Friday, March 4, 2011

"Mental illness," Disabilities Documentation, and Subjectivation

Salutations, New Mad Nation!

Once again, I apologize for my tardiness. A day late but hopefully not a dollar short - I'd like to deal with something pretty big tonight. I'm going to crack my knuckles here and try to translate one of the preliminary tenets of my ideal PhD on identity and performance theory into "lay terms," while dealing with a very practical issue - how to get institutes like a college or job to give you a fucking break.

As many already know, "mental illnesses" are often considered a form of disability, and there's a fair deal of back and forth between many camps over how exactly to break this classification down with respect to problems like the Americans with Disabilities Act. To the extent of my knowledge, the mentally ill are still not officially covered by it, and you can make of that what you will. If anyone can confirm this point one way or another for me, I would greatly appreciate it. For some insight on the subject of disabilities in the U.S., I recommend everyone check out the archives of this blog here: They have closed up, but the top article should have some nested links to other great stuff.

Now why am I talking about this? Because disabilities services and accommodations, as fraught with discursive violence as they may be, are not inherently a bad idea, and I believe they should be designed to extend to people carrying extra mental and emotional weight, so to speak. If you view "mental illness" as more of a "mental injury," as I have argued previously I believe, then a situation like "depression" might be likened to having broken a leg or two, and most institutions are now required by law to provide accommodations to such individuals. For example, professors will give extensions to hard-copy hand ins, since it takes people in a wheelchair longer than their non-wheelchair counterparts to get across campus. This is not unreasonable, I think - just a simple change in the expectations to reflect the capacity of the individual in question.

My heart carries a flicker of hope when I hear about how these accommodations are sometimes extended to students with "documented mental illnesses," because that means people who are depressed might be excused for being late to class a few more times than their non-depressed counterparts; or perhaps a student with some kind of "anxiety disorder" can be excused from an activity that would harm their health, while being assigned a worthwhile make-up activity. This is good, in theory.


But the reality is generally far uglier in terms of logistics, and extremely exclusive towards students who might need these accommodations most. And who is to blame in all of this? As you may have come to expect from me by now, I point the finger most strongly at the concept of "mental illness" itself. Let's start from the archetypal example.

You're a freshman in college. Holy shit. College. Honestly, you weren't even sure you'd make it through high school, but somehow you did, and yes, you made it here. You're out of that house full of horrible memories and your past is in another city/state/country, you're ready to move forward with new friends and a whole new identity. But you can never fully escape that baggage - you're still carrying it, and you've got the feeling it's going to slow you down in college-level academics. After that first week of intros to your classes, you've already realized you're going to have to up your game a bit, and you're not entirely sure how to handle it. Then you hear that there's such a thing as "Disabilities Documentation," and miraculously, it might apply to you! You got "lucky" and got a diagnosis on your way out of high school, so you're prepared.

With a signed letter from your psychiatrist, you march into the Associate Dean (or whoever is responsible for Disabilities services)'s office and have a little sit-down. They explain to you that they will send an email to your profs explaining your situation on your behalf, and then the profs will provide "reasonable accommodation." "Reasonable accommodation?" you ask. Well, turns out the school doesn't have the authority to set any particular requirements for mental illness disability accommodation, it's just heavily encouraged that the profs give you something. All the department can do for you is "negotiate" with the profs on your behalf (until they get tired of you and say "In the real world, we can't do this for you...")

Well, it's still better than nothing. Maybe you'll get a free absence out of this, which is great, because sometimes the depression still gets you at night and keeps you tossing and turning into the sunrise because your guilty conscience is just so good at conjuring those unforgiving phantoms when the moon is high, homework and productivity be damned. So you have your meeting and send out the letter and everything is swell.

