan Degerman, was originally published as an opinion piece in the British Journal of Psychiatry. It brings together some of the central insights we gained through our research and conversations with our mental health service user and provider advisory groups.

Calls to break silence pervade public discourse on mental health. Silence can of course be harmful if it results from stigma and prevents people from getting the support they need. Such socially imposed, harmful silence should be broken.

But we need to stop talking as though all silence in mental illness is like that. Although such oversimplification lends itself to punchy campaign slogans, it does not reflect the lived experience of patients. More importantly, it can inadvertently harm people already in severe distress.

Consider silence in depression. People with depression often report losing their ability to speak, especially during severe depressive episodes. The author Matt Haig recalls such an experience: ‘There was a time when I couldn’t speak. There was a time when my depression was so heavy my tongue wouldn’t move’.

The experience of speaking less or not at all in depression is well documented. It even forms part of the diagnostic criteria for depression. Individuals who experience this may be no more able to speak about their experience than they can just ‘snap out’ of their depression.

In such cases, other people’s well-intentioned attempts to help them break silence by encouraging them to speak about their feelings may simply compound their distress.

David Blistein describes this sort of situation in his memoir of depression: ‘[T]he hardest question to bear was: “Have you tried … ?” No matter how well-meaning, I’d experience the question as another person’s opinion/expectation I’d have to add to the invisible Sisyphean load of indecision I was dealing with’.

Some silence experienced during a depressive episode can, then, be very difficult to break. In fact, it can be so difficult that the effort of doing so might cause more harm than good in some circumstances.

By contrast, some silence experienced during mania can result from intense efforts to maintain autonomy, relationships and a sense of identity.

For instance, the then-lawyer Terri Cheney recounts winning a place in a prestigious writing retreat during an episode of mania. She arrived feeling a distressingly strong urge to talk. Cheney knew that giving into that urge would risk throwing away the opportunity. ‘So I managed’, she writes, ‘by clamping my jaw shut and sucking on my tongue, to get through most of the introductory small talk with responsive nods and a tight-lipped smile’.

Although unpleasant, for Cheney, this silence was a hard-won achievement that served her dream of becoming a writer and building the relationships that required. Her experience is far from unique.

While these are just a few examples, they illustrate that silence in mental illness is a complex phenomenon. It is not always harmful or imposed by stigma. Sometimes people with mental illness are silent because they cannot speak. Sometimes they are silent because they have good reasons not to speak. It is not clear that trying to break silence in either case necessarily serves the best interest of patients, particularly if those doing the breaking do not have appropriate training.

That is why we must complement calls to break the silence with a nuanced, phenomenologically informed understanding of silence. Such an understanding explicates the varieties and functions of silence in mental illness, including as a component of effective support and care. This could provide a vital resource for those caring for people with mental illness.

Recent insights from palliative care research are instructive. These suggest that silence can foster a therapeutic space of ‘respect and non-abandonment’. Such positive silence could be particularly important for individuals undergoing a severe depressive episode. It could provide them with a space where they can simply exist with someone, without having to confront the insurmountable difficulty in sharing their experience.

The understanding that silence in mental illness is a nuanced phenomenon will not be news to many healthcare professionals. But that understanding is far from universal either in healthcare or beyond. This needs to change. It is high time that we started talking about silence the way it actually is.

Please note that we have not included references in this version of the article. For a fully refernced version, please go to the original version published in the BJPS.

Guest post by Zishan Khawaja

According to Buddhist tradition, a certain disciple was troubled and distracted from his meditations by a series of questions. Is the world eternal or not? Is it spatially infinite? What about the self? Is it eternal? Is it identical to the material body or not? The disciple felt that the Buddha, being a renowned teacher, would have no problem answering these profound questions. But upon asking, what he received from the Buddha was silence. Buddhists consider this act so significant that it is referred to as a “Noble Silence”. Why this is so becomes clear when considering the goal of the Buddhist path – the end of existential suffering.

