In my experience, the world of ‘mental health’ is absolutely overloaded with what I like to call ‘false arguments.’ Literally every day, people are engaged in debates without ever questioning the premises upon which those debates are founded. It’s akin to my husband approaching me and inquiring, “Hey, should we fill our one-year-old daughter’s sippy cup with Pepsi or Coca Cola today?” followed by us arguing out the various virtues of the dueling soft drinks without ever bothering to wonder why on earth we’d even offer soda to our sweetly innocent and unsuspecting toddler in the first place. In other words, sometimes the biggest problems can be found not in the best arguments of opposing sides, but in the assumptions of the questions themselves.
What would happen if we simply started asking ‘Why?’ more often? WHY do we believe what we believe? WHAT would happen if we dug beneath the most typical arguments and looked for a different starting point? HOW did we get to this point, and is it the right one? And of course, WHO was it that led us here and how precisely did they come by that power?
Part 1: Don’t Call me Consumer (I won’t Answer)
“What should we call them,” someone asks.
“Just ask them what they want to be called,” another answers.
“Haven’t we been through this before?” A voice calls out. “Won’t whatever word we choose just become the wrong word in a year or two?”
“Yes, but we need to call them something,” goes the retort.
One-word labels abound within the mental health system, and the question ‘What do we call them?’ (sometimes offered in a more subtle format) yields a seemingly forever conversation. ‘Patient’ was a starting point for many, ‘client’ a slightly more recent option. Then, of course, there is ‘consumer,’ ‘member,’ and ‘participant,’ each one having taken its turn in the lead and remaining at varying levels of popularity. We also have our one-word labels masquerading as two words in ‘person served,’ ‘service recipient,’ and ‘service user’ (sometimes restored to the true and fabulous one-word term, ‘user’). The real charmers in the crowd dispense with all the efforts toward gentleness and cut right to calling people by their diagnoses (‘Schizophrenics,’ ‘Borderlines,’ and such) or group them all together amongst ‘the mentally ill’ (my personal favorite). I’ve even heard of some particularly creative groups combining labels to form the endearing term ‘consumer clients,’ or turning ‘individual’ into a bad word by using it so ritualistically only to refer to those receiving services that it became synonymous with the ‘client’ it was trying to escape. And then there’s the decidedly creepy ‘guest’ and the latest favorite, ‘peer.’ (We’ll come back to that one another time.)
I could spend many hours arguing the merits of these various words within the context of the system. ‘Consumer’ beckons images of a relentless beast inhaling everything in its path, or of prospective shoppers perusing a ‘Consumer’s Choice’ magazine evaluating which car to buy. ‘Client’ calls up the idea of voluntary relationships with other professionals – such as lawyers – whom the ‘client’ might reasonably fire should they not do their job well. Yet, these arguments miss the point entirely. The point is that all the squabbling over ‘What to call them now?’ is quite simply a false argument. I call this particular one the ‘myth of the one right word.’
Plainly put, there will never be one right word to describe all the people who are receiving or have received some sort of service from within the mental health system. N-E-V-E-R. Never. Any one word – even if it seems momentarily better or somehow ‘empowering’– that becomes systematized and used routinely to refer to those who that system regards as ‘the mentally ill’ might as well just start off being called ‘the mentally ill’ in the first place. That’s how the word will come to be understood. Just give it time. So, the questions then become: who came up with this idea that there needs to be one word, and why are we following along so blindly?
Without ascribing good intentions or bad, it strikes me as undeniable that the system conceived of the need for the binary of ‘client’ versus ‘staff,’ and the clear purpose served is to separate those who ‘need’ help from those who ‘give’ it. More simply put, it separates ‘us’ and ‘them.’ Were that linguistic division held only in the context of a short-term or occasional connection such as that between a divorce lawyer and his ‘client’ or a ‘consumer’ and a car salesmen, there’d be no harm done. However, the reality of the system is that many people spend days, months, or years contained within its stark white and green-tiled walls, and so those labels become identities. And, once those labels become identities, we don invisible shackles to the system and the cloak of invisibility makes them that much harder to break.
Imagine for a moment that you had to spend the next year being called primarily one thing. Are you a parent? A teacher? A friend? A spouse? An artist? Which of these would you choose, and which would you be prepared to give up? Now, what if someone else was choosing for you? And, what if that same person decided he or she was going to switch out that strengths-based label and choose a deficit based one on your behalf? One year later, how might you think of yourself differently? Introduce yourself differently? See your future differently? There is tremendous privilege in being able to walk so freely between different parts of who we are, and deep loss when we cannot.
Once, during a group conversation on language, someone said to me, “I have to use these words to be taken seriously in my work setting, but if a client flinches when I use a particular word, I stop.” I wanted to grasp him firmly by the shoulders and shake him until he understood that it’s the ones who don’t flinch about whom he needs to worry the very most. It seems to me that those who are still flinching have managed to retain some spark of sense of self about them. They have not yet fully given themselves over to be re-birthed into a mold made by someone else. We need to worry about the ones who have acquiesced, who walk into a room and introduce themselves as a ‘consumer’ or by their diagnosis without any prompting from the wings. These are the lost souls of our brothers and sisters. These are the ones we need to work hardest to free.
