What's up, doc?

On Tuesday the winners of the Mind Media Awards were announced.  These awards give recognition to those media channels that handle mental health issues sensitively, appropriately and without stigmatising. BBC1’s Casualty won the accolade in the Drama category, beating off competition from Holby City and a psychological thriller called Exile. Like I said earlier this week, I don’t watch much telly, and I haven’t seen Casualty for years, but when I saw the list of winners, it didn’t surprise me that the programme came out on top. It’s the sort of show I would expect to do all right when it comes to representation of people with mental illnesses.

More of a surprise was the discovery that only days before winning the award, an episode of Casualty was broadcast in which they managed to get in a stigma-inducing blunder. 

More of a surprise was the discovery that only days before winning the award, an episode of Casualty was broadcast in which they managed to get in a stigma-inducing blunder. While I was wandering around the National Portrait Gallery with a doctor friend of mine last night, she asked me if I’d seen Saturday’s edition of Casualty, and whether I’d be writing to the BBC to complain about the stigma. I’ve since checked out the offending episode on iPlayer, and, here’s the problem.

In what I assume is an on-going storyline about a doctor with bipolar disorder, the issue of medication during pregnancy has come up. The character in question has recently fallen pregnant, and is reluctant to stop taking the mood stabilising medication, lithium, because of her keenness to maintain a stable mood during her pregnancy. A concerned colleague intervenes with misgivings about the risks of lithium exposure to the unborn baby. The well-informed doctor says she knows the risks, and that a 10% chance of a heart defect amounts a 90% chance of being normal.

This is the big mistake. It’s also another example of the clumsy use of statistics thrown in just to suit the current purpose.  Like so many things, the real picture concerning the potential risk of taking lithium during pregnancy is much more complex, but some evidence suggests the risk of cardiovascular complications is more like 1 in 200 (compared to 1 in 2000 in the general population). A 0.5% chance is very different from a 10% chance.

This paper from 2008 compiles and examines all of the available evidence on this issue and concludes that lithium should be used in pregnancy without hesitation if needed. However, to make this argument, evidence is assimilated and discussed in such a way that does not lead to a single nice, neat, conclusive percentage of risk.

Okay, so Casualty got their figures wrong. But, why is this stigmatising, I hear you cry. Put yourself in the shoes of a newly pregnant mother who has bipolar illness and is taking lithium. Making the decision as to whether to discontinue treatment is a damned difficult one. You, like any expectant mother, are determined to do everything within your control to protect your unborn child. This includes looking after yourself and avoiding bipolar relapse. You look at the evidence, and see that, taking everything into consideration, the risk to your child of continuing to take lithium is probably lower than the risk of harm if you stop taking it. If people around you have gleaned their knowledge of the topic from Casualty, the chances are that they will hold that view that this is a more irresponsible and negligent choice than it really is.

The friend who told me about Casualty’s gaffe knows a real life doctor, who really has bipolar disorder who recently had to make precisely this choice.  She was really upset by this misrepresentation precisely because it made her feel people would think she’d been reckless. Perhaps it’s a small point, but it’s the kind of detail that a drama show with a reputation (and indeed an award) for careful treatment of mental health issues should take more care over.