Understanding the Brain

Mentalism (discrimination)

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Mentalism is a form of discrimination and oppression against people based on intelligence, mental type (ex. ADHD, bipolar or schizophrenia) mental action (ex. stuttering or Tourette syndrome) or neurology (ex. neurotypical or autism spectrum disorder) especially against those who have a mental disorder or a mental illness.

Like other "isms" such as sexism and racism, it is characterized by complex social inequalities in power. It can result in blatant mistreatment or multiple, small insults and indignities. The negative attitudes and terms may be internalized. Terms with a similar meaning that are sometimes used are "psychophobia" and "sanism".[1]

Origin

The term developed in the 1970s out of the Consumer/Survivor/Ex-Patient Movement,[2] mentioned specifically by Judi Chamberlin in a well-known book of the period "On Our Own", published in the United States in 1978.[3] People began to recognize a pattern in how they were treated, a set of assumptions which most people seemed to hold about mental (ex)patients - that they were incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational etc. It was realized that not only did the general public express mentalist ideas, so did ex-patients, a form of internalized oppression.[2]

As of 1998 the term had been adopted by some consumers/survivors in the UK and the USA, but had not gained general currency. This left a conceptual gap filled in part by the concept of "stigma", which could be focused on experiences and perceptions (a "mark of shame") rather than on the actual material discrimination (unfair treatment). Nevertheless, a body of literature demonstrated widespread discrimination across many spheres of life, including employment, parental rights, housing, immigration, insurance, health care and access to justice.[4]

Divisions

Mentalism, at an extreme, splits people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent. This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude. Further discrimination may involve labeling some as "high functioning" and some as "low-functioning". In either case, their behaviors are recast in pathological terms.[5]

The discrimination can be so fundamental and unquestioned that it can stop people truly empathizing (although they may think they are) or genuinely seeing the other point of view with respect. Mentalism may lead a person to erroneously believe they understand the other's situation and needs better than they do themselves.[5]

Clinical terminology

Mentalism is often enshrined in clinical terminology in subtle ways, including in the basic diagnostic categories employed. It is argued that they can stigmatize or communicate contempt or inferiority, rather than help with the understanding of specific experiences. Mental health professionals may argue that the terms are needed, which has been compared to the way a person may justify the use of ethnic slurs because they intend no harm, but it is argued that most could easily be expressed in a more accurate, less offensive manner.[5]

Some terms may be used far beyond their usual meanings, in a way that obscures the reality of the experience of the person concerned - for example, having a bad time may be relabelled as decompensation; incarceration or solitary confinement may be described as "treatment"; regular activities like listening to music, engaging in simple activities or even just being in a certain environment, become "therapies"; all sorts of behaviors are recast as "symptoms"; core adverse effects of drugs are termed "side" effects.[5]

Blame

Interpretations of behaviors, and applications of treatments, may be done in an arrogant unjustified way because of an underlying mentalism. If the recipient disagrees or does not change, they may be labeled as "non-compliant" "uncooperative" or "treatment-resistant". This is despite the fact that it may be due to inadequate understanding of the person or his/her problems, medication adverse effects, a poor match between the treatment and the person's lifestyle, stigma associated with the treatment, difficulty with access, cultural unacceptability or many other issues.[5]

Mentalism may lead people to assume that a person isn't aware of what they're doing and that there is no point trying to communicate with them, despite the fact that they may well have a level of awareness and desire to connect even if they are acting in a seemingly irrational or self-harming way. In addition, mental health clinicians tend to equate subduing a person with treatment; a quiet client who causes no community disturbance is deemed "improved" no matter how miserable or incapacitated that person may feel as a result.[5]

Clinicians may blame clients for not being sufficiently motivated to work on treatment goals, or as "acting out" when their own goals are not supported. It is argued, however, that in the majority of cases this is actually due to the client having been treated in a disrespectful, judgmental, or dismissive manner. Such mentalist behavior may again be justified by blaming the person as having been demanding, angry or "needing limits", but it is argued that power-sharing can nevertheless be cultivated and that when respectful communication breaks down, the first thing that needs to be asked is whether mentalist prejudices have been expressed.[5]

Neglect

Mentalism has been linked to negligence in monitoring for possible adverse effects, or viewing such effects as more acceptable than they would be for others. This has been compared to instances of maltreatment based on racism. Mentalism has also been linked to neglect in failing to check for or respect people's past experiences of abuse or trauma. Treatments that do not support choice and self-determination may cause people to re-experience the helplessness, pain, despair, and rage that accompanied the trauma, and yet attempts to cope with this may be labeled as "acting out", "manipulating" or "attention-seeking".[5]

