What happens when you're "the community": part 2.5
this interpretation of solidarity is straight up not working out
Sensitive content includes: anti-psychiatry, details of psychosis and other SMI experiences, guardianships
Don’t read this until you’re read parts 1 and 2,
Obviously.
You know how there’s Lion King 1 1/2 and it’s not like, between the first and second movie, instead, it’s Lion King 1 but from Timon and Pumba’s point of view? This is like that but if Timon and Pumba were talking about the same stuff from an organizer/mobilizer/activist/IG stories poster that we just talked about from a social worker point of view. I also think Lion King 1 1/2 is less serious and if you can’t tell by now, this bit will be too.
In the last part, I wrote about the good and bad facts that I used as a social worker to bring people to the camp of give money to homeless people/vote for legislation that supports Housing First/do not call the cops on someone for simply having symptoms of mental illness in public jesus christ. This essay is focused instead on left social movements and their participants. Really quick, I feel the need to establish some basic beliefs I continue to hold through my impasse:
The majority of people with mental illness are never violent in their lives. Trauma is a factor in the development of all kinds of mental health problems. Being affected negatively by class society under capitalism, racism, sexism, hetero-cis-sexism, ableism, sizeism, etc. contributes to mental health problems.
I’ve already outlined the financial motives that continue the project of deinstitutionalization from the right, and I want to name what I believe energizes this logic on what I’ll call the grassroots left, meaning movements and groups operating autonomously, unaffiliated with any particular institutions. Conflations come from a few different sources that I hope to explain. If mainstream bestsellers have Pop Psychology that deals with issues such as individual motivation and personal habits, what I am describing is its more collectively-oriented cousin. It’s kind of the Pop Bio-Psycho-Social Psychology of the Anti-Hierarchical Left.
These are things I hear all the time from smart and compassionate people that unintentionally moralize and reinforce the economic logic of deinstitutionalization. I don’t believe that people who uphold these beliefs are attempting to like, cut Medicaid or anything. They are not always technically wrong, but sometimes simply dishonest.
“I have lived experience because I have PTSD/GAD/MDD”
Let’s get this part out of the way. PTSD and MDD can have “with psychotic features” at the end of the diagnosis. But functionally, if you have that signifier, you are considered part of the serious mental illness (SMI) population (congrats?). If not, you do not get to do standpoint theory here. SMI is not a comparable experience to living with depression, anxiety, or PTSD.
People with SMI tend to have worse outcomes and more needs than someone with the most common mental health disorders. This is not to say that other mental illnesses can’t be debilitating or life-threatening. I know this from experience! The problem with equating even severe presentations of anxiety, for example, to SMI isn’t that you’re exaggerating your symptoms. Literally, why would I even care about that? The issue is that the comparison dismisses the higher degree of care needed for an average individual with SMI and minimizes the importance of social attention needed to achieve that higher degree of care for everyone who needs it.
Mental health advocates and mental health system survivors who do not have SMI tend to run a little anti-psychiatry in left social circles. I think it’s great that people take personal measures that make sense for them, but they are still the modern-day reflection of the 93-96% of patients of community mental health care clinics created right after state hospitals were closed. Some people with SMI take psychiatry-critical attitudes and do just fine without treatment. (Perhaps they can be thought of as the very real but very small 4-7% of the caseloads that consistently got themselves to the clinic in their community). The modern system is overwhelmingly built for the worried well, and honey, they might be worried but they’re still well.
Pretending that SMI and the more garden variety mental health diagnoses are in the same bucket just because they are in the same book results in people who are relatively well advocating against expanded funding for specialized treatment. Some people cannot safely discontinue medication because of their politics. Y’all are sucking all of the oxygen out of the room.
“mental health differences” / “labeled with schizoaffective disorder” / psychosis as a matter of neurodiversity
I used all of these. One time I went to a training through an organization that didn’t consider hearing voices or delusions of grandeur “symptoms”, but experiences. I immediately stopped using the word symptom with clients, but people didn’t find it as helpful as I did. People don’t take kindly to you thinking that horrifying demons and me not seeing horrifying demons as a value-neutral matter of difference and respecting diversity. And yeah. That’s because people don’t want to be accepted for seeing horrifying demons. Frequently, they want to do whatever stops them from seeing horrifying demons, or at the very least, for the horrifying demons to not make it so they don’t have a home or a job or relationships. Same goes for loss of sleep, dangerous behavior, catatonia, pressured speech, and disorganized thinking. IMHO, naturalizing these experiences and fitting them neatly into frameworks of power and oppression takes away social pressure to make sure that people aren’t forced to have these experiences as a matter of identity. Yes, it’s fine to have a mental illness! But normalizing mental illness shouldn’t mean that people are condemned to mental illness! Let people recover and give them everything they need to be able to do so!
