In this paper, I suggest that one way to bring mad perspectives and discussions about saneism/mentalism—systemic discrimination against people who have been diagnosed as, or are perceived to be "mentally ill"—into higher eduction is to situate them within existing curricula across disciplines. One of the ways curricula can be modified is by adapting existing theoretical frameworks from other interdisciplinary fields to mad issues and contexts. As an example of this adaptation, I turn Peggy McIntosh's article "White Privilege: Unpacking the Invisible Knapsack" (1988), a staple of undergraduate humanities curricula, into a teaching tool for showing not only the ways in which "sane" people—those who have never been psychiatrized or perceived as "mentally ill"—have access to privileges that mad people do not, but also the ways in which saneism/mentalism intersects with other forms of oppression such as racism, sexism, classism, heterosexism and ableism.
My history of involvement in the mental health system dates back to late childhood, when I began to suffer from depression and anxiety and was prescribed anti-depressants by my pediatrician. At the age of 16, I was assigned to a new psychiatrist and given a new "adult" diagnosis. I was treated for this supposed disease—on both an inpatient and outpatient basis, using a cocktail of different drugs—for approximately six years. Although I questioned my diagnosis before I got clear of psychiatry in my early 20's, it was not until I became a graduate student that I first read about the mad movement and finally had words to describe my experiences other than those used by psychiatry. I only wish I had heard about the mad movement earlier, and that I could have, as an undergraduate student in English and Women's Studies, talked about saneism along-side racism, heterosexism, cissexism, 1 ageism, classism and all those other isms. As I recall, our discussion of ableism in Women's Studies courses was brief, and both ableism and saneism 2 —discrimination against those who have been given a psychiatric diagnosis and/or who are perceived to be "mentally ill"—were not something we delved into. Arguably, the way in which psychiatry functions as an oppressive tool, and the systematic oppression of psychiatrized people both inside and outside of the mental health system, are still largely overlooked in academia. As James Overboe notes, "anti-oppression movements may have lessened the medical pathology based on racialization or gender. However, the experience of being psychiatrized continues to be pathologised [within liberal discourse] as a condition requiring a cure" (23). Now a teacher myself, I take every opportunity to educate students about interlocking systems of oppression, and to challenge colleagues and students when they use pathologising discourses to describe not only people who have been psychiatrized, but also those who have been marginalized in other ways. I want to show that "sane" people—those who have never had involvement with psychiatry and who are generally not perceived to be "mentally ill"—are privileged, just like people who are white and heterosexual and cisgender and able-bodied hold privilege. 3 This privilege is what makes it so easy to fall back on saneist language and assumptions.
During my undergraduate education, I learned a language which allowed me to frame gender and other aspects of identity as socially constructed categories. Courses taught from a feminist perspective showed me that my own experiences were important to the way in which I understood the subjects I was learning. I always felt that my own knowledge and identity (as a woman, and as queer) had a place in the classroom; however, feminist and other critical theories, as they were taught to me, did not give me a way to talk about my experiences as a psychiatric patient. A key critical premise of this essay is that it is especially important to introduce saneism to the humanities vocabulary as we move into a more inclusive era, one which recognizes the often racist, ableist, and heterosexist errors of the past. Unfortunately, despite having gained some recognition, those of us on the fringes are often not given spaces within existing institutions—whether they be universities, hospitals or government offices—to theorize our own experiences of oppression. Interdisciplinary programs such as Women's Studies, Queer Studies, Disability Studies, and Indigenous Studies, even when they are well-established in a university, are routinely devalued and constantly face the threat of funding cuts. In a university climate which is increasingly being depoliticized and corporatized, and which is evermore hostile to the arts and humanities, 4 it seems unlikely that there will be a department of Madness Studies any day soon. I still believe, however, that there are ways to bring the mad movement into academia.
I have been bringing the history of the mad movement and the perspectives of mad people into the classroom since I began graduate work, and I have specifically been using the term Mad(ness) Studies to describe my research into mad people's history, literature, culture, and activism. The fact that faculty and colleagues alike in my department and in others have shown interest in and have encouraged my work in Mad Studies has been heartening. Several colleagues have approached me to talk about their own or their loved ones' experiences in the mental health system and their doubts about that system. Many have taken great interest in the ways in which the dominant ideas about sanity and madness might be deconstructed, and have asked me to point them towards resources relating to the history of psychiatry and of psychiatric resistance. 5
It is not only faculty and colleagues, however, who are interested in madness: students are equally engaged. Recently, I led a discussion group for a first-year survey class called Shorter Genres. One of the short stories the class read was American writer Charlotte Perkins Gillman's story "The Yellow Wallpaper" (1892). The story is an autobiographical first-person account of a middle-class white woman's experience of what was then called hysteria. The woman, who is unnamed throughout, has been prescribed the rest cure: an order to remain at home and inactive, mentally and physically. The protagonist resists this "cure," however, continuing to write in secret. As time goes on, the woman's feelings of isolation begin to manifest in a belief that there are women trapped behind the pattern of the wallpaper in her bedroom. Stealthily, she begins to peel the wallpaper off, eventually liberating the wallpaper women, and achieving a feeling of freedom herself. Although some students quickly dismissed the narrator as a "psychotic" person hallucinating people living in her wallpaper, others sympathized with the woman, identifying the way in which the restrictions placed upon her by her husband and by society might account for her seeming insanity. With a minimum of prompting, the students were able to extend this critique of the woman's "hysteria" to ideas about "mental illness" today, which, as they identified, play out all around them, in everything from news to popular culture. In that class, we were doing Mad Studies work, even if we were in a literature class. Those students took to a critique of the medicalization of madness readily, and they were excited about it.