The Buddha believed that our experience in the world is characterised by what in Sanskrit is called “duḥkha”. This is often translated as “suffering,” but the term additionally conveys the idea of a pain more subtle than the physical, including senses of “dissatisfaction” and “uneasiness.” It captures the constant anxiety that is felt in a world in which all is impermanent, from our physical bodies and accumulated possessions to our dreams, goals, and relationships with others. The fact that all is impermanent produces an emotional restlessness that defines our existential experience. The Buddha’s great work was the discovery of the cause and cure for this condition.

At the root of suffering, according to the Buddha, is a craving that is driven by three poisons: desire, hatred, and delusion. That we desire to possess what is impermanent and hate losing what we currently possess leads to the constant experience of dissatisfaction. One desires beauty, wealth, or status, but these simply produce further desires to retain what one possesses or to continue accumulating possessions as a potential replacement for any others that may be lost in the future. We begin to hate the impermanence that cannot be avoided. The mind is never at ease, constantly seeking, scheming, and suffering. The earliest Buddhists believed the key delusion producing this craving was the belief in a permanent and enduring self – the “I” or ego. The Buddha claimed that the illusion of this self led one to believe there was something (the “I”) that could possess what was impermanent, and caused one to feel distress at its inevitable demise. If this presupposition was removed, through the sustained practices of discipline and meditation required by the Buddhist path, then the source of suffering could be removed. The mind would be at ease, existence would no longer be characterised by suffering – Nirvana would be attained. But what the earliest Buddhists had only begun to explore was the role of language and speech in this process.

Later Indian Buddhist thinkers and philosophical schools (such as Nāgārjuna and Dignāga, and the Yogācāra and Madhayamaka schools) continued to explore the roots of suffering and the conditions that produced the delusions in which it thrived. Why did the belief in a self emerge? Some of these philosophers realised that our linguistic practices and language played a critical role – that the very terms “I” and “mine” that generated the delusion. But they pushed even further. It was no longer simply the self that was a delusion, but the view that our language accurately reflected the world. Nāgārjuna (according to his commentator Candrakīrti) claimed that language will always distort reality, and offered a series of reductio ad absurdum arguments and paradoxes that result when one believes otherwise. This is done to show that the pursuit of a metaphysical truth, for a correct and complete description of the mind-independent world and the entities it contains, is the most dangerous of objects to desire. It is a source of yearning and distress, a doomed search within what Indian Buddhists called the “imagined net of conceptual proliferation” (kalpanā-jāla-prapañca), the phenomenal experience of a world of numerous impermanent entities produced by language. Nirvana, a state in which existential suffering ceases, is free of this net, and is described by Candrakīrti as a “silence of words” (vāgbhiravyāhṛtam).

Returning to the story of the disciple and his questions, it is now clear why the Buddha responded with silence. Any attempt to answer the questions would have led to further questions, further searching, and a continued restless pursuit for answers. It was only silence that counted as a refusal to fuel the process of conceptual proliferation and its associated existential suffering. Language is a wonderful thing, even if imperfect, and the great volume of scripture in the Buddhist tradition shows that they were not ignorant to this fact. But the Buddhists highlight that, where language fails, the silence that follows may be as profound as a thousand of the best chosen words.

Author bio

Zishan Khawaja is a Teaching Fellow at the philosophy department of Durham University, with research interests in classical Indian philosophy. His PhD thesis focused on the metaphysical, epistemological, and ethical aspects of Madhyamaka Buddhist philosophy.

Guest post by Jordan Adshead

Life, it seems, is getting louder all the time. According to one estimate, an astounding 15% of all human experience belongs to those of us alive today. That means that an awesome and unprecedented concentration of human life is focused on this specific moment. The world is busier than ever and it’s hard if not impossible to keep up with everything that happens. Following the news, no sooner has one crisis claimed our attention than another clamours to take its place. We hardly know where to look.

But it’s not just that there are lots of people around. We are increasingly living closer and closer together, too. A growing share of human beings today live in cities, with 56% of the global population now living in urban environments. Such spaces are dense hives of stimuli. Taking a walk through a busy high street, we are immersed in a discordant symphony of neon signs, advertisements, the buzz of a thousand conversations, cars and trucks, sirens, the sweet smell of fried doughnuts and the pungent reek of dumpsters. And everywhere something to do, somewhere to eat, something to buy. Wherever we turn someone or something wants our already saturated attention.

