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Why I’ll continue calling out attacks on mental illness

March 25, 2012

NB: I WILL COME BACK AND REFERENCE THIS PROPERLY IN THE FUTURE – THIS IS A PROVISIONAL PIECE WRITTEN WITHOUT ACCESS TO MY NOTES.

One of the topics that gets me the most abuse on twitter is when I suggest that accusing people whose actions or politics they disagree with are ‘mentally ill’, or have a specific mental illness, is an unhelpful approach. The claim is often that these comments are ‘jokes’ or that, because the DSM and ICD are so problematic, the democratisation of diagnosis is inevitable, and the best use of these tools is to attack and deligitimise political opponents.

Notwithstanding the issues surrounding the Welfare Reform Bill, this tactic is inherently problematic.

Now, by saying this, I *don’t* mean that political discourse cannot contribute to mental illness and mental health issues. Indeed, I think that, on both sides of the political divide, the rhetoric used by tabloid media and the government is often likely to fuel symptoms of paranoia, self-hatred, agorophobia and sociopathy. It is even possible that these results are, to a certain attempt, intended, as a fearful electorate is often a compliant electorate.

However, I also do not believe that there is enough evidence to support the line of writers like Thomas Szasz, RD Laing and, to a certain extent, Sigmund Freud, in attributing mental illness purely to socio-political (environmental) factors, or ‘problems in living’. Problematic though bio-medical models of mental illness are, medical (psycho-pharmaceutical) interventions have a positive impact on symptoms in enough cases as to suggest that the small steps we are taking forward in neuroscientific understandings of the brain/mind are gradually improving outcomes, despite the problematic influence of pharmaceutical companies.

So, to clarify, mental illness and mental health issues are most likely, when the latest studies are taken into account, a result of a combination of biological, socio-political and environmental factors. However, due to the speculative nature of a lot of current research, the balance between these is open to question (whether biological factors make certain socio-political factors more likely to have an effect, or whether certain relationships between the environment and the socio-political landscape precipitate changes in brain chemistry, or whether any combination in any order has the potential to have these effects.)

So much for mental illness as something which affects individuals. The point of this post is statements which suggest that the EDL are all ‘loons’, or that people who read a certain newspaper are ‘mentally ill’, or (as I noted in a post at the Madness and Theatre blog, that all mass-murders are ‘lone psychos’). Such statements are defended on a number of grounds, which I’ll address in turn:

1a) That this is a ‘joke’, suggesting wrongness, possibly with a hint of truth.

1b) That jokes about mental illness can transform attitudes towards it, thus reducing discrimination.

2) That it’s clear that an individual or group are experiencing mental illness, because no normal person would act like that.

3) That it’s ok to claim that others are mentally ill if you experience mental illness yourself.

Responses

1a) It’snot ok to use mental illness as a synonym for ‘wrongness’. For a start, this privileges the enlightenment concept of ‘rationality’ which forms the basis for bourgeois individualism and capitalism. The ‘rational’ decision is one uncomplicated by emotions (whether ‘normal’ emotions, or ‘pathological’ emotions attributed to mental illness). It is rational to look after one’s own interests, and those of one’s family, but altruism is irrational because you gain nothing from it.

Secondly (and fairly obviously) this implies that mentally ill people are ‘wrong’. It’s easy to justify this implication – after all, objectively, the voices which result from psychosis are not there: the individual’s perception is wrong. Even with ‘neurotic’ conditions such as depression or anxiety, there’s no reason for the individual to experience the feelings the are – these feelings are wrong. However, wrongness of emotional response doesn’t necessarily mean wrongness of intellectual response. It is possible to, for example, read and agree with the Daily Mail without suffering from a diagnosable mental illness. It’s possible to read and agree with the Mail, suffer from depression, and for those things to be unconnected. It’s also possible that there is an interaction between reading the paper and feelings that society is collapsing which feed into depression – but that doesn’t make the paper the cause: such an analysis is simplistic. By the same token it’s possible for an anti-Tory campaigner to campaign partly because she hears voices telling her to – this doesn’t make her position inherently intellectually right or wrong.

1b) It is, of course, possible to utilise comedy as a political tool, to overcome prejudice against mental illness, disability, a certain political position, a certain sexuality, or a certain gender identity. This isn’t at issue. By the same token, of course, it’s possible for ‘jokes’ to be made at the expense of people in these groups, even jokes which don’t make these groups their target. Without any further content, there is little difference between ‘Sunday Sun readers are mentally ill’ and ‘Sunday Sun readers are gay’. Something being a joke does not automatically render it harmless – indeed, by normalising a view within an apparently harmless context it can ingrain it.

2) This is the most problematic position. I was once accused of being ‘elitist’ for claiming that people shouldn’t attempt to diagnose public figures, especially if they don’t work in mental health. Whether the perpetrators of mass murder, or celebrities accused of having a ‘breakdown’ after separating from their partners, it has become culturally ubiquitous to offer more or less knowledgeable opinions on the state of someone’s mental health. When applied to public figures, this is often just insensitive and inappropriate, but when applied to political opponents, particularly as a group, it is downright dangerous.