Aside from reading fiction through a mad lens, another way I've found to incorporate mad perspectives and issues into the curriculum is to introduce them into already-existing theoretical frameworks. Peggy McIntosh's article, "White Privilege: Unpacking the Invisible Knapsack" (1988), for example, has become a standby text for explaining privilege, and is staple reading in undergraduate humanities curricula across Canada and the United States. It makes a provocative model for talking about what I have started to refer to as sane privilege. In her article, McIntosh explains how she came up with the metaphor of an "invisible knapsack of privilege." She states:
Through work to bring materials from Women's Studies into the rest of the curriculum, I have often noticed men's unwillingness to grant that they are over privileged, even though they may grant that women are disadvantaged…
Thinking through unacknowledged male privilege as a phenomenon, I realized that since hierarchies in our society are interlocking, there was most likely a phenomenon of white privilege, which was similarly denied and protected…
I think whites are carefully taught not to recognize white privilege, as males are taught not to recognize male privilege… I have come to see white privilege as an invisible package of unearned assets which I can count on cashing in each day, but about which I was 'meant' to remain oblivious. White privilege is like an invisible weightless knapsack of special provisions, maps, passports, codebooks, visas, clothes, tools and blank checks. (10)
Following this introduction, McIntosh goes on to list some of these privileges of whiteness in day-to-day life. I initially encountered McIntosh's article in my first year Women's Studies class, and it was a huge eye-opener for me, because for the first time, I saw clearly that not only does racism oppress people of colour on a systemic level, but that I, as a white person, benefit from that oppression, whether I want to or not. Interestingly, although I quickly recognized that: 1) I have certain unearned assets that others do not because I am white and middle-class and able-bodied and cisgender; and 2) that others have privileges I do not because they are men and/or heterosexual, I did not recognize for some time the fact that people who had never been labeled mentally ill—as I had been—and who were thus sane by default, had access to privileges that I did not. I was aware of the discrimination I had faced as a "mentally ill" person, but I accepted that oppression. I believed, at the time, that I was sick, and I believed that this sickness caused me to hurt myself and others. Should I not then, I reasoned, be restrained by the straightjacket of unequal treatment?
It was only later when I came to reject the medical model of madness 6 that I questioned my own internalization of an oppression I came to know as saneism. Though I began to think through the idea of saneism at the same time as I got free of psychiatry, in 2005, I only started to recognize sane privilege recently, as I have increasingly gained that privilege myself. When I began graduate school in 2007, I moved away from my home town. Nobody where I currently reside knew that I was, or ever had been, a psychiatric patient. Initially, I was reserved about my history of psychiatrization, because I feared that if I told my colleagues and professors, they wouldn't trust me, or would think me less capable. As Margaret Price argues, "the necessity of passing for survival perpetuates the conventional view of academe as an 'ivory tower'—an immaculate location humming with mental agility and energy, only occasionally threatened (from the outside) by the destructive force of insanity" (7). Even though I now talk quite openly about my psychiatrization, and about mad activism, in the context of both my personal and my academic life—with the aim of challenging this very image of academe as a space where only "sane" minds think, create, learn and teach—I am still perceived to be sane and am treated as though I am sane most of the time; I think this is partly because I have not been a psychiatric patient for a number of years, and never in my current community. It is also partly because people seem to assume that someone doing a PhD, someone who willingly spends a decade as a university student, must be sane, or at least not suffering from a "serious and persistent mental illness." Since people have not always treated me as though I am reasonable, trustworthy, safe to be around, and capable of taking care of and making decisions for myself, because they knew I had been diagnosed as, or they perceived me to be mentally ill, I very much notice it now that they do treat me as though I am all of these things most of the time. 7 Now that I am experiencing it, sane privilege has become obvious to me. It is not necessarily so obvious to those who have never lost that privilege, however; therefore, I propose to create a list, similar to the list McIntosh created for white privilege, to explain the invisible advantages granted to people who have never been psychiatrized, or perceived as mad. It is my hope that this list will not only prove to be a useful teaching tool but also that it might prompt educators to reflect on our own assumptions and practices regarding madness.
McIntosh herself encourages the expansion of how we think of privilege in a longer version of her knapsack article. She states: "since race and sex are not the only advantaging systems at work, we need to similarly examine the daily experience of having age advantage, or ethnic advantage, or physical ability, or advantage related to nationality, religion or sexual orientation" ("White Privilege and Male Privilege" 157). Indeed, many of the items on her list apply directly to sane privilege, and others can be adapted. There are also some items that I would add to McIntosh's white privilege list which are more specific to mad people. Below, then, is a list of the daily effects of sane privilege, from the perspective of a mad person, who most of the time has access to that privilege, along with some commentary to explain why some of these effects do not extend to the majority of mad people. This list is not exhaustive, but it does give some sense of what sane privilege looks like. List items marked with a single star (*) are adapted from McIntosh's short paper, "White Privilege, Unpacking the Invisible Knapsack." Items marked with a double star (**) are adapted from McIntosh's longer version of that paper, "White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences Through Work in Women's Studies." For the purposes of this article I use the term mad person to describe anyone who has been given a mental illness label, and/or who is perceived as "mentally ill" or mad. 8
As a person who is presumed to be sane (and particularly if I am a person who has access to other forms of privilege, such as white privilege, able-bodied privilege or cissexual privilege):
I can see other "sane" people (and particularly those who have access to other types of privilege) for the most part positively, on television, in the news and in other media.* The idea that mad people will inevitably do harm to themselves or others is perhaps the most prevalent saneist stereotype out there. Mad people are, for the most part, portrayed as volatile, manipulative and violent and/or as savants, prophets or "mad geniuses" in both the news media and popular culture. 9 As Erick Fabris remarks, "most people believe that madness begets violence; they believe that strange ideas eventually lead to a chain of events: confusion, ambivalence, distress, irritability, aggression, and finally unpredictable violence" (37-8). As Margaret Price furthermore argues, the stereotype of mad people as violent is prevalent in the context of higher education, where "faculty and staff are encouraged to be alert for signs of immediate violence in student writing, in an atmosphere that Benjamin Reiss has called 'quasi-psychiatric surveillance'" (3). The presumed threat of violence is used as a justification for not only the saneist policing of mad people in educational and employment environments, and public spaces, but also for forced incarceration, both physical (hospitalization, criminalization) and chemical (drugs); this fear of violence is unjustified, however, since, as Fabris notes "decades of statistics show that 'madness' and violence are not linked" (45). In other words, mad people are no more violent than anybody else.
I am never asked to speak for "sane" people.* As a mad person, I frequently speak on behalf of mad people, who are devoiced within academic, social service and government institutions. I do not, and cannot, however, represent mad people as a whole. As you will see in this list, we all have different intersections of identity which means that there are great variations in our experiences of being mad, and in the ways we are privileged and disadvantaged. Furthermore, I should not have to be the "token mad person," the only one responsible for identifying and challenging saneist discourse and behaviour. I and other mad people must be allowed to choose not to speak about mad identity, mad politics, and/or our personal histories of psychiatrization and madness when we don't feel comfortable doing so. "Sane" folks can use their privilege to call others out on saneism, too.
