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56 Responses

  1. auditorydamage
    auditorydamage February 23, 2012 at 10:36 am |

    Well-said. There is a curious, and infuriating, refusal to view mental conditions as the result of cause-and-effect relationships, instead hanging all responsibility for the genesis and management of the condition upon the patient. It seems to descend from ideologies that treat mental processes as somehow non-materialistic, as if they’re not biological processes themselves, that sheer force of “will” is enough to overcome any mental problem, and that those who can’t do it by themselves are weak or irretrievably broken or some damned thing. It’s yet another insidious form of victim-blaming that seeks to excuse society as a while for the effects of the abuse its individual members accept and encourage.

    If I showed up at a hospital with a broken arm and tooth, I’d probably get patched up and sent on my way. If I repeatedly showed up with physical injuries, the medical staff may start asking what’s causing my repeated injuries – am I being abused? Repeatedly assaulted? Do third parties need to be involved, perhaps even law enforcement? If I show up at a hospital and get diagnosed with an acquired mental injury/condition, is there any further investigation into what caused the injury, or am I simply stigmatized, medicated, and repeatedly sent on my way? I will only say that I semi-regularly hear about individuals who are diagnosed as “mentally ill”, that the illness in question is depression, the individuals are primarily abuse survivors, and that there seems to be no effort by doctors to determine the cause of the depression and develop an appropriate treatment/therapy program. They are simply labelled as mentally ill (which of course can be used against them by current and future abusers), prescribed drugs, and sent back out to deal with the stigma while the possible cause goes untouched. It’s a form of ableism that oppresses victims of abuse, placing responsibility for their acquired mental conditions purely upon them while ignoring and even excusing the causes of those conditions. Bust my face multiple times, and (theoretically; we all know far too well how this works in practice) you get punished and labelled. Break my will to live and drive me into a depression, and I get punished and labelled. I don’t see this changing until we stop wrapping the mind in gobs of woo and acting like mental maladaptations and injuries are shameful, solely the responsibility of the patient, and “different” from other biological maladaptations and injuries.

  2. Katherine
    Katherine February 23, 2012 at 10:49 am |

    This was a really good post. It very much brought to mind the Franz Wright poem “Pediatric Suicide”.

  3. 10G
    10G February 23, 2012 at 10:56 am |

    William, great post–I would like to know myself what of the mental illness of the bullies themselves? You can’t tell me that that sort of behavior is normal…..incidentally, bullying behavior contributed to MY diagnosis of BPD (and I’d be interested to hear your views on BPD in the future!)–combined with a non-supportive home life. What I’m getting at is that everyone in these situations focuses on the “mental illness” of the victims of bullying and not the fucktards who bully them in the first place. And why does this culture put up with bullies, anyway??

  4. Kristen J.
    Kristen J. February 23, 2012 at 11:06 am |

    This fits neatly with something I’m putting together now on the Evangelical Movement and its strategies. The concept of “brokenness” is at the heart of how they justify many of the horrifying things the Movement does to people and how they dodge the blame for the damage they cause.

  5. drdanfee
    drdanfee February 23, 2012 at 11:11 am |

    As I used to teach supervised graduate student counseling interns, DSM manual diagnoses are an attempt to be coherent about the link between Symptoms/Complaints/Life Difficulties and their classification. In the best scenarios we also get a potential cluster of probable leads into the personal history of the suffering person, since as the essay rightly points out, most significant depression doesn’t just spring from nowhere. How we slip up, escalate into making a DSM identification the summary of a whole suffering person, pretty much no holds barred? … is curious, sad, challenging, intellectually sloppy, emotionally tilted towards blaming the patient? … and for many professionals in USA mental health (perhaps), an ongoing vigilance. At their best, competent professional team members help one another to use all the technical/conceptual tools at our disposal while staying firmly rooted in the Hippocratic Oath (…’first of all, do no harm’ …), firmly rooted in our shared humanity and common human condition along with the patient.

  6. Li
    Li February 23, 2012 at 11:17 am |

    I’m just going to start off by acknowledging that a lot of my comments in these threads are likely to be fairly incoherent or slightly oblique in addressing the topics. So, like, if anyone has expectations of standard argument structure in my comments, feel free to um, not have them met? Brain woo and all that.

    A number of years ago, just before I started to develop my own crazy, a friend of mine suicided. She’d been fairly heavily involved in the university queer and feminist communities and so a bunch of us were drawn into a collective mourning process. Her family were conservative Christians from the Blue Mountains, and there was this underlying level of conflict between her family’s understanding of her suicide and my (and a few other friends’) own.

    My friend’s ongoing depression was for her family the causal factor in her death. Even among a lot of the activist community most people just treated her suicide as a result of her depression and “issues”.

    What was visible for me and the small group of other people I was mourning with, and this was underlined by the fact that I was editing one of her final pieces of writing at the time, was how her suicide wasn’t just part of a pattern of mental illness, but of the violence she faced constantly as a woman and a survivor of sexual violence. She’d first been assaulted by a family member as a child, then again a number of times as a teen an adult. Where other people saw madness, I couldn’t help but see the way sexual violence and systemic sexism had turned her imagination into a nightmare. Her writing was documenting the threads between her individual experiences of hurt and systemic sexism, the way that sexism within the activist community, even where it avoided physical or sexual violence, reinscribed trauma.

    I don’t think I’ve ever really accepted that her death was a result of mental illness. I think that sexism killed her. It killed her in failing to protect her from rape, it killed by her forcing her to cut bonds with her family to get away from her rapist, it killed her by ensuring that she couldn’t escape sexual violence, or catcalling, or people talking over her.

    No amount of mental health treatment or intervention would have stopped her from experiencing those things. If there’s a moment in my life when I couldn’t walk away from feminism and the need to be pro-feminist fully and strongly, it’s my friend’s death. Because until I personally engaged with my role in a system that produces profound trauma, that kills women, there was no point imagining that I could just provide emotional support and friendship to individual women within that system.

  7. drdanfee
    drdanfee February 23, 2012 at 11:19 am |

    Three important ethical lapses in exgay services are quite common. Informed consent hardly ever, if at all, allows a person considering the service or therapy to know in advance exactly how many former patients or consumers actually enrolled in that activity, for how long, and what precise or common sense outcomes were obtained across a range of positive to negative results, short-term and/or long-term.