I’ll never forget one woman who told me, “Initially, the labels meant something to me. They helped put all my confusing experiences into a framework. But those labels objectified me, and so when they started to talk to me about ‘recovering’ I was at a loss. How does an object ‘recover’?” So much of this talk of language is written off as ‘political correctness’ or the onslaught of the ‘language police,’ but that accomplishes little more than the devaluation of this woman’s story and the journeys of so many others. There is no doubting that this is a complex conversation made only more so by the fact that so many in our movement have also assimilated themselves into the language constructs of the system. That assimilation is common in any situation where there has been historic oppression, and I’ve always found it funny (in a very unfunny sort of way) when providers have attempted to bypass this whole conversation by stating, “We asked them what they wanted to be called, and they said they wanted to be called [insert whatever label here].” So often, you can literally hear the subtext, the “So, since we’ve addressed that, can we please just move on now?” dripping in their tone. But the reality is it makes sense that when a person has his/her agency taken away, is exposed to a particular set of limited options for a lengthy period of time, and is then asked, “Now, what do you want?”, that silence or a regurgitation of all they’ve repeatedly been fed is often the response. So, no, I’m afraid we can’t move on. Not yet.
This brings me to the biggest ‘rub’ in the vast abstraction that is this conversation. We can’t move on to other issues, because with so many identities still tied to this one, moving on would necessitate leaving those people behind. Many of us are crying out for a true human rights perspective of our movement. (What movement, you say? The consumer movement? The recovery movement? The peer movement? I don’t even know anymore, but let there continue to be movement nevertheless!) This perspective demands that we stop saying, “That group over there has rights,” and start saying, “We all have rights, and they happen to be the same ones: human.”
One’s rights should not be defined by a certain status of personhood or change based on labels received. But how on earth can we have that conversation, if we’re too busy figuring out what to call ‘them’? People’s minds will always jump to different rights – or at least different interpretations of those rights – as long as we see people who have been given psychiatric labels as a group separate from ‘the rest of us.’
So, the real question we should be asking is how do we talk with one another about these difficult experiences and the fact that we sometimes need support without dehumanizing each other in the process? How do we hold onto each of our respective personhoods with an inalienable fierceness? How do we talk about our needs and rights not as particular groups but as one group altogether called ‘human beings’? As long as we keep separating ourselves into these boxes, rights violations will continue and healing on a broader scheme will elude us. We must find a way – in language and in practice – to move beyond the fragmentation of our understanding of human experience. After all, only then does ‘us’ and ‘them’ become ‘us’ is ‘them.’
As I conclude Part I, I continue to be plagued by the image of so many of us shackled to a system through the very words we choose and so I leave you with this poem from an anonymous source:
Tools are Shackles
Tools are shackles.
Shackles are tools.
I was taught early on to follow the rules.
Listen to your elders. Respect authority.
Be sure to go along with the majority.
As I grew up, I followed rules less and less.
I didn’t give authority much respect.
Unbeknownst to me, I was headed in the wrong direction.
Living by my own rules, I lost my human connection.
It didn’t take long until I was far off course.
Roaming the wilderness of the mind, I encountered a powerful force.
I thought I was free in the bush because I had a wide range,
But I was trapped by the vastness. Isn’t that strange?
Tranquilizer dart pierced my rear, and I was introduced to psychiatry.
No more running away from authority.
I don’t know the institution’s intentions. It wasn’t all bad.
It took away every last bit of sanity that I had.
Tools are shackles.
Shackles are tools.
I was forced to follow a new set of rules.
They said your mind is sick, and how do we know?
It’s from the odd behaviors that you show.
Luckily, we’ve got a tool to help you out.
It’s called a diagnosis, and it lets us know the type and amount
Of medication needed to restore your health.
All the things you thought you knew about life, you can put on a shelf.
Now medication is our greatest and most revered tool.
Did I mention that it may very well likely cause you to drool?
Every Wednesday we’ll use a tool to give you an injection.
Everything we’re doing is for your and our protection.
You’ve got a bizarre illness. In the olden days, they called it sin.
But our tools have freed you from your boundless prison.
You’ve entered a systematic new world, though it’s a bit smaller than what you’re used to.
We’re all safe now, so be grateful for the subhuman to which we’ve reduced you.
Life may be a little boring. It may be a little dull.
Don’t blame us. Blame that unruly brain in your skull.
In our system, everyone’s got a place but not a direction,
You may not be moving forward, but you agree you required correction.
I agree I needed structure. That I don’t dispute,
But I didn’t need to be made agentially mute.
I guess when you think about it, a shackle is a tool,
But anyone who would try to free someone with a shackle has got to be a fool.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.