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I am here today as a disabled
person and organizer. I am here because I want to take part in the
conversation about how people who identify as disabled and psychiatric
survivors can move forward together to fight for social justice.
In order to move forward, however, I do think it is important to
put forward a constructive critique of the anti-psychiatry movement’s
organizing up to this point. My criticisms come with the utmost
respect for the movement and, in particular, its organizers, many
of whom have been fighting the psychiatric establishment for many
years and have worked to bring in meaningful changes to the lives
of people who are psychiatrized. I come here in the spirit of the
words of Bonnie Burstow:
Social moments have always
needed to say what to a lot of people would be unspeakable. When
we stop being able to say those things we're no longer at the
cutting edge of anything. We've been bought and sold[1].
I’d like to begin with
a question. What is disability? Disability is a social construct,
an identity invented to describe and invent deviance from a conscripted,
historically-contingent social norm. I reject the notion that impairment
or disability is a biological reality. This does not mean that biology
is not at play in our lives; however, biology is constructed by
and deeply imbued with social meaning, so much so that the two are
indistinguishable. Poverty is hereditary[2]. Women are nervous and
hysterical[3]. Black people are genetically lazy[4]. These are just
a few things that biology once “proved” true. Today's
biology is no more immune from social influence than it was when
science upheld these beliefs.
Strong social meanings are
imposed onto our minds and bodies. It is these social contexts that
create disability. We are labeled as disabled by those in power
to their own advantage. Who counts as disabled – and what
counts as disability - depends on the time, culture and context.
In a world without stairs,
wheelchair users would be perceived very differently than they are
here and now. Many wheelchair users might not be considered disabled
at all, or perhaps even be understood to have an advantage over
non-wheelchair users as they would never have to worry about finding
a seat.
According to, Gale Huntington,
when speaking about his community in Nora Ellen Groce's book Everyone
Here Spoke Sign Language, Martha’s Vineyard was a predominantly
sign language speaking community around the turn of the last century.
Huntington said the towns people “didn't think anything about
them [Deaf people], they were just like everyone else”[5].
Deafness was perceived very differently in a community where not
everyone knows sign language[6].
And our ideas of intellectual
disability have changed over time and as we moved from an agrarian
to industrial society[7]. These ideas about disability all shift,
depending on their contexts.
Further, what is considered
disability shifts depending on what power dictates, oftentimes in
contradictory ways. The most widely used and affecting definitions
are those used by government to determine access to social benefits.
As a general rule, when there are real or substantial benefits,
specifically relating to resource allocation, government excludes
many, if not most of us, from the categorization of disability and
uses a strict, demeaning medical definition[8].
The medical definition and
the medical model of disability are necessarily flawed, as they
empower an external body to label disability and ignore the social
realities of discrimination and oppression. The medical model limits
our realities to what the medical establishment defines as biological
and physiological experiences rather than reflecting what our lives
are like and what happens to us in the world at large.
Psychiatry, as many people
here are well aware, has been used as a tool of social control for
centuries. Under slavery in the United States, many slaves were
diagnosed with ‘drapetomania’. This, according to Dr.
Michael Greger, was defined as, “‘an irrestrainable
propensity to run away.’ For slaves with drapetomania…a
simple procedure – amputation of the toes – was used.”[9]
It goes without saying, in
this context, at least, that for a person being held and forced
into slave labor, one of the more sane actions one could take would
be to run away. Here psychiatry was being used to legitimize the
torture and punishment of slaves and to legitimize the racist slavery
system as a whole. For more on this particularly explicit connection
between racism, slavery in the Americas and institutional psychiatry,
it’s worth looking up the work of Suman Fernando.
Slaves were not the only group
to be targeted for social control by the medical/psychiatric profession.
According to prominent psych-survivor activist, Don Weitz:
Psychiatrists manufacture
hundreds of ‘mental disorders’ classified in its bible
titled Diagnostic and Statistical Manual of Mental Disorders (DSM).
The DSM is not a scientific work but a catalogue of negative moral
judgments which psychiatrists use to medicalize, target and stigmatize
dissidents and alternative ways of perceiving, interpreting or
being in the world. [10]
The DSM has become a reference
book for psychiatrists to use to legitimize the moral decisions
they make about deviance, difference, and diversity in society.
Moral judgments by the medical establishment, however, extend well
beyond psychiatrization. Epilepsy was once viewed by doctors as
being caused by “ungoverned temper” among other things,
including alcohol and sex[11]. Groups including intersexed people,
trans people, fat people and women are also medicalized through
moral judgment.
In the 1960s, organized gays
and lesbians created an active rights movement to resist medicalization,
making it one of, if not the first anti-psychiatrization movements.