    Ethics to guide experimental treatments strictly require that we:
    (1) monitor ongoing side effects – it is the clinician or treatment provider’s job to actively look for negative side effects, not mainly the patient or consumer’s responsibility;
    (2) categorically refrain from blaming the person when/if our experimental treatments fail; and
    (3) provide support, interventions, and follow ups to moderate or restore any detriments our treatment has helped cause.

    I know of no existing exgay program or therapist who adequately observes these three core ethical guidelines for experimental treatments.

    Outright or covert and somewhat subtle Blaming is alarmingly (and unethically) common when/if a patient or client or consumer fails an existing experimental exgay change protocol by:
    (A) not experiencing and naming same sex attractions as innately dirty, damaging, and/or dangerous; plus
    (B) not experiencing the self-neglect and/or repression of same sex related areas of inner sensory and emotional life and personhood as automatically positive, deeply ‘cleansing’ and humanly more substantively fulfilling of adult intimacy needs than a fully engaged, sexually committed pair bond could possibly ever be (again, per existing exgay protocols).

    Patient/consumer abandonment is so widespread that any ethical professional or lay person must be very wary of this thoughtless habit. If we are going to be guided by anecdotes, then we must ask why the exgay services never, ever address the individual reports that clearly suggest how exgay involvements happen to increase risk of suicide, in the short-term, and even in a very long-term frame, years after people have left such activities. We have new and old ways to adequately start studying potential PTSD-like effects of exgay services. Only a very blind group of self-appointed helpers and therapists could ignore how their work might contribute to negative stress outcomes.

    The wise caution about exgay programs, including various types of self-regarding reparative therapy? Still is: Buyer Beware. Alas. Lord have mercy. drdanfee

  8. CBrachyrhynchos
    CBrachyrhynchos February 23, 2012 at 11:30 am |

    I’m not convinced of it as a universal panacea. Engaging in mental dentistry about my complex relationships with grandparents, mixed expectations, premature responsibilities, and endemic school abuse doesn’t help me manage my moods from day to day beyond knowing what triggers to avoid.

    I might wake up on any given day filled with fear of nothing. And that fear colors the rest of my world. In extreme cases, that fear will create complete alternative realities to terrify me. Getting some critical distance from that fear is an essential survival strategy.

  9. anon for this one33
    anon for this one33 February 23, 2012 at 11:31 am |

    I wonder if one can extrapolate research on anorexia and bulimia out towards other forms of mental illness. From what I’ve read, it seems like many researchers now believe that the predisposition to have an eating disorder is genetic, but that individuals develop an eating disorder based on the issues that they encounter in their lives. I wonder if this is the same for all kinds of self-harm–if it’s the same for cutting, suicidal idealization, etc.–in which case it would seem clear to me that the most effective way to minimize suicide by high schoolers wouldn’t just be to increase access to mental health services but also to really enforce community standards about behavior. If we can presume that some people are built in such a way that they’re going to be really hurt by someone else’s lousy actions, why lay the fault at the hands of the person who’s hurt?

    I have to admit that I find the argument that someone is oppressed if they can’t make someone else’s life hell to be especially pernicious; obviously people can believe whatever they want, but claiming that having to follow basic standards of civility and politeness in schools (i.e., don’t like them? Keep it to yourself) is a governmental intrusion is really the worst.

  10. boredclerk
    boredclerk February 23, 2012 at 11:58 am |

    @ William, in the original post:

    Thank you for writing an excellent piece. I really enjoyed reading it.

    I especially agree with your analysis of the rhetoric of mental health. I agree that the phrase tends to remove whatever feelings and behaviors are classed as mental health problems from anyone’s control. You write that Carlson used the phrase to absolve the school district of responsibility for the suicides, and I think that’s an important point.

    You lost me, though when you talked about how the rhetoric of mental health shifted the locus of the problem to patient. My own experience of that rhetoric – as a patient with depression and suicide attempts/ideation – was actually the opposite. I felt that, by talking about a condition I “had” rather than what I was, the rhetoric of mental health actually removed the locus of my miserableness from inside of me. This made me feel worse about myself, like I was being afflicted by some outside force outside of my control. Eventually I chose instead to think of the deep sadness and hopelessness I was feeling as parts of me, or as aspects of my character. Once I started looking at it that way, I was able to accept that I was just a person whose character was just inclined to being really sad sometimes. In a way I can’t really articulate very well, this helped (and still helps) me get by a lot more than the disease model of mental illness ever did, precisely because it located the source of my feelings and behaviors as being within me.

    I recognize that my own situation was reaaaaally different from the young woman’s in that article, but I did want to point out that, at least for me, the rhetoric you’re pointing to actually served to take the problem away from me, rather than to locate within me as you write that does.

  11. Serenity
    Serenity February 23, 2012 at 12:14 pm |

    reading this reminded me of my own experience of being bullied while in middle school…and remembering my parents telling me not to “let it bother me”. Only when I burst out in tear in the middle of gym class (furthering my embarrassment because not only did I let it “get to me” but I let myself cry in front of everyone), did my teachers actually do something about the constant bullying, which only amounted to separating me from the bullies. They never got punished and I still had to see them every day between every class because my locker was right next to some of them. Just another example of our mess up view of bullying I suppose. Oh, and my parents knew I was being bullied and I guess knew I was depressed since I was crying myself to sleep every night, sometimes in my mom’s arms. yeah.

  12. CBrachyrhynchos
    CBrachyrhynchos February 23, 2012 at 12:23 pm |

    For example, because a fair chunk of my childhood was spent driving across the state of Indiana to care for dying relatives, my mind tends to run in that direction on long road trips late in the night when conversation is exhausted. I can work myself into a miserable funk of impotent anxiety, or I can be mindful of it, identify it for what it is, and move on.

  13. EG
    EG February 23, 2012 at 1:29 pm |

    It’s interesting to me to read how opposed boredclerk’s experience of conceiving of depression as an illness rather than part of character or essential identity, and just goes to show, I think, the importance of allowing for multiple paradigms.

    On that note, I’ve been thinking about this, the rhetoric of mental illness and the rhetoric of madness, and I’ve come to two thoughts that I think might contradict each other, but I’m not sure, so I’ll write them out and see.

