Mental Illness, Danger, and the Public – but Not In that Order
A reaction to the post Newtown Massacre reaction
I was at work when a friend sent me a text with the message, “What the f*** Connecticut…” My workplace is in one of the underground paths throughout the city, and perhaps it was the lack of access to the internet or a live news source, but nothing seemed to be amiss that Friday as people bustled back and forth in search of holiday presents. Still, my curiosity got the best of me and despite the “no cell phones at work” policy, I tried to connect to the wifi next door. No signal. Nada. I couldn’t find the answer to that nagging question: what happened in Connecticut?
By the end of my shift, I could barely stand and so opted for a taxi. The taxi driver swerved left and right, winding down my street, stopping just short of my front door. I paid and was about to leave when he said “be careful, bad things are happening today.”
“What things?”
“A man shot his mother, and then went into an elementary school and shot a bunch of children.”
“Oh my goodness. Was this in Connecticut?”
“Yes! Why would anyone do this kind of thing?”
Why indeed. I tightly pressed my lips together, waved goodbye, and went upstairs with a tense expectation of the kind of answers that would meet this new question.
In the moments directly after a tragedy of this nature, especially one with a large body count, a crime scene so counter to our imagined spaces of ‘predictable violence,’ and a perpetrator of the same order, a white killer who does not fit within our racist conceptions of the ‘predictable killer’ (black and brown people, specifically men) – the public is thrust into a confused frenzy as they grasp about for an answer to the question of why. Yet, it can not be just any answer, it must be one that fits within the skewed ‘logic’ and ‘commonsense’ way of knowing that pervades a society sick, not only, from racism, sexism, homophobia, transphobia, and classism, but also from ableism.
Indeed, the discussion about the racism that allows for white violence to be individualized by attributing the killers’ actions to mental illness, while black and brown violence is understood to be representative of an entire racial group through allusions to the “cultural” or “religious thing” needs to happen – always. Yet, let’s also look at how white supremacy’s attempts to paint violence as an aberration from the rest of white society relies on the demonization and homogenization of another marginalized group. What happens when ableist society decides that the only ones capable of acting out these ‘senseless’ acts (are these events really senseless? What in our culture predisposes violence), are those people whom ableist society considers to embody the most senselessness: people with mental illness?
First, a little context. Stereotypes about people with mental illness have been around for centuries. In 13th and 14th century Western Europe, they were believed to be in league with the devil. In 18th century asylums, they were chained naked in isolated cells with little light and heat. All of this justified by the belief that people with mental illness were less human, akin to animals, and oblivious to their conditions – one of many examples in Otto F. Wahl’s Telling Is Risky Business: The Experience of Mental Illness Stigma. Despite what many would like to believe, these stereotypes of inherent dangerousness and lack of humanity have not been outgrown. In fact, a 2002 study led by Patrick Corrigan, a past Executive Director of the Center for Psychiatric Rehabilitation at the University of Chicago, confirms that these two stereotypes have actually worsened in the past 30 years.
Prejudice against people with mental illness is not only enacted on the personal level, it is institutionalized in the public health sector in the U.S. Though the mental health care system has changed somewhat since the IMD (Institutions for Mental Disease) Exclusion was enacted in 1965, an act that restricted federal Medicaid funding to institutions established for the care of people with mental illness, the system continues to be discriminatory. The National Alliance on Mental Illness points out that though the Medicaid restriction will be lifted for people under the age of 22 and over the age of 64, unless choice and quality in care are to be severely compromised, people between the age of 23-64 must cough up the exorbitant funds themselves.
Moreover, though the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was passed on January 1, 2010, the law’s effect on mental health care parity is still largely bark without the bite. Though the Act’s mandate is to compel equal coverage of benefits, equal lifetime and annual limits, and equal cost-sharing as compared to physical health coverage for all group health plans with more than 50 employees, it exempts employers who have less than 50 employees from providing parity. This is not to mention that it does not even mandate employers to provide mental health care coverage in the first place. The same logic applies to individual insurance companies: parity with physical health coverage only if mental health care is already offered.
With this in mind, the prevailing response to mental health care in the moments and days after the Sandy Hook Elementary massacre was an interesting one. Netizens flooded social media sites with memes and articles calling for increased access to mental health care. On the surface, this seems like a progressive step towards the ultimate goal of destigmatizing mental illness. Yet, with headlines like “What if gunmakers paid for mental health care?, “Support greater access to mental health services, less access to weaponry,” “It’s Easier For Americans To Access Guns Than Mental Health Services,” I argue that we need to take a deeper look at what this recent call for greater access really says about our understanding(s) of mental illness.
