Abstract
Behind a provocative title lies a critical reflection on the classification of mental health problems as ‘disabilities’ that is both fascinating and eclectic. Contributions from a varied line-up of academics, practitioners, activists and users/survivors of mental health and disability services provide a diversity of perspectives and formats.
The shared starting point is the inclusion of people with ‘mental impairments’ within the scope of the United Nations Convention on the Rights of Persons with Disabilities (CRPD). A foreword from Jenny Morris argues that whereas the social model espoused by the CRPD has been ‘liberating’ for many people with physical and learning impairments, it is less useful for people with mental health problems whose impairment may itself be socially constructed. To paraphrase Spandler and Anderson, how can ‘reasonable adjustments’ be made for those whose behaviour society labels inherently unreasonable? Yet, as the editors counter, the high proportion of long-term sickness and disability benefit claims accounted for by mental health conditions suggests the existence of a constituency of chronically distressed people for whom the ‘liberatory potential’ of the social model must be worth exploring.
This divide runs through the contributions. Whereas some form of impairment is presented as a necessary element of disability, contributors do not necessarily accept that mental health issues are impairments (Plumb, Mills). Where ‘harmful pseudo-science’ sees ‘mental illness’ (Webb), these authors see non-conformity with social norms that themselves cause distress (Barker and Iantaffi’s chapter on sexual and gender norms) or acts of apparent self-harm that in their context may be understandable responses to trauma (Tew). Russo and Shulkes view ex-psychiatric patients as ‘survivors’ not of their mental health problems, but of the interventions experienced, and the term ‘disabled’ as itself disabling. With others, they warn mental health activists’ voices may be ‘lost’ if subsumed into the wider disability movement, robbing individuals of the ability to make their own decisions about what constitutes a desirable quality of life independent of biomedical definitions of ‘recovery’ (Tew).
Other contributors offer more positive perspectives on the application of the social model – perhaps in amended form – to people with mental health problems, whose experiences of oppression, social exclusion, lasting care needs (rather than ‘recovery’) and clinical interventions that harm rather than help reflect those of many disabled people even if their conditions differ (Beresford). While Wallcraft and Hopper adopt the capabilities approach to develop a bespoke social model of mental health, Penson advocates a ‘double-social model’ that recognises that definitions of impairment of any kind are as socially constructed (with reference to perceived physical, intellectual or behavioural norms) as disabling social experiences. Webb welcomes inclusion within the scope of the CRPD and wider human rights framework as a means of challenging detention and involuntary psychiatric treatment, which he claims ‘satisfies all the recognised definitions of torture’ (p. 164).
Whether someone with a mental health problem is disabled is not merely a philosophical question, but has consequences for economic welfare. For those whose condition is deemed beyond any employer’s duty to make reasonable adjustments, disability and access to associated benefits and support systems may be central to survival. In an age of ‘austerity’, even authors critical of the disabilisation of mental illness acknowledge the potential of the CRPD and integration into a disability movement to underpin more effective advocacy – perhaps also in respect of redress for past psychiatric ill-treatment. McKeown and Spandler’s chapter on building solidarity between mental health, disability and other social movements is particularly timely.
If this book furnishes a far from wholehearted endorsement of the conflation of the two, its advocacy of the applicability of the disability movement’s slogan ‘nothing about us without us’ to the ‘mad’ community should resonate. The attempt to put the emerging fields of ‘mad studies’ and ‘mad activism’ more firmly on the map is commendable in its range of perspectives on mental health issues and how they should be treated in policy and practice. Its blend of contributors and styles, spanning academic, polemic, personal accounts and interviews, is also a success – some of the most interesting and readable chapters take the latter forms. Whilst this reader struggled with the medical language of some chapters, and others will doubtless find some of the more legal discussions equally impenetrable, overall Madness, Distress and the Politics of Disablement is an enjoyable and thought-provoking introduction to the relationship between mental health problems and disability.