Hmm. You've missed a couple of classes right now, and your professors are starting to get a bit edgy. You see, they understand "mental illness" well enough to know that it can be treated, right? But for some reason you're still missing classes. Now they understand that your illness may be affecting you, but why is it still affecting you so much? They sit you down to have a meeting with you. "Are you sleeping?" "Well I'm trying, but sometimes it's hard..." "Why?" "Well I'm, you know...depressed. I 'have depression.' Things can keep me up." "Are you seeing a therapist? A psychiatrist? Taking meds?"
This last part is the crucial thing. They are only willing to forgive your condition for as long as you are seeking treatment for it, and the only kind of treatment that matters, as far as they are concerned, is the kind that acknowledges your condition as "mental illness." It must be quantifiable and scientifically measurable in order for the professor to verify it.
Well, here's the rub. Maybe you aren't seeing that psychiatrist anymore because you're in a new state. Maybe you haven't found a therapist yet because A) School and B) That's really fucking hard. Maybe you don't have a medicine that just "works" for your depression-induced-insomnia because the pills you've tried have all induced night-terrors and you aren't in a hurry to try that again. And the more of these realities you face, the less patience your profs are likely to have. "You need to take responsibility for your illness, I can't keep giving you hand outs," they'll say, holding it against you.
Now, if you actually ARE on meds for your insomnia and you do have a local p-doc and therapist and they are all helping, you MIGHT get sympathy for your plight - you might not, and that is a problem all its own - but you might. If you aren't doing those things, you will get no sympathy whatsoever, regardless of your perfectly legitimate reasons for not doing so.

So already we see how the language of "mental illness" privileges those who are willing to embrace their "ill" identity and get "traditional" treatment. Anyone who has a problem with this is considered to "not be taking responsibility for their illness" and nor worth accommodating. But this is just with a basic case of something that CAN be considered a "mental illness" and often is - depression. Even if you don't identify as "mentally ill" or "clinically depressed," you can allow yourself to be "subjectivated" (that's your grad school term for the day) by the system, and accept the identity they allow you to have, at least in their presence. You can play the part for them to get the accommodations - you can see that p-doc for as long as your insurance will let you, pretend to take those meds, or whatever else you have to do to "legitimize" your condition in your prof's eyes.

Not everyone can do that. Conditions like "Bipolar" are still stigmatized like no-one's business, even in highly academic circles, but with enough insistence on the medical insistence - which often paints the "Bipolar" person as someone who is absolutely out of control without therapy and medicine, thus robbing them of all agency in their emotions and thoughts (see my previous post) - you might be able to get some aid and respect from the profs. The problem here is that you have to accept the illegitimacy that comes with the condition - Bipolar is a form of invalidity that can only be healed by medicine, and LOTS of it. It's humiliating.

It reminds me of Alcoholics Anonymous. I'm not going to debate the validity of alcoholism as a disease (yet, anyway, I have more research to do), but the principle is similar: something is affecting you, you are powerless before it, and everyone hates you until you give up and resign your miserable self to the Higher Power that can save you. But instead of the God or Spirit of AA, it's medicine. Professors or employers might think they are like the concerned friends who are showing you stern support, but all they are really doing is forcing you to sacrifice your personal truth for the sake of their construction of reality. What's worse, this is all probably at great actual cost to your health instead of benefit, if medicine is not right for you, which it may well not be.

But again, horrible as this seems, this is still a much-sought privilege in the kingdom of the Mad/mentally ill. There is the possibility of being a recognized and cared after subject. Even if you are totally humiliated in the process, you are still recognized as part of the caste. When you use the Institute's terms (medicine) to define your reality and others, you are part of the Institute; possibly still sick yourself, but Healing so you still count. Those not using the discourse are "other" and to be cast off or converted. To avoid being a hypocrite here, I might put forth that I tend to otherize anyone not using my discourse either, and my point isn't the crime of othreizing different discourse, but rather, that it seems problematic when all it takes to be "other" and cast off is not wanting to take medicine that doesn't work.

