Mad is as mad does

This discussion about madness & the Icarus Project on Feministe ended up getting shut down because people ended up talking past each other and there was a lot of anger and feelings ended up hurt. With all due respect – as I said over there before the comments were closed – how the hell do you avoid having a discussion about mental illness and what it means and doesn’t mean without people getting trampled on? Is that even possible?

I think there are fine engagement rules that can facilitate honest debate (or bury it, depending on which way the wind is blowing), but personally, I don’t exactly attempt to be careful about the emotions of those around me when it comes to discussing mental illness. There are statements I have patience for and statements I do not have any patience for, and there’s that. I’m more or less grimly amused when, for example, someone shows up on my blog and asks me how I can possibly consider having children after suffering from PTSD. On the other hand, I refuse to be told off by people who tell me to stop using the word “crazy” as an insult – because, guess what? I own that word as much as anyone who has ever had it used to dehumanize them does. And I happen to think it’s a great word that has a variety of connotations – both negative and positive. I will not have my language purged of it.

I’m OK with hosting a largely unmoderated discussion on mental illness here, especially since one of the things I saw wrong with the discussion on Feministe was all of the assumptions people made about each other in their defensiveness (coming from an intensely personal experience, that’s actually quite normal) – assumptions such as “you’re just one of those people who thinks it’s cool to go off their meds and torment others” or “you’re just one of those people who thinks it’s awesome to strap people into chairs and give them injections that can harm them.”

I think if people can bear with each other and talk it out, they realize that nothing as extreme is being proposed – at the very least, I didn’t see anything extreme going on at Feministe.

It isn’t surprising that saying “people should try to manage their conditions” is going to be interpreted as “x and y and z should be mandatory for all the crazies.” It is, however, frustrating, because having been on both sides of the fence, I don’t think that managing one’s condition automatically includes mandatory medication (how about mandatory therapy sessions?).

I think it certainly includes a discussion of various social arrangements, however – especially as this pertains to custody of children, visitation rights, restraining orders, emergency contacts, and other flotsam and jetsam of human relationships.

As I’ve mentioned before, several of my relatives are mired in this mess right now – with mental illness as a bonus on the side! I do believe that mental illness cannot be disregarded in these situations, because if you’ve known a person over the years, and seen how drastically they change when they cease to manage their condition, you will often find that it’s like communicating with a separate individual.

An abuser may be just an abuser, or an irresponsible human being an irresponsible human being regardless of their mental health status, but if we accept that certain conditions can influence behaviour and reasoning, we can see how and why mental illness is blamed. At a certain point in time, for example, a wife may have to tell her ex-husband that he can’t see their child anymore, because he has repeatedly pulled a Michael Jackson and dangled the child over a precipice. She might still love her ex. She might respect his right to do whatever he pleases with his body. But she can’t allow her relationship with him to remain on the same level. I think this is one of those areas wherein the entire idea of what it means to “manage a condition” deserves much closer scrutiny.

My philosophy is – all of us: sane, mentally ill, half and half, one and three quarters, et cetera, have a right to our autonomy. But autonomy does sometimes mean that we will suffer the consequences of our actions, whether voluntary or involuntary. I don’t think the wife in the (very real) scenario I am presenting has any right to tell her ex what he can and cannot do with himself, but she does have the right to cut him out of her life and the life of their underage child (their other child is an adult and can make her own decisions). Not only does she have the legal power to do it, I view it as a moral imperative as well. I have a feeling that if the husband ever gets the help he needs, he might look back on this time and see it as a moral imperative too – lots of people do, once they pick up the pieces.

You may say that this is simply a stereotypical attack on an already vulnerable group by someone with Stockholm Syndrome, but I think it goes to the heart of autonomy. As William mentioned on Feministe – most people with mental conditions are functional. So it should be hard to blame any specific act – be it an act of violence, abuse, etc. – on a mental condition. The problem lies in mental conditions being used to presuppose some sort of guilt or – something that is rarer but nevertheless a problem – a guilty person saying that they are not guilty because their mental condition got in the way, even if they were aware that what they did was wrong.

Notice I’m not talking about a court of law here, I am, once again, talking about human relationships. I hate having legal debates around these issues – probably because I am not qualified, and think someone else should be having them. But I think that there are definitely our own personal rules that we make up for ourselves – and stick to, sometimes in the interest of basic self-preservation. And I’m not just talking about highly functional people with no mental health problems whatsoever.

