When It Comes to Mental Health Problems, The Disability Framework Fails

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This will be controversial, as I am going to argue against the idea that mental disorder is a disability. Nonetheless, it is a critically important issue to raise. Treating those struggling with emotional distress and troublesome behaviors as mentally disabled is a barrier to arriving at humane and dignified ways of assisting them.

Let me emphasize that by asserting this, I am not belittling them or suggesting their path to recovery is an easy one. Instead, my thesis is that despite the very real difficulties they face, they retain the ability to think and act differently.

An illustration of a tree with cartoon hands for leaves on a blue backgroundMy thinking about this issue starts with de-medicalizing mental disorder by rejecting its Diagnostic and Statistical Manual of Mental Disorders (DSM) identity as a “dysfunction in the individual.” A far more parsimonious, empirical, and humane explanation is that the various problems diagnosed as mental disorder consist of our beliefs, thoughts, and feelings about personal dilemmas and social problems, and the ways we respond to them. No dysfunction exists, as the brain and body are working just fine.

The only way for something to be dysfunctional in the individual is when there is a natural way of functioning, and research has consistently failed to demonstrate any disease, defect, or deficiency of natural bodily functioning as the genesis of mental disorder. That’s why it is still segregated from the rest of medicine as “mental” disorder or “mental” illness.

By mental disorder I mean those DSM categories that consist of our experiences of and reactions to distress.1

These have no natural ways of functioning in the individual. Obviously, they can become problematic in a social functioning sense, but not because they are impairments of natural human order that make the person do what they do. In fact, they can sometimes be quite functional, such as when a heightened state of fear and vigilance during war enhances a soldier’s safety, when disappointment and retreat from life provide an opportunity to renew one’s sense of purpose, and when dissociation can temporarily help protect one from intense and otherwise unavoidable anguish.

When social functioning problems are diagnosed as mental disorder, it is because they deviate from what is considered desirable or appropriate. Thus, conventional diagnostic judgments are based on observers’ moral ideas of right vs. wrong and good vs. bad, or the affected person’s own desires. This is where the term “mental disorder” comes from. It deviates from a socially ordained or personally preferred mental order, not a state of natural mental functioning.

It is important to highlight that the key feature of mental disorder is one’s cognitive and behavioral responses to emotional pain, not the pain itself. Emotions are indispensable for human life. They are not nuisances to be eradicated. Even when very painful and hard to understand, they still reflect something meaningful, and they can point to solutions if there is a willingness to tolerate and “listen” to them. At times it might be helpful to soothe the pain for practical benefit with chemical or other means but resorting to such an indefinite soothing strategy puts the person at risk of an indifferent, meaningless, and socially disconnect life.

Instead of dysfunction in the individual, the human problems that get diagnosed as mental disorders are about witting and unwitting, meaningful, and personalized reactions to felt circumstances. With mental disorder, nothing is dysfunctional in the person, and nothing removes the person’s agency.

Given this, we are left with the inescapable conclusion that mental disorder does not literally remove one’s abilities or dictate their responses. On the contrary, it is a label given to people who exercise their abilities in ways that are deemed unwanted or inappropriate. Circumstances and experiential histories, both positive and negative, remote and recent, understandably set the stage for emotional tone and intensity. Thusly, they form one’s motivation for responding in moments of emotional disturbance. They do not dictate or prevent what people do. Instead, they make it difficult to do otherwise, especially with engrained and routinized habits and extreme situations.

Therefore, mental disorder is not disabling in the same sense that paraplegia is. If one’s legs are paralyzed, and no medical treatment corrects the paralysis, then one has no choice about walking. One is not able to walk. This is because paraplegia is the result of an interruption of natural functioning that truly disables people, irrespective of their motivation to walk.

Yet if someone is depressed and remains in bed for days on end, while they don’t have the ability to merely flip a switch to feel better and believe different things, they still retain the ability to decide to get out of bed, get on with their lives, and avoid the harmful spiral of withdrawal from life that is characterized by depression. They aren’t incapacitated. Psychotherapy and social-emotional support do not restore a person’s capacity to do these things. These interventions restore their desire and willingness to tolerate ongoing distress, and to think and act differently, nonetheless.

Still, the widely accepted view among the lay public, as well as within professional circles, is that mental disorder is a disability, removing personal agency just as paraplegia disables someone from walking. In the case of depression, it is often claimed that the accompanying despair does more than just provide rationale for staying in bed. It is additionally claimed to prevent the person from getting out of bed, entertaining different thought patterns, and performing daily tasks.

This is because of the belief that mental disorder is either a physiological dysfunction of the brain/body, or a more ghostly type of mind dysfunction that dictates thoughts and actions by working independently of the person’s desires and decisions. It is neither.

Over two decades ago, the neurodiversity movement formed to normalize behavioral, emotional, and cognitive differences among people, and to eliminate the stigma of those who had been identified as mentally disordered. It was originally focused on de-pathologizing autism, but was later applied to many other mental disorder categories. However, despite this principled intention, the movement might inadvertently strengthen the stigma by conflating mental differences and mental disability.

The movement encourages the perspective that mental and behavioral diversity among individuals is ecologically valuable, and not a matter of pathological deviation from normal mental or bodily functioning. Yet, it simultaneously proposes that the neurodiverse, who are diagnosed with mental disorder, are impaired in ways that are disabling.

This critique has been made by autistic advocates, who argue that their differences do not need to be treated or medicalized, but instead that the neurotypical need to work to accept them as part of the diversity of society.

While I fully agree with the de-pathologizing of mental disorder, I strongly disagree that it is disabling. If the neurodiversity movement is one of trying to shift away from pathologizing people who are labeled mentally disordered in order to restore their dignity as valued members of society, then why would we want to continue using the limiting concept of mental disability that places into question their capacity to exercise mental and behavioral control?

Doing so without showing evidence of an incapacitating dysfunction in the individual would require such a broadening of the definition of disability that it would include the mental difficulty in doing something. This necessarily would lead down a very slippery slope and ironically make it impossible to distinguish between ability and disability as many things in life are mentally difficult to varying degrees. For instance, is mental disability involved when someone in the heat of passion kills another, or when a person agrees to comply with the demands of a gun-wielding attacker. Were they disabled and not able to choose differently? Less extreme examples are the mental difficulty in sticking to a diet or tolerating the fear of social ridicule when publicly speaking. In these situations, the person is not disabled. They are demonstrating their rationale for action.

A social model of disability has been offered to explain this no-pathology-but-still-disability idea. In short, this alternative to the medical model of disability identifies social impediments as the key disabling factor and not the person’s impairments. So, with the social model, a blind person is not disabled because they can’t see. They are disabled because of sight dependent traffic signals and other social structures that favor the sighted. Likewise, a depressed person is said to be disabled, not because of depression, but because of social structures that favor the non-depressed.

Notice, though, the social model still presupposes an impairment in the person, as does the medical model, but societal restrictions of the impairment are identified as the disabling factor, not the impairment itself. This perspective seeks to remove the negative connotation of the impairing issue and transfer it to the social obstacles.

This is a key element of the social model of disability. Something of an impairing nature in people, not just differences among them, is said to prevent them from getting along effectively in environments that favor unimpaired people. The impairment is present regardless of the environment, but accommodating environments remove the disability by rendering the impairment harmless.

But what is the impairment in the individual said to be mentally disordered? Unless we claim that one’s experiences and cognitions impair them, and not just form their rationale for action, there are none. There are only rare instances where intense and abrupt emotional experiences have such stunning effects that they render reactions largely reflexive and nearly impossible to control in the moment. Absent this, though, one’s beliefs, thoughts, and emotions do not dictate their reactions or decisions, they are the motivation for them.

Also, in contrast to physical impairments such as paralysis and blindness, it is hard to envision enabling accommodations that would aid people who are said to be mentally disordered. What things can’t the person do in an unaccommodating environment, and how could we change the environment to enable them to do it? It is one thing to be respectful, compassionate, and understanding with all people, regardless of mental disorder designation. But it is quite another to claim they don’t have the power to function because of an impairment that isn’t being accommodated.

Campaigns to reduce the stigma of those labeled with mental disorder diagnoses might come close to an accommodation. However, it is important to note that the stigma is caused by the very act of labeling the person mentally disordered, impaired, and disabled in the first place.

Certainly, it is a serious problem when discrimination prevents people from accessing social resources, and it is important to rectify this flaw. But if discrimination alone merits the “disability” label, then should we also apply that to racial, ethnic, religious, gender-based, and sexuality-based forms of discrimination as well? Is one’s race, ethnicity, religion, gender, and sexuality an impairment in the individual, to be “treated” or “accommodated.” This is obviously a stretch of logic and extremely offensive.

How can we reject the idea of pathological mental functioning that needs to be medically corrected or treated, while simultaneously claiming disabled functioning because of an impairment that needs to be accommodated? If mental disorder is not a dysfunction in the individual, there can be no impairment or disability.

Nevertheless, mental disability has gained widespread recognition. The United Nations Convention on the Rights of Persons with Disabilities demands certain benefits for those diagnosed with mental disorder: respect for human dignity, autonomy, freedom to choose, and independence. The same types of provisions are contained in the Americans with Disabilities Act to ensure those claiming mental disability have governmental protection and access to special care. Similarly, there are several national and international organizations pursuing rights and justice for those identified as mentally disabled.