    1) I wonder more and more about the efficacy of changing language to help effect social change. I do not mean to imply that language does not matter at all; I analyze literature for a living, so I’m pretty heavily invested in the importance of language. But more and more, I start to feel its limitations. I’m almost coming to think that language changes as a result of a paradigm shift in real-world power dynamics–it’s a result, not a cause.

    What I mean to wonder is this: the really fucked-up approach to suicide and misery highlighted by that article–I don’t really think it’s a result of the discourse of mental health. I mean, if you’re not a homophobic scumbag, it would pretty easy to draw a parallel to the long-term physical effects of torture. Certainly, those physical consequences need to be treated, but also, you need to stop torturing people, assholes. Or you could point out that a tendency to depression is a vulnerability (this is how I think of it, not how I feel everyone must), and that it is immoral to allow bullies to exploit that vulnerability, just as it would be immoral to allow bullies to take advantage of a fucked-up knee. It just seems like whatever discursive paradigm we were using to refer to people who suffer from depression and/or commit suicide, it would be manipulated by these scumbag assholes to provide cover for their inaction in the face of all this misery. I see what you’re saying about how the discourse of mental health fits into their inaction, but I do genuinely think they’d be able to use any other discourse as well, because their priority is not helping suffering kids or preventing suicide; it’s tormenting gay people.

    2) Perhaps opposed to all that, I am thinking about the inadequacies of representation in language and how they might be working here. I think you’re right, that we need multiple paradigms for understanding mental health/madness, not because all of them are right or wrong, but because not one of them is completely correct and will work for everybody, and I think that has to do with what gets lost when using words. Now, I happen to think that language is actually the very best, finest, and most precise tool we have for conveying meaning (but then, I’m a very verbal person–my friend the art historian may well disagree), but it’s far from perfect. There’s so much slippage in language, so much that it can’t convey, because representation of any kind is inherently different from the thing that’s being represented. If it weren’t, you wouldn’t be representing it; you’d just be presenting it.

    Most of the time, in most situations, language is good enough to get the job done and far more. But there are times when it is not, and so what we get is a series of shifting paradigms (oh my God, I have to stop using that word, even I’m getting sick of seeing it) that correct what came before, and meet the needs of the current situation better than the previous one did, but is not necessarily more accurate or less accurate, but just accurate in a different way, if that makes sense.

    I’m thinking about when the paradigm of mental health took hold, specifically in relation to suicide. I was recently researching suicide in Victorian England (what, doesn’t everybody?) and was reading about how the popularization of the mental health model was a real boon insofar as it replaced a religious model that considered despair and especially suicide as near-unforgivable sins, leaving the grieving family to picture their loved one suffering in hell for eternity (this attitude is not, obviously, entirely a thing of the past) because he or she had demonstrated a lack of faith in God (despair) or had taken God’s prerogative to end his or her own life. In the words of the parents of a friend I had when I was quite young who attempted suicide, she was “throwing God’s great gift of life back in his face.” (She did not find this a helpful mode of thought, surprisingly enough.)

    By introducing the mental health model, people were able to say, oh, she/he was sick and didn’t know/couldn’t control what she/he was doing; she/he wasn’t in her/his right mind and can’t be held responsible; she/he can still be buried in sacred ground with full rites, etc. I do think the shift from moral condemnation to medicalization is largely a positive one–at least for me, the last thing I need when I’m depressed is meta-depression (“I’m worthless, and I shouldn’t feel that way because it’s wicked to feel that way, which makes me even a worse person…”). But perhaps the medical model has simply outlived its usefulness for many people and we’re in another period of transition?

    Obviously, I don’t think it’s outlived its usefulness for everybody, or even most people, as so many are still stuck in the “moral condemnation” model (“What’s wrong with you? You need to just pull yourself together!”), and as it is the model that has freed me from so much suffering and self-recrimination. But I wonder what other paradigms we can develop.

  14. Syngen
    Syngen February 23, 2012 at 1:48 pm |

    When reading this post (and others about this terrible situation) I can’t help but be reminded of Jason Altom. Not many of you know who Jason Altom was. I will supply wikipedia and a new article:

    http://en.wikipedia.org/wiki/Jason_Altom

    http://www.nytimes.com/1998/11/29/magazine/lethal-chemistry-at-harvard.html

    Synopsis for those who don’t want to click through:

    Jason Altom worked for E. J. Corey (a nobel laureate) toward a PhD in chemistry at Harvard. He was working a really hard project. He was viewed to be very gifted and good natured. He killed himself and left a note that indicated an abusive relationship between student and advisor and that this was a systematic problem. Corey responded this way:

    “[T]hat letter doesn’t make sense. At the end, Jason must have been delusional or irrational in the extreme.”

    I’ve been through a PhD program myself. No matter how much Corey denies anything Altom said, everything that Altom had accused the system of rings true to most people in the same part of chemistry Corey (and I) specialized in. For a bit of background into what life was probably like for Altom by extrapolating my experience and what I know happens: 6 or 7 day work weeks are not uncommon. I don’t know what his vacation policy was but I had mandatory 6 day weeks (or 70 hours, whichever came first) and 12 vacation days a year plus 5 days that were major holiday/building maintenance. Graduate school lasts 5 years or so. My group had a practice of leaving the lights on when we left for the night so that it looks like someone is always working. There are also lots of rumors about things Corey’s students in particular used to do to make it look they they were always working, but I don’t deal in rumors. It is a very stressful environment. I would say that madness has become rampant. But, if you seek help, you are stigmatized and branded as weak. Plus, school resources for mental help are pretty paltry. And no one ever checks on the mental state of the advisors. Which someone should. If it weren’t career suicide to name names, I would. The worst part is that everyone in the community knows what’s going on and refuse to do anything about it. (the “I survived, why can’t you” mentality)

    I believe Jason Altom was also Corey’s third suicide in 10 years. In the program I went through, someone committed suicide the year before I started. Considering that there really aren’t that many PhD candidates in chemistry relative to the population of this country, or even the population of the high schools in this country, there are a lot of red flags madness-wise in my community. (By the way, I will also say that the way the community is organized, graduate students have zero power. The temperament of the advisor determines how the students are treated. If the students are lucky, there is a sympathetic dean. Otherwise, they are completely at the mercy of their advisor.)

