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.

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. • 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. 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. 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. • '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
hspandler@uclan.ac.uk
June 13th 2014