Now I realize it is a well-intentioned cause and there is practical and political value in using the existing disability concept and systems for people in distress. And I know that my critique is disadvantageous to those who depend on the system. Still, the problem I see is in identifying people as mentally impaired or disabled. That label is the very justification for the all-too-common contemptuous, paternalistic, and coercive treatment of them.

Further, in contrast to physical disabilities, we can’t point to something in the individual that is impaired. This commonly gives the impression that the person’s very essence is dysfunctional, leading to the popular moralizing and condescending ideas of character and personality flaws, and to the self-fulfilling prophecy of self-stigma, in which the person becomes certain that they don’t have the abilities that others do.

In addition, the disability system can create a strong social and financial dependency that can conflict with the goal of recovery. So, those who use the system can pay a very high price.

In an ideal world, it would be far more humane to eliminate the concept of mental impairment and disability in official proclamations and social support systems, and merely include those labeled with mental disorder among all other non-labelled people in terms of securing widely recognized and indisputable human rights, as well as social and financial resources. It is possible to help people in distress without diagnosing them mentally disordered or designating them mentally disabled.

We can’t take away the difficulties people face or the emotional pain they endure. But we can empower them by removing the falsehood that they are unable to think and act differently because of a disability.

I think this is the fatal flaw of the concept of mental disability, whether viewed with a medical or social model. In fighting for better rights, caring, and support for those labeled mentally disordered, the mental disability concept encourages the status quo of dealing with them as mentally defective members of society.

The neurodiversity movement is just replacing one bad idea with another. Both the disability and the pathology models rely on the idea of a deviation from normal, non-pathological (or non-impaired) functioning in the individual. They keep people stuck in the role of a person whose mental functioning and behaviors are impaired and, therefore, who do not have the ability to think for themselves or decide their course in life. In short, this disempowers them and devalues neurodiversity; the opposite of what the movement seeks.

Human diversity of mental experiences and behaviors can be valued without invoking impairment and disability. Let’s find a different way to assist those struggling with life challenges without branding them with the identities of the disordered, dysfunctional, and disabled.

I realize this is an enormous challenge.

Show 1 footnote

  1. For the purposes of this essay, I am excluding the DSM categories that are physiological illnesses (e.g., substance withdrawal, vascular neurocognitive disorder – they are disabling) and those that describe innate cognitive limitations and interests (e.g., ADHD, autism spectrum disorder – performing to one’s limits and pursuing interests can hardly be considered disordered).

***

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.

65 COMMENTS

  1. I wasn’t disabled until I had ECT and then a decade and a half of forced medication and other trauma inflicted by the mental health system. Now I’m disabled, most likely for good because there is no where to go and no one who will help a person in my situation. I’ve lost everything.

  2. My sense is that while some of the points Chuck makes are valid, his overall conclusion is misguided and unhelpful.

    I do think this issue is complex, because people can be harmed in two opposite ways around the issue of what they are told about disability.

    People can be harmed by telling them they will continue to be unable to do something when in fact they could easily learn to do something. That’s the harm the mental health system does with its idea of lifelong mental illnesses, that people are told to expect to continue to have and then they become dependent etc. That’s real harm, and I appreciate that many of us, including Chuck, want to avoid that kind of harm.

    But another way to harm people is to tell them and the people around them that they are able to do something, when in fact they are still lacking something they need in order to be able to do it. The harm there is that the person will be held accountable for failing to do something where they actually could not do it, when they will continue to not be able to do it until they obtain that missing ingredient, which might be a change in belief, perspective, learning how to handle difficult emotions and traumatic memories, etc.

    What I would propose is that we frame mental and emotional disability as always possibly temporary, because they can be remedied by learning, or organizing our minds differently. But they are also real, and sometimes both the person and those helping them don’t know how to help the person organize differently – as with a person who continues to be psychotic despite the best services of even programs like Open Dialogue. In those cases, recognizing the disability as real for as long as it continues is key to any kind of humane treatment.

    Of course, if we lived in a society where everyone got their basic needs met whether or not they worked jobs etc., then we wouldn’t need to be trying to figure out who is disabled and who isn’t. But in a society where help with basic needs is only extended to those seen as disabled, then calling people “not disabled” when they are in a mental state that is stopping them from being employable, is simply cruel.

    • I appreciate this rebuttal but I have to point out that these conversations almost invariably leave out those who have untreated disabling physical illnesses that are labeled as mental issues. Many Lyme Disease (and other physically ill) patients are misdiagnosed for years or decades with “mental illnesses” or with catch all “mental” associated illnesses such as “fibromyalgia”. These people are physically ill and need treatment. Many are left permanently disabled by the damage wreaked upon their bodies by a medical system who all but ignores them until they are nearing death’s door.

      When we discuss whether or not those labeled with “mental illness” should receive disability or be considered disabled, we can’t exclude those who have been so grievously treated by the medical system and who are indeed seriously physically ill.

      All of this also ignores the current state of the world. If you’re not depressed, something is seriously wrong with you.

      • Well, something must be seriously wrong with me, because since I am no longer taking the psych drugs or are involved in the therapies and treatments they throw on you, I am not depressed. Some days, I do get upset at the evil in the world and some of the stupidity I see; but then I have a long talk with Jesus and I feel oh so much better. I guess for those of us who choose Jesus over depression, something must be seriously wrong with us. Thank you and Merry Christmas.

    • Ron, you make an excellent point: “…if we lived in a society where everyone got their basic needs met whether or not they worked jobs etc., then we wouldn’t need to be trying to figure out who is disabled and who isn’t.”

      You mention people who “are in a mental state that is stopping them from being employable”. There is nothing wrong with my mental state, but I don’t fit in. I have always been an outsider and a loner, since my childhood.

      I had very serious social difficulties for most of my life. There were periods in my life where I had literally no friends – not even one person. I have gained in confidence in recent years, but there is now a gulf between me and most people, a gulf I can’t overcome (in terms of social capital etc.).

      I don’t know if I am “employable”. And the very term “employable” is highly problematic. Of course, in every society there are some hard and extremely stressful jobs which few people are ready to do, but if a person accepts such a job only out of necessity, is it a good thing? If the job mentally and/or physically destroys the person, will it be a good thing? And would it be fair to expect a highly educated person to work at a job largely below their education level only because the person is unable to find any other job?

        • Bill, yes, of course I have considered it. I have been working as a translator and I have even translated two books since losing my job.

          However, this profession is extremely competitive and very badly paid, so I have been unable to earn a living in this way. One’s social capital (whether or not one has friends in publishing houses etc.) plays a huge role.

          And most of the translators who are much more successful than me work extremely hard, which is definitely not good for their health. This workaholic lifestyle is seen as normal in the profession.

          As I explained in one of my comments, in order to become e.g. a psychotherapist I would first have to pay for a very expensive course. I don’t currently see any other opportunities for self-employment in my case. My love of writing, reading, research and foreign languages is sadly not enough to earn a living!

          Let me add that I am quite an introverted and contemplative person, which makes things even more complicated…

    • “Let’s find a different way to assist those struggling with life challenges without branding them with the identities of the disordered, dysfunctional, and disabled.”

      The above conclusion seems to me a very empowering, reasonable, honest, and pro-human message. Perhaps you and I have come to identify a different conclusion of the article, but I think aiming to remove often stigmatizing, potentially damaging, inaccurate labels from individuals encountering complex, meaningful, difficult, and expected life challenges is not misguided or unhelpful, but absolutely essential to furthering our understanding of the human experience.

      People don’t have to handcuff themselves to the idea of medicalizing human suffering, experience, and living— and I appreciate that being pointed out regularly and often. I don’t actually find the compassion in forcing one to eternally or temporarily accept being labeled disordered, dysfunctional, disabled, (or diseased) by anyone else, when they are encountering unique life problems and desire help with them, or not. Also, what on earth qualifies any another human to tell me my mentality is disabled? I have not and will never agree to giving anyone such a power or authority over me or others. For anyone to assume such a role seems like a terribly unwelcome overstep at best.

      If my partner of fifty years dies tragically in front of me (and we can use our imaginations to make tragically mean- as bad as it gets) I may for example want to stay in bed in an attempt to escape how that feels to me. I would no doubt be experiencing a devastation and pain so great that anyone could understand why I may want to shut down. I may even *feel* or *say* that I can’t get out of bed, but this isn’t actually true— which I think is the authors main point. It is still possible for me to get out of bed if I want to— and not doing so doesn’t make me disabled— it just confirms that I don’t want to because of how deeply sad I feel— there is no failure or moral trespass to be found here. There is also no mental, mind, or brain dysfunction or disability.

      The fact is that this loss of my partner would not actually render me disabled in the true sense of the word, thankfully— and I wouldn’t have become mentally dysfunctional or disabled… even temporarily. On the contrary, I will be responding quite naturally and understandably to an incredible loss. I will be profoundly and deeply sad— but I will still have the physical ability to get out of bed, assuming I had it before the tragedy, and assuming I want to after it. I am not disabled on the days I stay in bed, and fully functional on the days I happen to get up. Instead, I will be faced with having lost a person who was most important to me, and being unable to get them back ever again. I may want to stay in bed in an attempt to cope and sooth myself— maybe even for a long time. Maybe even forever. Who has (or wants) the right to tell me how long I can grieve or feel sad, or how long I can stay in bed before I must receive some arbitrary diagnosis like depression or adjustment disorder? Who would dare call my natural, human response a dysfunction or disability? To me, *this* would be cruel— and not the reminder that if and when I want to, I am actually still physically mobile and able to get out of bed, go to work, hug my children, get in shape, laugh at a joke, etc. My pain may decrease or even end my desire to move forward, but the point, I think, is that I am still able to if that’s what I decide I want- I am not actually dysfunctional or disabled. I think this is a more helpful and truer example of human compassion.