Access to mental health care. Guns!! Come right in. Open. Welcome. (Nick Anderson/Houston Chronicle)
This image by a Washington Post Cartoonist, posted in the Houston Chronicle, sums up the problematic logic behind this recent call for greater access. Here, the cartoonist is trying to deliver two messages. The first message is the most obvious one: mental health care is significantly more difficult to access than firearms. The second message however, is the one that truly makes this cartoon ‘make sense’. The second cartoon ‘makes sense’ to those who have a very ableist understanding of mental illness – the cartoonist is not actively trying to deliver this message because he assumes that the audience already feels the way he does. Let me explain: note that the character (which is a caricatured image of a person with mental illness), is staring besottedly, almost drunkenly, into the gun store. In order for the cartoon’s ‘punch line’ (mental health care is so hard to access! But look at all those guns so freely available to the mentally ill! Look at this dangerous combination!) to get across, the audience must have already mapped violence onto the body of people with mental illness as something natural and essential to what it means to have a mental illness. In other words, mental health care acts as a distraction to prevent the very ‘natural’ indulgence in violence. The second message – the troublesome assumption that violence and mental illness are fundamentally connected - is in fact, the foundation on which the first message depends.
The underlying assumptions at work in this cartoon are the same assumptions pushing the recent mainstream, post-Lanza call for increased mental health care. This is a backhanded advocacy, one that calls for the ‘care’ of people with mental illness while simultaneously constructing them as inevitable killers, as ticking time bombs. This ‘advocacy’ drips with barely shrouded ableist misconceptions of mental illness.
Yet many would retort “The means do not matter if they achieve the same end, don’t you want increased mental health care?”. Of course I do! The deaths of the children and teachers of Sandy Hook Elementary are absolutely heartbreaking, but if we are truly serious about preventing any future tragedies, we must realize that there are negative implications to proposing that mental health care be the preventative measure for violence. What of gun culture? What of rape culture? What of racism, sexism, homophobia, transphobia, and ableism that tells the privileged who to kill?
So what matter the means? Well, let’s take a hypothetical leap into a future where mental health care is free. If the prevailing logic is that there is a confluence between mental illness and violence, would it be fair to say that many would be deterred from ‘outing’ themselves as people with mental illness? Would they not be deterred if they knew that the sight of them walking in or out of a counsellor’s office would induce the fearful stares of others? Though there is no question that accessible mental health care is a must, the movement needs to be founded on education, destigmatization of mental illness, and an open discourse about ableism. As Autistic Self Advocacy Network notes, “Autistic Americans and other groups of people with disabilities persist in facing discrimination and segregation in school, the workplace and the general community. In this terrible time, our society should not further stigmatize our community.”
New York City’s Rikers Island (Joseph a/Flickr)
And what’s the other terrifying consequence of uncritically assuming that mental illness and violence go hand in hand? Did you know that the United State’s largest psychiatric facility is New York City’s Rikers Island, with an estimated population of 3,000 persons with mental illness? Though the deinstitutionalization movement of the 1980s was precipitated by a want to improve the standard quality of life for people with mental illness, encouraging community care, massive federal and state cuts has resulted in the criminal (in)justice system taking over. Police often mistake the symptoms of a mental illness as disorderly conduct which results in plenty of arrests for misdemeanor crimes: disturbing the peace.¹ In extreme cases, police have been known to respond to people with mental illness with excessive force causing injury and sometimes death. The sad reality is that prisons, poorly equipped for the care of people with mental illness, have become de facto mental hospitals, looking more and more like the ‘horror house’ state run hospital that deinstitutionalization was meant to end.
So this means that while ableist society continues to naturalize violence onto the bodies of people with mental illness (as an ironic strategy that calls for ‘care’), the reality that people with mental illness are four times more likely to be victims of violence, is erased. So as my parting thought, I want to ask you to consider the fact that our society is victimizing and in that process, enacting violence on more innocents in our uncritical crusade for safety. I want you to question who it is, that is in fact more dangerous to whom.
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1. Serper, M.R., Bergman, A.J.Criminalization of Mental Illness. Madison: Psychological Press, 2003
Responses to Mental Illness, Danger, and the Public – but Not In that Order
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