I can be pretty sure of finding people willing to give me career advice that is based around my abilities and ambitions, rather than their assumptions about my sanity.** When asking professors, counselors and family members for career advice, they have alternated between cautioning me to not set goals that are "unrealistic" for a person who is "mentally ill" and denying my madness ("you're no crazier than anyone else") despite my psychiatric history and my current mad identity. When I was 17, my psychiatrist told me I would probably never be "well" enough to go to university. Psychiatric survivors Anne Wilson and Peter Beresford relate similar stories of being pushed towards "less stressful" occupations, such as employment as a retail clerk, by their psychiatrists (153). Survivor and mad activist Pat Capponi's mental health professionals likewise encouraged her to do something less demanding, such as furniture reupholstering, despite her college education and experience working in a group home (Capponi 77). This condescending style of advice-giving feeds, and is fed by, the stereotype of mad people as incapacitated or unproductive, where productivity is defined as earning money or a degree. On the other hand, however, when mad people do well (or excel) in school, at work, or as activists we may be treated as exceptional for having "overcome mental illness." In such cases, mad people may also be told we are successful only because we received special accommodation, or because people feel sorry for us. When talking to mad people about our ambitions, take what we tell you about our dreams, goals, needs and limitations at face value, rather than making assumptions or projecting stereotypes onto us.
It is unlikely that, as a "sane" person, my employer will ask me about current or past medical information and feel that they can legitimately do so. Mad people's medical histories are often on display in a way that "sane" people's are not. As Overboe notes, "it only takes an initial documented diagnosis of psychiatric problems to affect how others read your past, present [and] future" and the longer you remain in the psychiatric system, the more this history comes to weigh on your life (24-5). Wilson and Beresford similarly point out that "an individual's psychiatric record, once written, constitutes the dominant version of that person and serves to place restrictions… on future life opportunities, understandings, rights and possibilities" (144). The visibility of mad people's medical histories can be particularly weighty in the contexts of employment and education. If you go mad, and it becomes public, you will indefinitely be the subject of gossip, and the recipient of patronizing inquiries of "how are you?" Even if you work and learn in a place where people have not witnessed your madness, or your absence due to madness, your supervisor, and possibly your colleagues, may become aware of your history when you ask for accommodation or make use of disability or accessibility services. Like many mad people, I am wary of expressing too much emotion (or not enough, or the wrong kind) at school or at work, lest those around me consider it a symptom. I fear they will either ostracize me as crazy, or encourage (or force) me to get medical "help." Regardless of what you know, or think you know, about someone's psychiatric history, don't make assumptions about what kind of "care," treatment, or intervention they require. If a colleague, student or employee seems distressed, ask them what you can do to support them.
I can choose religious or spiritual beliefs and practices, eating habits, and political affiliations without people wondering if or assuming these choices are symptoms of a disease. While particular religions may be more normalized in certain cultural contexts than in others, most "sane" people are not labeled mentally ill because, for example, they talk to God. For people who have been given a psychiatric diagnosis, however, there is a thin line between such practices being considered religion or being categorized as "delusions." Mad people's political affiliations (for example, choosing to take part in a public protest) 10 and food choices (for example, being a "picky" eater, a vegan etc.) can similarly be framed as symptoms within the context of having been given a psychiatric diagnosis. 11 Mad people differ from one another in politics, spiritual beliefs and cultural backgrounds, and express these aspects of their identities in a variety of ways, just like "sane" people do.
It is less likely that my sexual orientation, my gender identity or performance, my relationship style, or my choice of partners will be considered symptoms of a disease. These aspects of identity may contribute to a person's psychiatrization, however. While homosexuality was removed from the list of psychiatric disorders in the Diagnostic and Statistical Manual (DSM), in 1986, you can still be psychiatrized if you're distressed or depressed or unsure about your sexual identity. Furthermore, many forms of sexual and gender identity are still listed in the DSM. Being transgender is still considered a mental illness, for example (it's called "Gender Dysphoria" in DSM-IV). So is being asexual (DSM-IV calls it "Sexual Aversion Disorder"). In some cases, a person's sexuality or gender, especially if fluid, can be considered the symptom of a disorder, such as Borderline Personality Disorder, which is characterized by an "unstable self-image" (APA). Being non-monogamous or polyamorous is also sometimes labeled "promiscuity," considered "self-harm," and counted as a symptom. Take mad people's gender and sexual self-identifications at face value. Do not ask whether these aspects of our identities are tied to "mental illness" or assume that they are signs of our "confusion" or "instability."
I can choose to use some recreational drugs, or not to take certain prescription drugs, without these choices being considered symptoms of a disease. Although this varies by social circle, "sane" people can generally get tipsy at a party, or share a joint with friends, and not be labeled as engaging in high risk behaviour. The same is not true for people who have a psychiatric diagnosis. When mad people use drugs and alcohol, this is generally considered self-medicating at best, or a symptom of either an existing or new disorder (such as alcoholism) at worst. A "sane" person can also choose not to use an elective drug (such as hormonal contraceptives, or pain medication) and to instead use an alternative (barrier contraception, massage therapy) without this decision being medicalized. In contrast to this, a mad person who decides not to take psych drugs is considered "non-compliant," or "lacking insight" into their condition, and their choice is considered further evidence of their disease. "Sane" people, just like mad people, make both good and bad choices about substance use. While it is okay to take the car key away from a mad friend who has had too much to drink at your party, do not assume that their substance use warrants any more policing than that of any of your "sane" friends.
I can criticize the mental health system, corporations, and the government without being called a conspiracy theorist, or having my opinions dismissed as a sign of illness. * When I have spoken out about injustices and corruption in the mental health system, I have often been treated with suspicion, doubt and scorn. For example, I was once called "nasty" and accused of being paranoid when I suggested to an acquaintance (a mental health professional who is aware of my psychiatric history) that the people who write the DSM are not primarily interested in consumer welfare, since in many cases, they work for pharmaceutical companies. 12 The act of speaking out against psychiatric oppression, like choosing not to take psychiatric medications, is often framed as a "lack of insight" into, or further evidence of, one's "illness." If someone talks to you about their negative experiences of, their suspicions about, or their research into the workings of the mental health system, corporations, or the government, keep an open mind, even if what they are saying seems "crazy." Whether what they are saying is true or not (and it very well may be!) you risk (re)pathologising that person when you dismiss their critiques.
Being a sane person (and particularly one privileged in other ways) means that I have never had to fear the power of authority figures, particularly those in the medical professions.** As a person who has had traumatizing experiences of health care, I am afraid every single time I go to the doctor. I worry that if my general practitioner, or a doctor in a walk-in clinic or emergency room finds out about my full medical history, that they will force me to undergo psychiatric evaluation and treatment. I am afraid to show too much anxiety, or social awkwardness or eccentricity, lest these be seen as symptoms. Once I accidentally cut my wrist, and had to go to an emergency room in my home town to have it stitched up. Since my patient records there indicated past suicide attempts, I was subjected to a psychiatric evaluation before I was allowed to leave the hospital. As a result of experiences like that one, I am ever wary of interacting with people who have any authority to potentially force me into "treatment." If you are in a position of power, that means you have to work harder to put people who have been hurt by authority figures at ease. Do not ask invasive questions, focus on the issue at hand, and do not call what we say into question simply because we are mad.
