The Conversations We Should (and Shouldn't) Be Having

In the aftermath of the Arizona shootings/assassination attempt, mental illness seems to be something of a hot topic. Yahoo! lists "mental illness" as "trending now," putting it in such illustrious company as Miley Cyrus and Kid Rock.

People are talking about mental illness in light of recent events. But generally, the things which are being said are, far from being helpful and productive, actually contributing to the problem of stigmatizing mental illness. This is true even of many who advance the liberal, "progressive" position.

There seems to be a strong consensus, even among people who generally would not agree with each other, that the tragedy of the Arizona shootings could have been prevented, if only society treated individuals with mental illness differently.

All right. But what, exactly, needs to change?

Some people are straightforward enough in their response: It needs to be easier to forcibly institutionalize people and/or force people into "treatment." See, for instance, this position being advocated by numerous commentators (and the author, by strong implication) here, at NYTimes.com's Motherlode blog, as well as this article which inspired the Motherlode posting. You can always count on Motherlode to bring ableism into any issue, and this is no exception. Still, it's important to note that this is only one example that I might have chosen.

Let's spell out exactly what is being proposed here. People want it to be easier to incarcerate someone who has committed no crimes and force people to ingest medications--many of which have significant side effects and haven't been studied very much long-term--against their will. And this is supposed to improve society.

Well, I suppose this doesn't matter much if you have neurotypical privilege. For those of us who aren't neurotypical, however, these ideas pose a serious threat to what precarious freedoms we have.

There are very many neuro-atypical people around, and very few neuro-atypical people who take part in shootings like the one in Arizona. And yet some people apparently have no problem taking away all of our freedoms in the name of possibly preventing an event which, while undeniably tragic, is also extremely rare.

To use an analogy, it is infinitely more likely that any given person will die or be injured in a car accident than in a shooting. We also know that certain classes of people are far more likely to be in car accidents--young people (especially males), older drivers, SUV owners. Yet we, as a society, do not deem it acceptable to eliminate the freedom to drive, or certain people's freedom to drive, in the name of safety. We have collectively decided that such impositions on freedoms are unacceptable, even if they might prevent death and serious injury.

I do not want to live in a society which limits freedom in the name of security, especially since further limiting the freedoms of neuro-atypical people would hardly eliminate violence--most of which is committed by people who are perfectly "normal." And I am appalled that so many people apparently have no qualms making this trade-off. But I guess when you're not the one who faces possibly being locked up and medicated against your will, it's easy to make these kind of pronouncements about people categorized as Other, and therefore less human, less worthy of rights.

It is also easy to say, "but this person is refusing medications because it's part of zir illness! Ze doesn't think there's anything wrong with zir!" Because you do not get to make that call for someone else, end of story. You do not get to decide that someone else's opinions are illegitimate based on a psychiatric diagnosis, you do not get to disregard people's wishes about their own bodies, and you are not the final arbiter of "what's best." Yes, even if you are related to that person. And I really, really wish this didn't need to be said in 2011.

It's easy to spot the ableism and civil rights concerns in statements which explicitly advocate forced institutionalization and "treatment." There is, however, another strain of argument which also needs to be unpacked.

This is the compassionate, so-called "progressive" position. The position which tries to avoid stigmatizing mental illness (or not), but nevertheless insists that we must use this opportunity to discuss inadequacies of the mental health care system. On the surface of it, this position doesn't sound so bad. But I'm kind of skeeved by it.

Why? I suppose part of it is that I'm inherently suspicious of people using this particular incident to prompt a discussion about access to mental health services...when many of these same people don't appear to give a damn about mental health/disability issues under normal circumstances. Where are all these Concerned People when neuro-atypical people are, for instance, harassed by police officers? When we have trouble finding appropriate employment and housing? I pass many homeless individuals every day, most of whom could probably be classified as neuro-atypical in some way. Where is the concern for them? Where is the concern for the millions of neuro-atypical people who aren't likely to hurt anyone except for themselves? How many of the people now pontificating about The Inadequacies of the Mental Health System spent much time considering mental health issues before the Arizona shootings, or before the Virginia Tech shootings, or whatever? Why does it take a possibly-neuro-atypical person committing an act of horrendous violence for this to become a Hot Issue?

In my more cynical moments, I think it might be because "normal" people are affected when tragedies like these occur. And we can't have that.