Homosexuality was considered pathological - a disability - beginning
in the late 19th century. One of the key aims of the struggle was
to establish homosexuality as, in their words, a “minority
group” rather than a disability.
One of the most well known
American gay rights activists, Frank Kameny, noted that the “entire
homophile movement” would “stand or fall” on the
issue of psychiatrization of queer people[12].
The mainstream gay rights
movement criticism was not of pathologization or the oppressive
nature of the classification of disability in general, simply that
those in power had erred in classifying them as disabled. This strategy
actually worked to maintain ableist oppression and the status quo
while negotiating privileged homosexuals' co-optation.
In 1973, the mainstream gay
rights movement was successful in getting homosexuality de--listed
as a psychiatric disability. One activist called it “the most
important achievement of the Gay Liberation Movement”[13].
Around the time of the APA
decision on homosexuality, the psychiatric survivor and anti-psychiatry
movement began coming into its own. This movement also began working
to remove itself out from under the disability umbrella. According
to Beresford, Gifford and Harrison in Speaking Our Minds: Personal
Experience of Mental Distress and its Consequences:
Many psychiatric system
survivors are unwilling to see themselves as disabled. They associate
disability with the medicalization of their distress and experience.
They reject the biological and genetic explanations of their distress
imposed by medical experts. They may not see themselves as emotionally
or mentally distressed either, but instead celebrate their difference
and their particular perceptions.[14]
Liz Sayce, in From Psychiatric
Patient to Citizen: Overcoming Discrimination and Social Exclusion,
suggested additional reasons that some psychiatric system survivors
do not identify as disabled including:
(1) “Disabled people
(some user/survivors believe) have a tangible impairment, for
example, being unable to walk or see. A diagnosis of mental illness
is much more in the eye of the beholder; it is not clear that
there is something 'wrong'”[15], that (2) “Mental
distress is not a disability because it is not something that
you are born with and it is not permanent; people recover, they
are 'survivors'”[16], and that (3) “taking on the
term 'disability' means taking on another stigma. Having one stigma
is bad enough”[17].
I would like to address these
three positions from a radical disability perspective. Firstly,
what is labeled as disabled is not always immediately apparent.
More importantly, however, these labels depend on the time, culture
and context that they are being assigned within.
Who and what counts as disabled
shifts depending on what power dictates. One of the primary reasons
we are categorized as disabled is because we are considered to be
unproductive or under productive in the capitalist system. As what
is viewed as socially acceptable or desirable shifts, so to does
who is considered disabled. That is why homosexuality is no longer
considered a psychiatric disability.
With respect to the permanence
of disability, 80% of disabled people acquire our disabilities and
are not born with them[18] and many of us shift in and out of the
disability identity. Practically everyone will experience some sort
of disability label at some point in their lives.
Lastly, in regards to some
psychiatric survivors not wanting to adopt another stigma by identifying
as disabled, I would argue it is irrelevant whether or not people
want to be stigmatized or be associated with the disability stigma.
The reality is that that stigma exists, and like people with physical
disabilities and cognitive disabilities, it is already imposed upon
psychiatrized people.
I would argue that there is
no difference between a psychiatric survivor perspective one and
a radical disability perspective. All of us view ourselves as people
with whom there is nothing fundamentally wrong and who make meaningful
contributions to our communities. The reason for this commonality
is simply that there is nothing fundamentally wrong with us; rather,
the problem is rooted in the way we are labeled, viewed and treated
by society.
Similar to the early mainstream
gay and lesbian rights movement, many psych survivors and the anti-psychiatry
movement rallied against the notion of disability with respect to
them. There is a patent rejection of the idea of disability being
applied to psychiatric survivors.
While psych survivor groups
have gotten to the point where they reject what are considered to
be 'impairments', 'flaws' or disabilities by the medical establishment,
they continue to uphold those judgments against other disabled people.
At times, the attempts of some psychiatric survivors to remove themselves
from the disability umbrella manifest itself as active and overt
disableism. Griffin Epstein in Extension: Towards a Genealogical
Accountability says that there is a “national mandate for
the formerly marginalized to pick up the mantle of the oppressor
in exchange for the rights and privileges of citizenship”[19].
In the psych survivor struggle for dignity and respect, people sometimes
carry the disableist mantle.
In doing so, many activists
talk about disability in wholly negative terms. One commonly heard
affirmation by psychiatric system survivors is something like “I
am not disabled, I was targeted by an oppressive system, and there
is nothing wrong with me.” As a disabled person, when I hear
statements like that, I hear, “There is nothing wrong with
me, but there is something wrong with you, and I do not want to
be associated with that.” Positions like this actually work
to legitimize medicalization and that it is okay to decide who is
an acceptable person and who is unacceptable, they only reject that
that system has imposed negative assumptions onto them.