This kind of experience can be stimulating, intoxicating, and – let’s be honest – even kind of fun. There is a buzz about the city which we can’t find anywhere else. It feels alive and, in it, we feel alive too. But it is likewise possible to lose ourselves in the noise, to grow numb and fatigued with it. As our skin grows calloused by the repeated action of touch, our minds grow calloused by the repeated action of stimuli.

Encircled by the summons of a busy world, it can be tempting to think of silence as dead or idle time, time when we could be doing something productive. But silence can itself be productive in its own fashion. Ten years ago, I attended a meditation class headed by the Buddhist monk Ajahn Khemadhammo. The session took place at 6pm, after a long day of work. We were to sit for a few minutes in silence and focus only on our breath. Simple enough, right? Well. At the end of this fitful and restless endeavour, Khemadhammo supposed – correctly – that we had, each of us, struggled to concentrate. Pulled hither and yon by our churning thoughts, aching backs and legs, worries about tomorrow, and the urge to get up and do something else. Our hurried minds, it felt, had a mind of their own.

Laying quietly in bed that night, I was awed watching the ebb and flow of my thoughts and feelings, rising and falling according to their own whim. Even if I willed them to stop, they still stirred. Though they were, undoubtedly, my thoughts, I could not exactly call myself their author. Thoughts come to us. But what struck me the most was that this had been going on throughout the entirety of my life, right under my nose. How could I have possibly failed to notice it? What else had I failed to recognise?

According to how we actually experience it, it is not – as Descartes had supposed – that “I” think. Nietzsche perhaps said it better when he wrote that “a thought comes when ‘it’ wants to and not when ‘I’ wish”. In this way, the mind is a little bit like a garden. We are no more the author of our roses than we are our thoughts. We cannot compel a flower to grow. We can only plant the seeds, nourish them, and let nature do its thing. Just as a flower needs soil, sunlight, and water, understanding needs silence in order to bloom. Without affording ourselves the opportunity to experience silence in our lives, it is entirely possible that we will look right through it.

Author Bio

Jordan Adshead is an AHRC-funded PhD student at Durham University, presently working
on a phenomenology of apathy in the face of ecological crisis. Beginning with the premise
that apathy is a modification of situated human behaviour, he argues that we can better
understand apathy by placing it within the context of a phenomenological study of human
existence. The current aim of his research is to expose the nature and existential possibility
of apathy and to probe how apathy is articulated in and through the urban-virtual milieu of
contemporary post-industrial society.

Guest post by Caroline Greenwood Dower

Psychotherapy is understood as the ‘talking cure’.  “It’s good to talk” has become a mantra of efforts to de-stigmatise mental ill-health and distress.  But sometimes it is good not to talk. So what is the role of silence in the process of therapy?

As a practicing psychotherapist, I see the aim of therapy as restoring, or initiating, a set of possibilities for how the individual relates both to the world and to themselves. Some qualities of silence reveal how the individual has closed, or been closed, to connecting with the world and with themselves. Other qualities of silence offer possibilities for greater connection with the world and with themselves. Silence between us may feel respectful and empowering.  Silence for the individual may offer the space for deep connection with the felt-sense of their experience.

How can we know the difference?  How can we come to an awareness of the quality of silence we experience?  It surely begins with a close attention to the quality of the present moment.  How is this individual before me for me?  How do I experience myself in their presence?  How are they with themselves?  Their words, their experiences, are important, of course.  The key issue though is how words, or the lack of words, feels between us.

If the silence between us was expressed in a gesture what would it look like?  Our talking and our silence has moving qualities.