      Though one may struggle to navigate the many incredible and serious challenges of life- our sadness, confusion, fear, loss, and tragic experiences do not render us disordered, dysfunctional, or disabled- they render us human. I think it’s perfectly reasonable and responsible to seek new ways of making sure we can get help when we want it, without forcing us to be diagnosed, interrupting our self-determination, or obfuscating our ability.

      Being human is not a debilitating disability— I think it would be most helpful if we stop demanding people think otherwise before we agree to assist them- don’t you? Isn’t this for what the author is advocating?

      • Jesse James, I don’t think that anyone here is saying that people who are suffering should label themselves as “disabled” or “dysfunctional”. But “disability” can be defined in various ways. It does not have to mean anything negative, it does not mean that the “disabled” person is inferior to other people.

        In my own case, I certainly don’t feel that there is something wrong with my brain. But I know that since my childhood I have had difficulties which most people don’t experience. For some reason many people did not accept me, even when I was trying hard to “be like others” (actually I was sometimes very painfully rejected when I was trying hard to “fit in”).

        I feel that lots of people somehow sense that there is something “different” about me and don’t like it. I feel deeply grateful whenever I feel truly accepted by a person. I had a psychotic episode when I felt rejected by someone I saw as my only friend.

        Because of my social difficulties I am very isolated and I have not had many experiences which most people take for granted. In today’s world social skills have become extremely important; life can be very hard for those who are perceived as “weird”.

        I know that my being very isolated in my workplace was the main reason why I lost my job. If a colleague talked to me, I felt grateful. I am now unable to earn a living, though I am a highly educated person and an excellent translator.

        To me, “disabled” does not mean that I see myself as inferior to other people. I simply see that there are things I can’t do or don’t have because I am different, because my development has been different. Even though I have gained in confidence in recent years, there are things I simply can’t achieve – things which seem natural to most people.

        2 years ago I joined my country’s association for psychological and social approaches to psychosis because I was hoping that I would be valued there as a sociologist with personal experience of psychosis. Sadly, I was very disappointed – no one was interested in me, my knowledge and my experiences. I was probably dismissed as a “patient” with nothing important to say, though I don’t see myself as mentally ill and don’t take psychiatric drugs…

        This is how many “professionals” treat people with experience of psychosis – they often seem to think that these people have nothing important to say (a psychiatrist kept interrupting me whenever I tried to say something). Yes, people with experience of psychosis are often dismissed or even ignored by “professionals”. Or they are patronized…

        I believe that I have the right to financial assistance or to supported employment. I am a person who has accumulated many experiences of being rejected since her childhood, I am a person who is very isolated. I don’t find the term “disabled” offensive in any sense.

        I know that I will probably always be poor and I don’t have a problem with it. I simply want to feel safe, to know that I will never risk being hungry or homeless. I think that plenty of people don’t even realize what it means to be a poor, socially isolated person with experience of psychosis who does not get any kind of disability payment… (And I am one of the lucky ones because I have a few loving family members and because I feel quite happy despite my situation).

    • Joanna,

      It’s nice to virtually “meet” you!

      Thank you for your very kind and candid response, and for sharing some of your experiences; I truly appreciate your generosity and openness.

      Perhaps we are confused by each other, but I have not argued in favor of casting or seeing anyone as inferior, nor do I— no matter what label (including disabled), self given or received. On the contrary, I argue that no one should have the authority or power to cast another as “emotionally or mentally” disabled— which has been discussed by others on this thread.

      While I do agree that “disability” can be defined in many different ways, I think that actually strikes to the heart of the issue. It seems to some that, if one *feels* disabled, then they are. That if someone has a “missing ingredient”= a lack of knowledge or understanding in relation to beliefs, perspectives, traumatic events, memories, emotions, etc- then they are disabled, at least temporarily. If this is the definition- then I strongly feel we have just inadvertently labeled every single person as disabled. By nature, every single human being will lack knowledge and understanding about many, and maybe even most things. What is the advantage or utility of deeming us all disabled?

      If I may very respectfully take from your sharing:
      You don’t feel there is something wrong with your brain. You don’t see yourself as mentally ill and don’t take psychiatric drugs. And though you have challenges in front you, you report feeling quite happy. I think this is all fantastic! To me, and I am truly not trying to be offensive but honest here, it seems that you accept referring to yourself as “disabled” because that’s what you’re forced to do in order to get the support you need and want in your location. My argument is that you *shouldn’t have to*. What if you and I could get the help and support we need without having to be referred to as disabled? Do you think such a reimagining could be helpful? I do.

      While I’m very happy to know you don’t see the term “disability” as being something negative— I do think it can at times have a negative and stigmatizing impact on individuals for a variety of reasons. I also think it cloaks, confuses, and obfuscates natural human experiences, emotions, and reactions which isn’t helpful. I think the label can sometimes make people feel like something is “wrong” or “inadequate” about them, when the body (including the brain) is actually operating without defect. While it happily hasn’t been the case for you, that can then lead many people down the very dangerous road of taking dangerous psychiatric drugs, for example, and amongst other dangers.

      Not to compare or downplay your experiences at all— but I too have faced unique forms of rejection, traumatic childhood experiences, traumatic adult experiences, isolation, social difficulties, etc. I don’t and wouldn’t profess to know how challenging all of that has been for you, but I do know how difficult it has all been for me— it seems nearly impossible to describe how difficult it can all be to endure— wouldn’t you say?

      But…

      I also…. simply see that there are things I can’t do or don’t have because I am different, because my development has been different. I have confidence in some things, and none in others. There are many things I may achieve, and there will be many things I can’t and won’t achieve. *I think this is the truth for us all.*

      Which brings me back to the article— I like the idea of trying to figure out a way for you and I (and all others) to get the help and support we need in life, without having to be called inaccurate and *potentially* harmful names like disordered, dysfunctional or disabled as stated by the author. To me, that seems a very important, meaningful, and worthwhile project.

      While I understand that you do not find the term “disabled” to be offensive, I truly hope you won’t take offense to my thinking the term is/can be unhelpful, misleading, and dangerous. I think we will put ourselves in a better position to understand *natural* human experiences and emotions without referring to ourselves as being “disabled.” I don’t think we are a disability.

      With the utmost respect, appreciation, and admiration— I view you as a human who seems honest, intelligent, unique, kind, hardworking, inquisitive, articulate, and engaged. I appreciate that very much and hope my words feel as constructive and genuine to you as yours do to me.

      From a person who has found the joy in being “weird” and “different”, I say keep trying your best and don’t give up! Great things and people may be just around the corner! : )

      Best

      • Jesse, thank you so much for your very kind and thoughtful reply to my comment. Yes, it is very nice to virtually “meet” in this way and the Mad in America website is definitely one of the friendliest online spaces I know!

        I agree with you that no one should have the power to say that someone else is “disabled”. In general, no one should believe that they have the right to label another person in some way.

        You say, “It seems to some that, if one *feels* disabled, then they are.” I don’t personally think that people with various problems are quick to label themselves as “disabled”. I would rather say that many people are quick to embrace various psychiatric labels and often seem to find them somehow reassuring.

        Jesse, you say: “What if you and I could get the help and support we need without having to be referred to as disabled?” Yes, of course people should be able to get the help and support they need without having to refer to themselves as “disabled”. However, I don’t feel that I am forced to accept the label “disabled” in order to have a chance to get financial assistance etc. in my country.

        Let me explain my attitude more clearly. I am genuinely forced to use the “schizophrenia” label in order to try to get a disability payment, though I reject this label. But I have no problem with the term “disabled”. I don’t find it negative, painful or stigmatizing, unlike the “schizophrenia” label.

        I think that labels like “mentally ill” or “schizophrenic” are far more stigmatizing than “disabled”. As we both know, many people fear the “mentally ill” and find them repulsive, believe that they should be forcibly treated etc.

        You say that the label “disabled” can “lead many people down the very dangerous road of taking dangerous psychiatric drugs”. However, people start taking or being forced to take these dangerous psychiatric drugs when they get a psychiatric label – not when they are labelled as “disabled”.

        No psychiatrist has ever told me: “you are disabled”. And if a psychiatrist had used this label, it would have made me feel much better than the labels “schizophrenia” and “mental illness”.

        Of course in a sense everyone can say: “there are things I can’t do or don’t have, there are things I can’t achieve” etc. But I am not talking simply about individual limitations and frustrations…

        As I have been trying to explain, I know that my development has been strikingly different from the one of most people. Even today I find it difficult to talk about it because I know that most people take certain things for granted…

        To take just a few examples, for long periods in my life I was used to not having any friends, not even one. I have never assumed that I would find a partner as an adult. I did not have boyfriends.

        I found my only real relationship only in my late 30s, after some very painful experiences. Some men clearly assumed that I was desperate or that there was something wrong with me – in fact, in some cases I was ready to give plenty of love and attention while expecting very little from the other person.

        As I said earlier, I was extremely isolated in my workplace. I am used to being rejected by other people for reasons I don’t really understand.

        I look at my life and I see how different it is from the life of most other women my age (I am now 41). I have only one friend and I feel very lucky because we will probably never stop talking to each other. I can openly talk to him literally about everything.

