This is a guest post by William. William is a psychodynamic psychotherapist currently working in an educational setting in Chicago, and a regular commenter at Feministe. The first post in his guest-posting series on madness is here.
This post was originally going to be about the problems with psychological diagnosis. I’d had a nice plan to outline the diagnostic criteria for Borderline Personality Disorder and do some nice, sterile, academic radical critique.
Then I read One Town’s War on Gay Teens (if you haven’t read it already…brace yourself and do it). Its a brutal read, to be sure, but beyond the rage and incredible sadness there are two passages which I think are worthy of unpacking and will better address what I was aiming at with my comfortable critique of how we diagnose madness.
If the article is too long or too heartbreaking for you, the summary is that years of anti-gay bullying, teachers afraid to confront students for calling other students faggots because of a policy against supporting “gay lifestyles,” and a school district too cowardly to confront Evangelical political interests lead to a rash of teen suicides in Minnesota. Whats this got to do with madness and diagnosis? Well, as it turns out, the story includes two very good illustrations of the ways in which certain assumptions about madness serve to privilege certain interpretations of an event.
In the thick of it, the school’s superintendent tries to deflect some of the criticism coming his way:
The school district insists it has been portrayed unfairly. Superintendent Carlson points out it has been working hard to address the mental-health [theres that dangerous word -William] needs of its students by hiring more counselors and staff…”We understand that gay kids are bullied and harassed on a daily basis,” and that that can lead to suicide, Carlson says. “But that was not the case here. If you’re looking for a cause, look in the area of mental health…”
Lets get down to the language here, shall we? Superintendent Carlson invokes the phrase “mental health” to absolve himself and his staff from responsibility. He explicitly makes the connection between madness and abnormality. After all, normal people don’t commit suicide, right? That’s part of how psychologists determine if someone is healthy: do you pose an immanent threat of harm to yourself or others? “Mental health” is here being used as a rhetorical tool to shift responsibility for a suicide from the school district to a dead child. Stop for a moment and think about that, really let it sink in. By using “mental health” as a framework Carlson is attempting to avoid the question of bullying by placing the pathology inside of the students who commit suicide rather than inside of the school which allowed children to be driven to suicide because of their sexuality.
Done vomiting? Its ok, I’ll wait.
The dodge of “mental health” goes deeper than just one coward trying to avoid blame. When children kill themselves, people want answers. “Mental health” comes to the rescue because it is an ambiguous term. It offers anyone the ability to read in their prejudices and transform an individual tragedy into a sterile policy narrative.
For the people looking at the case who believe that homosexuality is a sin to be repudiated it provides a subtle dog whistle. After all, these suicides happened in Michele Bachmann’s district and Evangelical Christians have been abusing psychology to do “conversion therapy” (treating the gay out which, incidentally, is considered unethical by the American Psychological Association). Bachmann’s husband made quite a lot of money doing faith-based conversion therapy (although I’m sure he did it for god and doesn’t feel like a welfare queen for taking gubmint money to do it). When the Evangelicals in the community hear “mental health” they are able to hear “the gay lifestyle makes people kill themselves, just like our pamphlets say.”
For the people who just want something to make themselves feel less culpable for a culture that hounded children to suicide “mental health” is also a convenient term. By linking suicides to madness and madness to the concept of “health” once can think of suicide as something that “just happens” like cancer or an aneurism. Its sad, yes, but poor health is the great equalizer and everyone has their time. You wouldn’t blame a principle if a student with an undiagnosed heart problem had a heart attack and died one day, would you? Its not because we’re cowards, see? Its because these children were sick!
For those looking for something to do, Superintendent Carlson offers a bit of meat as well with his use of “mental health.” He works “hard to address [student] needs and is hiring more counselors.” Because what we’re looking at is a “mental health” problem we can use public health concepts and social services to address is. The Great Society can step in and offer increased services to these children, this tragedy happened because we didn’t spend enough money. Lemonade out of lemons, I suppose.
Almost anyone can hear something they want in “mental health,” but at the same time the words all but foreclose the possibility that preventable trauma pushed otherwise well-adjusted and developmentally normal children to suicide. By using a phrase like “mental health” we allow ourselves to think about these issues in the context of broad ideas, rather than specific victims in need of specific remedies.
In short, “mental health” (and it’s flipside, “mental illness”) allows us to avoid engaging with experiences like this:
”They said I had anger, depression, suicidal ideation, anxiety, an eating disorder,” she recites, speaking of the month she spent at a psychiatric hospital last year, at the end of eighth grade. “Mentally being degraded like that, I translated that to ‘I don’t deserve to be happy,’” she says, barely holding back tears, as both parents look on with wet eyes. “Like I deserved the punishment – I’ve been earning the punishment I’ve been getting.”
She’s fighting hard to rebuild her decimated sense of self. It’s a far darker self than before, a guarded, distant teenager who bears little resemblance to the openhearted young girl she was not long ago.
The way in which what this young woman experienced is related tells us a great deal about the diagnostic framework in which she exists and the systems of power to which she has been subjected; it tells us about how her madness is perceived, understood, and treated. She “has anger, depression, suicidal ideation, anxiety, an eating disorder.” For her these things are part of her life, but diagnostically they discrete are symptoms and syndromes which are understood to exist inside of her, the same way one might have fluid in their lungs or a break in a bone. A month in a psychiatric hospital is designed to give doctors enough time to observe symptoms, issue a diagnosis, plan treatment, and deploy that treatment until its safe for the patient to go home. Functionally, the process is not dissimilar from going into a doctor with a sore throat, going over some symptoms, and walking out with a diagnosis of Strep Throat and a prescription for antibiotics.
The problem, of course, is that someone doesn’t share a soda and catch an eating disorder from a friend. While depression can sometimes be genetic, generally you’ll find that people with severe depression and suicidal ideation have things to be quite sad about. By looking at these symptoms as manifestations of discrete syndromes which are generally universal from patient to patient, and by defining them from their presentations rather than their causes, we dictate specific ways in which we will understand and interact with madness. We silence victims, we render their histories and the things which lead to them seeking treatment irrelevant, we transform them from people to diagnostic categories.
How does “mental health” lead us to understand and interact with madness? One need look no further than medicine. If you have a broken leg you get it fixed, if your appendix bursts you remove it, if you bump your elbow and it swells you take an aspirin. In medicine we fix symptoms and return people to normal. A doctor isn’t going to throw salt on your porch if you slip on ice and break your tailbone, the where of your illness is only relevant so far as it related to the specific contours of your deviation from the norm.
By focusing on symptoms, on fixing people, “mental health” leads us to attend to the needs of society rather than of patients. Stop the suicide attempts, make the girl eat, reduce explosive outbursts, get back to normal. The patient quoted above identifies this as degrading and, frankly, she is right. Her friends died and no one did anything about it. She knew that they died because people hated them, because they couldn’t take the abuse anymore, and so she alters her eating patterns in an attempt to be good enough for people to treat her like a human being. She is angry and confused and in mourning and all people want to talk about is what is wrong with her. Of course she would internalize judgements and feel she deserved what she got because the identifications of her symptoms were located within her. She is depressed. She is angry. She has suicidal ideation. Nowhere is there an understanding of the things which caused these symptoms to manifest.
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?