This dynamic frequently plays
out when anti-psych activists are talking about the problems with
psychiatry. For example, the way people talk about psychiatric drugs.
One of the main reasons to stop psychiatric drugging is that it
creates more of us, disabled people. Dr. Peter Breggin's Brain-Disabling
Treatments in Psychiatry is one of the most commonly cited books
by the anti-psychiatry movement. In a submission to the U.S. Presidential
Consultation Regarding Community Mental Health Services, six prominent
anti-psychiatry activists wrote: “Psychiatric drugs such as
the neuroleptics do not cure and are not meant to cure or relieve
disease but to disable and disempower through their unique disabling
effects”[20]. And, Don Weitz's “25 Good Reasons Why
Psychiatry Must Be Abolished” has reason #1 as: “Because
psychiatrists frequently cause harm, permanent disabilities, death
- death of the body-mind-spirit”[21].
Douglas A. Smith, when talking
about the “disabling effects” of psychiatric drugs,
in “Janelle's Story” says that Janelle is “wheelchair-bound
by her drug-induced physical disability” and that “despite”
this “her husband, Greg, fell in love with her and married
her”[22]. Smith implies that both the creation of disabled
bodies is a tragedy and that wheelchair users are unattractive,
undesirable and have to be "exceptional" in order to attract
partners. While talking about psychiatric drugs works to reinforce
the idea that psych survivors are not disabled, it also establishes
disability, and by extension disabled people, as wholly negative,
undesirable and where we can be prevented, we should be prevented.
Of course, not all psych survivors
and anti-psychiatry activists see things this way. Gisella Sartori,
founder of the Second Opinion Society, says of her organization,
“we came to the point of saying 'Yes. We're disabled; we don't
have an inherent disability, but the system has made some of us
disabled.'”[23] This statement is about the side effects of
psychiatric drugs, however, rather than the system that imposes
disability identities on people.
I would argue that anti-psychiatry
activists, academics, psychiatric survivors and mad pride activists
all need to re-think not just the way they talk about disability
but also the way they conceptualize disability. Yes, I think that
the negative value put upon disability by anti-psych activists is
problematic and needs to change and people need to find ways to
talk about harm without reinforcing disableist ideas. But, more
significantly, I think it is important for people to recognize that
none of us are disabled because there is something wrong with us,
rather because this political identity is imposed upon us. Whether
or not we want the stigma, whether or not we view ourselves as disabled
is, frankly, irrelevant because it has no impact on whether or not
we are labeled as disabled.
There is an element of self-interest
for psychiatric system survivors in adopting this position as well.
Removing a group out from under the disability umbrella while leaving
the mechanisms in place that allow disability labels to be placed
on people will leave people at constant risk of repathologization
if it suits those in power. Announcements are made about what are
the biological causes of gayness, transsexuality, and what is called
“mental illness” on a regular basis. New developments
in these areas constantly bring forward new and innovative ways
to pathologize people. What leads to repathologization, however,
is not the latest study; it is the social and political context.
Because the psychiatric survivor
and mainstream gay rights movements have worked to reinforce the
idea that disability and, by extension, disabled people are bad
and undesirable, they will be left with few political options should
a push for their repathologization take place.
Unless the mainstream gay
rights movement and anti-psychiatry movement break out of the organizing
model of separation and division, it will only be able to, once
again, rally against medicalization on those in power's terms -
a fight that may not be successful. Should it be successful, however,
there would always be the risk of re-repathologization.
Anti-psychiatry is at a crossroads.
Either the movement can continue down the road it has been going
and fight to remove psychiatrized people out from the disability
umbrella, which means working to uphold the oppression of those
of us who are left behind, or it can apply many of the thoughtful
and thorough analyses it has of psychiatry to the entire medical
establishment and recognize that psychiatrized people are disabled
solely because those in power say that they are. This is not to
say that the burden falls solely on the anti-psychiatry movement.
There is a long history of activists in the disability rights movement
excluding, demeaning and discriminating against people who are or
have been psychiatrized. These issues too must be addressed and
remedied. However, should we be able to deal with our histories
of mutual oppression, I believe that, from there, we can use this
understanding as a point of unity to build a broad based social
justice movement that is far more inclusive and can win fundamental
change.
The author would like
to thank Griffin Epstein for editing and assisting with research
and Loree Erickson for providing useful and necessary feedback.