Consider this – say you are suffering from a problem that often makes you too scared for outside. You need your friends and loved ones to at least understand what’s happening to you. You don’t need someone who yells at you about taking a long time to get ready, for example, because they fail to appreciate your anxiety and the pain, both mental and physical.

At the very least, you have the right to make a decision to be close to those people who do not abuse you because of your problem. Autonomy doesn’t just exist for those of us in perfectly good health, after all. It’s a concept that is especially important to someone who has extra challenges when it comes to navigating life, society and friendships. Crazy folk have all sorts of do-gooders with messiah complexes foisting themselves on us – and an individual needs to be empowered to run like hell from people whose motives aren’t at all pure.

I don’t know if I’m down with “mad pride,” but then again, I’ve never considered myself “mad” – terrified and in pain at various points, sure, but the word “madness” I’ve associated with the happier moments in my life, the moments I was able to let go of terror and do something I’ve always wanted, such as my recent trip to Britain (which is sadly drawing to its conclusion). Perhaps there’s a lesson in there too, because what the Feministe discussion clearly shows is that there is no way that anyone who has lived with mental problems is going to be coming from the same place.

So telling someone “you just don’t know” is probably redundant. None of us really “know” most things that exist outside our skin. But this doesn’t mean that we shouldn’t share our experiences, because maybe there is a person reading on the other end who might not feel so hopeless after hearing what one of us has to say. That’s pretty damn maudlin of me – but having been that silent, searching observer a few times in my life, I can’t help but wonder about it.

Thoughts? Rotten tomatoes? Etc.?

13 thoughts on “Mad is as mad does

  1. I wasn’t able to read the thread at the linked Feministe post because my browser malfunctions when I try to access the Feministe website.

    So, even though the following questions may have been discussed in the thread at Feministe, I would like to ask some questions which I hope can be answered here:

    First question: Is the term “mental illness,” as used in Natalia’s post and at Feministe, limited to cognitive disorders (like schizophrenia), where the sufferer actually perceives reality differently, or does “mental illness” as discussed here include severe personality disorders where, at least as I understand it, the sufferer has, over time, willfully constructed a certain way of coping (a personality) as a defensive reaction, that turns out to be maladaptive?

    I ask about severe personality disorders because, if the sufferer actually prefers his maladaptive way of coping, he/she might very well resist treatment.

    And of course, in some occupations in the U.S., MEN with severe personality disorders might be perceived as high-functioning individuals, even though, in the same occupation, WOMEN with similar personality disorders might be perceived as mentally ill.

    And that’s my second question: In the U.S. and other developed countries, are men with varying degrees/diagnoses of mental illness perceived and treated differently from women with a similar degree/diagnosis? In developed countries, are women who are diagnosed as mentally ill more severely stigmatized than men with a similar diagnosis?

    Obviously, class differences would play a role here as well, although I’m not informed as to exactly how that plays out in real life in the U.S.

    It would be interesting to hear people’s views on these questions.

  2. An additional question, on Natalia’s above post:

    In paragraphs #5 (next-to-last line) and #6 (first line), in each paragraph is the verb “PREcludes” meant to be read as “INcludes”?

    The context in each paragraph suggests “INcludes” is meant.

    I just want to be sure.

  3. I’ll try to be careful not to overuse my commenting privileges here, but after I posted my initial comment I was able to get my browser to work properly when I accessed the Feministe website and I was able to read the thread.

    I agree with many of the comments by the commenter “William” who is working on a doctorate in clinical psychology, particularly where he mentions mental health diagnoses being used as a form of social control, and also his comment that DSM diagnostic criteria are qualitative (subjective) rather than scientific. A clinician’s cultural preferences do impact that clinician’s diagnosis and treatment recommendations for a patient’s behavior.

    I also note William’s argument that he doesn’t want to see patients, whose behavior is simply culturally aberrant, strapped to a gurney against their will and forcibly injected with Haldol or Thorazine.

    In the U.S. state of Georgia, where I live, for a patient to be involuntarily committed and forcibly treated with psychotropic meds would require a court order (in Georgia I think this is called a “1013”). In Georgia, the criterion for obtaining that court order is that the patient is a danger to himself/herself or others. The question would be whether the criteria for being a danger to self or others are so culturally skewed as to amount to nearly arbitrary imprisonment for disfavored groups or genders.

    I raise the last point because I’ve worked as a hospital transcriptionist for the last 19 years in Georgia, and over that time I’ve noticed that, in nearly all the charts that I’ve transcribed that mentioned involuntary commitment of the patient on a “1013” order, the patients were women.