I am not made acutely aware that my physical shape, bearing, clothing, hairstyle, manner of speaking and other aspects of my physical and verbal presentation will be taken as a reflection of my madness.**
An untidy appearance or "strange" speech, within the context of psychiatry, are treated as the first signs of mental disorder in psychiatrized or potentially mad people, and are apt to be recorded as evidence in doctors' notes. 13 People who are identified by others as "mentally ill" because of physical characteristics or behaviour—whether it be an "odd" appearance or speech, or bodily movements such as tremors or tics (often side-effects of medication)—are commonly either ignored when they attempt to interact with others, or are asked to leave shopping areas, restaurants, libraries and other public spaces. The proprietor, other patrons, or security personnel in these spaces may fear that mad individuals will shoplift, act violently, or simply make others uncomfortable. Because of the assumptions made about appearance, I am always conscientious about "looking sane" especially when outing myself as mad, so that nobody thinks I'm mad enough to (still) require intervention.
Some mad people, however, have less choice in how they present themselves, and those who cannot "pass" as more-or-less normal are those most likely to face discrimination and erasure. As Cynthia Lewiechi-Wilson argues, the liberal humanist subject is defined by their ability to engage in verbal rhetoric. This emphasis on speech "creates a barrier excluding the severely mentally disabled not only from rhetoricity but also from full citizenship, tied as traditional rhetoric is to the liberal ideology of the public forum, where good men [sic], speaking well, engage in civic debate" (158). In other words, those who cannot, or choose not to assert themselves through speech in ways that are recognizable according to social norms, including some mad people, are all-too-easily dismissed as delusional, sick, stupid, dangerous, and generally not worth listening to. Catherine Prendergast similarly notes in her work on the schizophrenic as a postmodern metaphor that "typically schizophrenics are considered beings with speech, but speech that is generally treated as an index of sanity or insanity, with referentiality only to diagnostic criteria, and without referentiality to the civic world" (60). In other words, the speech of people who have been labeled with certain psychiatric diagnoses is only recognized as a marker of how "sane" they are in any given moment, and not as communication with the world around them. In order to be heard and recognized as citizens, and not just treated as patients, Prendergast suggests that those who have been psychiatrized must speak rhetorically some of the time. She further argues, however, that the very possibility of rhetorical mad speech challenges the stereotype of mad people as incapable of "rational" communication. Lewiechi-Wilson, in a different approach, advocates for the acceptance of assisted communication or "mediated rhetoricity" for mad and other "mentally disabled" people, a suggestion which points to the necessity of broadening our notions of listenable speech. One of the ways we can undermine saneism is by calling ourselves to task for our assumptions about appearance and speech. Additionally, those of us with sane privilege and able-bodied privilege can use that advantage to encourage others to listen to—and consider the perspectives of— individuals whose communications may otherwise go unacknowledged or be dismissed.
I can choose to ignore developments in mad peer-support, advocacy, and activist programs. Regardless of whether I choose to disparage them or learn from them, it is unlikely that I will have to face the consequences of this choice directly.** Mad people risk being remedicalized or criminalized when there aren't alternative and peer-run sources of advocacy, community, and acceptance for them to turn to in a time of crisis. We are directly and immediately affected when ongoing support services such as drop-in centres and patient advocacy boards are de-funded or amalgamated with main-stream mental health services. Since anyone could potentially become mad in the course of their lifetime, I argue that a wider availability of and support for alternatives to psychiatry would benefit everyone. Furthermore, most of us are apt to come into contact with a person experiencing madness of some sort at some point; rather than referring that person to the handiest psychiatric crisis hotline or centre, why not consider also finding out about the peer-run and mad-positive services in your community so that you can support friends, colleagues, students or clients who are looking for alternatives?
If I should need to move, I can be pretty sure of renting or purchasing housing in an area which I can afford and in which I would want to live. My neighbours in such a location will likely be neutral or pleasant to me.* Housing has particularly been a problem for mad people since deinstitutionalization. 14 Psychiatric consumers and survivors often have low incomes or are on social assistance, and live in areas where housing is substandard. Sometimes they are assigned to (underfunded) city-run boarding houses, such as the one Torontonian and mad activist Pat Capponi lived in during the time portrayed in her memoir Upstairs in the Crazy House (1992). Areas where mad people live become the object of stigma. Simply being attached to a particular address can result in being treated with suspicion or disdain. Even psychiatric consumers and survivors who can afford to live in non-stigmatized areas may not be welcomed by their "sane" neighbours. Be neighborly to your mad neighbours, and advocate against saneism and gentrification in your community.
I can go home from most meetings of organizations I belong to feeling somewhat tied in, rather than isolated, out-of-place, outnumbered, unheard, held at a distance, or feared.** In her work on happiness, Sara Ahmed argues that certain bodies get "seen as converting bad feeling into good and good feeling into bad" (126). Feminists and people of colour, for example, are often perceived as "killjoys" because they remind others (often through their mere presence) of their role in oppressive structures (127). Ahmed describes this experience through the metaphor of "bad feelings" getting "stuck" to certain types of bodies. Let me suggest that bad feelings often get "stuck" to mad people and people with other forms of visible disAbility (125). Our expressions of feeling (whether this be "bad" feelings, like anxiety, sadness and anger, or "good" feelings, like joy and amusement) are often framed as "crazy" behaviour which unnerves others, making them feel uncomfortable. Our protests against saneist assumptions are also often seen as killing the joy of those who are "only trying to help" (generally by reinforcing psychiatric discourse) or who feel they have legitimate reasons to fear or ostracize mad people. When someone calls us out on saneism or any other type of oppressive speech or action, that means it is time to listen, and reflect on our behaviour, not to get defensive. Remember that even the best ally falters sometimes.
Because I am sane, it is unlikely that someone will question my ability to raise my children, to care for a sick or disAbled friend or relative, or to have a pet. Mad people's parenting capabilities, on the other hand, are routinely questioned, and images of abusive mad parents abound in the media and popular culture. As S.E. Smith notes in Bitch magazine online,
Pop culture tells us a number of dangerous things about parenting and mental illness, particularly when it comes to mothering. Parenting, we are told, is simply not possible with mental illness… You are too unstable to be trusted with the tremendous responsibility of childrearing, unless you are willing to abide by very strict rules for the management of your condition. (emphasis original)
As Wilson and Beresford note, it can also be difficult for mad parents to access fertility services, or to become foster or adoptive parents (149). 15 All parents and caregivers, mad or sane, need support. We need to ask parents and caregivers what we can do to help, rather than assuming that mad people are any less capable of, or entitled to, that important work and relationship.