        I can’t openly talk to most people about my life because there are things I have to hide (like my psychotic episode) and because I don’t want to be pitied. I don’t want anyone to pity me because I don’t have a partner or a successful career.

        I am not saying that it all somehow makes me “disabled” in an objective sense. But I know what kind of difficulties I have encountered and I know how hard I have had to struggle to experience even very basic things (the first romantic kiss etc.).

        I know that I could think of myself as “autistic” (I do have some traits associated with autism), but this label does not really describe me. In fact, there are many autistic people who have never had such social difficulties.

        I once said in an online group for autistic women that I am wondering how they have been able to find their partners (the vast majority of them had male or female partners). No one responded and I guess that others were surprised by my question and did not know what to say…

        Let me make it clear that I don’t feel unhappy because of not having a partner – I am simply sometimes wondering why (as it seems) plenty of people did not find it difficult to find a partner or to make friends.

        You may have experienced similar (or different, but no less serious) difficulties yourself. I hope that even if your experiences were much more more painful than mine, you have also been able to fully accept yourself and your life.

        I do sometimes feel very bitter, especially when I think about people who did not really appreciate me, though I was truly doing my best (and maybe simply trying “too hard”!). But I accept these feelings of bitterness and I am glad that I no longer talk to these people…

        Jesse, all these things you say about me are so kind and heart-warming. If more people were like you, this world would be a much better place for everyone, not only those who feel “different”! Some people seem so cold and self-centered, but they somehow tend to think that they are “more normal” than those who find it easy to show warmth to others… This speaks volumes about the world we live in!

        Yes, I will keep doing my best, and I would add that my experiences have made me stronger, more resilient and happier! Yes, I am much happier now than I was in my 20s… I worry much less about what other people think about me and it is very liberating.

        • Hi Jessie and Joanna,
          This is a good conversation and I agree with much that’s been said. But any linking of what causes psychological problems with whether or not they are debilitating, concerns me. I had a severe psychological problem and found it very debilitating. I was established in a job at the time it developed. If I had to find employment during that time, I’m sure I wouldn’t have been able to. I was barely able to continue the job I had.
          I don’t think psychological problems develop from genetic or biological abnormalities. But many people do and will take the position that if it isn’t genetic or biological, then any struggle you are having is just a choice. In their mind, there’s no excuse for any impairment, or reason to provide any accommodation. We shouldn’t have to agree on the cause, to have some recognition of how difficult and debilitating a psychological problem can be.

          • Christine, I could not agree with you more. As you say, unfortunately many believe that only problems which have genetic or biological causes are real. There is a widespread belief that some people are just “making excuses for themselves”, “feeling sorry for themselves” or even being simply too lazy to work.

            I fully agree with you – people with serious psychological problems deserve support independently of the causes of these problems. I can’t say that the problems I have been having since my childhood have a biological cause, but I know that they are very real problems.

            There are many types of disabilities and we have to remember that disabilities don’t have to be caused by a physical impairment.

          • Sincere questions for Christine and Joanna (or anyone else):

            Is anyone who has very serious and very real problems disabled?

            If one says a disability isn’t caused by a physical impairment, what is then being used to determine disability?

            If I feel disabled, am I?

          • Jesse, problems can be only temporary. However, there are people who have very serious problems e.g. with social interaction or with “fitting in” all their life, since their childhood.

            Disabilities include long-term mental impairments, e.g. according to the Article 1 of the UN Convention on the Rights of Persons with Disabilities.

            You ask: “If one says a disability isn’t caused by a physical impairment, what is then being used to determine disability?” A person can be disabled even if s/he does not have an observable physical impairment. I see two problems here:

            1. Your question seems to imply that there is no such thing as long-term mental impairment. There are many examples of people who are unable to find or keep a job or even simply to look after themselves because of very serious and long-term mental health issues. I have seen many such patients when I was locked on a psychiatric ward.

            2. Currently there is no way to prove that there is no physical impairment of any kind in the organisms of people who experience or have experienced psychosis. Let me use my personal example: my psychotic episode began when I was taking an anti-malaria drug which may cause auditory hallucinations. I have never experienced another bout of psychosis, though I am not using neuroleptics.

            Many people use the same anti-malaria drug without experiencing any hallucinations. I am sure that for some biological reasons I was much more prone to developing psychosis than most other users of this drug. I am unable to indicate the impairment which made me susceptible to psychosis, but this does not mean that such an impairment does not exist.

            You also rhetorically ask “If I feel disabled, am I?” First of all, I have not been talking about people who merely “feel disabled”. In my own case, I have experienced serious social difficulties since my childhood, a psychotic episode and ostracism at work. I find it difficult to “fit in”, I have often been rejected by others, I am very socially isolated.

            If I say that I can describe myself as disabled, it’s not because I want others to feel sorry for me or because I feel inferior to others, or because I think that I can benefit in some way from describing myself as disabled. It’s because I know how different my life and problems have been from the lives and problems of most other people.

            People who have never experienced similar problems with social functioning often struggle to understand them. For most of my life I kept being blamed for my problems by people who claimed that there was something wrong with me, that I should “change” (most of them never explained what they meant).

            The idea that disability is real only if it has an undeniable physical cause is highly questionable. My mother has a friend whose adult son is severely autistic, unable to talk and to live on his own. There is no proof that his situation is caused by a physical impairment, but it would be ridiculous to say that he does not have any disability.

            Telling someone “no, you are not disabled” can be a form of gaslighting, of telling him or her “your problems are imaginary, stop feeling sorry for yourself”.

            I will end with this example from my own life: for some reason I was unable to learn many things at physical education lessons, or I was doing them much worse than others. Unfortunately there was no name for my problems. The teachers assumed that I was simply not trying hard enough… My problems were very real, though I did not have any visible physical disability.

          • Jessie,
            There currently isn’t any test showing physical impairment that used for disability eligibility regarding mental health issue. It’s currently the person’s report of symptoms or observation of symptoms. Clearly there are people disabled for mental health reasons. I worked with people who were so disabled they couldn’t apply for disability without help or obtain food and housing. Yes, I believe that someone can become that disabled solely from trauma. Should they not receive any help because their problem is not the result of a physical disease?

          • I fully agree with Steve and Christine. People have the right to the help/support they need. And there are certainly people who are disabled for mental health reasons. We should not assume that people deserve help only when their disabilities have observable or provable physical causes.

  3. When you have meningitis you FEEL ILL. You do not care what anyone else outside of your own brain says. The word “ill” has many alternatives. You can use any of them on yourself. You can call yourself “wasted” or “acursed” or “poisoned” or “fed up” or “depressed” or “schizophrenic” or “traumatized” or “swiped by a mythical glow worm” or “down trodden” or “rejected”. All of these are ways of saying “I feel ill”.
    It is not for anyone outside of your experience of your body and your brain to tell you that your choice of way of calling your “illness” is wrong. What business is it of ANY human being to dismiss your definintion of your illness. Doing so is a short step to dismissing your actual experience of being ill. It is as pushy as someone who is NOT YOU dismissing your ethnicity or dismissing your gender just because your claim lacks their definition of evidence or credibility. If you feel ill then you are ill. Illness can be severe and disabling. Ask anyone with iatrogenic illness how disabled by that they feel and then tell them there is no evidence anything is physically the matter with their brain. Not everything that does not glow like a glow worm on a brain scan means nothing is going wrong at a quantum level.
    This love affair humans have with “proof” of illness comes from the human tendency to bully the apparently well back into dead beat jobs that destroy them body and soul. Science may be lambasted for poisoning tots but hey ho lets all kneel on our kneelers and believe that science has got it righty again a few years after a mass scandal. Let’s all believe Daddy God Science can still see directly into our corpus vexum and tell us whether we are good to go and take up our checkout bib at the bargain store job.

    I am saying here that the human being with the illness should be “the expert” telling you and you and you and you and you whether they are ill or not ill.

    There is NO need for asking Pappie Science what he thinks about the plausibility of someones intimate private interior landscape. Its a form of specialist voyeurism as an attitude to the ill.

    This article says…

    “When social functioning problems are diagnosed as mental disorder, it is because they deviate from what is considered desirable or appropriate”.

    I must but in by saying that I can barely socially function because of my illness which to me, is a mental disorder, given that I can hardly manage to maintain a phonecall.

    Anyone with a brain blitzed by iatrogenic chaos would likely also stuggle making a phonecall. But go ahead and call in smug Science to pronounce their illness suddenly healed.

    Those who have won holding bad science to account, justifyably, may now notice that the same scientific know-all proclamatons have crept in to the discourse of the new trauma informed paradigm of care. Experts are going to start telling strangers whether they are traumatized or not because the lesson has not been learned. The understanding that our fellow human is, and should be, left alone to understand themselves in whatever way they freely prefer. Even if…shock horror….they choose a daft DSM Big Daddy Science way of defining their own illness. What business is it of anyone else to voyeuristically tell someone they are ill….or not ill? Or ill in yonder way but not this way? Or an old way but not new way? Or a new way but not an old way?

    Illness is like having a baby. In the past having a baby has been met with bizarre quasi scientific tools. A dinner set of unnecessary steely innovations. Eventually, several centuries later, someone bothered to ask the mother what sort of birth she wanted.

    Illness is the contractions before you give birth to yourself but nobody is gonna let you do it your way.

    What I am saying is there are TWO ASPECTS to diagnosis. One is that it is a vital way of saying this…

    “I FEEL ILL”

    Muffling that goes against human rights and freedom of speech.