    I guess this was the most roundabout way ever to say that some madness has a very direct cause. It’s pretty willful ignorance to think otherwise.

  15. jillian
    jillian February 23, 2012 at 3:06 pm |

    i’ll repeat roughly what i wrote when the RS article came out.

    The concern-trolling about “mental-health” by thehomophobic bullies is very similar to the concern-trolling of conservatives that abortion=depression, when usually, if a woman does have any serious emotional concerns before, during or after an abortion it’s because of the isolation, stigma and external damnation and negativity created and cultivated by the anti-choice crowd.

  16. armillaria
    armillaria February 23, 2012 at 3:40 pm |

    Insofar as the mental health system is a ruling class institution, it really has no incentive for distinguishing between suffering and disobedience.

  17. Sarah Harper
    Sarah Harper February 23, 2012 at 3:42 pm |

    William: thank you so much for posting this stuff. It means so much to know that among all the crap there are some therapists who actually see their patients as human beings.

    Feministe: thank you so much for having him as a guest blogger, and in general for calling out ableism. It means so much to find a space that’s not specifically devoted to the rights of those with mental health labels but nevertheless supports them.

  18. karak
    karak February 23, 2012 at 4:13 pm |

    I’m very wary about your understanding of mental health as a traumatic reaction.

    Some people develop mental disorders because of a specific trauma, like, say, being locked in the trunk of a car for a week by a madman. That would cause mental health issues in anyone.

    Others are very susceptible to envirnoment triggers–the death of a parent will trigger mourning in one person, a deep depressive episode with suicidal ideation in another.

    And some people have *nothing* wrong with them outside of the fucked-up chemistry in their brains. I had a client who literally woke up one day and had a schizophrenic break–full on psychosis with hallucinations, paranoia, delusions. His family had no idea what happened, he’d never been through any serious trauma, one day his body decided it wanted to do this and that was that.

    Just like heart attacks. Some people smoked for 45 years, eat bacon every day, and have a heart attack (and some, like my grandpa, live to 80 years old, doing that exact thing, no ill effects). Some people smoked on and off, ate okay, but still have a heart attack. And some people never smoke a day in their life, don’t drink, don’t go to bars, run 6 miles a day, and are devout Mormons (like my college professor) who had a massive heart attack and lost 40% of his heart and nearly dropped dead on my foreign term. No damn reason for it but pure bad luck and genetics.

    I believe in the use of coping mechanism, and therapy. I believe people who are abused are vulnerable to mental health issues, and people with mental health issues are vulnerable to abuse. But I also believe that many, many issues, especially schizophrenia, major depressive disorder, and manic depression are largely to do with malfunctions of the brain, and only medication has a chance of helping these people.

  19. Rob in CT
    Rob in CT February 23, 2012 at 4:16 pm |

    A small thought about bullying (I have nothing smart to say about mental health in general):

    Oddly enough, one of the things I feared most was that my parents would try to help. I thought it would make the bullying worse. I was mortified when my father boarded the school bus to give a bullier a verbal lashing. Mortified.

    But you know what? I can’t remember that kid ever bothering me again. Others did, though the worst was actually a “friend” of mine. It took me some time to fully realize he was no friend at all, and act accordingly. Around that time (end of middle school), things started looking up for me. Highschool ended up being much better (though still, well, highschool).

    When I read these stories, I so often see “non-supportive family” or active abuse from the family. My middle-school experience was hellish even with a loving, supportive family (and I’m also straight, white & male. I was tormented for mundane things like being small, weak and nerdy). How much worse would it have been if my family was otherwise? Would I have “gone mad?”

  20. sprout
    sprout February 23, 2012 at 4:55 pm |

    Thanks for this post – it has given me a lot to think about. I currently work in the mental/behavioral health field, in a group home for teenage girls who have histories of physical, sexual, and substance abuse. These girls, more often than not, have diagnosable “mental health” issues that are intertwined with their abusive pasts. We do spend a lot of time and effort dealing with their past traumas and how they have affected their current mental and behavioral issues, but we also do diagnose and treat specific mental illnesses as mental illnesses. I guess what I’m trying to say is that this is a new perspective and I’ll have to give the issues you raise some thought as I interact with the girls over the next few days. Again, thanks for the post.

  21. Jane
    Jane February 23, 2012 at 5:11 pm |

    @ Syngen:

    Hoooooly shit. I was interested in this thread on various (rather academic) levels, but your comment made it suddenly click with my personal experience.

    In short: I went to MIT for my undergraduate degree, and I still bear a lot of shame due to the fact that the environment there fucked. me. up. Sure, in some ways the constant challenge was good, but the expectation of working all the time, not sleeping until you cannot stand up any longer and not staying asleep any longer than one or two sleep cycles, and constantly comparing yourself to the best of your classmates — oh laws. If I tried to conform to expectations, it made me sick (lack of sleep makes me particularly unwell.) If I couldn’t handle the expectations, I felt ashamed and wanted to hide. The idea of “rampant madness” is one I became really familiar with — of my living group of 20 people, I would bet one-half of us had to seek counseling at some point.

    MIT has vastly widened their mental health support network in recent years (due, probably, to a string of suicides in the late 90s), but what always frustrated the hell out of me was that it always felt like the emphasis was on preventing that last final choice, rather than trying to prevent students from getting to the place where that’s what they’re considering. They have made some institutional changes (like making failing grades in the first year disappear), but largely it still seems like so long as they can keep you alive all four years, they don’t care if you’ve been screwed up otherwise, because hey, some people can hack it, right? Some people come out totally fine and not doubting every choice they make for years afterward! It’s hard for me not to be a little cynical about the fact that at least one of my classmates died (usually in questionable circumstances) every year I was there, while when I talk to a friend who went to another school of similar size but different focus, she doesn’t remember any students dying while she was there.

    I still feel guilty about describing myself as having gone through a depression while MIT, because it was definitely brought on by not being able to cope with everything I had to do. I’m not sure if I have the sort of chemical imbalance that would mean my depression was . . . a natural state? A “real” disease? It feels like I’m putting it on, in other words, because maybe in a different environment it wouldn’t have happened, or because other people in the same environment didn’t have the same problem (though many, many did and do.)