Social disability modeling of mental illness
A disabled activist I had followed for years once publicly questioned the model, and then never again. In an Instagram story, they said “I don’t know how the social model of disability really lines up with my pain disorder” In what society would my symptoms themselves not be the primary issue with a pain disorder? What social barriers are preventing them from participating fully in social life? Physical pain is both the most universal and the least ambiguous experience we have. We have all had it and we all know that its primary feature is “being horrible”. Is the mental pain that some describe less clear? I for one have not heard of an economic or social model that lessens the burden of chronic mental suffering.
I think it’s essential for healing that people can make their own meaning out of their experience of mental illness, including meanings that do not have public consensus. That is between individuals and their support systems. SMI can hold the grounds for community and identity, and make life inherently more difficult.
“Psychosis is a manifestation of trauma”
About 75% of the time I talked to people seriously about my job they would put on their academic voice and ask if all of my clients had trauma histories.
I’m going to go all the way and say this belief is wrong instead of the kinder “sometimes but not always :)” because the only times this belief is invoked is to downplay genetic, neural developmental, neurophysiological, and other determined risk factors. I think people think that the trauma explanation is helpful because the medical model is inherently disempowering or stigmatizing. I mean, I think that ignoring the existence of other clear risk factors present in someone’s life is pretty disempowering, too. The idea that trauma not only sucks to experience but can single-handedly scramble your brain is not a hopeful one to me.
I also think people love the trauma idea because it would be really helpful if SMI fit easily into a trauma etiology story so we can imagine that SMI doesn’t happen in our vision of the future in which trauma that occurs due to the effects of capitalism, patriarchy, and white supremacy is automatically prevented.
Trauma can be a catalyst for all kinds of mental health conditions, but SMI is not more likely than other kinds of mental health issues to be caused by trauma. In cases where it is clear that trauma is the culprit for a first psychotic episode, it is not dose-dependent like it is in the popular imaginary. Serious trauma does not result in serious mental illness. It can be the same mundane, run-of-the-mill traumatic experiences that happen to a lot of people with different results.
“All conservatorships/guardianships are oppressive!”
#FreeBritney, But not everything is #FreeBritney. First, I’m so glad she’s free and her case made us all think about the ethics of limiting the rights of those with serious mental illness. Conservatorships are certainly used to exploit people with less power, and an SMI diagnosis can create that imbalance of power in and of itself. It’s a massive problem. I wish we didn’t need them at all, but I think we do.
The thing that changed everything for Britney was the ruling that allowed her to hire her own lawyer with her own money to challenge her conservatorship instead of continuing with a court-appointed attorney. It wasn’t as simple as her word against her (horrible, disgusting, villainous) father’s. I’ve recommended the guardianship option to the parents of young adults who consistently make extremely dangerous decisions. I know my colleagues have too. I don’t talk about the details of my past clients’ lives because those stories are not my own. But my not being brave makes me in implicit agreement with the idea that we should get rid of this whole institution and always let individuals determine their own paths, including decisions about whether or not they want treatment. And because that would be profitable for health insurance companies and their lobbyists that do not want to pay for things like hospital beds and assertive community treatment, I’m not comfortable letting that sit silently in the air. So here’s my thought. If you clearly put yourself or others in danger of serious harm due to a mental illness, the people closest to you should be able to step in, even if you don’t want them to. And, everyone who is put in that position should be able to engage in grievance procedures and count on swift and effective investigations. We need a national system tasked with monitoring and supervising guardians. We need to promote and grow alternatives to guardianship that deal directly with the problem at hand, such as representative payeeship and supported decision-making agreements. But some people, at some points in their lives, need more than that, too.
“Everyone is the expert on their own lives.”
This one is hard. Honestly, I knew I had to leave the field when I realized I didn’t think this anymore and that I didn’t have time to come up with a new organizing belief before my foundation fell out below me.
I believe this is true most of the time. I believe that at some point in the life of someone with SMI, they won’t be able to make good decisions for themselves. They may not be able to access their expertise at every moment. I feel confident with my choice of the word “good”. Good can be used in a wobbly way, but “good” can also be pretty damn objective in cases of life or death. And those cases do come up. I can’t square it. I promise I’m trying. I can’t figure it out. And that’s the biggest reason I can’t go back.
Part 3, the final essay in this series, is on its way but it may take a week or so as I’ll be away from my computer for about a week. Thanks for making it this far.
Image Credit: Seph Lawless. Metro North Mall in Kansas City North, Missouri, was demolished shortly after Lawless documented its remains.