Foucault’s accounts of psychiatric power suggest that the ascription of the label ‘mentally ill’ to individuals with problematic characteristics has long been a large part of psychiatric practice. This view is shared by the historian Andrew Skull and, to a lesser extent, Roy Porter, even when these writers (rightly) attack the historiographical issues in Foucault’s work. Indeed, from the incarceration of the Marquis de Sade after the French Revolution, to the pathologisation of homosexuality and later ‘ego-dystonic homosexuality’ (see this recent Guardian article for a harrowing account of the impact of this diagnosis), there are many examples of this tendency to be found. Although, in the West, it’s common to mock the pathologisation of political opposition in China, even the DSM lists ‘Oppositional Defiant Disorder’ as a potential diagnosis, and the DSM-V may lead to a further widening of potential categories (the reference is the the Guardian here because it’s a Sunday night and I want to get to the pub!).

In this context, for political campaigners to ‘diagnose’ their political opponents, or those whose actions they disagree with, has problematic political overtones, which are not limited to the ‘identity politics’ of disability. For me, the major problem with pathologising political opposition is not that it trivialises and problematises the experience of people suffering from mental illness, but that it justifies the broader abuse of psychiatry for purposes of controlling dissent. This does not only threaten freedom of expression, but also the future treatment of mental illness, since it has the potential to split the loyalties of researchers.

One final point on this – suggesting that those who commit terrible acts of mass murder, or who are persuaded to take part in group acts such as the mass murders in Rwanda, or the Nazi regime in Germany, or any other situation like this, are, by definition, mentally ill, is obviously a safe and reassuring proposition. However, it is most probably not true. The propaganda which works on individuals in situations like this plays on normal brain function – the identification of ‘others’ who are outside and in opposition to the status quo which would enable ‘myself’ to fulfill my potential. The propaganda may lead to some people becoming mentally ill – but not everyone who goes along with will be, or at least not simply as a result of doing so. This is, in part, because ‘mental illness’ is defined against societal norms. However, it is also important to remember because to assume that those involved in those situations were ‘ill’, we can differentiate ourselves from them – “I’m not ‘ill’, so I can’t possibly be implicated in anything like this”. Such a view allows people to take their eyes off the political ball, and may even contribute to the perpetration of such acts.

3) Personal experience of mental illness *does* provide patient knowledge which may enable you to recognise the signs of mental illness more easily in friends and others who are close to you. However, it does not justify mentioning your suspicions to anyone other than the person involved (or possibly their closer family), and it especially does not justify using your suspicions to delegitimise that individual. Mental illness does not delegitimise the opinions of individuals, and when used in this way it can impact on the credibility of mentally ill people in general.

So, at the risk of becoming embroiled in more twitter arguments, I’ll continue to tell people when I believe that their attribution of mental illness is unhelpful, obfuscatory and possibly dangerous. Hopefully, being able to link people to this blog will help explain my position, and maybe save unnecessary arguments.

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6 Comments leave one →
  1. Bobity permalink
    March 25, 2012 9:27 pm

    An interesting post that at times tries to over intellectualise what needs to be a simplistic message. Mental illness is not an insult to be thrown around when someone disagrees with media content or media users. I cannot agree that reading a newspaper will make someone mentally ill. It’s contents may depress, or it may aggravate what already exists but it is important to highlight that mental health and mental illness are not the same thing. There is a striking difference between poor mental health or feelings of depression and having a mental illness. Depression as an illness goes a long way beyond that which highlights poor mental health practices or feelings of a normal depressed state, which everyone experiences in their lifetime. An alternative argument could be that one can have an unhealthy diet without being ill, just as someone can be ill with a perfectly healthy diet.

    I agree with 90% of what you have said and in light of the source of the debate, you have kept your head well.

    I am saddened that people still feel it acceptable to liken people who consume different media or who hold different opinions, to having a mental illness. During my period of severe mental illness I was far more sane than 99.9% of the population, but I was seriously ill. To have someone compare a dubious readership based on personal preference to what was the most destructive and traumatic event in my life is insulting to me and does nothing to reflect the hard work, blood, sweat and tears… Lots of tears that I endured to face recovery.

    The stigma of mental illness will never go away as long as people continue to think it is acceptable as an insult or joke. Well done for standing up to that attitude!

  2. Hankie permalink
    March 26, 2012 12:52 pm

    “diagnosis is sometimes used in an emotional context as a sophisticated insult”
    -the stones(not those ones)

  3. September 5, 2012 10:07 am

    Thanks for this – a very useful summary of why language matters.

  4. September 11, 2012 10:35 pm

    It would be best if we all just met here to discuss. Twitter – the MacDonald’s of rhetoric.

  5. October 10, 2012 1:12 pm

    shall just chat away 🙂 personally I used the word ‘mental’ all the time. Try not to on twitter as I know some people would be offended.
    Cos I have a personality disorder, I kind of like it that teenagers use it as an insult, as I feel it renders it as meaningless as it is.
    Feminists with Borderline have been trying to get rid of the term for years, and I was shocked when on twitter openly talk about having it. I now have no problems calling myself Borderline. We have to fight very hard to ‘come out’ as having a personality disorder cos of the stigma attatched.
    Problem here is *so* many politicians have personality disorders! An MP wrote about about Tony Blair and his narcisscism. If only we listened then!
    I do have my own Godwins Law when it comes to slagging people off. If the word personality disorder is mentioned, the arguement is specious.

    Another thing, just cos I know your interested in all this stuff. Another reason for mental trauma, is past-life experiences and the soul working out some karma.
    Many people with Dissociative Identity Disorder really believe this. I think we should respect that.

  6. October 11, 2012 5:11 am

    oh, also the word ‘loon’ has a different meaning in sort parts of scotland.

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