In my silence am I receiving them, taking a moment to consider them deeply?  Am I refusing to offer something?  Does it feel like a withholding of something they want or need, or dread?  Or am I offering something to them – a warm encouragement for them to continue with their private contemplation or musing?  And their silence – are they refusing me, blocking me, putting a wall between us for their safety, or mine?  Or are they taking a moment, feeling the support of my presence, to open to themselves?  Am I providing a containing structure, or a neutral background, for their own awareness to unfold?  Does the space between us feel spacious and calm, or does it feel charged, narrowed?  I use a fully embodied sense of the moment to feel how I am moved by and appear to be moving my client.

And yet, how can we know?  I may imagine that my silence is supporting their awareness, and they may be sat on the other side of the room full of anxiety for how I am holding them in my mind.  As I fall silent and consider my client, they may feel excited by being of such interest to me, or it may be threatening.  It may not always have been safe to have been privately considered.  And as they sit in silence, are they opening to themselves, or dissociating from the present moment, or quietly losing a sense of themselves and their reality, and unable to say.

The challenge, of course, is that to really know, we will need to enquire, but enquiry inevitably breaks the silence.  Therapy above all is a process of clarifying experience, and mostly we do this through the words – through describing our experience, and through words being put to that experience.  Our experience comes to make sense, to the therapist and to ourselves.  Again and again I have witnessed the relief that comes with the deep realisation that we make sense.  At some point, it will surely be helpful to reflect openly, verbally, on the quality of the silence.

In therapy and in life, it seems to me that an important skill is to have the capacity to move between states of deep experience and states of reflection upon the experience.  A therapeutic skill – to be aspired towards, and rarely achieved – is the sense of timing.  How long to leave the experience of silence to unfold, and when to enquire into that very experience, in a way that offers the possibility of making new sense without prematurely cutting through an important moment.   And how we will know?  We can feel how our enquiry lands, or we can enquire about how the enquiry felt?  More talking… And so we go on… in a rich journey of exploration, moving in and out of experiencing and reflecting.  As we move, how can we find support, or an anchor?  Perhaps one valuable anchor is a quality of respect – respect for the value of talking and the value of silence. 

Author Bio

Caroline Greenwood Dower is a psychotherapist and researcher.  As a psychotherapist she has a particular interest in integrating embodied awareness into talking therapies – so how we non-verbally create our world and relate to it.  Her academic research is on anxiety, looking at developing a deeper awareness of the embodiment of anxiety may contribute to our understanding of the phenomenon and point to new ways of supporting individuals with chronic anxiety.

This post was originally written for the Bristol University Arts Matter blog by Dan Degerman and Jae Ryeong Sul

When we talk about silence in mental illness, it is nearly always as something harmful that we need to ‘break’. Of course, some silences in and around mental illness should be broken. Think of the silence of someone afraid to talk about their distress because of mental health stigma. Or, think of the silence of someone who wants to share their distress but can’t find the words to make others understand.

However, silence is a diverse experience, as most of us will recognise from our own lives. Silence can be painful, imposed, and disempowering. But it can also be pleasant, chosen, and empowering. While it can feel like a barbed cage that keeps us from saying what we want, it can also feel like an oasis of freedom from other people’s demands.

Why should we think that silence in mental illness is any less diverse? Our AHRC-funded Beyond Voice project suggests there’s good reason not to.

Beyond Voice is a philosophical project that sheds light on the role of silence in the lives of people with depression and bipolar. Our research engages deeply with first-person accounts of people with lived experience of these illnesses from different backgrounds. That involves analysing autobiographical accounts and qualitative research, as well as working with a research advisory group consisting of both experts-by-experience and mental health professionals who provide invaluable guidance on our research.

Mapping the rainbow of silence

So far, our research has shown that many first-person accounts defy common assumptions about silence in depression and bipolar. For one, they suggest that silence can be part of what it means to be depressed. The writer Andrew Solomon, for instance, writes that depression ‘is like going deaf, hearing less and less until a terrible silence is all around you until you cannot make any sound of your own to penetrate the quiet’.

By contrast, in the manic episodes that form part of bipolar, the loss of silence can be a source of suffering and longing, as the writer Bassey Ipke suggests in her account of such an episode: ‘The thoughts have started to flood. They tumble and race so quickly that only focusing on [the cab driver] helps slow their circling. … [M]y mind is never quiet’.

