Firstly, I write this in a resolutely affirmative, movement-building, consciousness-raising spirit. I make this disclaimer because I have become fatigued, as I suspect many others have, by what I perceive to be a very rigid, destructive, and ultimately narrow social justice discourse, delivered mainly on the Internet. (So as not to be hypocritical, I own that I have undoubtedly contributed to this stupor in my rasher moments.) Though I intend for this to be an introduction to that discourse, I am worried that, once introduced, the spirit of my request could soon turn bitter and devolve into a circular “us versus them” debate, as often happens online. Which is unfortunate, because it is the primary place where expressions like the one I am making can be made available. And, in turning sour, I worry that it undermines the potential of the good ideas to gain popular traction and enter the mainstream, along with their potential for community building and real world impact. This is the unfortunate conclusion that my experience has brought me to. I’ve witnessed the dark power of “the discourse,” particularly when it is oriented towards shame and shut-down, and I do not take it lightly.
I am going to present some heavy material, and I want to maintain a discipline of collective respect as I speak to some rough and potentially condemnatory points. And I want to be clear that the purpose of writing this is not merely to indict or identify an unjust, limiting order, but to point towards a new order after it, and in so doing invite all people to identify a better life for themselves in it. Despite great reason for despair and consternation, I want to confront the issues presented here from a place of camaraderie and common cause. What I am speaking to is too universal and too important for anything less.
As one who is well-acquainted with mental illness, I am often frustrated by the lack of respect and lack of recognition that I perceive not just towards the severity of this experience, but also towards the complicated and often deeply unjust social and political context in which it resides. And I have been frustrated for years. Despite a fairly ubiquitous conversation about social justice — perhaps more ubiquitous than at any previous time in American history, thanks to the media of the internet — I almost never read anything about this form of oppression, though I am certain it exists and has considerable impact.
There are reasons for invisibility, and I can nod towards a couple of them. For starters, while there have been historical movements against this form of oppression, such as in the psychiatric survivors or antipsychiatry movements (the oppression was then called psychiatric oppression), none of these movements reached the level of mainstream recognition that other social movements have, such as feminism, LGBTQ rights, or the civil rights movement. The story of “mad people” is not yet a part of the elementary school version of US history, nor is there an “Ex-Patients Caucus” in Congress. This is not recognized as a part of the American social fabric in the way that other groups or histories are, though they are very much a vibrant and important part of it.
Furthermore, I suspect that there is something uniquely enduring about the tendency to put experiences of depression, psychosis, or mental illness out of sight and out of mind. Most people I know can identify this tendency in their own lives or in their own families, and very many of them seem powerless to put words to it. The affliction often has deep and widespread impact, yet conversation never comes up. That itself needs its own analysis and its own term.
In addition to that, there are probably countless more explanations for why this issue seems as marginal as it is. Beyond personal conjecture — the makeshift theories I can create out of personal research and observation — I would not know how to analyze this phenomenon as brilliantly as I see my peers take on other forms of oppression. The social, cultural, academic, and political infrastructure required to achieve a comprehensive analysis and reach a critical mass simply does not exist, leaving many who are in need of such thinking more or less helpless to find words. And the places where this infrastructure might exist are relatively small in the whole of things, and therefore the population it reaches is similarly fractional.
To borrow an old phrase, we are dealing with a problem with no name. I’d like to identify that problem in the hopes of developing a more thorough theory on what this nameless oppressor is, and how it operates. If, for example, sexism refers to a social attitude, and patriarchy refers to the social structure that produces and upholds this attitude, then I’d like to promote a working definition of how social attitudes and social structures restrict the freedoms of people with mental illness along similar lines. (Importantly, I use the phrase “mental illness” because it is most predominant in our culture and media, and therefore will communicate to the widest amount of people. I am familiar with and respect the criticisms made about this phrase, and I hope that more people will follow this thinking towards those criticisms). I propose we identify a pervasive but not-yet-politicized attitude known as sanism, and do so alongside its associated structure — for lack of a more adequate phrase, structural sanism.