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[1] Burstow, Bonnie. Call
Me Crazy: Stories from the Mad Movement. Ed. Irit Shimrat. Vancouver:
Press Gang, 1997. Press Gang, Vancouver, 1997, 43.
[2] Rafter, Nicole H. “Claims-Making
and Socio-Cultural Context in the First U.S. Eugenics Campaign.”
Social Problems, vol. 39, no. 1, 1992, 21.
[3] Ehrenreich, Barbara and
Deirdre English. Complaints and Disorders: The Sexual Politics of
Sickness. New York: The Feminist Press, 1976. 22.
[4] Beckwith, Jon. “A
Historical View of Social Responsibility in Genetics.” Bioscience,
vol. 43 no. 5, 1993, 327.
[5] Groce, Nora Ellen. Everyone
Here Spoke Sign Language: Hereditary Deafness On Martha's Vineyard.
Cambridge: Harvard University Press, 1985. 2.
[6] The Deaf community is
another group that has worked to set itself apart from disabled
people by arguing that Deaf people are a linguistic minority rather
than a disabled group. While it is true that Deaf people are a linguistic
minority, this is not related to the fact that they are considered
disabled, that this label is externally imposed on people and out
of their control.
[7] Gobel, Colin. “Dependence,
Independence and Normality.” Disabling Barriers, Enabling
Environments. Eds. John Swain, Sally French, Colin Barnes, Carol
Thomas. Thousand Oaks, CA: Sage, 2004. 41.
[8] See, for example, the
Ontarians with Disabilities Act and the Ontario Disability Support
Program Act.
[9] Greger, Michael, M.D.
“Appendix 43.” Heart Failure: Diary of a Third Year
Medical Student. Retrieved February 12, 2005 from http://www.upalumni.org/medschool/appendices/appendix-42.html
[10] Weitz, Don. “25
Good Reasons to Abolish Psychiatry,” “What Difference
Does it Make?” (The Journey of a Soul Survivor). Ed. Wendy
F??k. Cranbrook, B.C.: Wildflower, 1998. 159.
[11] The Cincinnati Medical
And Surgical News, v. III, 1863. 158
[12] Kameny, Franklin E. “Civil
Liberties: A Progress Report.” New York Mattachine Newsletter,
July 1965, 12. Retrieved from: http://www.rainbowhistory.org/kameny75b.pdf
[13] Silverstein, Charles.
“Are You Saying Homosexuality Is Normal?” Journal of
Gay & Lesbian Mental Health, vol. 12 no. 3, 2008. 277.
[14] Beresford, P., Gifford,
G. & Harrison, C. “What has disability got to do with
psychiatric survivors?” Speaking Our Minds: an Anthology of
Personal Experience of Mental Distress and its Consequences. Eds.
J. Reynolds and J. Read Eds. Basingstoke: Macmillan, 1996. 209.
[15] Sayce, Liz. From Psychiatric
Patient to Citizen: Overcoming Discrimination and Social Exclusion.
New York: St. Martin's Press, 2000. 133.
[16] Sayce, Liz. From Psychiatric
Patient to Citizen: Overcoming Discrimination and Social Exclusion.
New York: St. Martin's Press, 2000. 134.
[17] Sayce, Liz. From Psychiatric
Patient to Citizen: Overcoming Discrimination and Social Exclusion.
New York: St. Martin's Press, 2000. 135.
[18] “The Politics of
Women's Health: Prenatal Testing and Disability Rights,” Our
Bodies Ourselves Health Resource Center retrieved April 29, 2010
from: http://www.ourbodiesourselves.org/book/companion.asp?id=31&compID=43
[19] Epstein, Griffin. Extension:
Towards a Genealogical Accountability (The Critical [E]raci[ing]
of Mad Jewish Identity), unpublished thesis, OISE, University of
Toronto, 2009. 33.
[20] McCubbin, Weitz, Spindel,
Cohen, Dallaire, Morin. “Submissions for the President's Consulation
Regarding Community Mental Health Services,” Radical Psychology.
Retrieved April 22, 2010 from: http://www.radpsynet.org/journal/vol2-2/submission-mccubbin.html
[21] Weitz, Don. “25
Good Reasons Why Psychiatry Must Be Abolished” retrieved April
22, 2010 from: http://www.antipsychiatry.org/25reason.htm
[22] Smith, Douglas A. “Jenelle's
Story” retrieved April 22, 2010 from: http://www.antipsychiatry.org/jenelle.htm
[23] Sartori, Gisella. Call
Me Crazy: Stories from the Mad Movement. Ed. Irit Shimrat. Vancouver:
Press Gang, 1997. 131.
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