The reality that others face, a reality that keeps many from even attending college, is that their emotional and mental struggles get absolutely no validation because there is no "mental illness" to qualify them, that is, they cannot be diagnosed. There are others who can be diagnosed, but to do so would be to expose impossibly personal truths, something that many are not prepared to do (and given the company in question, they are justified). The first example might be seen in someone who, like me, has experienced "reality warping" where the sense of existence is altered in a way beyond language. Every doc I ever saw just scratched their head about this, but I assure you that it was very real and VERY hampering to my academics. Because of over-medicalization, though, I never could have tried to gain understanding on this issue, because without a diagnosis, it isn't legitimate.
The second example might be someone with DID. (Dissociative Identity Disorder, aka "Multiple Personality.") I'm going to do a profile on this condition some day, but for now, suffice to say that it tends not to happen unless something REALLY HORRIBLE happened to you. Admitting you "have this" might require you to admit that you went through something - it is exposing a weakness to teachers who have probably seemed pretty hostile up until this moment, not something easy or even possible. What's worse, the fact of being multiple people at once can feel extremely compromising - so compromising that it is impossible to bring that truth to light anyway. Besides, if you DO tell a prof or someone that you are Dissociative, then they will know forever and will always be judging you with that in mind, and probably from a really ignorant perspective. Suddenly you are expected to educate your faculty on one of the most personal and complicated conditions of your existence, all because a "diagnosis" and "treatment" plan are required to get accommodation.

Meanwhile, someone who doesn't suffer from their depression all that much because they have a good relationship with their therapist and decent meds, they miss a class or two per semester and get absolutely no difficulty from their prof whatsoever. This is because "mental illness" as a concept has favored them. 

As long as "mental illness" is valid, profs will need diagnoses and treatment plans to even considering granting mercy to a troubled soul, even when such things may be practically or emotionally impossible. In my opinion, this is another reason why the language of "mental illness" is basically unethical. Even if it can accurately describe some, it creates an incredibly unfair dynamic where those whose condition is "medical" get special privileges over those whose conditions are not.

"So Rius, are you saying that people who don't have any kind of medical condition should get disabilities documentation?"

Good question. No, I'm not saying that - I'm saying that the connection of "medical condition" with "disabilities documentation" should be abolished to begin with. In fact, I'm not fond of calling them "disabilities" either, but that is a very complicated point on which I am not qualified to comment (try the above-mentioned blog, instead). What I am saying is that, when it comes to mental and emotional situations, we need some kind of criteria other than "mental illness" and medicine for determining how to give people breaks, extensions, accommodations, and other nice things. I don't know exactly what it is yet, but there has to be something that works better than what we have now. Because what we have now assures that the least "unhealthy" people get the best service.

In other words, the chill get chiller, and the Mad get "sicker." Which consequently makes us more Mad...and thus the cycle continues.

Hope that all makes sense. Please comment to elaborate if you have anything to add, and of course, questions are always welcome.

As always, to the New Mad Nation, I bid my fondest salutations.

Sincerely and with thanks,


  1. I completely agree with you on your point here that there should be some allowance/ more understanding for those with a "menatal illness". I think that one of the biggest reasons, however, that nothing has been done is that people will be to willing to abuse it (like claiming a fake diagnosis just to be able to come in late every now and then.) Hopefully some day in the future this can be achieved, but I think society and the media need to clean up what their definition of a "mental illness" is first ( as you explored earlier).

  2. You are absolutely right in that people would abuse a system that was not based on "strict medical rigor," so to speak. I think that people still find ways to abuse the system in place, however; I think there are many who get diagnosed with "Depression" and may use it to their advantage when they are not really in any serious trouble. Even if that isn't the case, however, which requires more faith in humanity than I'm normally willing to afford, I think a few "abuses" of the system by people who "aren't that unwell" is well worth what it affords the people who actually deserve that kindness. But hey, I'm an idealist; what do I know? XD

    I think that the issue of "claiming a diagnosis" should be abolished. No diagnoses. Just give extensions to people who are in serious distress. You know the profs won't sit down to grade all of the papers in one night's sitting anyway. Sometimes profs do this anyway, if an entire class has reasons they cannot get a paper in on a certain day; I think these kind of allowances should also be made on a case-by-case basis. I don't know /exactly/ how it would work but it's got to be better than this.