Sanism, along with its related –isms, more or less connotes a set of prejudicial or discriminatory attitudes. The social construct implicated by the term sanism is “sanity.” This is the concept around which structural sanism is formed, and which influences social experiences based on designations of sanity or insanity — or, more commonly, sanity and mental illness. I have suggested this to people in my life, sometimes to be met with skeptical responses. “Sanity is a construct? Sanity is just common sense. Sanity is being normal,” they might say. But identifying a given attribute as the norm is precisely the action that ignites the process of a social construct. And by making sanity the default normal, it must be signified by an adjacent abnormal quality — in this case, insanity, “crazy” people, mental illness. And what is insanity? I am not entirely sure. That depends on who you ask, and, like other constructs, it is probably a fluid, indefinable concept, albeit one we give much significance to. Insanty could be a diagnosis of mental illness, an extreme psychological or emotional experience, unique thinking, or any number of “strange” behaviors or dispositions we call “crazy.” It is not connoted by fixed definition, but by membership in a broad, open space outside of a mental, behavioral, or emotional norm.
For a communicable example, the colloquial uses of the phrase “crazy” shows us just how much exists within this territory of the insane. A cursory glance at the thesaurus for “crazy” contains the words, “mad, insane, deranged, demented, lunatic, mental, raving, loopy, ditzy, stupid, foolish, idiotic, silly, absurd, ridiculous, farcical, laughable, risible, unworkable, ill-conceived, senseless, daft, passionate, enamored of, infatuated with, amongst other terms.” Anyone who attunes themselves to its uses in daily life will soon find that the word has so many definitions that it actually has no meaning at all. Just as obviously, an idea of “crazy” is being produced and reproduced here — often in very negative terms, though (just as importantly) not exclusively so.
“Very well,” the skeptic might say, “I see what you’re getting at. But if sanism exists, what makes it so bad?” I posit (and this is a working outline) that sanism in action is primarily represented in a double standard of treatment marked by social isolation, exclusion, neglect, control, paternalism (restricting another’s liberty while telling them it is in their best interests), fear, shame, silence, and assumptions of deviancy, ignorance, incompetence, and violence. I believe that the structural form of sanism was most concretely represented by the era of the asylums. Though the asylums were largely shut down, in the absence of a commitment to change the conditions surrounding them, these conditions did not disappear. Rather, they continued to influence American society in more diffuse ways, which brings us to the complicated, unidentifiable place we presently reside in — where the standards of the asylum maintain some social power even if asylums are no longer a fixture of American life.
The skeptic may then say, “Fine theory, but show me what that looks like.” Without annotated studies, all I can point to is my own experience and observation, and hope that it is enough to convince a skeptic. I have seen civilians cower in terror when others identify themselves with mental illness. I’ve seen parents devolve into hysterics over their perceived “failure” in their pained, afflicted child, and the marginalization it has brought them. I’ve seen people go unaware of mental illness in their own family for a near lifetime, only to have a major, hidden chapter of a family history of mental illness revealed to them in their sixth decade of life. I’ve met people with law degrees who were told that they would never work again after a psychiatric break, and I’ve heard people say that it would be inhumane to have children if mental illness is in one’s gene pool. I’ve heard of engagements break apart after the diagnosis of a mental illness. Totally unsuspecting people are blindsided by a friend’s suicide, only to wonder in desperation, “I had no idea anything was happening. My god, what could I have done differently?”
Community mental health services across the country have undergone years of disinvestment, leading a 2003 Presidential report to declare that the mental health system was “in shambles.” Fifteen years of inertia and economic collapse later, things are no better, leaving large swaths of people with mental illness without any supports. Police operate as the default line of response for mental health calls. Too often this results in a shooting, and the victims are subsequently portrayed as disheveled and irrational in the media. Police themselves have some of the highest rates of death by suicide, while institutional norms in policing serve to discourage the recognition of underlying distress. Our prisons and jails bear the shame of being America’s largest mental health providers, and, in Illinois, the “treatment” received there has been declared “cruel and unusual punishment.”
The “mental illness” explanation for acts of grotesque violence is promoted as ordinary common sense. An outraged and aggrieved populace denounces their President elect as “mentally ill,” placing this form of derision well within the bounds of so-called civil discourse. I have friends who have had to cede control of their lives for 72 hours at a time to involuntary commitment, to the detriment of their personal and professional lives, and others who have been drugged against their consent in the name of mental health treatment. Members of every ethnic group tell me, “In the (Asian, Black, Irish, Hispanic) community, we have a problem with stigmatizing this, we don’t really talk about it,” as though this is a local complaint rather than a universal one. Individuals struggling with mental illness believe, “I’m the only one,” as though the complaint is even more specific.
