CW for sanist/ableist BS and a reference to suicide.
I have noticed this trend lately where people talk about Madness (or usually they’re calling it ‘mental illness’) as a thing that obliges treatment. That is, if you have mental health struggles or neurodivergence of any kind, you are expected to seek treatment once you recognize that you ‘have a problem.’ Almost as if care/treatment is compulsory.
There is a theory in feminist studies known as ‘compulsory heterosexuality,’ forwarded by Adrienne Rich circa 1980. According to this theory, as Americans we live in a heteropatriarchal society that assumes human sexuality is hetero and binary, and thus our baseline of understanding is heternormativity: intimate relationships are (or ought to be) between ‘men’ and ‘women’ only; this is what is normal/natural/good. This understanding is so pervasive that anything contrary to heteronormativity is framed negatively or rendered invisible altogether (Rich was particularly concerned with the erasure of lesbian identity and existence).
More recently (2006), disability studies scholar Robert McRuer has identified a parallel phenomenon that he calls ‘compulsory able-bodiedness,’ which he ties in with the erasure of both queer and disabled existences. In our ableist society, the norm is ‘able-bodiedness’ (or as others of us call it, able-bodymindedness); if you are in any way outside the norm, the expectation is that you will seek to fix it in order to become as able-bodied as possible. For some of us, our ‘unwellness’ or disability or disfigurement is such that it cannot be ‘fixed’ or ‘cured,’ and in this case this means such bodies (or bodyminds) should be hidden away from public view.
“Like compulsory heterosexuality, then,” McRuer explains, “compulsory able-bodiedness functions by covering over, with the appearance of choice, a system in which there actually is no choice”(2006, 92). This lack of ‘choice’ arises from the fact that our ableist culture defaults to a question with an assumed answer: Wouldn’t you rather be normal? Able-bodied people (aka ableds) tacitly enforce the question (“[W]ouldn’t you rather be more like me?” [McRuer 2006, 93]), and assume the answer— everyone wants to be able-bodyminded, no one wants to be disabled/crazy/neurodivergent.
As an extension of critical disability studies theory on compulsory able-bodiedness, it seems logical to me that our culture is also infused with a tacit assumption of compulsory able-mindedness. Now, I am partial to Mad Studies scholar Margaret Price’s use of the phrase ‘bodymind’— which points to the intrinsic interconnection between body and mind (that is, they’re really one and the same, there is not one without the other, GTFO Descartes). However, I wanna write a bit about the notion of un/wellness in relation to the ‘mind’ to show how, for many of us, living with a ‘different mind’ is stigmatized and pathologized in particular (albeit parallel) ways from living with a physical or bodily disability. Of course, many people experience both because they have various Madnesses, disabilities, and/or neurodivergences; and/or because one affects the other (whoa, interconnectedness!)— for example, some people with physical disabilities (e.g. cerebral palsy) experience cognitive impairments (e.g. ‘delayed language development’) as a result of their physical disabilities, and some people with mental health issues (e.g. depression) experience physical disability (e.g. chronic pain) as a result of their mental health issues.
I want to focus on our culture’s particular disdain for differences of the ‘mind,’— there’s even a word for this disdain, it’s called sanism (or saneism). Sanism is beliefs and practices predicated on the idea that there is such a thing as a ‘sound mind,’ leading to harm of all kinds being directed at those determined to be of ‘unsound mind.’
Sometimes, this harm takes the form of ‘treatment’ or ‘care.’ How can care be harmful? you may be wondering. Care is frequently harmful when it is a response to something perceived as a deficit, disorder, or deviance. This is often true for those of us who are Mad/experience mental health struggles or neurodivergences: non-Mad/neurotypical folks view our lives as suffering, and the ‘natural’ response to suffering is to end it. Do they necessarily inquire of Mad folks if we are, in fact, suffering? Nah. Do they necessarily get our consent before initiating ‘care?’ Not always.
Even when consent is supposedly present, we have to remember how consent truly functions: we cannot assume that a ‘yes’ is, in fact, a ‘yes’ when there is a power differential, when there is fear of retaliation, when (a history) of coercion or violence exist, when internalized ableism/sanism exists, etc. We need to be critical of that ‘yes.’ When I first consented to take medication to ‘remedy’ my madness, I was guilted into doing so. They called up my history and reminded me of how scary things could become, how much of a failure I had been, and how I had (at times inadvertently) hurt people. I didn’t start taking medication because I believed it would help me feel better or improve my overall wellbeing, I started because I was afraid of the consequences of not taking it— which, the psy folks assured me, would be devastating (joblessness, friendlessness, maybe even homelessness or, lolz, lifelessness).
The funny thing about ‘care’ of Mad and neurodivergent people by able-bodyminded people is that it often exists to make the latter feel better. Many psychiatric meds, cognitive control meds, and even some non-pharmacological therapies exist to mediate Mad/neurodivergent behavior. Perhaps those behaviors are deemed disturbing (the silences of a depressive), disruptive (an ADHD person not ‘following directions’), frightening (a schizophrenic person hearing voices), or frustrating (an autistic person not making eye contact). Whatever it is about a neurodivergent person’s way of being that is considered ‘atypical’ or ‘disordered,’ the treatment of that thing is regularly mandated by neurotypicals whose discomfort comes from being in proximity to that person. It’s less about the Mad/neurodivergent person being disturbed than it is that we are disturbing to neurotypicals. If there is one thing I hope we clarify about ‘care’ of Mad/neurodivergent people in the near future, it’s that much existing ‘care’ is intended to tamp down on Mad and neurodivergent ways of being, doing, moving, and thinking in order to help neurotypicals feel better. I’ll say it again: most ‘care’ of neurodivergent people is actually intended for the comfort and peace of mind of non-disableds and neurotypicals.
That is not to say that care and treatment are never helpful for crazy/neurodivergent people. I, myself, have found some forms of care tremendously helpful— most of them outside mainstream care, though. But a great deal of care/treatment is developed and implemented without including us, the recipients, in the creative process. Until care/treatment is reimagined and regenerated with the consent and inclusion of Mad/neurodivergent participants, it is going to continue to harm many of us. It doesn’t matter how ‘well-intended’ it is.
A final comment, for now: Mad, disabled, and neurodivergent people— including manic depressives, OCD people, autistic people, addicts/substance users, people with PTSD, depressives, borderline people, and all the rest of us— have the right to seek care and/or treatment on our own terms. We have the right to help shape what that care/treatment looks like. We have the right to refuse care/treatment. Others do not have the right to say we ‘must be treated.’
Addendum: Here is Part II of this piece.
McRuer, Robert. “Compulsory Able-Bodiedness and Queer/Disabled Existence” in Disability Studies: Enabling the Humanities. Edited by Sharon Snyder, Brenda Jo Breuggermann, and Rosemarie Garland Thomson. The Modern Languages Association of America: New York, 2002. Read it here: https://www.academia.edu/16338241/Compulsory_Able-Bodiedness_and_Queer_Disabled_Existence
Rich, Adrienne. “Compulsory Heterosexuality and Lesbian Existence” in Feminism and Sexuality. Edited by Stevi Jackson and Sue Scott. Columbia University Press: New York, 1996. PDF here: http://www.weldd.org/sites/default/files/Compulsory%20Heterosexuality.pdf; read Rich’s reflections (2004) here: https://muse.jhu.edu/article/53008