There are other problems with the "liberal" position. Namely, we don't know what kind of access Loughner had to mental health services. We can't simply assume that every neuro-atypical person will avail themselves of "treatment" even if it were more affordable. And there are many perfectly legitimate reasons for doing so, not least among them the fact that many of us have had bad experiences with psychiatry and psych meds in the past.

Because that's the other thing. Mental health services, as they currently exist, are far from perfect. This is for reasons both scientific--the brain is an incredibly complex system--and social--frankly, many mental health professionals can be condescending, ableist assholes (and oftentimes racist/sexist/homophobic, etc). It is incredibly presumptuous to state that had Loughner only received "treatment" he never would have killed all these people. There's no way to know that. And perfectly "normal" people commit horrible acts everyday. Yes, there are real issues with mental health access which need to be addressed, but let's not pretend that "treatment" is a cure-all for all violence.

I am in favor of easing access to mental health care--for those who want it--though I am somewhat queasy about using Arizona as a launching pad for this discussion. And there is definitely a need to emphasize the voluntary nature that should ideally characterize mental healthcare. As several people pointed out on this Feministe thread, you can't really talk about these things without acknowledging that for many neuro-atypical people, lack of access isn't the issue so much as being forced into "treatment" involuntarily is.

There are different degrees of coercion. While involuntary commitment is the most extreme and horrendous of coercive practices, it isn't the only one. Telling someone that they must receive a psych evaluation (or "treatment" or whatever) in order to stay in college, as appears to have happened to Loughner, is also a form of coercion, and one which we should work to avoid, not promote. It doesn't even seem to be particularly effective. In Loughner's case, for instance, I think it's more likely that his expulsion from community college (because of his refusal to submit to a psych evaluation) did more to further alienate him and heighten his resentments than anything else. But that's not the primary reason why we need to be careful to not coerce people into treatment. The primary reason is the right to privacy and choice--progressive/feminist values which apparently don't exist for neuro-atypical people. But they need to.

These issues are, I think, most pronounced on places like a college campus, simply by virtue of the fact that a college is a discrete community in a way in which most other units of organization (cities, states) are not. There are perhaps other kinds of similar communities, but I am going to focus on colleges because that's where my knowledge and experience lies, it seems relevant to the Loughner case, and colleges have been particularly scrutinized in the wake of the Virgina Tech shootings.

To put it bluntly, being a neuro-atypical college student in today's society sucks. Thanks to the demonization of neuro-atypical people that happens every day, particularly after tragedies like Virginia Tech, neuro-atypical students often find ourselves subjected to surveillance from other students and staff simply because we behave differently. Not because we have actually harmed another individual, but because we can seem strange and scary to the "normal" folk. It happened to me. I was identified as crazy by my hallmates at various times during my undergraduate career, and it got to the point where everything I did in public (and oftentimes in private) was interpreted through the lens of my perceived abnormality and instability. Oftentimes the problem got started because I do have meltdowns (in private, usually), which I recognize can be scary to someone who overhears, but it got to the point where perfectly innocuous behaviors were being interpreted as pathological. I am not exaggerating when I say that people reported to the Dean of Students about the ways in which I walked and closed my door. I wish that I was.

Why did people do this? I suppose some of them were genuinely concerned for me, even if their methods were completely off. Others, I suspect, were scared of me, even though I had never said a single word to any of them. But the trope of the scary crazy person who is going to come and kill you in your sleep is a socially powerful one, so powerful that neuro-atypical folks who have never laid hand on or said a threatening word to anyone are subjected to a kind of surveillance.

That is truly fucking scary.

My experiences aren't particularly unusual. I suggest reading this story about a man who was essentially kicked out of medical school because he had the audacity to be depressed and Asian-American in the period after the Virginia Tech shootings.

What does all of this have to do with the Better Mental Health Services argument? Quite a lot. See, the kind of rhetoric about "not letting people slip through the cracks" is exactly the kind of thinking which leads to neuro-atypical people being subjected to surveillance and coercion in a variety of situations. Good intentions don't necessarily matter one whit. So before making a "compassionate" plea to "keep people from slipping through the cracks," please please please take time to consider how this is going to happen. If it involves subjecting some people to increased surveillance, rethink this plan.

Eliminating stigma surrounding mental illness really is the central issue here. Yet many well-intentioned people are actually contributing to it in seemingly "liberal" and "compassionate" ways.

That, I suppose, is the main reason why I recoil from Using the Tragedy to Discuss Lack of Access to Mental Health Services. Because associating the two simply adds to the stigma. And we already have more than enough of that.

Be a part of the solution, not the problem.