And I could go on and on about the horribly backwards and needlessly repressive ways this reveals itself in the world, and the ineffable torrents of pain and hopelessness people endure as a result. None of this is merely coincidental. These incidents are far too common in theme and in their rates of occurrence for coincidence. No, I believe this is a systematic affair, all related to how we’ve organized society to deal with — or not deal with — the suffering of the mind. This is sanism. The word is currently so foreign to American English that a squiggly red line develops as I write it, so as to say, “This is not in our dictionary.” We are looking at, to paraphrase what lawyer Michael Perlin wrote, the tip of a deep and ominous iceberg — one with wide impact, deep historical roots, and, despite its apparent magnitude, marginal resistance. I believe it constitutes a major burden on human freedom — possibly even one of the largest, once it is exposed in full.
In the models of other social movements, I implore us to advance a multifaceted, structural, cultural, and political analysis of mental illness in America, to illuminate the reality and mechanisms of sanism, and to then envision and implement ways of organizing American life around it that do not limit our potential for flourishing so drastically. I want this movement to recognize the power in numbers I believe it has — millions, at the least — and charge towards the heart of American culture, and take hold of it.
This sounds like a wildly grandiose agenda, but there are reasons for optimism. In the last decade, we have witnessed great potential for major consciousness-raising efforts to surge into the mainstream out of seemingly thin air. The first was the Occupy Movement, followed by Black Lives Matter, the Bernie Sanders Campaign, and most recently, MeToo. Each of these efforts took aim at a repressive structural phenomenon, be it a rigged economy, structural racism and policing, the common sense of the American electoral system, or sexual harassment, and each then found a deep and sudden resonance across the American population. Whether or not these efforts have translated into institutional change, or will someday do so, is a separate and much bigger question, and any consciousness-raising effort around sanism and mental illness should be carefully attuned to the fine print of this task, and acknowledge that there is always much more to change than the conversation. Nevertheless, at a baseline level, the capacity to add another layer of social awareness to the American mainstream is enormous. This fact has been demonstrated repeatedly in our times, we should consider ourselves on the cusp of another awakening, and we should urgently pursue a contribution of our own with tactful, concerted efforts.
Given the pervasiveness of common disorders like depression and anxiety, the raw deal dealt to those with disorders such as bipolar disorder or schizophrenia, and the rising incidences of suicide in the United States, I believe there is a vastly wide population of people who would not only respond to such an effort, but who are outright desperate to see one hold influence in our culture. There is a great awakening on the horizon, and we have the power to instigate it. More to the point, if real, substantive change in American society happens when all facets of it work together — faith-based groups, businesses, politics, media, community organizing, advocacy groups — I think you can identify each of these arenas murmuring about the “mental illness problem” in their own way. It would be a shame if this convergence of factors were seized by multinational pharmaceutical corporations, who are well situated to do so, and who plausibly have no stake in the system beyond making drugs the only systemic response available for mental illness. We can seize this opportunity ourselves and present an alternative vision.
Should such a process develop, then there are subsequently deep, profound, beautiful questions to unpack about mental illness in American life. What is suffering, and where does it come from? The world? The brain? The soul? How is it relieved? With relationships? Environment? Drugs? How do social or economic structures induce mental illness? Why are suicide attempts and trauma more common in marginal populations? What if experiences of mental illness are totally natural responses to the issues presented by movements like Black Lives Matter or MeToo? How do we account for the reality that death by suicide in the United States is very heavily a white, middle aged, male, and rural phenomenon, and how might hypothetically deplorable responses to this reality have enabled the politicking of Donald Trump? How is male depression and suicide influenced by gender, how might engagement with feminist thinking relieve these burdens, and what mutually beneficial outcomes could be reached from this? How does one make sense of the paradox of suicide amongst affluent people, and how is that related to systems that produce wealth and poverty? What commonalities can we reach by re-politicizing mental illness?
But all of that must come after the introduction has been written. For now we face a much simpler task: identifying the problem and communicating it to the world. All of this deserves a deeper, more annotated treatment, and I hope the best minds of our time will lend their efforts to it. It needs its history books, its social theory, its great films, great novels, and hordes of organized citizens to be remembered and revered by history. The problem is just that big and just that urgent, and I know that there are millions of people who understand this simply through first-hand experience. I hope you will join me in pursuing this, and I hope we can bring this process to everyone who could benefit from it.
Which, incidentally, includes literally everyone.
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.