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Madness and the sociology of disablement: tensions and possibilities by Helen Spandler


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Madness and the sociology of disablement: tensions and possibilities by Helen Spandler - a presentation from the symposium on social movements and their contributions to sociological knowledge on mental health at the University of Wolverhampton. Held on 13 June 2014.

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Madness and the sociology of disablement: tensions and possibilities by Helen Spandler

  1. 1. Madness and the sociology of disablement: tensions and possibilities (notes) - Helen Spandler, Department of Social Work, University of Central Lancashire BSA symposium, University of Wolverhampton 13th June 2014 These are reflections based on ongoing discussions that have formed part of a book I am editing with Jill Anderson and Bob Sapey - provisional title: Madness and the Politics of disablement (Policy Press forthcoming, 2015) The book, in turn, was based on a symposium we held back in 2012 inspired by Anne Plumb's pamphlet written in 1994 for the Greater Manchester Coalition of Disabled People where she highlighted some of the difficulties of integrating mental distress within broader disability politics (now 20 years old). Although it was widely circulated amongst disability activists in the 1990's, it hadn't been used by academics in either disability or mental health. Academics need to look outside academia & not assume knowledge/theory is produced in academy waiting to be applied. See Colin Barkers and Laurence Cox's important paper 'what have the Romans ever done for us?' Indeed, it is worth noting, that most of the better 'sociological' theories didn't come from sociologists (or academically trained sociologists anyway) but from political activists and social movements (e.g. feminism, Marxism, and I would also argue, psychoanalysis) and the social model of disability (SMD) Big changes and shifts... • The maturation of the both the disabled people's movement and the psychiatric survivor movement , to such an extent that it is no longer viable to talk about these as a 'movement' as it has lots of different elements, strands and conflicts within and between them. • The placing of 'mental illness' increasingly within a disability policy register. This means that mental health services users have to claim a 'disability' (or impairment) in order to get protection from discrimination (via DDA and Equalities act) and human rights (via the UNCRPD) as well as support, benefits and services.
  2. 2. • The current situation of austerity and threats to the provision of support and services has meant the possibility of alliances (but maybe also divisions) to defend services and provision- • What might be some of the tensions and possibilities for the users/survivor movement in being categorised as disabled? These tensions and disjunctures are harder to articulate Tensions / Disjunctures between disability and madness 1. Many disability social policies have been influenced by SMD (at least 'soft' version). Focus on how DP are stigmatised, discriminated against and socially excluded, 'on top of' pre- existing impairment . More recently, the SM has included how people are disabled at the psycho-emotional as well as the social level through micro social interactions, as well as social barriers (Thomas' relational social model). Donna Reeve has done some really useful work about how this might maps on to madness, but thinking about this is still very much in its infancy. Ironically, at least at a surface level, the SMD only really works in any straightforward way if we take a bio-medical view of a pre-existing mental illness which is then oppressed by social relations. This is what we see by a lot of social workers - who try to apply the SMD. Whilst the Social Model is usually positioned as the most 'radical' in physical disability circles, it could be positioned as quite conservative in mental health (because of the apparent need to accept the existence of a pre-existing mental illness). This is a curious paradox. For some mental health radicals, focusing attention on social exclusion and discrimination 'brackets out' discussions about the nature of madness itself and this may inadvertently concede interventions to psychiatry. This is ironic given the focus of the survivor movement. . 2. Mad people are, by definition, pathologised and labelled as such by others. Unlike in physical disability, where a part of the person is 'impaired', in mental health, the whole self is usually implicated. More importantly, the person does not necessarily agree with, or