    But the other aspect of diagnosis in this TWO ASPECT debate is that diagnosis can be used externally as a form of controlling people. It can be used to shut them up if they have legitimate greivances, ones that may be making them feel differently ill. And it can be used to almost religiously groom people into believing they have a condition that they may not. This second aspect of diagnosis gets all the press these days. But in the haste to pooh pooh this second aspect of diagnosis, and subsequently binning it, it potentially could allow new bullies from the church of Daddy Science, a faith that has never gone away, to berate the genuinely mentally ill for even saying they “FEEL ILL”.

    I am laughing because I know this will come to pass, and when it does the good thing is nobody will be lumbered with a diagnosis of an illness they do not have….a worthy development in care…..but the millions who are FEELiNG ILL will be told they have nothing wrong with them.

    Lets all help our governments make crippled people walk again.

    Bibs at the ready….

    • Agreed.
      When the people working in the system have proposals for how to address the massive iatrogenic harm that has been inflicted on people who became patients, voluntarily or involuntarily, then I may begin to believe any of this is about helping people. Until then, no. I know how I live and I know how on my own I am with everything because the powers that be, the people who run the system, continue to bury the truth of how much harm has been done to patients. Yes, I will need disability for the rest of my life because of what’s been done to me. I don’t need a change in perspective or a change in belief or to be told I’m perfectly able. I know I’m not anymore. I have trouble walking. I have trouble with so so many things. I need acknowledgment of what has been done to me and help getting through the remainder of my life, help that I’m sure will never come.

  4. Understanding on a surface level the history of the evolution of how ISEPP from ICSPP is important. For the organizational struggle into the very eytymology is critically important to what we hear as to what we read that is typed. The dis function and dis ability become caught up in an academic dog fight while potentially denying insightful and engaged learning by which the self can become whole. Whether one’s self was led to believe the temporary nature of learning context advanced by old belief systems, then being shunt aside can be a gross violation of civil rights. When elected and civil servants would not address the issue as framed and shown with documentation, from local to federal levels, then can one still file a law suit, or is the challenge one or economic disenfranchisement at the level of mind, not the color of skin? Contrary to your thesis, the “dis” may be akin the gap in the spark plug, that needs to be adjusted along with points. From an artist perspecive, many would like to close the gap in the Sistine Chapel, but then the gap just as the dis as in the stuttering of Moses serves a role.

  5. At present in our system, disability is more of a legal term that may or may not grant a person benefits, some needed, some maybe not. Personally, I did not become disabled as defined legally, until after I had been on psych drugs and therapized for several years on and off. At that time, I considered the fact that I could no longer work because even in the job interviews, I believed they were immediately judging me as being very mentally ill. Of course, by that time through vocational rehabilitation and a “job coach” I was considered “severely and pervasively mentally ill.” So, my only option was to apply for disability. Now, that I look back and am no longer on the psych drugs, I see that it was the psych drugs that were causing my “severe and pervasive mental illness.” No, I am drug free, etc. but because of the damage done to my brain, which at times, affects my body, I can no longer work. So, whether or not mental disorders can be called disabilities is patently untrue, if one considers that psych drugs are probably the greatest cause for most mental illnesses, if not all in this nation. Even if we can claim that our symptoms may have come before the illness and diagnosis, it may very well be that we were in some way (even in the water or groundwater) affected by the very pervasiveness of these psych drugs which are everywhere.
    I think the author also mentions “neurodiversity.” In the end, this may prove to be a catch-all term and thus useless. However, I am beginning to think it was what we have called “learning disabilities” that may be sending vulnerable people into the evil jaws of psychiatry and thus what could be called disability. Please remember that even in the United States, having a disability does not necessarily mean one is jobless or is unable to work. However, I do share the sentiment of another person who posted that this article seems to be another article written in terms of the “able-bodied.” As far as disability, etc. goes there is still a lot to unpack. It can not be unpacked in one article. We have yet to figure out to successfully integrate those in society who are unique and different. But you see, each one of us unique and different, 1000% individual with unique and individual needs and desires. The only way we can successfully navigate this entire situation is no longer play victim. I know this is hard. But it is the only way to really conquer this situation. We are not differently abled and thee should be no division between the abled-bodied and the disabled. We need to find out what makes each one of us—unique and remember that no matter who we are we are here for a purpose and that purpose involves our uniquess. Sadly, this article misses that and thus helps no one. Thank you.

  6. I agree with what Ron Unger said above, but want to add one more thing.

    While the issues of employment and social functioning are important, emotional disorders cause great distress even when people are employed and even when their social systems aren’t impacted at all.

    I suffered from major anxiety and OCD for decades in secret, while doing quite well in college and career, and without being on meds. Nobody knew what was going on inside my head, yet I was suicidal because I WAS SUFFERING.

    I often encounter the idea in this forum that people with emotional and mental illnesses are just “different” and everything would be fine if society allowed them to be the way they are. I can tell you that even if society had PAID me a zillion dollars to have anxiety and OCD, I still wouldn’t want them BECAUSE HAVING THEM FEELS HORRIBLE.

  7. This article appears to be predicated on a false dichotomy, in suggesting that disease is an acceptable disability whereas mental illness is not since it doesn’t “dictate or prevent what people do. Instead, they make it difficult to do otherwise”. Paraplegia may indeed render many activities impossible, however, what about many other disabilities such as migraine, autoimmune conditions, or arthritis? Surely, the pain caused by such conditions may render many activities difficult, but like mental illnesses, disability occurs based on how individuals react to their suffering, rather than the suffering itself. Migraine may cause light sensitivity, and significant pain, yet, disability occurs when individuals fail to participate due to their reactions to how they feel, rather than a simple byproduct of their condition. Indeed, what we call mental illness is not the meaningless result of a hypothesized biological abnormality, nonetheless, this does not infer that psychological suffering should not be viewed as a possible cause of disability. In my view, it is also problematic that the attribution of a disability label may cause individuals to look inwards, rather than consider the social dynamics which may contribute to individuals distress, however, at least based on our current system of disability, psychological suffering is surely also a valid cause.

  8. I think your viewpoint is common but wrong. A psychological problem can be both not genetic or biological and still be disabling and limiting. Refusing to listen or accommodate, when someone who is struggling says that what is being asked, is beyond what they can do, pushes him/her down further and interferes with recovery. It creates a more hopeless situation because you are denying support unless the person does what he/she can’t do. It very hard to recover when you receive criticism mixed with unrealistic expectations instead of people working with you and providing support.

  9. Agreed, this is rubbish.
    No wonder there is a lack of parity of esteem with physical health when so called professionals, who ought to know better, deny mental illness’s existence.
    Clearly, the author has never experienced mental illness, because if they had, they would realise that it is not a choice.
    I’m quite shocked by this article.

  10. Your article deserves more careful reading and close attention than I can give it now. But I will say that the social model of disability, like everything else in human rights, keeps evolving. I have long advocated that we do not need to accept the concept of impairment to be included for rights purposes as people with disabilities.

    For myself as a survivor of psychiatry, I am someone whose life is significantly impacted by having been perceived as a person with a disability and discriminated against violently on that basis. Psychiatric labeling that was used to lock me up entails the view by those who did that, that there was something ‘wrong’ with me – exactly the medical model of disability that the social and human rights model in CRPD weighs in against. And furthermore, that I couldn’t look after myself, that I was probably dangerous, that I might have needed some kind of help to manage during a difficult time, and therefore the only thing they could think of to do with me was have other people ‘care’ for me against my will in a locked space – the social welfare model of disability, in part, that still locates defect in the individual, and which the CRPD also militates against.

    I have come to use the terminology of ‘experiencing intense distress and/or unusual perceptions’ as a non-pathologizing way to describe what someone might be going through when they are labeled as mad or mentally ill. And the social stigma, prejudice, and discrimination including the violence of forced psychiatry that we face when we have these experiences – and also when someone else thinks we are even if we’re not – are the barriers that together with this experience create disability, according to the social model.

    Many disability rights advocates talk about diversity now and may or may not use the term ‘impairment’. (I am just reading a document that will be launched on Monday, that takes this approach – avoiding the term ‘impairment’ in favor of diversity – and explains it well; I will try to remember to update my reply here to share a link when available.) Deaf people may be most similar to survivors of psychiatry in our rejection of that term, but the framework of ‘diversity’ to understand all kinds of disability is in the CRPD principles (Article 3 paragraph d) and the former UN Special Rapporteur on the Rights of Persons with Disabilities Catalina Devandas did one of her thematic reports on disability-based discrimination in the field of bioethics, highlighting the principle of acceptance of diversity that bioethicists have widely failed to respect.

    The disability framework is also useful in another way, I believe. It helps to bring together in one framework, the rejection of the ‘normality/abnormality’ dichotomy that oppresses all of us, and the fact that some of us but not all actually do need and want supports, services, and reasonable accommodations in relation to the distress/unusual perceptions we experience whether once or many times or all the time. The disability rights framework opens up space for us to think about what we need apart from the question of ‘are you or are you not mentally ill’ which I think is a shaming discourse on the whole.

    I’ve addressed an alternate vision within the disability human rights framework in my book Reimagining Crisis Support: Matrix, Roadmap and Policy. As I’m not sure if MIA allows urls, I won’t add it but it should come up in a search for Reimagining Crisis Support with my name.

    I’ll come back to your article later to read more closely.

