Compulsory Able-Mindedness II

CW for sexual violence, psychiatric violence, suicidality.

If you have experienced the suicide of someone close to you, it might be best not to read this post.

In my last post with this title, I talked about the nature of compulsory able-mindedness and how there is a ubiquitous expectation in our society that we all will pursue this, do our best to achieve this. I pointed out that this expectation is sanist/ableist and that Mad and neurodivergent people should not have to conform to normative ideas about how we should or should not behave/move/think/act. Beyond this, I suggested that ‘care/treatment’ in its current manifestation is designed for the benefit and improved wellbeing of able-minded people, not for Mad and neurodivergent people.

A lot of people had strong reactions to this; it was clear that many disagreed with me. As far as I could tell, virtually none who disagreed with me identify as Mad/neurodivergent/otherwise non-neurotypical. As far as I could tell, it was able-minded people rejecting my stance that Mad/neurodivergent people should be free to be/live/die as we wish. As far as I could tell, the people most adamantly protesting my view that non-Mad people should not define, prescribe, and administer (without consent) care/treatment of Mad people are not, themselves, Mad. It seems to me that the people who find the idea of Mad/neurodivergent self-determination most offensive are able-minded people. In other words, the neurotypical people who were angry at my rejection of ableist/sanist ‘care’ were enacting the kinds of normative expectations I mentioned within the concept of ‘compulsory able-mindedness.’

Here’s a thing: no one disagreed that our society expects Mad/neurodivergent people to (want to) seek care/treatment.

Here’s another thing: Most people agreed that ‘care/treatment’ of Mad/neurodivergent is often implemented without consent. Most people agreed that some Mad/neurodivergent people cannot consent, at times. On this point, we all agree: non-consensual ‘care’ of Mad/neurodivergent people is normal in our culture.

I must say that it surprised me that neurotypicals readily agreed that some Mad and neurodivergent people aren’t capable of giving consent at times. It surprised me, in part, because many (especially progressive/liberal) Americans subscribe to a ‘rights’ model of humanity: human beings are special and our rights should be protected; we should have individual liberties; we should have bodily autonomy (a concept foundational to the anti-rape movement); and so on. Rights-based thinking leads many Americans to accept that, in most cases, it is wrong to do something to someone who has not consented to that thing (be it sexual contact, medical treatment, etc.).

This is not the case for Mad/neurodivergent people. When we venture into certain territories—in particular, ‘A Danger to Myself or Others’ territory—we suddenly lose many if not all of our rights. I suspect this is because, to some degree, we lose our humanity. Neurotypicals can expect to hold onto their rights until they have actually harmed someone or something. Mad/neurodivergent people, though, can have our rights taken away by neurotypicals if we are suspected of being ‘a danger’—that is, before we’ve harmed anyone or anything. There is a chicken-egg dilemma here in that it’s hard to know if our rights are being taken away because we are seen as less human, or if we are dehumanized because neurotypicals have seen ‘the need’ to take our rights away. Either way, ‘It’s for our own good.’

All of these thoughts on bodily sovereignty, rights, humanity, and so forth have been leading me to a particular realm of thought: suicidality. It is possible that I’m drawn here partly because of my own morbid inclinations, but more likely that conversations of bodily sovereignty inevitably turn to ‘the most extreme’ beliefs about the body and our entitlements.

There are books to be filled (and that have been filled) about bodily sovereignty. I don’t want to write a literature review here. I want to talk about the everyday effects of neurotypicals casually accepting the violation of the Mad bodymind while vehemently rejecting assertions of Mad autonomy and self-determination.

Before I delve into the connections between suicide and bodily sovereignty, I want to say a few things about perceptions of suicidal people.

One paradox of suicide is that thinking and talking about it makes one crazy and irrational, yet avoiding or preventing it (and healing from ideation) often hinge on our ability to discuss it. In the neurotypical imagination, to admit that I’m thinking about killing myself precludes me from partaking in potentially life-saving discussions about suicide.