These are just two examples of the rainbow of silence experiences – to borrow a metaphor from our advisory group – that people with depression and bipolar report. The first key objective of our 18-month project is to begin to map out that rainbow.

A better understanding of the variety of silences that occur in depression is not simply a matter of dotting some ‘i’s in an otherwise complete picture of depression and bipolar.

A clearer picture of the rainbow of silence will have important practical implications for people with those illnesses and those who want to help them, including friends and family, healthcare professionals, and policymakers. The second and third objectives of Beyond Voice are to draw out those implications.

Silence matters for mental health

Some implications have already begun to emerge.

Since silence can be a part of what it is to be depressed or a desperate attempt to keep the worst consequences of mania at bay, we need to recognise the potential harm that the blinkered insistence on ‘breaking the silence’ around mental illness can have.

For example, other people’s well-intentioned appeals to share experiences or unsolicited advice can cause more harm than good to an individual whose depression is so severe that they cannot speak and do not even feel the urge to. In such cases, simply sitting with them in silence – honestly acknowledging the depth of their despair and quietly blunting their isolation – may instead be the crucial first step towards providing the appropriate support.

In other words, we must consider how we can help those who want to speak to do so without pathologising and pressurising those who cannot or have good reasons not to.

Our work will continue over the next year and we’d love to hear from you with your own thoughts on and experiences of silence.

Guest post by Lucy Haydon

The silence in manic psychosis is deadly and deafening. It connects dots of imagination and untruths in the loudest of ways whilst not saying anything out loud.

This silence is the scariest I have ever experienced. This silence should not be allowed to exist. This silence needs kind company, trust, time, love, and often even medication to overcome and navigate through and out of.

This silence is not fun. I would not wish it on my worst enemy.

As a complete contrast, another type of silence I have been lucky enough to experience is the one where you are sat under a beautiful tree, back against the bark, alone in body but oh-so connected to something so much greater than just yourself. 

In this quietness, you can hear the birds of hope, feel the warmth of the sun, the bliss of the breeze and you know all will be more than ok.   

I write about these two types of silence to give you an idea of just some of the many experiences someone may have when thinking of the concept of ‘silence’.

A group of six people with lived experience recently met up with three facilitators from the University of Bristol in a workshop to share time together and discuss ideas and experiences of silence.

It was a very intriguing and interesting topic, bringing up themes of connection and isolation amongst others.

Silence is more than a word and much more than just something to be ignored, with a spectrum of emotions and experiences counted. It needs to be explored in greater depth, and, hopefully, that’s what this project will do.

Author bio

Lucy Haydon is a Bristol-based artist.

Guest post by Cat Papastavrou Brooks

When I was at my most depressed, I lived with someone who was also depressed, and a silent and wretched-looking lurcher we had bought after seeing a Gumtree advert which just read “Dog. £150. First come, first served.” Left with time, and no ability to fill it, we sometimes played a kind of word-game where we attempted to describe how depression felt.

“It’s like feeling very light and empty and insubstantial, but also very hard and heavy and dense all at the same time.” 

“It’s like being in love with someone, but instead of obsessing about them, you’re just obsessively thinking about how you are the worst person in the world and how much you want to kill yourself.” 

That episode wasn’t my first time being severely depressed. The last time round (in my early 20s and more alone in my suffering) I’d been fanatical about a book called ‘Wittgenstein’s Private Language’. This aimed (amongst other things) to unpack the connection between pain, language and isolation in the philosopher Wittgenstein’s work, a subject I think has a particular pull for unhappy or depressed people. In it, the author (Stephen Mulhall) writes that we could see: 

“the provision of a language for pain to someone immersed in inarticulate suffering as a means of giving him some perspective on his own condition- at least enough distance from it to articulate that condition, and thereby to place him in the position of acknowledging the state he is in, which must include acknowledging that it may end, that he may be comforted, that he might transcend that state, if only in his imagination.”