    • While the advancement of laws that shape Rights, to what extent is the design profession even including architects and planners awakening to the shaping of the physical and operational space that is more responsive to the disability presence? When the visiting architect behind the rebuilding of the World Trade Center, in response to my query about green with universal design, his response was, “BS”. Somehow the amount of horsepower going into the expense of creating a better understanding for the challenge that embraces LIFE requires a way forward, that here to date, would give rise to Ed Roberts, Peter Breggin, and countless others to do what We CAN! Take the risk and try an url. All that could happen is an edit or rejection…. a minimal rewrite as we learn the pedagogical horizons of this site.

        • Tina: Just because you make the declarative sentence that my reply was not pertinent to your comment, does not invalidate the relevance to my efforts to make, to type a comment that is in silence rather than the oral tradition required in the practice of law. Ruby starts off by stating “This will be controversial, as I am going to argue against the idea that mental disorder is a disability”. In spending the time, and allowing the article to percolate within my evolving thinking, I wonder if the effort was to create only an argument, to weigh in on argument being placed in the scales of justice?

          To write a paper for the academy, to write a brief (which is difficult for me, in a logic that can border irrationality) or even spend time writing in to post a comment, requires of me an effort in the awe of trying to connect with what, the machine, the invisible audience where after a night’s rest the collective intelligence of society has advanced?

          You are spending a life fighting the good fight, that has been tempered by an injustice that seemingly is a dark, deep hole. I think I too have tracked on a parallel track, having worked my way through graduate school in Regional and Resource Planning while being forced to take the lithium. Time would also be spent writing an article titled “Creating the Dis-City” for the Disability Rag as an effort to address the socio-political nature of the designed space we live in that for most occurs under the jurisdiction of laws.

          Just as one frames a house in the building process, in order to realize a case or a project, does the thinking that accompanies the creation of policy require framing? One that is tight, to the point written from within the humanities trying to create a response to the practice that in psychiatry is showing major issues in methodologies for lack of proper and appropriate experiments? And who is and has been experimented on in the practice, the Art of medical care? Which can be incredibly different from the clinical trials staged with varying degrees of integrity? And then in practice, practice, practice?

          Ruby made reference to the socio-political but not the economics by which the psychiatric oppression is operating.

          Further, where is the definition for “the medical model” in the DSM or CRPD, terms not first spelled out in writing for the audience. For the held beliefs and validity of a model, a large scale model as dealt with within the framework for the United Nations and impacts may be or can trigger even further abuses of Power.

          In trying to weigh in with a better degree of clarity, I hope this effort is not received as impertinent matter, but rather a better effort that suggests exploration. For there are issues of scaling, the verb by which our visual eye and inner eye adjusts the relationships which is in part a gift that we have.

          Seemingly, are there cases, examples surfacing to take to the United Nations that will and can address the different sort of thinking Ruby alludes to? And yet, as we know, to be or become an outlier while retaining the courage to question authority(s) requires entering the unknown space within orders and ways of knowing reality? And can the practice of law create the language that embraces the difference while affording and affirming life rather than deaths that have occurred indirectly when the wrestling with these questions collapses our inner self and selves?

          Thank you for your time.

    • I have a mentality. I love my mentality. I feel no shame when my mentality feels ill.

      Mentality is like the word gay. It can be used as a denigraton by bullies. But as with a word like gay it can express an important area of feeling.

      Your word impairment is great. There are lots of lovely choices. I do not want your choice though and you maybe do not want mine and it is THIS that we need to HONOUR.

      We need to get rid of the attitude that forces anyone down a path of thinking of their disability in THE CORRECT WAY and instead free everyone to use THEIR OWN PREFERRED WAY.

        • Maybe the impairment is in the LAW, itself? But does that bring a self into the LAW? As something that is alive? (In other words, too in reading of the work realized by the Senator from Arkansas Bumpers and friend Clinton, was something created by the lawyers in Silicon Valley that just pushed the conceptual on paper infinitely forward, thereby creating currency? Thereby challenging people to learn how to manage capital gains and losses. Who says We are not Knowledge Creating People of Incredible Worth? Just seems to be that even the government, not the people that work inside the layers of government just might have created a killing machine, that they do not wish to atone for? Or what? I am told the Truth will set one free. But we will not know until the issues are made public, and if one is so inclined, might consider even running for office. (That one can be real about).

    • Many thanks for your comments, Tina. You say that some of us “do need and want supports, services, and reasonable accommodations in relation to the distress/unusual perceptions we experience whether once or many times or all the time.” I agree with you and I would add that some of us need and want supports etc. because they find it very hard to function in a capitalist society, even if they no longer experience distress or unusual perceptions.

      Like you, I have been “locked up”. But even though most people don’t know about it and don’t discriminate against me for this reason, I sometimes feel painfully different from others and I have felt that way since my childhood. I have embraced my difference, but it creates very real problems in my life.

  11. Still the greatest cause for mental illness are the psych drugs and the accompanying therapies and treatments including ECT and the other therapies like CBT, etc. I even believe Robert Whitaker in his books noted how as the prescription rates for these drug went up, so did the rates of disability. And yes, this does affect the economy in some manner. So what we have are a bunch of drug lords who are considered acceptable in the eyes of society and the law who are making super big bucks off the suffering of others. No this is not kind or humane or good for anyone even those who are making these big bucks. But these people are not capitalists. With this kind of system, we have evolved in to an oligarchy. Like the robber barons of the nineteeth century, they need to be broken up. Of course, it doesn’t stop the suffering of those who have taken these drugs. And if anyone thinks I implied, “suck it up.” I did not. But the reality is that even in the midst of pain or whatever one is feeling, one must not let these psych world evils rule our lives anymore. Yes, we may be on disability and we may all kinds of obstacles to face, but never ever must we let them win. In fact those who drugged in the first place would likely enjoy seeing us suffer off the drugs. Even on the difficult days, we must be at least be grateful that we are still alive. Even in pain, living in gratitude and joy is the best revenge. Thank you.

  12. Chuck I owe you an apology. Having read through your article I see your intentions are of the highest good.

    Just because it is not my good does not mean it is not good. There are many many many good ways in the world. Splendid choices.
    It is not the specific good choice that contains “the good”, it is the fact there is a CHOICE of MILLIONS of free choices.

  13. Though I find the prose a bit difficult at times, I see this article as a rational discussion of the issue. But for me it is not so much an issue regarding actuality but more one of public policy.

    If I can’t play the piano and want to, I can hire a piano teacher. If I can’t control my anxiety in certain situations and want to be able to, I cannot find a secular expert who can help me to acquire that skill. Psychiatrists will give me harmful pills and psychologists will give me CBT (or something they like better) which might or might not do any good. We don’t have any “experts” in the field who are really competent, at least not in the secular world.

    And regardless of how we treat these human problems in public policy, they will remain human problems until real experts arrive on the scene and actually handle those problems. Currently, all public policy does is cope with problems that never go away and grant certain favors to all the false “experts” that most stridently assert their competency. Public policy has never been good at solving problems and probably never will be. It’s current approach is to ignore the various brilliant solutions that already exist in favor of the careers of all the various incompetent “experts.”

    If we bring Spirit into the conversation, as I always like to do, and contemplate what any spiritual being should be natively capable of, we find not one single being on Earth (or anywhere else) today who is totally “able.” In that sense, we are all “disabled” and the various mechanisms we put in place to help us through our days are the product of our sense of how far we have to go to prop ourselves up before the expense greatly exceeds the return. Fully able beings (to give an often-experienced example) would not require traffic lights, whether they included accompanying audio signals and cub cuts or not.

    We live in a world of disabled beings, and the big question of the day is whether we should resign ourselves to our various disabilities or attempt to overcome them. Public policy, then, tends to reflect our personal attitudes in regard to these matters. I really don’t care that much how we choose to cope with all our numerous disabilities. I do, however, think we should aspire to rid ourselves of them, and not succumb to them in apathetic resignation.

    • l.e. cox, I think you make some important and valid observations. In fact in “disability” classes that I took in college, the thinking was to teach that all are “disabled” and none are fully abled. And this is true if you consider that each one of us has our strengths and our weaknesses. And some do have extra things to consider such as blindness, deafness, mobility issues, etc. Historically, there have been at least some protections for people so affected. So, in that way “disability” is both a legal term and a public policy issue. Overall, we must consider that none is “perfect” or meant to be “perfect” just yet, that is, as we mere imperfect mortals think of the word, “perfect.” I do think wallowing in one’s disability is useless and harms not only oneself, but others, too. In that manner of thinking, the answer to me lies in realizing each one of us is a uniquely created person, yes, with strengths and weaknesses. And, as thus, we need to strengthen our strengths, not hide behind our weaknesses but not live our lives living our weaknesses but instead use our strengths to adapt our weaknesses or find those in our lives who strengths compliment our weaknesses. Many times, people succomb to the weakest side of themselves and believe that is how they are meant to live. All kinds of things can result even premature illness and death. This is, in my definition, wallowing in our disability, which in strict Christian thinking would be sin. But, in secular times, many do no want to confront sin and prefer the wallow. Thank you.

      • Is “perfection” a Christian concept? I have heard it used now and then and not sure how you mean it here.

        I might be able to play the piano, which gives me an ability a lot of others don’t have. But to play a piece perfectly depends on my skill level, my willingness to practice, my dedication and other factors.

        To do a perfect job is a worthwhile aspiration, but to try to “be perfect” is folly. What does that even mean?