Perhaps stemming from this, another weird thing is that if I don’t mention suicide/suicidal ideation, neurotypicals assume that I’m ‘not extreme’ or even that I’m ‘on their side.’ But the minute I do mention suicide/ideation, suddenly my opinion is crazy, irrational, and devoid of merit. This is evidence of the ways that Mad people are alienated from discussions of our own needs, problems, desires, and strategies for (not) living with Madness. The void created by the absence of Mad voices is filled by sanist and non-Mad voices telling us ‘the facts’ about suicide and sane-splaining how to prevent it. David Webb discusses the striking absence/exclusion of Mad people from suicidology (the study of suicide) in the piece “Thinking (Differently) About Suicide.” Webb explains that because suicide and suicidal ideation are heavily pathologized in our culture, neurotypical suicidologists assume that Mad people who think about, plan for, and/or attempt suicide are irrational have nothing to contribute to the study of these topics, which is primarily science-based.

I do take issue with an aspect of Webb’s piece, though, which is its focus on the notion of ‘prevention.’ Thinking about the Western obsession with ‘prevention’ guides us back to the links between suicide and bodily sovereignty.

‘Suicide prevention’ is a collocation in English, indicative of anti-Mad and anti-suicide beliefs that run deep in Western cultures. If I’m suicidal, it’s assumed that I am crazy and also that I should get ‘treatment.’ If I discover that someone else is suicidal, it’s assumed that I should prevent it. This prevention should happen regardless of the suicidal person’s wishes; intervention and prevention should happen by any means necessary, up to the point of violating the suicidal person’s bodily autonomy and forcing ‘treatment’ upon them.

Here is another paradox of suicide: sometimes feeling suicidal means simultaneously feeling out of and in control. Suicidal ideation is empowering for some us precisely because it is a means of taking control, even when we feel out of control.

Violating a suicidal person’s bodily autonomy can have the effect of reinforcing that person’s feelings of disempowerment. Forced ‘care/treatment’ reifies our experience of not being in control.

Even for those of us for whom suicidal ideation is never empowering or does not make us feel in control, non-consensual ‘care’ is rarely empowering. Feelings of being out of control are often accompanied by feelings of disempowerment, fear, hopelessness, and worthlessness.

There is a connection between violation of bodily autonomy and subsequent depression and suicidal ideation. This is not remotely surprising to anyone who has experienced and/or studied sexual violence (i.e. experiencing sexual violence is a risk factor for suicide), medicalized trauma, imprisonment, or other instances in which a person experiences bodily violation or loss of control over the self.

Considering this, it seems antithetical to frame intervention/prevention as ‘caring’ when it entails a lack of consent. It seems odd to take for granted that we must intervene on the suicidal person, and that we do so under the guise of ‘care.’

So we live in a sanist culture where non-consensual ‘care’ of/intervention on Mad people is normalized (even when Mad people experience it as harm), while Madness and the exercise of Mad autonomy is pathologized. Not choosing treatment is a non-option; ‘treatment’ is narrowly defined within the range of the neurotypical imagination (and obviously does not include suicide). The very rejection of treatment is, itself, pathologized: when we are told something is ‘wrong’ with us yet we do not choose ‘treatment,’ the neurotypical assumption is that such rejection is symptomatic of our ‘mental illness.’

If Mad people reject treatment, we do so because we are crazy and this opens the door to non-consensual enforcement of ‘care.’ Therefore, not only is able-mindedness a standard expectation in our culture but ‘treatment’ is mandatory.

I think I should make it really clear that I do not think suicide is wrong or bad. Sometimes it is sad, devastating, angering, terrifying— suicide pings the range of human emotions. Suicide is also extremely personal and context-dependent. I will probably write more about this some day, but I don’t want readers to get the impression that a) I’m over-the-moon happy about suicide all the time or b) all suicidal people are the same. In fact, that is a sanist perspective: all suicidal people are the same, which is why there are only a tiny handful of approaches for dealing with us. Suicide and suicidal people are complex, and the sanist temptation is to boil us down into the least complex terms imaginable. The sanist imagination strikes me as a lack-thereof. If you are reading this as a binary (“they didn’t say suicide is 100% bad, therefore they are saying suicide is 100% good”), then you hold a sanist perspective.

One of my goals with writing about this crazy stuff is to try to imagine new ways of thinking about and approaching Madness and Mad people, and to get sane people to be more imaginative about life, death, in/sanity, un/wellness, care, and community.