Coming up with our depression similes years later, it became clear that this approach did not work for our particular problem. Talking about depression did not give us any perspective on or comfort in our condition, which was all-encompassing and surely endless. Attempting to say the truest, most secret name of depression had not – in fact – given us power over it. But then why would it? We also played Boggle for hours and hours a day (a far more popular word game than our invented one), which – shockingly – didn’t magically end up curing us either.

After I finally got well, I told my friend he’d saved my life. He was nonplussed by this and said, “But I was just there, I didn’t help you, I was just there”, but then that was the extraordinary thing. The form of care he gave helped me get better because it didn’t require me to say or do anything to be understood and loved. Depression is both so incredibly mind-numbingly boring and makes you so incredibly mind-numbingly boring to others – we knew that inside-out. In that state, what could I possibly have had to say? So, his main role (apart from the difficult work of keeping me alive) was just being there, mostly unable or unwilling to talk either, just waiting it out together.

This is not how UK mental health campaigns tend to suggest that caring for your friendly neighbourhood depressive is supposed to work. Things like the recent “Time to Talk” campaign (“Some conversations are scary, some aren’t”) emphasise how easy and un-frightening it is to use words to connect a mentally ill person, both as a necessary precursor to and as a form of care in itself. The artist, activist and researcher Rachel Rowan Olive, has an excellent parody of this campaign, styled in the same way, but the text says “Screaming Awareness Week. It’s way past time to talk; it’s time to scream. Let’s bang our heads on the wall.” The top of the poster reads: “Every week from now until the end of time #aaaaargh.” Aaaaargh indeed – truly the only form of silence-breaking adequately suited to mental illness (and to dealing with mental health services).

To be clear, I’m not entirely against talking. I think words can be vital in dispelling the shame, self-hatred and loneliness that are part of depression, and I believe in good therapy. However, I also think that a combination of the failures in the UK mental health system, an increased mental health awareness in the general population and the dominance of cognitive therapies like CBT have led to people being more likely to have a stab at wrangling their depressed loved ones into speaking about their depression, in a desperate but misguided attempt to alleviate it through rational argument. For me, the idea of your loved ones somehow talking you out of being depressed or giving you the right space to talk yourself out of depression baffles me. It reminds me of the tweet, turned popular meme, which reads [sic] “guys r like don’t kill urself ur so sexy aha”, funny for many reasons, but at least partially because of the ridiculousness of the idea that being told you’re attractive could ever stack against the terrible, terrible logic of depression. What words could?

We’d had the dog for a whole horrible, hot, and silent summer, when she got over excited running in the park, and finally let out a sharp series of barks. We were taken by surprise and ran after her shrieking and whooping, which completely freaked her, something that was so comical to witness it made us laugh as well. Which- for me – was the closest that speech had got in that time to making me feel well again.

To purchase Rachel Rowan Olive’s “Screaming Awareness Week” artwork (and others), visit her website. 

Author bio

Cat Papastavrou Brooks is a PhD candidate at the University of Bristol, working on the impact of community violence as part of the TRUUD programme, and a researcher at the SPIRED Clinic, SPFT NHS Trust working on eating disorder research. 

Her X handle is @TheBeetleBox

Guest post by an anonymous contributor

Too articulate for support. Named as a ‘Personality case’ by a Health Care Assistant. Although this led to a lot of distress and a complaint, I now know on reflection that this assistant is the most honest person I have come into contact with the mental health system. At least I know where she stood and how she would treat me.

Requesting to be reassessed, as have no connection with EUPD. However, no one wishes to listen. I’m silenced as no one hears. Then, the angrier I get about this, the more of a “personality case” I become. Silenced due to judgement and stigma.

8:30 pm: Left my home for a walk, I had tried everything to stop the suicidal thoughts, voices, and visual hallucinations.

10:00 pm: Rang Crisis Team in distress. Told to look at my coping mechanisms book. I was walking along a dual carriageway, but I was not asked where I was so I did not say. Silenced by choice? 

11:00 pm: Rang crisis line. Was told to breathe; I feel unable to speak, now on a motorway junction.