        I can’t speak for people who can’t see, or can’t hear, or have missing limbs. That would make life really tough! But I can’t play the piano, and I wish I could. I probably could still learn how if I wanted.

        Fact is, a blind person could learn to see (without functioning eyes) if he really wanted. But that would take a lot of work and dedication. I agree with the author that many “mental conditions” should be easier to remedy than blindness or deafness. So to categorize them both as the same sort of disability seems incorrect. But that doesn’t change the fact that a lot of people with depression wish it would go away, just like a lot of blind people wish they could see.

    • I am interested in what you say about bringing spirit into the conversation. It can be hard to do that because some people relate to that language/concept and others don’t, and some people relate to it through their own particular lens which might be a religion or faith or belief system. But I agree that a spiritual outlook on life – so long as we see ourselves as spiritual agents and not just the recipients of a divine law from outside ourselves – is useful in thinking about these things.

      I think whether one resigns oneself to a disability or seeks to overcome it, can depend on a lot of things – and even that language would be incorrect from the point of the disability rights movement. (That movement would talk about accepting oneself as whole, including an impairment or difference/unusual personal characteristic of mind or body, or trying to change some part of that to make one’s life better.)

      In the survivor/mad/anti-psych oppression movement I think many of us relate to this tension in an active way, what is about ourselves that we love and accept despite society’s negative judgments, and what do we see as undesirable and want to change? In relating to this tension whether discussing with others – in peer support or therapy or with friends – or contemplating alone, how we see it can change over time. There’s nothing that automatically belongs in one category or the other.

      • I stand by God and Jesus who do not look at whether we are disabled or not or anything about our outward appearance or even our feelings or emotions or mental capabilities but our heart. He looks beyond that seem to matter to only to mere human mortals and sees us for who we really are—that which is in our heart. If this is cosidered “outside of us” then so be it, although it is not as all believers know Jesus lives within each one of us if we only accept Him as our Personal Savior. This is the definition of Spirit I know works best and is available to all. Thank you. [

      • I appreciate you commenting on this, Tina.

        Yes, the subject of “spirit” is extremely problematic! No two people seem to understand it the same way.

        The most basic part of my understanding of it is that we are (as personalities, or “ourselves”) immortal spiritual beings. This is difficult for most people, as they have no conscious memory of any other existence besides this life. But some children do have such memories, and some of those cases have been validated. And others have been regressed into past lives, or used similar techniques, and some of those cases have been validated as well. Those who do this work for a living would say that the therapeutic results from past life recall itself validates its reality. I agree with that.

        But once we are willing to think with this basic, what follows is the possibility that we have a long term memory of experience (I have been calling it “spiritual memory”) which we might be able to learn from. And indeed, from what I have studied, this is the case.

        For a little boy to remember being a fighter pilot 40 years ago (and that memory is validated) is one thing. But for the process of locating that memory to result in the lessening or cessation of violent nightmares about drowning in an enclosed space is therapeutic. This is a publicly known case, which is why I cite it here. There are MANY more such cases, as this reality has been used for therapeutic benefit for decades now.

        But we can extend our knowledge even further if we are willing to explore our pasts with more persistence. Dena Merriam’s memories of past lives extend over a thousand years on Earth, and are quite educative. Other researchers have explored much farther back, into our days Before Earth. The data gained in this way are amazing and highly illuminating. They have opened up whole new avenues of therapy, though these currently are only being used in a non-secular (religious) context.

        My point is that the mental health community – of all communities – should be aware of these things and willing to discuss them. It is one thing to decide “that’s not for me.” But it’s quite another to be totally clueless. The data are out there. As time wears on, and conditions on Earth worsen, cluelessness is becoming a poorer and poorer excuse.

        • I agree, this community should be aware of and be wiling to discuss these things. I don’t like to call it a ‘mental health community’ – characterizing all our unusual states of mind as ‘health’ issues gives power to those who claim to be experts on our health, not because of the language per se but because of how things are in the world, with mental health systems systematically disempowering and oppressing us, enacting torture and arbitrary detention and enforcing oppressive social norms.

        • This is the mistake most all of us make is to think that life and the world is supposed to be rational. It is essentially irrational which is “bugs” all alleged experts. When we learn to stop trying to control not only the world, but ourselves, also, we will be happier and healthier and in no need of diagnosing ourselves or others or the others doing it to us. It is only in surrendering our life and our will to our Creator in which we have that happiness, health and freedom. The beginning of this is to allow ourselves and the world to be irrational and to stop lying to ourselves about the rationality of both the world and ourselves. When we do that, we will no longer feel the need to control the world and we will be free, free, free….Thank you.

          • The world needs a certain level of rationality to keep the game of life going. But insisting on totally logical thinking and zero emotionalism is going way overboard.

            While I don’t believe we need to surrender our lives and wills to The Creator, there is a basic level of madness about life on Earth that we must be willing to tolerate.

            I don’t want to surrender my life and will to a tyrant, either, which is the other extreme we are being asked to agree with. That goes way beyond my limits of tolerance.

  14. Chuck, I want to go further in my apology and I want to beg apology to all psychologists and psychiatrists. I have been drunk on the party food of strident discource about ideologies here, this ideology, that ideology, the new ideology, the old Ideology. I prefer to go by a sense of love. Love is NOT an ideology. It is easy to get sucked in to thinking that a “belief” is love.
    A belief can only be a useful or not useful “description” of a feeling of love.

    Feelings are not rational. You either feel a feeling or you do not feel it. You cannot “talk” a mother or father in to loving their baby. Feelings are unreasonable. That is what is so beautiful about feelings. Too much reason takes away from the still tranqility honesty of simply feeling. A very reasoning and arguing debate thinks it is enshringing feelings whereas sometimes that intensity of bickering makes the establishment of the welcome of feelings get nowhere.

    So take my unreasonable love and have a few dollops more. I intend to give much of it to all the psychiatrists I have slandered.

    I want to apologize to all the brave doctors and nurses who ever took an interest in psychiatry or psychology. There is no harm in a person wanting to…

    A. heal people.
    B. Discover interesting ways of understanding people in order to make them better.

    The problem is one of “bad treatment”. That phrase means different things to different people. Having a nurse look at you coldly can be construed by you as bad treatment yet to another person it is not that, it is just tired flawed humanity working in impossible conditions.

    All that is not to glibly say that bad treatment should be dismissed as a fluke. Any bad treatment must stop. For the most part I think psychiaty’s marriage to the pharmacy, with all those dubious loyalties, is where bad treatment has blighted the profession of psychiatry. In particular the drugging of children is flat out an ethical and bodily abuse of their human rights, given that we do not know much about how the brain works. All of that over prescribing has to stop. However, nobody ever pressed a drug in my adult hand in my many years of being disabled with schizophrenia. In my life I have met thousands of psychiatric service users. I have only met one who felt forced to take medication. One! The rest were fully responsible for measuring out their doses and putting those in their mouths. They were responsible adults. There is a point can be made about not knowing the extent to which such medications are harmful. This is the bigger error. The medications may work in a crisis but there is a huge crisis that they do not seem to work longterm. Indeed, most of those pharma drugs are damaging. But that is down to Big Pharma.
    Everyone adult who reads the side effects leaflets knows fully that nearly every organ in the body will be potentially harmed by the meds they pour a glass of water to imbibe. I am certain I have shuddered at the litany of possible effects that could have occurred to me, as detailed in such leaflets, whilst taking the drugs that some fed up doctor asked me not to take. Most doctors and psychiatrists I have ever met tried everything to put me off taking medication, barring a few stalwarts.

    I am uneasy about where the world is going in terms of blame culture. The DSM book is not, to my mind, the worst source of bigotry out there. Try pornhub for people hatred. The DSM is just a book. A book is a wedge of paper. It makes a useful door prop. It is not dangerous. No book is. Only people who read books as excuses to bully are dangerous. The “reasonable”.

    Someone famous once said “After they burn the books they come after the people”.

    I am not wanting to hate anything or anyone anymore. There is a choice to try to heal your past with a sense of righteous indignation or move on into welcoming harmony.

    I cannot stomach coming out with any more petty grievances that I do not believe were ever actually my own.

    I want every word I utter to be true.

    You are never clean until you are zestfully clean.

    You are never telling your true word until your true words feel zestfully true.

    I want to be zestfully true in my choice of words and never pander to the helpless nauseous sea drift of culture change.

    Why I want to choose my words with care…love’s care…is because on a large planet that is about 8000 kilometres across I am just the size of a tiny inconsequential dot. That means anything I say will have no influence on anyone anyway, since I am not that powerful. So all my zestfully true little words are merely the mad chattering of a forest bird enjoying releasing a burst of meaningless birdsong.

    So why waste my time learning tedious ideology lessons from other strangers who have a completely different set of experiences?

    The truth is I am yet to met a vile psychiatrist, after twenty years of staring them a straight in the eye and manipulating them to jot a prescription to me.

    That does not mean I cannot be supportive and empathetic to those whose experience was by all accounts very different.

    I am an adult. I am not a toddler in a mansion house with a villanous shrink oppressing me. What definitely is oppressing me is my illness, my hallucinations and so on. Nobody gave me that illness. Psychiatry did not give me that illlness. My parents did not give me that illness. The spell casting crone by the milking pail in the village barn did not give me that illness. Sin did not give me that illness. Ego did not give me that illness. Bad diet did not give me that illness. A fumbling priest did not give me that illness. The DSM did not give me that illness. Wealth did not give me that illness. Poverty did not give me that illness. God did not give me that illness. Supernatural angels or wizards did not give me that illness. Pharma did not give me that illness. Trauma did not give me that illness.