I am unlikely to be forcibly subjected to treatment which, though carried out in the name of my health and well-being, might be considered torture in other contexts. Some current psychiatric treatment methods, such as electroconvulsive therapy (ECT), as well as certain drugs, such as neuroleptics (anti-psychotics), have been used as torture methods for political dissidents, notably in the Soviet Union (Fireside 49). 16 Many people who have no or little experience of the mental health system are surprised when I tell them that ECT is still a commonly used treatment in Canada and the United States, and that it is even prescribed to children and the elderly. Educate yourself about different perspectives on current psychiatric treatment methods. Listen to and believe mad people if and when they chose to share their experiences of these treatments with you.
I am unlikely to be incarcerated without being charged with a crime, given a chance to defend myself, or being allowed to speak with a lawyer or other advocate. Although there are certainly problems and biases within the criminal justice system, there is also some form of due process. Under the current Ontario Mental Health Act, however, anyone can submit evidence to a justice of the peace which shows that a person who has previously been treated for a "mental disorder" is now suffering from this same disorder and cannot make his/her own decisions. 17 If the justice of the peace approves this application, he or she can order the police to take the "mentally disordered" person into custody and deliver them to a psychiatric facility for evaluation. The attending doctor may then certify an involuntary admission or community treatment order (CTO). (A third party can also call police directly, if they believe someone to be a danger to themselves or others.) Through this kind of legislation, which exists not only in Canada, but also in other jurisdictions across the West, mad people can be subject to both police and psychiatric detainment without committing a specific offense, and without being given a chance to defend themselves, or to be defended by another person. If you feel threatened by a mad person, interrogate your own fear before seeking legal, medical or police intervention. Are you, or that person, actually at risk of being harmed? Or are saneist stereotypes playing into your fear? Would you seek outside intervention if that person did not have a psychiatric history? Consider that in most cases, forced treatment poses a greater risk to a mad person than they pose to themselves. Support mad people's choices about their use of psychiatric drugs and services.
When I seek police assistance or medical attention, my history of sanity will not result in me being assaulted, ignored, dismissed, made to wait, or treated as though I am lying, or in receiving diminished quality of care.** People of colour, trans people, the homeless and street-involved, sex workers, criminalized people and mad people are particularly subject to harassment and/or assault at the hands of police. Race, class, gender, sexual orientation, previous medical history (such as HIV+ status or a mental health diagnosis) may also affect quality of care in a hospital. In the case of Jamaican immigrant Esmin Green, for example—who died because of neglect in King's Country Hospital in Brooklyn, New York, while waiting for an involuntary psychiatric evaluation—racism, sexism, classism and saneism were all intertwining factors in the way in which she was perceived and treated both before and after her death. 18
If my day, week or year is going badly, I don't wonder if each negative situation I experienced happened because I am perceived as sane.* For many mad people, however, it may be difficult to discern whether their day, week, or year is going badly because of saneism, or because of a number of interlocking systems of oppression and privilege. Mad people are more likely to be re-medicalized or to come into conflict with the law if they are people of colour, if they are poor, or if they are (or appear to be) queer or transgender. As I have tried to show in many of the examples above, there are many intersections between sane privilege and privilege based on race, gender, sexuality, class and ability.
I want to focus on these links between sane privilege and other types of privilege because I think it is important to note, in the spirit of intersectional feminism, that oppressions work in overlapping ways. I also want to emphasize, however, that the advantages associated with different types of privilege are not the same, even though there are many similarities between them. Being mad or psychiatrized, for one thing, is not as consistently visible as, say, being a person of colour. Generally, people have the same skin colour all the time, whereas many mad people may only be perceived as mad some of the time, and our history of psychiatrization may only be on display in certain contexts; that being said, "sane" people can loose their sane privilege at any point in their lives if they are deemed mentally ill, and people who are already oppressed because of their sex, race, gender, sexuality, age and/or disAbility are more likely to be psychiatrized. For somebody living with multiple intersecting oppressions it may be difficult, if not impossible, to distinguish instances of saneism from other types of discrimination, since saneism is often so closely bound up with other mutually-reinforcing forms of oppression.
You might be wondering, now that you have read this list, why is it important, and how might it be used. This list, like the white privilege list, is important because it shows the way that sane privilege operates, and, as with white people and white privilege and men and male privilege, sane people are taught not to recognize sane privilege. McIntosh notes the ways in which men in the academy deny their privilege in curriculum discussions, justifying the exclusion of women's or feminist materials. She writes: "when the talk turns to giving men less cultural room, even the most thoughtful and fair-minded of the men… tend to… fall back on conservative assumptions about… distributions of power, calling on precedent or sociobiology and psychobiology to demonstrate that male domination is natural" ("White Privilege and Male Privilege" 149, emphasis original). In similar fashion, and often in a way that is intertwined with this sexism, I have found that many "sane" people, when addressed with the idea of mad scholarship, fall back on the medical model, justifying exclusion of particular materials or approaches by saying that those who suffer from "mental illness" are just not amenable to inclusion in the same way. The plight of the "mentally ill" is to be pitied, but it is a biological problem that we should leave to doctors and scientists. Alternately, I have been told that mad issues are already being addressed under the rubric of disability awareness, a claim which not only overlooks the specificity of mad culture, identities, and experiences, but also disAbled people who do not subscribe to a medical model of disability, 19 and who, in any case, are still largely ignored in the context of higher education. 20
In her article, McIntosh also cites Elizabeth Minnich's argument that "whites are taught to think of their lives as morally neutral, normative, and average, and also ideal, so that when we work to benefit others, this is seen as work which will allow 'them' to be more like 'us'" (149-50). Similarly, those who have not been psychiatrized—and particularly those have never been called weird or freakish or treated as though they are abnormal in some way—assume that they are sane, morally neutral, and average, and that their "normal" ways of thinking and interacting with the world are envied by people who are mad or "mentally ill." They don't understand why we would want to bring mad perspectives into the classroom, because they see these as diametrically opposed to the rationality espoused by the academy. This discourse of academic rationality and neutrality, I might note, is still heavily dependent on patriarchal and colonialist discourses of both gender and racial otherness. In these discourses, women and people of colour, in addition to people considered to be disabled or mad, are, as a rule, not considered rational, and are thus not worthy of being included in intellectual discussions. 21 Although sane privilege may benefit the "sane," it also disadvantages them. It stops those who experience the world "normally" from learning from mad people's experiences. Showing "sane" people how the lived experiences of mad people differ from their own, and how they might learn from them, is the first step in enlisting them as allies. One of the best ways for "sane" people to become allies of the mad community is for them to come to recognize and challenge the discourses of sane privilege. A list like the one above is a step in helping to do that.