    So . . . yeah. Not sure how this applies to a wider scope, except that having unrealistic expectations and demanding that people conform to them results in some people rising to great heights and others simply giving up. I’m not sure the latter is worth the former, or rather, I wonder if there’s a way to achieve the former without also causing the latter.

  22. boredclerk
    boredclerk February 23, 2012 at 6:32 pm |

    @ William, #22

    Boredclerk:
    I certainly don’t mean to suggest that my readings of rhetoric are the end all. My own experiences have lead me to the opinions I wrote about, as have the experiences of the kinds of clients I have worked with, but I’m a big believer in whatever works. If the rhetoric of mental health helped you to externalize your experience…great! This is part of why I wanted this discussion. I know its provocative and I know a lot of people will have had different experiences. Learning about other points of view helps me flesh out my own and is likely to help me translate what I’m thinking into an interpretation which a patient might be able to make use of.

    Just wanted to clarify – the I did better when I rejected the rhetoric of mental health and internalized my sadness and suicidal thoughts by thinking of them as intrinsic parts of my character rather than outside afflictions. I appreciate how willing you are to entertain other points of view on this, though!

  23. anon
    anon February 23, 2012 at 6:56 pm |

    This was uncomfortable. I’ve been depressed all my life, I’ve spent years in severe depression where I’d given up going to doctors because they just gave me pills that didn’t work, and I’d given up going to counsellors because it made no difference and I didn’t have the motivation to get out of the house and go to counseling, and just kept hoping tomorrow would be better and that tomorrow I’d be able to leave the house and do anything more with my day than sit on the Internet and then leave the house at ten pm to buy food.

    And I’ve been able to connect that intellectually with some patterns of low-level and unintentional but persistent emotional abuse from my parents, and with all the consequences that emerged from the social anxiety and depressive symptoms I had as a child and adolescent going untreated and ignored till I became an adult without any ability or motivation to function in the world.

    But at the same time I’ve always put it down to something wrong with me. I didn’t want to really think about the ways in which unintentional ill treatment from people who really did love me might have created the depression as a kind of injury, and how being forced and guilt-tripped to go to school without emotional support when the ways in which I was already injured made it impossible to cope successfully a school environment made everything 100x worse. Because for my own health I didn’t want to be bitter and blame people, and also because when I finally found something that did work for me a lot of emphasis was put on personal responsibility, and finding the ways in which I had chosen the “illness.”

    I did know that an illness paradigm didn’t work for me. And you haven’t used this precise word, but your post is making me think of it as an “injury” instead. Which I think is working for me, much better than “illness” or “character flaw” or “whatever the fuck it is that’s wrong with me” or sometimes “problem? What problem? I can force myself to do absolutely anything, just like everyone else!” ever could.

    I have actually about 70% recovered from this longstanding, severe injury that was persistently aggravated over many years of my life, and I’ve learned to loosen up and fall better so I won’t get injured in the same way in future, and maybe I’ll always walk with a limp, or maybe only just in cold weather. Thinking about it like this works for me. Thank you. But the problem I had with it at first, and the reason it made me uncomfortable, is what you articulated: owning it as an injury means acknowledging that it’s not that there’s something wrong with me; it’s that my upbringing injured me, and that (in my case) people I love and care about injured me.

  24. victoria
    victoria February 23, 2012 at 7:47 pm |

    It almost seems like the system is built to stop her symptoms from bothering others, rather than to stop them from bothering her, doesn’t it?

    this. a thousand times, this. so often treatment (at least in my experience) has been focused on the fastest, most cost-effective ways to return me or people i care about to a “proper” level of functioning in the world, back to a full time job, back to school, back to acting in a way that does not make others uncomfortable. it’s not about us finding health and well-being, it’s about us not causing others inconvenience.

  25. Iris
    Iris February 23, 2012 at 9:24 pm |

    These are an interesting couple of posts and, William, I always enjoy your framing of arguments.

    I was threatened with being locked up in a mental hospital often from a young age. It was used to keep me in line.
    I am a truth teller (I can’t help pointing out the emperor has no clothes) and it caused discomfort in my family.

    At 16, I was sent for evaluation to a psychiatrist who made me strip and sexually assaulted me. (The reason for the evaluation is a complicated backstory – suffice to say my mother was doing her best to manipulate me into taking care of her and supporting her financially.) He then pronounced me manic depressive. Subsequent encounters with therapists were not so overtly violent, but I could never stop myself from splitting the word therapist in two after that.

    It has taken me decades to arrive at mental health. I define my own mental health as being free from obssessing over and over on something and honestly valuing my own opinion of myself over the opinions of others. I had to arrive at the conclusion that only I knew what was best for me. And then, I had to put that into practice by unconditionally trusting myself.

    I agree the mental health label is used to make other people feel better. I don’t see how it could do anything else as its roots are mired in Freud’s desires to adjust people into their proper places in society. To the best of my knowledge, therapy doesn’t change society to fit sane people.

  26. Iris
    Iris February 23, 2012 at 11:23 pm |

    @William:

    My apologies for offending you with my comment. No doubt you have a deeper and more complex understanding of the man & the industry than I do. I only speak from my own lens of viewing – I see that I was less than tactful. Thank you for a different perspective.

  27. 10G
    10G February 24, 2012 at 12:58 am |

    “Stop torturing people, assholes”–me like!!! Again, I would LOVE to know the psychology behind bullies and how we make these fucktards STOP. It’s not JUST the fucking poor parenting, although that sure is a contributing factor. And nope, not just a “rite of passage”…whomever thought THAT one up needs more medication than I do.

  28. K
    K February 24, 2012 at 1:11 am |

    This is a fascinating topic for me, because I believe my madness has both biological roots and experiential trauma roots. I have a family history of severe depression, but I also experienced childhood abuse and suffered deeply during college (as an engineering major at a prestigious institution in Boston…). My genetics made me vulnerable, the self-image and assumptions about the world I developed as a result of my childhood made me susceptible, but the unrelenting stress of my four years of college is what triggered and then cemented my depression and anxiety.

    As far as the RS article, I found the comments about “mental health” grimly laughable. Of course they had problems with mental health-you deliberately abused them and that results in problems with mental health! But in general I think the divide between focusing on symptoms and focusing on causes is more complex.