    That leads me to suspect that, at least in the state of Georgia, the criteria for behavior deemed dangerous to self or others might be culturally skewed against women.

    Since, in Georgia, behavior that is deemed dangerous to self or others is usually what is deemed ‘inappropriately’ aggressive behavior, that leads me to suspect that aggressive behavior that might be tolerated in men is considered ‘inappropriate’ in women — i.e., men are allowed more autonomy to be aggressive in ways that would be considered dangerous in women.

    That was also my thought when I initially raised the question of different treatment of men and women with similar severe personality disorders — e.g., a man who is a pathological narcissist, until he actually commits a crime, might be deemed to be showing a variant of ‘normal’ male behavior, whereas a woman who showed similar behavior might be recommended for therapy.

    It would be interesting to read other people’s thoughts on these issues.

  4. You should write an article about what you saw, P – because that would be really interesting. I think there is a certain cultural expectation for male behaviour, especially when it comes to aggressiveness. A man who gets into a fight outside a bar, for example, is just being a man. We can’t say the same about women.

    I think sexual behaviour plays a huge role in this as well – because lots of families (usually, families play a big role in who gets committed, right?) have different rules for boys and girls. What’s considered “normal” for a man – say, hooking up with lots of women in his teens – is an aberration for a woman, particularly if she comes from a conservative background.

  5. Haven’t dived into the Feministe discussion yet so I have to ask, the opinion you presented here seems pretty reasonable, in particular the example of the wife and ex-husband. Was it really being met with resistance? Seems like that would fall under the catagory of “you’re right to swing your fist stops at my (or my underage child’s) face”.

    BTW, I also agree with your defense of the word crazy.

  6. It seems to me that as long as someone poses no threat to anyone else then whether or not they receive treatment should be up to them. During my mercifully brief brush with clinical depression I tried drugs and counselling, and both proved to be a complete waste of time. The depression still comes back, but because it’s quite mild and I’ve worked out some strategies for dealing with it I never need to see a doctor.

    Anyway, I digress. I’m very much behind removing the stigma from mental illness, and compulsory treatment for anything should always be a last resort. I’m certainly not a great believer in using drugs to cure all ills (only very rarely do I even take aspirin for a headache); but once your ‘dark gift’ turns into someone else’s night of terror, then it’s only fair for someone to step in and find a solution for you: society has a duty to everyone, not just one interest group. However, when society does step in it ought to do so impartially and compassionately, and that includes ensuring that when someone is deprived of their rights it’s on a fair and rational basis, not due to some twisted social more or the personal opinion of one or two people.

    This is only a comment, so I’d better wrap it up there. Nice topic, Nat

  7. I didn’t touch that thread with the proverbial ten foot pole. To mix my metaphors, I could see that coming like a freight train, and I just got the hell outta the way!

    Too bad, though. I agree. How will we ever learn more if we don’t speak honestly? And the honesty WILL always bring criticism and second-guessing. No way around that. (sigh)

  8. As far as ugly threads on Feministe go, it really wasn’t that bad. I suspect the bigger problem was that it got going very quickly and Jill wanted to head off something particularly rough being said. Honestly though, I could give a shit about the hurt feelings. The bullshit, coy intimation disingenuous defensiveness, and just general “well I once had a bad experience and my desire to oppress is as valid as your desire not to be oppressed” needs to be challenged. If that makes Jill & Co. uncomfortable, I can understand that, but its unfortunate.

  9. Kevin, no one over there was being extreme or anything. I guess the area of custody and other issues like that interests me greatly, if only because it’s presently an issue for people I care about.

    William, I don’t think it was so much “desire to oppress” as “this is what happened and I am clearly not over it.”

    Without knowing the details of anyone’s life or anyone’s pain – some things you just don’t get over, it’s true (and I’m speaking about everyone right now, not just selected commenters). Until worse things come to replace them, I suppose.

  10. I suppose you might be right. In discussions like these I tend to focus on final effects rather than motivations and that can leave me with blind spots. Still, I think some of what we were seeing in that threat might have to do with social power. There seems to have been a trend I’ve seen in feminist communities (and, really, all communities) to find someone who can still be oppressed. I don’t think it’s necessarily a conscious process, but there seems to be a definite line. You start with making sexism off limits, then racism pops up. You begin to challenge that and homophobia pops up. That gets challenged and you find transphobia. That gets challenged and you run into ableism and fear of the mad.

    Its human nature to find someone to get over on. When we see things in others that remind us of things we don’t like about ourselves we use that as an opportunity to attack those things which scare us.

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