12:00 pm: Rang Assist Line as needed someone human to listen to me, and just be with me so I could clear my head enough to work out what I really wanted… They heard the cars and asked where I was. I told him and he called the emergency services. I told them it was a waste of time and went to the bridge, which was the plan. Stood and cried. The police came. The crisis line tried to convince the police to take me home, offering no further support. Silenced by no one being prepared to care or listen. 

Police detained me under section 136 of the Mental Health Act. I said it was a waste of time as I felt the mental health system did not care at all.

After 4 hours of broken sleep at ‘the Place of Safety’, I woke.

At the assessment, I was told:

• ‘We all have negative thoughts, people just do not talk about them’ (Literally being told to be silent)
• ‘Look at me, try to look out and not inwards because that’s just making it worse’ (I am using every bit of my energy to answer questions… let alone look at you. Is this my fault? Should I be silent?)
• I know I am seen as a personality case – ‘I know you have had many discussions about your diagnosis. Personally disorders, is such a horrible term as what it really means is that people experience trauma and then create unhelpful coping mechanisms’. (So I am the problem…).

I stop talking…

‘You have so many positive things in your life we are going to let you go home’, the mental health team concluded.

A waste of time. No one was listening. Silenced.

Guest post by Sally Latham

‘Tell us your story…’

It is widely assumed that asking the ill to tell their story offers them empowerment and liberation through being heard. But the demand for illness narratives, well-meaning as it may be, can place an additional and damaging burden on those already suffering.

In recent years, there has been a huge growth in illness narratives, especially digital stories, as online accessibility increased. Stories of suffering and recovery, particularly concerning mental illness, are now common, and published by everyone from school children to celebrities. Part of the motivation behind this growth was the desire to move away from a biomedical model of mental illness where knowledge is guarded and dispensed by medical professionals and to move toward a more holistic, patient-centred approach.

These are all good intentions, yet we now have a phenomenon where narrating illness is on the verge of becoming a social imperative. For example, the sociologist Arthur Frank argues that we need to acknowledge our ethical responsibility to narrate one’s illness. One must narrate to aid one’s own recovery but also to show solidarity with fellow sufferers, to inspire others and to highlight the place of suffering in life. There are also expectations about how that story should be told.

For example, in the US, the Substance Abuse and Mental Health Services Administration (SAMHSA) produced a 70-page guide titled Share Your Story, A How-To Guide for Digital Storytelling: Supporting the Recovery and Healing of Self and Others Through Messages of Hope. In this document, adorned with stock photos of smiling families, the sufferer is told that sharing their story will reduce negative stereotypes, encourage others to seek help and empower the narrator. They are guided in how to ensure the story comes from a ‘strong foundation of recovery’along with ‘messages of hope’ or a ‘call to action’. An illness narrative must have the right amount of hope, resilience, inspiration and recovery.

But this expectation is dangerous. It risks isolating those whose stories do not fit this genre of hope and inspiration, overlooking those stories that highlight anger, despair and even neglect and inequality in healthcare that needs to be addressed.

Not only does the demand for illness stories alienate those whose stories do not fit the accepted genres, it also alienates those who do not wish to narrate at all. We fail to recognise that ‘suffering in silence’ is a legitimate choice rather than something inherently bad, externally imposed and oppressive. This assumption is highlighted by the philosopher Dan Degerman who has claimed we should challenge the ‘fetishisation of silence breaking’. There are different types of silence, some of which are a choice. Some suffering cannot be put into words and to do so would distort it. Putting pressure on the ill to narrate their story at all (let alone through socially sanctioned genres of hope and inspiration) is an extra and unnecessary burden which could lead to further distress.

If silence can be the way to honour suffering, then we need to learn to honour silence.

Author bio

Sally Latham is in her final year of a PhD with The Open University researching narrativity, non-narrativity and mental health and is a recipient of The Royal Institute of Philosophy Jacobsen studentship. Her most recent publication, co-authored with Mark Pinder, is ‘Is it Good to Conceive of One’s Life Narratively?’