    In my experience, even good mental health treatment tends to focus on symptoms because that is often the most effective way to reduce a patient’s suffering. It has been very helpful for me to understand the root causes of my madness, but that alone did not relieve my symptoms. Because the brain forms strong chemical habits, I still have to work hard to combat my symptoms even when I understand why I developed them.

    If you are a doctor treating a specific patient, I understand why you might not be strongly focused on causes. But who then is responsible for tracing the causes and working to prevent other people from getting sick? Eliminating the social causes of madness falls in the realm of prevention, but we don’t do preventive care for the mind. I wish we did-I really needed it.

    Occupational medicine practitioners look at occupational causes of illness. Seems like we need occupational mental health providers.

  29. librarygoose
    librarygoose February 24, 2012 at 3:25 am |

    I recently had my idea of what “mental health” was challenged. My mom was talking to me, and she told me, “I think you should see someone about your anxiety and depression.” Which was a shock, because I was fine. I told her so. She said, “Okay, but I remember you happy…you haven’t been lately.” It fucking shook me. Because I haven’t been. Not really. I’m just…existing. But what gets me is, with out someone challenging it, it was happy to me. Well, not happy, but what is normal. I think it goes back to when I tried living on campus in college, I started having anxiety attacks. But I wonder, ’cause I am having trouble gauging whether or not I do need help. I dunno. But it has made reevaluate my thoughts on my own “mental health”.

  30. John
    John February 24, 2012 at 5:26 am |

    Fascinating blog, thanks to everyone who has contributed.
    I am not gay, but I was badly bullied at school in England from the age of 11 till 16 for being “different”. The mental effect was enormous and I have suffered from depression on and off ever since. I understand how awful it is and why some people are driven to suicide. “Zero tolerance” policies in schools are usually bullshit. They are a box-ticking exercise to show Child Protection, not a reality.
    My daughter, now 15 has had to face school bullying, including ostracism and being called “a slut” by other girls (some who call themselves Christian and go to Church twice on Sundays) for having a boyfriend. She is not in fact sexually active, (not that it’s necessarily any of my business, but the stress made her severely unwell last year and she wanted me present during the Q&A part of her medical examination in hospital and that was one of the answers she gave). Her class teacher even blamed her for being bullied, saying she brought it on herself. Where do these pillocks come from?

    Don’t let the bastards get away with it!

  31. EG
    EG February 24, 2012 at 8:16 am |

    Again, I would LOVE to know the psychology behind bullies and how we make these fucktards STOP.

    I’ve got nothing to back this up with but personal experience, but I do think the key is starting young, at the age when children are very much seeking approval from the adults around them, parents, teachers, everybody else, and then active intervention from the adults around them not just explaining how bad they’re making the other person feel, but expressing real disappointment in and disapproval of them. I bullied somebody for one day in kindergarten, and I remember exactly how I felt when our teacher took me aside and made her feelings about this situation clear. And yes, the empathy with the girl I was bullying was important, but what I remember even more clearly is realizing that my teacher was disappointed in me and thought I had done something terrible, and feeling just awful about that.

  32. EG
    EG February 24, 2012 at 8:26 am |

    It is in these kinds of settings (schools and families not dominated by vicious theocrats, hospitals, drop in clinics, long term residential facilities, the academy, etc) that I think working with language can really change perceptions and outcomes.

    I hope so. I hope you’re right. Certainly if those places are full of people who are trying to help, not hurt (ideally), then a reconsideration of language can at least bring the issues you’re talking about to the forefront of people’s minds.

    Your thoughts on how the mental health model effected perceptions of suicide in victorian Englad are fascinating. Have you read Foucault’s History of Madness or his lecture series Abnormal”? I think they’d be right up your alley.

    You know, I haven’t. In grad school I read Discipline and Punish and History of Sexuality and I hated them both so much that I never looked at another Foucault book (I can go into detail about why I hated them, but it would be way OT). But your recommendation makes me think I should give those a look. I know my uncle, who is a therapist, finds his work very significant to how he works, so that’s two people whose opinions I trust.

  33. Angie unduplicated
    Angie unduplicated February 24, 2012 at 9:09 am |

    I watched my family train a bully, on me. Their rationale was that she needed to learn to dominate people to get what she wanted.
    The school system defined the suicides as mental illness to defend themselves against potential and/or ongoing litigation. Our tiny town had a highly publicized bullying suicide case where the vic was an Aspergers patient targeted as gay by bullies. Investigation revealed that his sister bullied and cooperated with the bullies.
    This is an extended family which includes an insurance agent, and I suspect that the siblings were set up to harvest a life insurance payout and to rid the family of a medical expens, mid-Recession. Never underestimate fraudsters. My take on Atoka-Hennepin is similar: well-placed pol and friends drum up clinic business believing that GOP candidacy is the immunity idol. Sorry I couldn’t be academic, but my experiences with and around hillbilly criminal families give me an outsider’s perspective.

  34. Alara Rogers
    Alara Rogers February 24, 2012 at 9:46 am |

    I find the comments about mental illness and locus of control very interesting.

    I was bullied as a child and teenager. My parents were very supportive, going so far as to remove me from the school when the school refused to do anything about it, but at the same time, my mother at least engaged in some degree of blaming me, because the proximate cause of the bullying was that I was “weird” and she thought if I could just learn to behave like other people, they’d leave me alone. (As it turns out, I probably have Asperger’s, but because I was a child prodigy who did amazingly well in pretty much every academic subject ever, no one noticed. Also, not sure the diagnosis existed then… I’m in my forties.)

    However, I was not depressed as a child. I had my first bout with depression in grad school, where I was not being overworked (but I was getting fucked in the head by the fact that we were doing animal research and I had convinced myself that I was too strong and tough to be bothered by animal research, so I couldn’t figure it out). The problem didn’t occur again until 1999, when I was under enormous personal stress, had a horrible commute, and was on the wrong birth control pills. So I came to understand depression as something that happens to me as a response to certain types of stress, not something within me.