    No one gave me my schizophrenia. It is a real illness because it makes me feel ill. Since nobody gave it to me, nobody is to blame for my having it. Not even a psychiatrist. To think one ordinary flawed jaded tired medic has that power is to think a dot on an 8000 kilometre planet can affect every other dot. Even Jesus wasn’t that celebrated.

    Jesus did not build a private exclusive desert club for the worthy and virtuous or the grovelling obediently saved, he went to town to befriend the lost, the bewildered, the satanic, the temple dancing girls, the entrepreneurial barman, the dealer, the boss, the criminal, the liar, the theif.

    I do not feel he did so to angrily convert them. I feel he went there because these people probably warmly received his love without bickering with him about whether it was ideologically perfect love.

    Anyone for some sandal oil?

  15. In the case of psychiatric survivors or neurodivergent people one of the “enabling accommodations” could be simply financial assistance. It can be very difficult to find and keep a job if one is e.g. prone to psychosis.

    I personally have had social difficulties since my childhood. I have simply not had the same type of development as most people. I find it difficult to make friends; I have had very little experience with relationships; I tend to feel like an outsider in groups.

    I have had only one steady job, despite a very high level of education. I don’t have a competitive mindset, I am not good at promoting myself. I have never wanted a career, I enjoy a peaceful life and feeling free.

    I am not a lazy person, but I have not been able to find a job where I would be able to use my knowledge, talents and skills. I am now trying to gain teaching qualifications, but I don’t know if I will be able to work as a teacher (I am afraid of being rejected by other people, of being mocked behind my back etc.).

    I don’t identify with any psychiatric label (though I have experienced psychosis), but I think that some people find it really hard to survive in a capitalist world – and that I am one of them. I don’t know if I would be currently able to find a job (ANY job) in my country (I did try to find a job in the past – unsuccessfully). I have been able to pay for my teaching course only thanks to my mum’s help.

    I was getting a disability payment because of “schizophrenia” for a year – it is a ridiculously small sum in my country, but at least I had an income and I had some rights as a disabled person (reduced price bus tickets etc.). I was never ashamed of using my disabled person ID card.

    I am trying to get a disability payment again and I do see myself as disabled. Not because I see myself as mentally ill/disordered (I don’t), but because I am simply unable to earn a living, and because I know that it is linked to all the things which make me different from most people.

  16. Chuck writes in his article: “In addition, the disability system can create a strong social and financial dependency that can conflict with the goal of recovery. So, those who use the system can pay a very high price.”

    This is how many people think – that disability payments create dependency. What these people don’t realize is that it can be very difficult to stand on one’s own feet, especially if one comes from a poor background.

    It is easy to say that disability payments create dependency if one is a psychologist in private practice. I wanted to become a psychotherapist, but I can’t afford to pay for a psychotherapy course. They are simply much too expensive.

    If a person does not have any income and can’t find or keep a job, the situation is very dangerous to this person’s health, both mental and physical. It is much worse than getting a disability payment. Being afraid of hunger and homelessness can never be good for people. I have experienced unemployment and I know how an unemployed person feels.

    I think that the author also forgets that poverty deepens people’s social isolation. As an example, I can’t afford to go to restaurants with other people. I go to a hairdresser as rarely as possible. I don’t buy new clothes. I can’t travel to another city or country whenever I feel like it. I can’t openly tell people that I am simply too poor to do things they take for granted.

    • I agree with Harold. One can interpret the term “disabled” in a negative way, but one can also say that people with various disabilities are simply people who have difficulties with functioning in society because of their health problems or other personal features.

      Disabilities are largely created by people’s environment, including society’s attitudes. To take an example, a person with experience of psychosis who is afraid of societal stigmatization can be seen as disabled simply for this reason. The necessity to hide one’s experience of psychosis or to convince others that one is not unpredictable and dangerous is a very real problem.

      I would also say that if a person is expected to agree to use neuroleptics as a condition of any support, it is also an excellent example of the way society disables (and oppresses) people with experience of psychosis.

  17. I think this disability argument as in relationship to any alleged framework of mental illness is getting to be a circular argument. There are, as I said, certain legal type ramifications here as regards to obtaining disability payments or other services depending on the country, state, city, etc. in which you live. That is one aspect of it. And it can questionable sometimes as far as the determination the disability oneself for obtaining these services if needed. I say questionable because unfortunately they are those who would abuse the system—making it more difficult for those who do really need it. Yet, in a way we all need services of some sort. And we all need to be able to choose whether to get them “publicly” as in some type of governmental institution or “privately” non-profit, church, etc. In some places, however, there are restrictions that you can receive the private unless you receive the public or are approved by the public (government) as being disabled. There is also the fact that some people are only disabled temporarily while others are disabled for life. And there are those who are actually born with a disability. However, in a way, the real truth is that each one of us no matter our situation is both abled and disabled. Both are subject to different degrees. I doubt if we will ever come to a point that this is successfully resolved. Part of it just has to do with the human condition and that each one of us is uniquely, individually created with our own journey and purpose in life, specific to each one of us. I think each of one must live with a certain degree of ambiguity and uncertainty about this issue and work to see how this definition applies to our lives. It is not and can never be a “one size fits all.” We must develop to the best of our ability compassion, empathy, humility and forgiveness not only for others but for ourselves as well. Thank you.

    • Rebel, I agree with you to a large extent. I think, however, that if we say that “each one of us no matter our situation is both abled and disabled”, this erases the difference between people who are really struggling because of serious difficulties and others. This also erases the difference between those who are coping very well in life – having well-paid and stable jobs, owning houses and apartments, having much more money than they need, large social networks – and others.

      It is obvious to all of us that not everyone is poor and/or socially isolated. Many people’s mental health issues are directly linked to their poverty or even caused by it.

      If we say that every person is abled and disabled at the same time, we still have to find a way to decide who deserves help and support. Otherwise we may end up saying that no one deserves it, that people should just “try harder”, whether they are billionaires or homeless. As any of us who has ever experienced poverty knows, it is not true that we are all facing the same “problems in living”.

      As to people who “abuse the system”, I don’t think that there are many affluent people who lie about being disabled in order to get some money. I guess that most of these people see the disability payment simply as their way of surviving in a very cruel society.

      • I am sorry. I stand by what I say. I, also, feel that I have earned to right to say what I say, and it makes absolutely perfect sense. We must bring up these questions in order to discuss them for the best interest of each individual. The concept that each person is both “disabled” and “abled” is a well thought concept that assists people to understand that just because that have some sort of “disability” does not mean that they do not have something to contribute and are not worthwhile individuals. To consider otherwise is to compel people to have undeserved thoughts of worthlessness when they are absolutely not worthless just because they have a disability. As far as affluence and someone lying about their disability, I do not know. That might depend on one’s definition of affluence and that, too, can be very deceptive. And, sadly, any system can be “abused.” And, for that reason, we do need some semblance of laws and regulations to govern both those who apply for disability, those who decide who is disabled and, also, those who do make recommendations as to the determination foe disability. However, the truth, no matter what we do, we will always have imperfection in the whole process. Thus, we must, always, have humility. This is the whole purpose of realizing that each person is both “abled” and “disabled.” There is no other way to deal with “disability” for the best interest of all concerned, which is everybody. Thank you.

        • Rebel, you say “we do need some semblance of laws and regulations to govern both those who apply for disability, those who decide who is disabled and, also, those who do make recommendations as to the determination foe disability”.

          The problem is that these laws and regulations can be very unfair for people who genuinely need help. In the case of mental/psychiatric disabilities it can be very difficult to prove that a person is “disabled enough” to deserve help.

          Of course a disability should not make anyone feel worthless or inferior to others. However, if we say that literally everyone is disabled, the concept of disability loses all meaning and usefulness.

          I think that we could all agree that there are people who are in good health and who don’t have difficulties with social functioning. We could also agree that among people with psychiatric diagnoses there are people who encounter very serious difficulties with social functioning.

          A psychiatrist can claim that a person is not “disabled enough” to deserve a disability payment or other support. However, in many cases the psychiatrist has only a very limited (if any) knowledge about the person’s problems.

          I find it easy to express myself, so psychiatrists don’t see me as “disabled enough” despite my “schizophrenia” diagnosis. They don’t understand my social difficulties or they simply don’t care about them.

          I think that we have to remember that the system has not been created to genuinely help people with psychiatric diagnoses. The system does not care if they are alive or dead. If the system cared about vulnerable people, they would always receive the support they need.

          To return to people who “abuse the system”, I think that they are doing it because they feel that they have no other choice.

          • With all due respect, I am stopping this conversation from venturing further. No, I do not agree, nor will I ever agree. I will always hold the absolute truth that each person on earth has both an ability and a disability. I will also hod the truth that there are varying ways to deal with this, including laws and regulations to protect all concerned. I believe wholeheartedly that there are creative ways to deal with the issue and sometimes, we are all blind to the creativity, including me. In truth, it only does a person harm to consider oneself totally disabled without also being abled— no matter one’s status in regard to receiving disability status. Each person needs help to prosper. It starts with God and flows from there. I am sorry that you cannot see it from my point of view. Finally, to quote the great reformer, Martin Luther, “Here I stand. I cannot do otherwise.” Thank you.

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