Privilege, the Construction of Sanity and Answering the Afiya Phone Line


By Ana Keck, Afiya

The person who answered your call to stay at Afiya could have been me. When I answer the phone at the respite, I often find myself wondering what the caller thinks of me. When I called to stay at Afiya myself, I had a quite radically different vision of what the person on the other end of the phone was like.  I pictured someone very much in charge, with their life together, who maybe had some hard times years ago.  

Now being on the other side of the phone, I can tell you I have not reached some recovery nirvana.  I don’t actually want to get there, because I personally don’t think it exists.  I could be in the midst of a variety of hard or wonderful or transformative life experiences right now.  I just happen to have the emotional space to support other people, too, and so here I am at work today.  

I have my own path in life, and sharing it with someone doesn’t mean I offer some kind of “cure” or that people who listen to me will then automatically find a path away from the hard things in their life. It likely won’t immediately alleviate their pain.  What has impacted me profoundly doesn’t make it so I will never go through a hard time again.

When I came to stay at Afiya, it was the first time I was not treated as fragile or incapable for admitting to having a hard time.  When I worked in traditional mental health settings, I heard plenty of rhetoric about how talking to a ‘client’ about oneself takes away from them or isn’t good ‘boundaries.’  In contrast at Afiya, I found being able to chat as a regular human being while also “in crisis” was (unfortunately, in this world) truly radical.  

My perceptions of myself and my story have changed substantially after staying at Afiya and then becoming more involved in this movement.  For instance, I’d been told when I was fourteen that I had a gene for eating disorders and depression. I concluded that it would be unethical to have children, a sort of internalized eugenics. While I am still undecided on having children, my “flawed” genes aren’t going to be the reason now.  Instead of my struggles being something to eradicate at all costs, there could be space to explore what meaning they might have for me.  

However, this is more than just saying someone is “not their psych history” or “not the labels” placed upon them.  It’s a radical act to allow space for someone to define their experiences for themselves.  And it’s still just a first step, especially given all the many other barriers and misdirections that exist.  People’s lives in the system or out of the system are profoundly influenced by systemic oppression, the color of their skin, their gender, their sexuality, their class, any of their identities and the world at large.   

In the system, the color of your skin affects what you are diagnosed with, your access to treatment, and your likelihood of incarceration (more here).  Homosexuality until recently was a psychiatric disorder (more here).  For insurance to cover hormones, gender reassignment surgery, etc, people still have to be diagnosed with Gender Identity Disorder and  trans* people face many systematic and legal prejudices in and out of the mental health system (more here

The construction of what is considered “mentally ill” versus “normal” is intrinsically linked to our societal norms, prejudices, and power structures.  The drawing of the “sanity” line is much more arbitrary and less scientifically determined with the bigger picture in play.  

My own story also looks powerfully different when I look at it from a systems perspective.  When looked at in isolation, struggling with food can at best be seen as a maladaptive coping skill for my troubled young adult self. That would make it easy to sweep under the rug as a ‘psychiatric disorder’ in the DSM, playing masquerade as a scientific fact that could really only be ‘caused by a gene.’   But one look at a fashion magazine and the way bodies (especially women’s) are objectified and sexualized, and only valued when they are incredibly thin or at the intense amount of emphasis and pressure our society places on physical appearance (more here).  Is it really just all in my head after that?  Or if, unlike the suicide prevention rhetoric, we can acknowledge all the ways in which the world is profoundly messed up, is it really so irrational to think of leaving it?  

Privilege also plays a big role in how people enter the mental health system and what kind of experience they have.  My hospitalization experiences were quite privileged and also not always helpful.  I cannot ignore the fact that I benefited greatly from being a white, middle-class, educated, mostly quiet when in distress, female-identifying person, who wasn’t perceived as a threat or worse.  Often in parallel ways, race, class, gender, sexuality, etc., affect who has access to this movement and other alternatives and who doesn’t.   

Being the person on the answering end of your call is a privilege.  Whether or not I profess to be more “recovered” than anyone who calls to stay, there’s a presumption that I am.  If I were to interact with a mental health provider or person in your life, they are more likely to treat me as an equal and value what I have to say… even though I don’t have a magic path that “worked” for me, much less any idea of what might “work” for you.  Ultimately, I don’t want to tell you what to do with your life.  But I’ll be glad to be there to take your call and be part of providing some space for you to explore what this all means to you.  



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.


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  1. I wouldn’t get too carried away with this until I saw what was going on at the Earth House, down in New Jersey, near Princeton. In existence since the early 1970’s, they place great energy on appropriate nutrition and the formation of healthy habits for the residents. They might be too medical for you, but I suspect you won’t see any residents of the Twilight Zone dozing off as soon as they stop moving around- their medical model concerns real medicine and not Big Pharma or psychiatric pseudo medicine. They also have a web site.

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