Mentalism can lead to "poor" or "guarded" predictions of the future for the person; a pessimistic view skewed by a narrow clinical experience, that can be impervious to contrary evidence because those who succeed can be discounted as having been misdiagnosed or didn't have the "real" disorder. The result can be self-fulfilling, as individuals are told they have no real hope.[5]

Institutional discrimination

Offensive and injurious practices may be integrated into clinical procedures, a form of institutional mentalism to the point where professionals no longer recognize them as discrimination. Mentalism may be apparent in physical separation, including separate use of facilities or accommodation, or lower standards. Mental health professionals can be drawn into systems based on bureaucratic or financial imperatives and social control, resulting in alienation from their original values and disappointment in "the system", and adoption of the cynical, mentalist beliefs that pervade such organizations. However, just as employees can be dismissed for disparaging sexual or ethnic remarks, it is argued that staff who are entrenched in negative stereotypes, attitudes, and beliefs about those labeled with mental disorders need to be removed from service organizations.[5]

At a society-wide level, mentalism has been perceived as linked to people being kept in poverty as second class citizens, to employment discrimination keeping people living on handouts; to interpersonal discrimination hindering relationships, to stereotypes promoted through the media spreading fears of unpredictability and dangerousness, and to people fearing to disclose or talk about their experiences.[6]

A 2001 publication by psychiatric nurses on stigma in healthcare that included the view of a leading figure in the Consumer/Survivor/Ex-Patient Movement, Pete Shaughnessey, concluded that the National Health Service in England is "institutionally mentalist and has a lot of soul searching to do in the new Millenium" including addressing the prejudice of its office staff. He suggested that when prejudice is applied by the very professionals who aspire to eradicate it, it raises the question of whether it will ever be eradicated.[7] Shaughnessey committed suicide in 2002.[8]

It has been argued from a feminist perspective that mentalism in psychiatry "acts as a threat to all women" and to women's families and children.[9]

A psychiatric survivor and professional said that "Mentalism parallels sexism and racism in creating an oppressed underclass, in this case of people who have received psychiatric diagnosis and treatment" She reported that the most frequent complaint of service users is that nobody listens, or only selectively in the course of trying to make a diagnosis.[10]

Multiple discriminations

A spiral of oppression experienced by oppressed groups in society has been identified. Firstly, oppressions in society on the grounds of difference (for which terms may exist, such as racism, sexism, classism, ageism, homophobia etc.) can have a negative physical, social, economic and psychological effects on individuals, which may cause emotional distress and sometimes "mental health" problems. Society's response to such distress is to treat it within a system of medical and social care rather than understanding and challenging the oppressions that gave rise to it, thus reinforcing them with further oppressive attitudes and practices, which can lead to more distress, and so on in a vicious cycle. In addition, due to coming into contact with mental health services, people become subject to the oppression of mentalism, since society (and mental health services themselves) have such negative attitudes towards people with a psychiatric diagnosis, thus further perpetuating oppression and discrimination.[11]

See also

References

  1. From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion. By Liz Sayce. Basingstoke: Macmillan. 2000. ISBN 0333698908 Page 16.
  2. 2.0 2.1 Judi Chamberlin The Ex-Patients' Movement: Where We've Been and Where We're Going National Empowerment Center
  3. Reaume G. (2002) Lunatic to patient to person: nomenclature in psychiatric history and the influence of patients' activism in North America. International Journal of Law and Psychiatry. Jul-Aug;25(4):405-26. PMID 12613052 doi:10.1016/S0160-2527(02)00130-9
  4. L Sayce (1998) Stigma, discrimination and social exclusion: What's in a word? Journal of Mental Health, 7, 4, 331-343
  5. 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 Coni Kalinowski and Pat Risser Identifying and Overcoming Mentalism InforMed Health Publishing & Training
  6. Deegan, P. Mentalism, micro-aggression and the peer practitioner
  7. Tom Mason, Caroline Carlisle, Caroline Watkins (eds) (2001) Stigma and Social Exclusion in Healthcare Chapter 17: Not in my back yard: Stigma from a personal perspective. Routledge ISBN 0415222001
  8. Mark Olden (2003) "Obituary: Pete Shaughnessey" The Guardian, p22, 23rd January
  9. Wendy Chan, Dorothy E. Chunn, Robert J. Menzies (2005) Women, Madness and the Law: A Feminist Reader Routledge Cavendish, pg257, ISBN 1904385095
  10. Lindow, V. (1995) "Power and rights: the psychiatric system survivor movement", in Jack, R. Empowerment in Community Care. London: Chapman and Hall. Cited by Kelly, A. Disability and Social Exclusion University of Canterbury
  11. Kamaldeep Bhui (2002) Racism and Mental Health: Prejudice and Suffering Jessica Kingsley Publishers, p77, ISBN 1843100762

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