I have yet to fully test out different ways that the concept of sane privilege might be used pedagogically, but one of the methods that I have found effective in getting people to think through how sane privilege operates is to get them to generate a similar list of their own in a seminar focused on the idea of privilege. It helps to have folks read McIntosh's "White Privilege: Unpacking the Invisible Knapsack" ahead of time, or to go over it together as a group, to give everyone a sense of what privilege looks like. Once the audience understands the concept of privilege, they can work in small groups to brainstorm a list of the unearned assets held by those who have sane privilege and/or other forms of privilege. Ideally, this exercise should get them to see that there are both similarities and differences among types of privilege, and that systems of oppression and privilege interlock with one another, often compounding people's experiences of marginalization, discrimination and violence. I tried this exercise for the first time in June 2011 with a group of people who attended a panel I was part of at PsychOut: A Conference for Organizing Resistance Against Psychiatry, in New York City. Although I already had the suggestions above (as well as a few more items) written down as a back-up list in case the groups had trouble coming up with examples, I needn't have worried. The audience at this particular conference, which was made up of mostly mad people and our allies, easily brainstormed most of the items I have presented here, as well as others, because they themselves have experienced and/or witnessed saneism.
In the case of a more mixed audience, however, such as a group of undergraduate students, there may be more resistance to the idea of sane privilege, either from non-psychiatrized people who are uncomfortable with the idea of their own privilege, or from psychiatrized people who accept themselves as mentally ill, but who do not see themselves as disadvantaged or even different because of it. Many students also see madness as something private, not something to be "out" about or proud of. I have encountered fierce opposition when talking about the history of the mad movement and alternate perspectives on mental health in classroom spaces, often from students who have a "mentally ill" family member, or who have themselves had (generally positive) experiences of the mental health system. In these cases, I am careful to note that I support people's various self-identifications, their decisions to be "out" as mad or mentally ill or not, and their choice about what kinds of treatments and/or supports they access. I emphasize that my aim is to show that there is more than one perspective outside of the dominant medical model of madness, rather than to debate whether or not that model is correct. I also point out that, even if we were to accept that "mental illness" is an inherent, biological difference, we would still need to undermine the idea that that "the mentally ill" are therefore less deserving of dignity, rights, choices or participation in the public sphere. I stress the importance of challenging the sane/mentally ill binary. As Wilson and Beresford point out "the world does not consist of 'normals' and 'the mentally ill'; it consists of people, all of whom may experience mental and emotional distress at some time(s) in their lives" (144, emphasis original). Like Wilson and Beresford, I am interested in critiquing, and in teaching students to think critically about, the ways in which biomedical notions of madness often work to construct psychiatrized people as other. One function of this othering is the creation of hierarchies between "normal" mental health services users—or as Wilson and Beresford put it, the "worried well"—who see counsellors or take anti-depressants, but who are not visibly mad—and the "real crazy people," (who Wilson and Beresford call the "threateningly mad"): those who have been diagnosed with a "serious mental illness," who are visibly mad, strange or different (by choice or not) and/or who have made more extensive use of psychiatric services (also by choice or not) (153). It is important to point out to students that sane privilege and saneism is often reinforced through just such a denial of affinity with mad people of various identifications, on the part of both "sane" individuals and other mental health service users, who may or may not consider themselves mad or mentally ill. 22
In some cases, it may not be practical to do a full class on saneism, or even on privilege more generally, particularly in teaching environments where (as was the case for me when I was a TA) you may have limited control over the course content and/or pedagogical methods. Even when this is the case, however, the ubiquity of madness (whether it's an overt theme, something mentioned offhand, or merely a covert subtext) in course content across disciplines allows points for inserting discussion of saneism and sane privilege into broader conversations about privilege, oppression, self and other, the categorization and regulation of bodies, and discourses of madness. The sane privilege list can be used not only in a targeted exercise focused on making privilege visible, but the specific examples it includes can also help teachers to think through ways in which they might incorporate discussions of saneism into their courses, as I did when discussing The Yellow Wallpaper with first year students of literature.
Although I have directed this article mainly towards allies who have not been psychiatrized, and who are generally perceived as "sane," I'd like to close by noting that mad people also need to think through the ways in which various oppressions intersect in saneism. I am continually frustrated when mad people are resistant to recognizing the differences and inequalities among us. While we need to ask mad allies to educate themselves about and to challenge saneism and sane privilege, we also, as mad people, need to continually educate ourselves about, recognize the ways we are implicated in, and speak out against aspects of saneism we might not have experienced first hand. 23 This project of inclusivity and intersectionality also entails acknowledging and actively resisting other forms of oppression which we may not have experienced. Sexism, racism, heterosexism, cissexism, ableism, ageism and classism have an impact not only on many mad people, but many of our allies and potential allies as well.
Deepest thanks go out to S. Brophy, G. Reaume and A. Das for their helpful edits and input into this article. Thank you to those who attended my presentations at PsychOut 2010 in Toronto and PsychOut 2011 in New York City. Your positive response to my presentations, and your feedback, inspired me to merge the two papers into an article. Thanks also to my two DSQ peer reviewers, who provided helpful suggestions for revising this piece.
- Ahmed, Sara. "Multiculturalism and the Promise of Happiness." New Formations. 63 (2008): 121-137. Web.
- —. On Being Included: Racism and Diversity in Institutional Life. Durham: Duke University Press, 2012. Print.
- American Psychiatric Association. "DSM-5 Development." DSM-5: The Future of Psychiatric Diagnosis. 2010. Web. 6 Dec. 2011.
- Beresford, Peter and Anne Wilson. "Madness, Distress and Postmodernity." Disability/Postmodernity. London: Continuum, 2002. 143-158. Print.
- Beresford, P., G. Gifford, and P. Harrison. "What has Disability got to do with Psychiatric Survivors?" Speaking our Minds: An Anthology of Personal Experiences of Mental Distress and Its Consequences. ed. Jim Read and Jill Reynolds. Basingstoke: Macmillan 1996. 209-14. Print.
- Bergstresser, Sara M. "The Death of Esmin Green: Considering Ongoing Injustice In Psychiatric Institutions." The International Journal of Feminist Approaches to Bioethics. 4.1 (2011): 221-30. Web.
- Birnbaum, Rebecca. "My Father's Advocacy for a Right to Treatment." Journal of the American Academy of Psychiatry and the Law. 38.1 (2010):115-23. Web.
- Bousquet, Marc. How the University Works: Higher Education and the Low Wage Nation. New York: New York UP, 2008. Print.
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- Burstow, Bonnie and Don Weitz. Shrink Resistant: The Struggle against Psychiatry in Canada. Vancouver, BC: New Star Books, 1988. Print.
- Capponi, Pat. Upstairs in the Crazy House. Toronto: Viking, 1992. Print.