  3. 3. embrace, their impairment/diagnosis. Indeed a part of the psychiatric survivor movement has actively resisted such categories and identities. In contrast, no matter how far disability scholars may debate impairment and disability (e.g. the claim that impairment is also 'socially constructed') no-one would dispute the very existence of impairment. In fact the disability movement requires its existence to be able to argue for support for equal access, participation, independent living support etc. There is no such consensus in mental health. Indeed, the raison d'être of some sections of the survivor movement has been to contest the nature of mental illness itself (about which the movement is still quite divided). And one of its main achievements has been to reframe our understanding of madness itself as thoroughly and ineluctably meaningful (hearing voices and self harm are good examples) 3. Unlike physical impairment, madness is often, by definition, seen as unreasonable /irrational. A lot of discussions avoid this tricky issue. In some ways, this parallels the hesitation of some disability activists and social model advocates to talk about 'impairment effects' (such as pain, discomfort that relate to the impairment). This is often referred to as the 'Elephant in the room' Given the negative pathologising assumptions and stereotypes about madness this reluctance may be understandable. Yet, without these discussions, we feel it is difficult to move the debate forward in a positive way. It is often impossible to disentangle the ‘impairment’ from the social conditions that give rise to it. Madness and distress is thoroughly social and deeply relational. In other words, it originates, is manifested, and played out, in relation to others, in a social context... Madness is deeply interpersonal (as well as intrapersonal). As has often been pointed out, contrary to a lot of psychiatric critiques, it is not psychiatry that labels people as mad, they usually rubber stamp (and specifically medicalise) decisions made already in the lay arena by family, friends, colleagues etc (Pilgrim and Tomasini 2012) The very definition of mental disorder often involves behaviour that actively transgresses commonly agreed social norms and 'emotion rules'. Therefore, the 'impairment', effects not only the person themselves, but people around them. This situation is more acute and tricky than in physical disabilities, where the person's interpersonal functioning is usually unaltered by the impairment itself (even if it might be
  4. 4. effected by disabling social relations). This makes things like 'reasonable accommodations' and adjustments more complex. There are good examples of 'collective reasonableness' (e.g hearing voices and self harm). However, this isn't always easy to achieve on an individual basis especially with people in crisis, and even more so with people experiencing a 'first episode' crisis where they are more likely to lack the resources to negotiate their distress with others. The person might not know what they want need (esp in an altered state) and what the claim they need may be seen as inherently unreasonable -including to themselves, in hindsight. It is these more 'extreme' states, where the person is not always understood by themselves and others, where the difficulties in application and alliances between disabled people and mad people are most acute. - but perhaps, precisely because of this, more important and necessary. We try to see these disjunctures as 'possibilities' rather than problems. So... What might be some of the possibilities for the users/survivor movement in being administratively categorised as disabled? • Opens up the possibility of more legal protection and legitimacy (re: oppression/stigma/discrimination etc. • May enable mad people to see themselves (and others to see them) as more legitimate & visible. This can effect issues of entitlement (e.g. to support/benefits./valued identity etc). • Forces us to think about these issues - foregrounds these discussions • Might makes alliances easier (esp if we can discuss/air differences) • Of course, many people are often both mad and disabled • Potentially expands our ideas about reason and rationality ('the reasonable man')
  5. 5. • 'Reasonable accommodations' in relation to mental health potentially involve the creation of more mentally enabling environments. Whilst this might be very challenging, it might ultimately benefit us all • 'Application' in the context of mental health remains problematic, but not insurmountable. Beresford argued that the social model suggests a 'different lexicon to mental health services users'. What this 'different lexicon' might be remains to be seen, but ongoing work is proceeding (ref to JRF work) and our book. • People are actively utilising and applying things like SMD and psycho-emotional disablement to new areas: such as suicide (David Webb) sexual distress (Meg Barker and Alex Iantaffi) • 'Mad studies' might sit alongside (or within?) disability studies to help enrich both. Cross fertilisation of ideas from disability studies might help both by enriching understanding of both madness and disability and inform what Carol Thomas has recently called a broader 'sociology of disablement'. • Other shared goals (as well as tacking discrimination) emerge which have potential to unify mental health and disability movements contesting prevailing normativities, the demand for control, reframing impairment as 'positive difference', (affirmation model of disability / Post conventionality - affirmation, possibility and becoming). Finally, perhaps we need to start with what ;people re actually doing, rather than with 'theory'. After all, social movements and protest already mobilise theories-in-practice. Activists don't need to wait around for the 'right' or 'correct' theory in order to act to defend or advance their collective interests. Helen Spandler June 13th 2014