In that vein, mine is not the only perspective. If you feel like you have something to say about this stuff (madness, mental illness, suicide, bodily sovereignty, psychiatric care, disability, sanism/ableism, etc. etc.), I would love to give you a platform for talking about it—this blog could be a place to start. If writing appeals to you, I am happy to serve as an editor if you so desire. If you want to post something here on my blog, you can do so under your name or anonymously. Consider this an open invitation. ^_^

 

References and Further Reading:

Webb, David. “Thinking (Differently About Suicide.” Searching for a Rose Garden. Edited by Jasna Russo and Angela Sweeney. UK: PCCS Books. 2016. Link: https://thinkingaboutsuicide.org/thinking-differently-about-suicide/

“Victims of Sexual Violence: Statistics.” RAINN. June 22, 2016. https://www.rainn.org/statistics/victims-sexual-violence

The Icarus Project. http://theicarusproject.net/

Reblog: On Being Depressed, Part I by The Belle Jar

Trigger warning: mention of suicide There’s a funny sort of paradox about depression where it’s probably the mental illness that people who haven’t experienced mental illness find easiest to identify with while simultaneously being a condition that is incredibly difficult to understand if you’ve never lived through it. I mean, I get it. We’ve all […]

via On Being Depressed, Part 1,826 — The Belle Jar

Crazy Is as Crazy Does

I’ve been wanting to write on here about neoliberalism for while. This post should most likely be preceded by a post devoted solely to neoliberalism, as a concept: where it comes from, what it entails, how it shapes our lives and worldviews.

But this particular post feels more pressing. Maybe it will even help clarify things for me later when I try to write other posts about neoliberalism.

I want to talk about mental health. It needs to be talked about in a different way than the mainstream tends to talk about it, and I want to attempt that, aided by against-the-stream or on-the-edges-of-the-stream perspectives from those I’ve read, those I know personally, those who have spoken to me and others about it.

Mental health is something that most people would rather put on the backburner as far as topics of conversation go. Mental illness is one that most people would rather avoid altogether. It is, admittedly, uncomfortable for speakers and listeners, those who have been diagnosed or treated for it, those who haven’t but feel or fear that they should be, and those who never have and never wish to be.

I wonder what this says, if anything, about the sorts of people who end up in fields and disciplines connected to the study and treatment of mental illness. Are they more compassionate, maybe? Trying to do people and society a favor? Are they ‘atypical’, themselves, perhaps trying to understand their own behavior or suffering? Are they just morbidly curious? (Friends and relations of mine who work in such fields, know that whatever we agree or disagree upon, I am not passing a judgment, but rather posing some earnest questions about the nature of these fields– if anything from a cultural, not moral, position of questioning.)

Whatever their motivations, there is frequently a common thread running through mainstream study, prevention, and treatment of mental illness. This might be hinted at by the very term ‘mental illness’. If it is an illness, it arises within a single person; it is an individual, not collective phenomenon. The same ‘illness’– schizophrenia, OCD, or manic depression, for instance– can present in many individuals, but it is nevertheless an affliction of individuals, not of society. As such, it must be studied, treated, and prevented at the level of the individual.

I recently discovered that there is a thing called dermatillomania— a ‘condition’, I suppose, also called Skin-Picking Disorder (SPD)**. People ‘afflicted’ with this condition pick at their skin: face, arms, legs, backs, scalp. Lips. Cuticles. It is cataloged in the DSM-V under Obsessive Compulsive Disorder (OCD). Those with a related condition, trichotillomania***, pull out their hair, strand by strand. Eyelashes. Eyebrows. These disorders are also considered to be Body-Focused Repetitive Behaviors (BFRBs), and is sometimes seen as a symptom or manifestation of Body Dysmorphic Disorder (BDD).

If you followed any of the above links, you may have been struck by a commonality among several of the treatments offered: Cognitive Behavioral Therapy (CBT), Habit-Reversal Training (HRT), and Mindfulness training and practices are by and large focused entirely on the individual. They encourage patients to think about what they can do to change their environments, their routines, themselves in order to change their ‘habits’. Habits which, while they may be harmful in various ways to that individual, are most like to disturb, embarrass or repulse others– that is, society.

I want to preface the rest of this by saying that I do not believe that we as individuals should not in some way be responsible for our own mental health, treatment or improvement of well-being. To the contrary, I think that such participation can be an empowering and transformative experience. However, we should note a few disturbing observations about this schema.