    Since then… I’ve had to acknowledge that it’s become a full-blown, more or less chronic disorder and if I don’t take meds, I lose all will to do anything whatsoever. But I still perceive it as “not me”. Taking my meds makes me back into me; who I am when I’m not on meds is not who I am. I have almost entirely externalized my problem, because I’m very, very comfortable with medicalizing the human brain (my studies in grad school were psychobiology). It’s really easy and comforting for me to say “this isn’t me, this is just being caused by a quirk of brain chemistry, all I have to do is take a pill and it will go away.”

    But it’s gotten worse as I get older, and I’ve had to increase my dosage, and sometimes it doesn’t work, and I’m starting to wonder if the stress in my life is causing the depression to be chronic because it never goes away, and if maybe the fact that I’ve totally medicalized it and am just taking a pill to fix it is preventing me from seeing what I could do to *change* my life so it stops happening. So, you know, I’ve got my model and it’s very comforting to me, it’s nice and friendly and non-judgemental, I have a disease and I take pills for it and that’s all… but is that getting in the way of curing, or ameliorating, the disease? I *know* I’m just treating symptoms, but antihistamines just treat the symptoms of your allergies and yet when you are allergic to dust and cleaning your house it’s not like you can avoid allergens, so antihistamines are needed. For that matter, insulin for diabetics just treats the symptom of “pancreas doesn’t work right”. We don’t really have a lot of models for literally curing chronic illnesses.

    (For that matter, recognizing that I probably have Asperger’s has made me much less anxious and improved my self-esteem, because I recognize that I am not an emotional cripple, I just don’t recognize or demonstrate emotions in the same way everyone else does. But now I feel resentful when people try to demand that I behave in ways that are difficult for me, like demonstrating emotional support for a person with a problem rather than trying to fix their problem, because now I feel like saying “I have a disability! I can’t do that!”… whereas in the past I’d *try*. And fail, and feel like shit about myself because I’d failed, but at least I’d try. So in some ways maybe I am behaving in a less adaptive-to-real-world way now that I know it’s a known medical problem that’s causing my issues and not just a general failure on my part?)

    So I feel like, from personal experience, even if the person *with* the problem is happy with saying “It’s not me, it’s not things that are happening to me, it’s just a mental illness!”, that that can be problematic. Obviously if someone *else* is saying it, while the person with the problem is saying “I’m miserable because your school is making me miserable” and the someone else is saying “You’re mentally ill, it’s your problem”, that becomes infinitely worse. But you can actually be someone who is helped to feel better by the external locus provided by “it’s a mental illness” (and I do feel like, though William’s point is valid for some, that a *lot* of people perceive “it’s a mental illness” as an external locus of control), and still it can cause you problems.

  35. Angie unduplicated
    Angie unduplicated February 24, 2012 at 10:53 am |

    @10g and John-I want a bumper sticker that says “Stop schooland workplace terrorism”. Bullies are, in a very real sense, terrorists, and anti-terrorism is popular enough to garner interest from the general public. Couple this with “Stop relationship terrorism” and someone has two superb fundraisers or Etsy ideas.

  36. EG
    EG February 24, 2012 at 12:27 pm |

    Most of my problems are with History of Sexuality, and they pertain mainly to two issues, his lack of historical accuracy and his complete erasure of female sexuality as well as sexual abuse from his “history.”

    The first is pretty simple: my memory is that he cites Victorian England as an example of the scientific approach to sex as opposed to earlier methods, and he says that confession is a major reason for this transition. But by the time Victoria took the throne, Britain had been Protestant for 300 years, with some pretty serious anti-Catholic laws, so confession had not been a thing for quite some time.

    And he completely erases female sexuality from his book. I think he does so because if he did not, he would have to acknowledge that indeed there had been major shifts involving some pretty serious repression of sexuality of the sort he tries to deny in the book, that during the middle ages and the Renaissance, it was widely known that women had much stronger appetites for sex than men (it was part of what made us inferior), but by the nineteenth century, of course, the “normal” woman was supposedly inherently above all that base sort of thing. He never once discusses this major shift in attitude.

    There is a particularly chilling passage early in the book where he describes how in 17th-century France, a “simple-minded” young man was taken into custody for molesting a young girl–I think she was six (I’m not at home, so I can’t check my copy of the book). He waxes eloquent about how unjust it was to take this fellow into custody merely because he had paid with a few pennies for what her older sisters would not give him for free (while I can’t recall the exact quotation, this is close to the language used). What’s wrong with a bit of harmless fun, after all? Of course, he completely erases the experience of the girl involved, so much so that he can’t be bothered to tell us how the authorities discovered this event–did she run home crying? Did she tell her parents? It’s not even worth considering, in Foucault’s estimation. Later on, he includes “[sexually] precocious little girls” with “brutal husbands” on a list of sexual deviants. First of all, I highly object to putting girls who develop an early interest in sex on the same list with men who brutalize their wives, and second of all, given the earlier episode, I wouldn’t trust Foucault to know a sexually precocious little girl from a victim of sexual abuse if he tripped across one.

    There’s also the fact that he enacts in the book the very dynamic he heaps scorn on–the writers who claim that they will liberate us from prior sexual ignorance.

    Discipline and Punish, I mostly hated the writing style, though I also recall objecting to the sharp division he makes between spectacle societies and surveillance societies. Cultures were one or the other, and I just didn’t think that was a nuanced enough approach.

  37. Cécile
    Cécile February 24, 2012 at 1:11 pm |

    William, this post, too, is so powerful. I am about to read everyone’s comments, but for now, I have two words:

    BRADLEY. MANNING.

    The position his defense lawyers are pleading is absolutely ludicrous to me. And baffling. And tragic.

  38. firelizard19
    firelizard19 February 24, 2012 at 1:24 pm |

    I haven’t exhaustively read this thread, and I am in a privileged class- white, cisgendered, straight, upper-middle-class upbringing woman. But I do feel that it’s important to share that there *are* plenty of positive experiences with mental health care, and there are healthy ways to approach and educate society about how to understand mental health.

    I have ADHD, a slow processing speed, and clinical depression. I take medications and see a therapist to allow me to compete and succeed in the modern world and manage my triggers and overall life to hold down a job and apply to schools, etc. I have been very lucky in that my parents fought hard for me while I was in school against teachers who didn’t understand that my brain chemistry was a little different and required some accommodations like extended test time- and who *especially* didn’t understand that I could be all these things and be gifted at the same time, and want to challenge myself in AP courses etc.