- Chamberlin, Judi. On Our Own: Patient Controlled Alternatives to the Mental Health System. New York: Hawthorn Books, 1978. Print.
- Cosgrove, Lisa, Sheldon Krimsky, Manisha Vijayaraghavan and Lisa Schneider. "Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry." Psychotherapy and Psychosomatics. 75 (2006): 154-160. Print.
- Fabris, Erick. Tranquil Prisons: Chemical Incarceration Under Community Treatment Orders. Toronto: U of Toronto P, 2011. Print.
- Fireside, Harvey. Soviet Psychoprisons. New York: Norton, 1979. Print.
- Gilman, Charlotte Perkins. "The Yellow Wallpaper." 1892. University of Virginia Library Electronic Text Centre. Web. 6 Dec. 2011.
- Kutchins, Herb, and Stuart A. Kirk. Making Us Crazy: Dsm : the Psychiatric Bible and the Creation of Mental Disorders. New York: Free Press, 1997. Print.
- Lewiecki-Wilson, Cynthia. "Rethinking Rhetoric Through Mental Disabilities." Rhetoric Review. 22.2 (2003): 156-67. Web.
- Loomba, Ania. Colonialism/Postcolonialism. New York: Routledge, 1998. Print.
- Mangold, James, dir. Girl, Interrupted. Perf. Winona Ryder, Angelina Jolie, Brittany Murphy, Whoopi Goldberg. Columbia Tristar, 2003. DVD.
- McIntosh, Peggy. "White Privilege and Male Privilege: A Personal Account of Coming to See Correspondences Through Work in Women's Studies." Race, Class, and Gender: An Anthology. ed. Margaret L. Andersen and Patricia Hill Collins. Belmont: Wadsworth Publishing Co, 1992. 70-81. Print.
- —. "White Privilege: Unpacking the Invisible Knapsack." Peace and Freedom. July/August 1989. 10-12. Print.
- McNamera, Julie. "Out of Order: Madness is a Feminist and a Disability Issue." Encounters with Strangers: Feminism and Disability. ed. Jenny Morris. London: Women's Press, 1996. Print.
- Mindfreedom International. "Psychiatric Survivor Movement History." mindfreedom.org. web. 18 May, 2012.
- Morrison, Lydia. Talking Back to Psychiatry: The Psychiatric Consumer/Survivor/Ex-patient Movement. New York: Routledge, 2005. Print.
- Nabbali, Essya M. "A 'Mad' Critique of the Social Model of Disability." The International Journal of Diversity in Organizations, Communities and Nations. 9.4 (2009): 1-12. Print.
- Nussbaum, Martha. Not for Profit: Why Democracy Needs Higher Education. Princeton: Princeton UP, 2010. Print.
- Minkowitz, Tina. "The United Nations Convention on the Rights of Persons with Disabilities and the Right to be Free from Nonconsensual Psychiatric Interventions." Syracuse Journal of International Law and Commerce. 34 (2007): 405-28. Web.
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- Movement Defence Committee, The. "A Legal Guide for Activists." movementdefence.org. 28 Nov. 2011. Web. 6 Dec. 2011.
- Ontario, Government of. "Mental Health Act." Service Ontario E-Laws. 2010. Web. 7 Dec. 2011.
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- Price, Margaret. Mad at School: Rhetorics of Mental Disability and Academic Life. Ann Arbor: U of Michigan P, 2011. Print.
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- Titchkosky, Tanya. The Question of Access: Disability, Space, Meaning. Toronto: University of Toronto Press, 2011. Print.
- Wolframe, PhebeAnn. "The Invisible Straightjacket: Theorizing and Teaching Saneism and Sane Privilege." PsychOut: A Conference for Organizing Resistance Against Psychiatry. PhD Program in Environmental Psychology, The Graduate Centre, City University New York, New York, NY. 19 June, 2011.
PhebeAnn Wolframe is a psychiatric survivor, a member of the Mad Students Society (Toronto) and a member of the Psychiatric Survivor Archives of Toronto. She is also a PhD Candidate in English and Cultural Studies at McMaster University (Hamilton, Ontario, Canada). Her thesis project examines the ways in which post-WWII Eugenic-Atlantic women's literature works to critique psychiatry as an apparatus of biopolitics and to envision madness both as a way of reading texts, and as a space for building new kinds of community.
Cissexism refers to systemic discrimination against transgender (trans) people and others who do not easily fit into a binary system of sex and gender. Although I do not believe the term cissexism had been coined during my undergraduate days, I recall discussing gender discrimination in a fairly broad sense. (This may not be true of all Women's Studies programs). Julia Serano defines cissexism as "the belief that transsexuals' identified genders are inferior to, or less authentic than, those of cisexuals" (33). Cisexual is the opposite of transsexual, while cisgender is the opposite of transgender, but the two are often used interchangeably. Cisgendered means that one's physical sex characteristics (ie. penis) matches up with the gender they were assigned at birth (ie. boy), and with how they currently experience and perceive their gender identity (ie. man).
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As Erick Fabris notes, saneism, which "means prejudgement or prejudice against mentally ill people" was coined by Mortin Brinbaum in conversation with Florynce Kennedy (Birnbaum 10). Fabris, however, "uses the term to mean the very constructions of difference as 'madness' and the dividing of bodies into mad and sound" (9). I use the term saneism to mean both discrimination against those who have been given a psychiatric diagnosis (who may or may not be perceived as "mentally ill" in some or all situations), as well as discrimination against people who are perceived to be "mentally ill," delusional, mad etc. (who may or may not have a psychiatric diagnosis, or be psychiatric users/consumers/survivors). It is important to note that another term, mentalism, is used often synonymously with saneism. Mentalism, a term first attributed in print to Judi Chamberlin, refers to discrimination on the basis of intellectual or psychiatric disability (Fabris 29-30, Chamberlin 66).
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Although some mad people use the term ableism in addition to, or instead of, mentalism/saneism, others prefer not to use the term ableism at all because they do not consider themselves disabled. This devision in terminology is reflective of the complex and often fraught relationship between madness and disability. This tension affects mad and disability activist communities as well as academic (inter)disciplines. For further reading, see Wilson and Beresford 145; Nabbali 4; Price 14; Beresford et al in Speaking our Minds, and Judi Johnny's piece in Shimrat's Call me Crazy, 38-42.
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For further discussion of the corporatizing of the university, the purpose of higher education, and place of the humanities in the university, see Bill Reading's The University in Ruins (1996), Marc Bousquet's How the University Works (2008) and Martha Nussbaum's Not for Profit (2010). For work more specific to feminist and equity politics in the university, see Ann Braithwaite et al's Troubling Women's Studies (2004) and Sara Ahmed's On Being Included (2012).
