Mental Health Stigma and Social Power

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James Goldman

Bisexual, left-wing, intersectional feminist philosopher and general bookish type.

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Editor’s Note: The following article contains discussion that may be difficult for some folks to read including references to sexual assault, suicide, and slavery. There is no graphic content ahead. 

Many people have no idea how to react when I tell them I have severe depression and PTSD. It’s upsetting, but understandable – we live in a society where mental illness is still widely seen as either a pathetic failure to manage one’s own emotions or a threat to other people’s wellbeing and safety. I suppose many see me as either incompetent or potentially violent. Journalists perpetuate this picture with sensationalist and highly selective reporting of cases involving mental illness. While every conceivable news outlet in the UK was only too happy to obsess over why Germanwings pilot Andreas Lubitz was ever allowed to fly with a history of depression and suicidality, not one of them balanced these reactionary bursts of stigma with a far more important fact, that individuals suffering from severe mental health problems (especially schizophrenia and psychosis) are overwhelmingly more likely to be the victims of crime than its perpetrators, and that most of the violent crime that is committed in our society is committed by those with no history or indication of mental illness.

Neither the absence of these indisputable truths from mainstream discourse, nor the threat of violence and violation to the unwell is coincidental. As with all stereotyping and stigmatisation, popular lies about mental illness have always served the interests of the most powerful in society at the expense of the oppressed. It is no accident that hysteria was often diagnosed in (especially queer) women who loudly resisted their subjection to unfair social circumstances, including marital rape and domestic violence, nor that one of the most common ‘treatments’ was for a ‘doctor’ to sexually assault the subject with a vibrator. The fact that this ‘treatment’ is more commonly referenced as a hilarious joke than a vicious sex crime is testament to our own society’s ongoing attitudes to both mental illness and sexual assault. It is also unsurprising that runaway slaves in the 19th Century American South would be diagnosed with a specific psychiatric disorder that had caused them to abscond. Don’t get me wrong – I know only too well that mental illness is real – but we must never forget the history that the psychiatric profession has of fitting its diagnoses to prevailing social norms in a manner that has inevitably been deeply conservative. The vital, caring, spectacular, and enormously undervalued (and consequently underfunded) work that many mental health professionals do everyday must be acknowledged, but not at the expense of a wider critique of the psychiatric profession, and its effect on the lives of so many of the most vulnerable in society.

Societal approaches to mental illness are, and always have been, about power and powerlessness. In some guises, this is painfully obvious. The role of much legislation specifically impacting mental health service provision is to allow for the withdrawal of rights from patients who are judged to pose a severe threat to themselves or others. Detention under the mental health act, or ‘sectioning’, is still one of the few ways someone can be indefinitely imprisoned in the UK. While such a thing is perhaps occasionally a necessary part of successful treatment, the fact that black women and men are two and three times more likely (respectively) than their white counterparts to be detained under the act should give us pause. We should also reflect on the fact that black men are much more likely to be diagnosed as schizophrenic, a disorder unfairly characterised as leading to the perpetration of violence (a stereotype that black men already face in their day-to-day lives).

Further, we shouldn’t be surprised, though utterly disgusted, that women who have gone through the mental health system regularly come out complaining of abuse and sexual violence – accusations that are often conveniently ignored as the delusions of a lunatic even amongst those service users who have never experienced delusions. That women are also far more likely than men to be diagnosed with a variety of personality disorders, sufferers of which are branded as unstable, manipulative, untrustworthy, and (here we go again) hysterical, is both a result of, and serves to reinforce, societal perceptions of women that already see them as embodying those character traits. Further, psychiatric patients gendered as female, especially those with eating disorders, are often said to be expressing depressive symptoms if they are not wearing make-up or typically feminine clothes. This small act of gender non-conformity is supposed to indicate a failure to look after yourself, and reveals the way our hospitals enforce gender norms as a condition of recovery.

Perhaps a more personal example is warranted. I was never more aware of the lengths that a monosexist society will go to suppress expressions of sexuality that do not confine themselves to a single gender than when I was told that my bisexuality, and thus my ‘uncertainty and indecisiveness’, was what was causing my distress and even my suicidality. I am far from the only one to have experienced this, despite innumerable claims of mental health services to be uniformly inclusive of LGBTQ individuals. Similar points could probably be raised about the fact that one of the few widespread and coordinated social responses to those in the transgender, fetish, and asexual communities has been that of over-medicalisation, though I leave those topics to a more qualified writer than myself.

The upshot of all of this is to note that, while individual mental health practitioners probably very rarely have any such intention, gender, race, sexuality and mental illness combine in a variety of ways to further marginalise those who are already oppressed. But this by no means exhausts the oppressive potential of psychiatry. It is also a useful tool for individualising societal problems. A psychiatric problem is still, at best, seen as a problem internal to the patients themselves. But we do not have to stretch our imaginations very far to see the effects of an oppressive society on people’s mental health. Eating disorders such as anorexia and bulimia (in both men and women, though they are more prevalent in the latter) look very much like potentially lethal manifestations of the already extreme pressures piled upon women and men by patriarchal capitalism. As Laurie Penny, who has herself recovered from an eating disorder, puts it,

…women, precarious workers, young people and others for whom the lassitudes of modern life routinely produce acute distress and for whom the stakes of social non-conformity are high, lash out by doing only what is required of them, to the point of extremity. Work hard; eat less; consume frantically; be thin and perfect and good; conform and comply; push yourself to the point of collapse… We followed all the rules, sufferers seem to be saying – now look what you made us do.”

Locating eating disorders within the individual alone has the effect of largely neutralising any kind of social criticism that might emerge from observations like Penny’s – society isn’t the problem, but certain people’s inability to adapt to the violence it visits upon them.

A similar thing may be said about depression and suicide. It is well documented that those who are under extreme economic pressure are vastly more likely to experience severe depression, anxiety, and suicidal ideation. And the familiar patriarchal capitalist understanding of men as familial breadwinners, and the necessary failure of achieving this ideal when one is being economically exploited, has been hypothesised to be at the root of the epidemic of suicides amongst young men. The natural consequence of seeing such widespread mental illness amongst the economically and socially disadvantaged as their failure, rather than that of their elected representatives, has been for the UK government to impose ‘positive thinking’ classes on those seeking social security benefits. In one of the most absurd lies yet, the Conservative party now propagate the idea that desperately low self-esteem is a cause of poverty, rather than an inevitable consequence of being forced into it.

All stigma serves a purpose. It is never a mere symptom of social inequality, but a contributing factor. Mental health stigma is no exception. It serves to mark many of those who suffer under and resist current social arrangements. The reason why so many in positions of power are unwilling to fight against it, despite its obvious consequences for people’s wellbeing, is because it serves to sustain present social hierarchy. This is why fighting mental health stigma is so important. Those labelled mad are not merely deserving of our respect, as is any human, but the way we treat them, and the choices we make in deciding to brand someone as insane in the first place, also reveal uncomfortable but important truths about the inequity and violence done in our world, and often in our names.