    Therapy saved my life- I had suicidal ideation in college, and I learned positive coping mechanisms and was put on medication. I may not have survived without these. I never felt stigmatized or labeled for my depression, only relief that I could get treatment. And my treatment involved *plenty* of discussion of the causes of my depression- it really can’t succeed without addressing these. The problem is the limitations inherent in addressing the causes of depression and suicide in the case of school bullying- after all, the psychologists are limited by confidentiality and can’t directly refute incorrect assumptions about why these teens are depressed and suicidal. The community has to act, including the parents.

    I suppose my point is that mental health care is less to blame for these problems than larger society’s stigmatization and lack of understanding of mental health issues, and the tendency to argue backwards from the conclusion you want, so that all evidence presented supports it, even the most shocking possible evidence.

    I do my part to educate the general public about mental health by being open with my friends about my conditions, and frank with them about what they mean in layman’s terms and how I handle them. I feel that understanding minor mental health conditions like mine helps them understand better all the issues surrounding mental health, as well as it being similar to “coming out”- in that, if you know you know someone who has mental illness, you won’t find it so strange or abnormal.

  39. Iris
    Iris February 24, 2012 at 5:13 pm |

    @William:

    Oh. Well then, never mind.

  40. j.
    j. February 24, 2012 at 8:01 pm |

    William, your posts and comments have been terrific.

    I have a question about the intersection of extremists political beliefs and mental health nomenclature. I’m not speaking so much of people flippantly using terms like “crazy” to describe someone in, say, the Christian Identity movement as I am of people who think that, perhaps, some future edition of the DSM or whatever eventually replaces it will cover political extremism, maybe on an axis we have yet to conceive of.

    On the one hand, there is a truly sordid history of governments conflating dissent with madness. We don’t want to go there, not only because a right-wing government could turn the tables on us.

    On the other, science seems to be whittling away at the concept of “free will,” bit by bit, and studies have repeatedly come out hinting at various deficits of cognition, imagination, etc. among conservatives.

    I don’t have a specifically worded question to that end, but I was wondering if you wouldn’t mind giving your thoughts on this subject. Thanks.

  41. EG
    EG February 24, 2012 at 9:48 pm |

    Yes, lots of really smart people do find Foucault’s work generative, and I wouldn’t want to take that way (I find what Angela Carter did with the panopticon in Nights at the Circus far and away more interesting than what Foucault had to say about it, but would Carter have even been thinking about it if Foucault had not published?). But I just cannot get past what to my mind is the blindness of male privilege in pronouncing the history of male sexuality to be the history of sexuality itself.

    I think your analysis of Foucault’s intentions in including sexually precocious girls on the same list as abusive husbands is generous, very generous–I think, actually, it speaks volumes to your own analytical strength and understanding. I’m just not at all convinced, given the episode I mentioned above and Foucault’s erasure of female sexuality in general, that Foucault has that same strength and understanding. Did/does Foucault understand that girls who demonstrate sexual interest at an unusually young age have often been victims of sexual abuse? Given that he didn’t even see fit to consider the abusive possibilities of a grown man, even a “simple-minded” one having some kind of sexual relations with a little girl, I just don’t trust him to have understood what sexual abuse is, much less its victims process it.

    I think what I’m saying is that I trust you on these issues a lot more than I trust Foucault, and perhaps that I suspect you are projecting your own level of understanding onto a writer who didn’t have it.

    Leaving that aside, I think the issue with me and Foucault is this: Foucault likes to make grand, startling, sweeping, general pronouncements about cultural trends across large swathes of time. Doing so is important–it can trigger paradigm shifts, etc. But it will always necessitate at least some basic inaccuracies, inconsistencies, and lack of nuance, and I just hate that. I prefer detailed, historically reliable analyses of one small thing to large theories that gloss over inconsistencies, even when those large theories are revolutionary and can transform our mode of thinking in a necessary way. I suspect that even if he did acknowledge women, Foucault’s work would be uncongenial to me because of that basic difference in scholarly approach. Does that make sense?

  42. EG
    EG February 26, 2012 at 9:44 am |

    Oh, I absolutely understand about finding work personally and professionally meaningful and valuable despite its flaws (ask me about Nancy Chodorow’s work on mothering!). And in my opinion, both kinds of scholar(ship) and thinking are necessary to advance understanding: we need the people who make grand, sweeping pronouncements and generalizations, because they shift our understanding in dramatic ways, providing new perspectives and usually confronting entrenched assumptions; and we need the people who look closely at the details and suchlike, because they can increase our understanding of the complexity and nuances of whatever discipline they’re working in. So while I personally can’t stand Foucault, I think that’s because we’re just essentially two different types of thinker, but not that one type is more valuable than the other. It’s kind of a dialectic, to my mind.

  43. firelizard19
    firelizard19 February 26, 2012 at 7:08 pm |

    Gosh- I guess the thread just died before I posted, really. I’d love to hear a response to my contention that therapy etc. can have positive outcomes and positive goals, and even deal with the causes of mental illness.

    I feel a little sick- like I bared my soul but nobody was listening…

  44. EG
    EG February 26, 2012 at 8:34 pm |

    I’d love to hear a response to my contention that therapy etc. can have positive outcomes and positive goals, and even deal with the causes of mental illness.

    I feel a little sick- like I bared my soul but nobody was listening…

    I suspect this is because, as you said, you hadn’t read the whole thread, and there is a context. I don’t think anybody here said that therapy has no positive outcomes or goals and can’t deal with the causes of mental illness–certainly not William, who is a psychodynamic therapist. If you read his earlier post, you’ll see he comes down strongly in favor of therapy as a means of helping people with what I would call mental illness and he would call madness achieve a variety of goals–coping with symptoms, getting rid of symptoms, living with symptoms, dealing with marginalization and devaluation. Also, in that thread, I posted a ten-billion-word comment about how the mental illness paradigm has helped me immensely.

    This post is pursuant to that one, and is specifically about how the mental illness can and has failed many people. So that’s what the thread has been about.

  45. EG
    EG February 26, 2012 at 8:35 pm |

    “how the mental illness paradigm can and has failed many people,” I mean.

  46. firelizard19
    firelizard19 February 27, 2012 at 10:21 pm |

    Got it- thanks for the clarification., both of you.

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