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For more on the history of psychiatric resistance and the mad movement, see Burstow and Weitz's Shrink Resistant (1988), Irit Shimrat's Call Me Crazy (1997), Morrison's Talking Back to Psychiatry (2005), Judi Chamberlin's On Our Own (1978) and the history links on the Mind Freedom International webpage.
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The medical model of madness is that which frames mental difference and/or distress as illness. The medical model typically understands mental illness to be primarily based in genetics and other aspects of biology, rather than as a principally social, cultural and/or spiritual phenomenon.
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My experiences are only one example of the way in which one can similarly be both privileged and disadvantaged. James Overboe describes a similar struggle with being both. On one hand, he has gained the rights of full citizenship through his access to particular discourses, and to a position as a university professor; on the other hand, his "cerebral palsy and spasms" signal "a (potential) impediment to [his] full participation within a political life," a life of full citizenship that is routinely denied to disabled people (26).
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People who have had experience of the mental health system, as well as people who perceive themselves to be, or are perceived by others as mentally different, may choose to use a variety of identity labels including, but not limited to: mad, crazy, psychiatric survivor, ex-patient, mentally ill/disabled, psychiatric consumer and neurodiverse. Individuals and communities choose and define these terms in different ways depending on their geographical location(s), generational/historical location(s), personal experiences of mental difference and psychiatrization, intersections with other aspects of identity, politics and activist goals, and desires to reclaim or resist certain labels.
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Bitch magazine online has a series called "We're All Mad Here," which reviews portrayals of mad people in popular culture. (I cite one of the articles in this series in this list). I am also currently working on a research blog project in which mad people can review depictions of madness and mental health treatment as part of an online reading community. Through this project, I hope to explore the ways in which people's experiences of the mental health system do or do not affect their interpretations of depictions of madness.
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As The Movement Defence Committee (an autonomous working group of the Law Union of Ontario) notes in in their Legal Guide for Activists, "certain people face increased risk of being targeted by the police because they are a member of a marginalized group, because of their political beliefs, or because of how they look." This includes "people with disabilities, people of colour, visibly queer or trans/intersexed people, psych survivors and people with mental health issues, parents or caregivers, people with criminal records, and those with precarious immigration status" (movementdefence.org, emphasis added).
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An example of dietary choices being considered a symptom is the case of Leonard Roy Frank, whose parents, in the 1970s, arranged for his psychiatric commitment when he began observing Orthodox Jewish dietary laws and became a vegetarian (Chamberlin 5). The idea of food-choice-as-symptom continues today: in the upcoming DSM-5, as currently proposed, will include "Avoidant/Restrictive Food Intake Disorder" According to this diagnosis, being a picky eater, or choosing a restrictive diet such as veganism, could be interpreted as a psychiatric disorder in and of itself as long as it is deemed to be significantly impacting a person's life. The diagnostic criteria also notes, however, that "if the eating disturbance occurs in the context of a medical condition or another mental disorder, it is sufficiently severe to warrant independent clinical attention" (APA, K02, emphasis added). Thus if a person already has a psychiatric label, being a "picky eater" can be considered more significant or "severe" than it would in someone without a prior diagnosis. This only adds to the constant monitoring of diet that mad people endure.
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A study conducted by Lisa Cosgrove et al reveals that 56% of members sitting on the review panel for the Diagnostic and Statistical Manual of Mental Disorders have financial ties with pharmaceutical companies. As Cosgrove et al additionally note: "the connections [between drug companies and panelists] are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders" (154). See also Kutchins and Kirk, Making Us Crazy: DSM — The Psychiatric Bible and the Creation of Mental Disorders.
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An untidy appearance is also, I'd argue, a trope of representations of mad people on television, in film and in novels—whether it's Beethoven's mad genius, with his wildly fly-away hair, or Angelina Jolie, kicking and screaming as femme fatale Lisa in the film version of Girl, Interrupted.
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Deinstitutionalization refers to the move from the treatment of the "mentally ill" in hospitals and other types of long-term care institutions to treatment in the community. Deinstitutionalization began in Canada, the United States and Britain following World War II as patient populations boomed (Scull 105). Institutional closures became increasingly frequent in the late 1970s to the 1990s, however, spurred by a neo-liberal agenda of more effective patient management for less expenditure through community treatment orders (CTOs) which allow patients to be treated both voluntarily and involuntarily on an outpatient basis (Moncrieff 237). Deinstitutionalization has been supported by CTO legislation in all three countries: The National Health Service and Community Care Act (1990) and the Mental Health Act (2007) in the UK, and in the US and Canada, policies at the state/provincial level such as Kendra's Law in New York (1999), and the Mental Health Act in Ontario (1990, 2010).
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See Steinberg 86-7; McNamara 199.
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Psychiatric survivor and human rights lawyer Tina Minkowitz has also argued successfully to the UN Rapporteur on Torture that forced treatment is a form of torture, and that it infringes on the rights of persons with disabilities (405).
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For the order to be passed, the person must also be deemed either a danger to themselves or others, or unable to care for themselves (Ontario Mental Health Act 16.1). The person must also have "shown clinical improvement as a result of their [previous] treatment" (16.1.1.b). These measures, are, of course, subjectively determined.
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For a discussion of Esmin Green's case, see Sara Bergstresser's "The Death of Esmin Green: Considering Ongoing Injustice In Psychiatric Institutions."
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A medical model of disability defines disability as a physical, biological problem to be solved through medical means. A social model of disability sees non-inclusive infrastructure and social environments as the cause of disability. That is, physical difference is not experienced as a problem in an environment that accommodates that difference.
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For a further discussion of the disAbility (dis)inclusion within the context of higher education, see Tanya Tichkosky's The Question of Access (2011).
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For an overview of the ties between Anglo-American educational histories, colonialism, and discourses of race, sex and rationality, see Ania Loomba's Colonialism/Postcolonialism (1998). See also Margaret Price's chapter "Listening to the Subject of Mental Disability: Intersections of Academic and Medical Discourses" for a discussion of the ways in which notions of rhetoric and reason—which systematically exclude mentally disabled people—are at the foundation of academic discourse.
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See also Overboe's discussion of the way in which both the general public and psychiatric service users often surveil and report upon one another's behaviour (and are encouraged to do so) as a way to assert their own compliance, normality and/or recovery (25).
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The mad movement has historically been made up mostly of white, heterosexual, able-bodied people. Though Judi Chamberlin argues in On Our Own (a book foundational to the movement) that peer support needs to take multiple identities and oppressions into account, people with disabilities, members of the queer community and people of colour have often felt excluded from the mad movement (19). That being said, there are mad activists who have been working since the 1980s, but particularly in recent years, to address issues of exclusion in mad communities and to recognize intersectionality (Shimrat 138-141).
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