To begin with, such treatments begin from the presumption that illness like dermatillomania are problems of the individual: that is, they are disorders of single and separate minds. For instance, we might acknowledge that two different people who are each suffering from schizophrenia are experiencing a similar phenomenon, but we wouldn’t suggest that the experiences of those two individuals are in any way correlated– this person is not suffering from schizophrenia because of that person. They might be suffering from schizophrenia due to similar psychologies or circumstances, but this person’s illness is not the direct cause of that person’s illness. As such, being an illness of an individual person, it is up to that individual, or up to us on behalf of that individual, to take some measures to treat it. In any case, it’s the individual that requires treatment.

Now, in all fairness, many people who work on treatments for mental illness acknowledge that it is often the product of exterior factors or circumstances. A person close to you dying might cause severe depression, intimate partner violence might produce anxiety attacks, wartime violence and near-death experiences can cause PTSD. There is also a recognition that many circumstances cannot be changed: we can’t reverse the loss of a loved one, domestic violence can be difficult or impossible to escape, the violence of war may reside in the mind long after the war ends. Keeping this in mind, let’s look again at illnesses like schizophrenia, manic depression, OCD, borderline personality disorder.

Is it possible that the majority of responsibility for mental illness should rest on our sociocultural surroundings? What if, instead of beginning with the individual, we began with society as the place from where illness arises? What if we assumed that it is possible that society– the sociocultural structures by which we are all bound, though in different ways– needs to change in order to ‘cure’ mental illness, not the individual? I’m not suggesting that all mental illness could be solved merely by finding the most ideal sociocultural circumstances, but it isn’t a coincidence that some societies have higher rates of certain types of mental illness and suicide than others; varying societal factors must have a major impact on definition, prevention, and treatment of mental illness. I’m quite ignorant here, and many posts could be devoted solely to this topic, but among ‘modern’, ‘industrialized’, and ‘developed’ countries, there has come to be a very particular way of approaching mental illness, and that is by focusing on the level of the individual.

I want to suggest that this a symptom of the neoliberal worldview. Neoliberalism focuses almost entirely on the level of the individual, even when talking about phenomena like globalization and transnationalism. States, corporations, and organizations are compartmentalized and atomized into individual units: citizens, consumers, employees, members. As members of a neoliberal culture, we see ourselves as part of organizations and states, but at the same time as self-contained, discreet Selves, part of and yet apart. Those who feel their identity to be part of a common or collective consciousness, who ‘lose’ their individuality, must have joined some sort of cult.

Mental illness is often talked about in terms of individual shortcoming, weakness, or failure. Those who kill themselves or attempt to are considered selfish, short-sighted, making excuses and lacking accountability or self-control. Solutions for individuals include being mindful, focused more the present, utilizing coping skills, and so forth. All of these are individual behavior and attitude changes; society is not required to change its behaviors or attitudes. Basically, by trying harder, individuals can work towards greater self-reliance, independence, responsibility and strength. The idea is, after all, that healthy individuals do not or should not have need of a therapist and do not excessively burden those close to them with the side effects of their mental illness or mental health needs. Well, and the therapist exists for that very purpose: to unburden those around us, which contributes to the notion that mental illness is a private and shameful matter. Yet the person who kills themselves for the very purpose of permanently unburdening those around them (and they are likely thinking of the individuals whom they love, not their school or company or country) is considered selfish. We need to have personal accountability to ourselves and others regarding our mental well-being– society is not accountable to us. As such, society should be right to fear, berate and institutionalize the mentally ill individual. Music, TV shows and movies often reflect neoliberal ideals, perhaps unconsciously and unselfcritically.

Briefly returning to dermatillomania: the websites referenced above readily admit that researchers are unsure of the causes of dermatillomania. In spite of this, treatments are still focused upon the individual. Why should this be, if we can’t even be sure the individual is necessarily able to stop these behaviors?

I want us to thing about new and different ways of looking at the treatment of individuals with mental illness. Is it so outrageous to imagine accommodating certain aspects of mental illness? Or better yet, to change sociocultural structures that might be catalyzing mental illness in the first place?

More thoughts to come… In the meantime, what are yours?

**I am wary of any group (bureaucratic agencies, NGOs, academic disciplines, whoever) who are overly fond of acronyms. Fuck, acronyms are annoying.

***How interesting, the insertion of “non-cosmetic” into their definition.