Monthly Archives: December 2015

Social Justice for the Mentally Ill

Social Justice for the Mentally Ill
Hunter P. Drake
University of South Florida, Saint Petersburg
Dr. Elisa Minoff
IDH4000.601F15
December 3, 2015

Social Justice for the Mentally Ill

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is purposed with the diagnosis of persons with mental illness (PWMI). The diagnoses embody a diverse pantheon of labels ranging from catatonic to manic. In contemporary society, outside of the medical arena, fear and misunderstanding transform those wildly disparate diagnoses into harsh, pointed, and accusatory labels. Through these labels, the diagnoses have the common effect of making the PWMI population extremely vulnerable.

There are many reasons for this vulnerability. First, mental illness is primarily invisible. It comes with no visible physical symptoms. Physical symptoms are sometimes a secondary function of mental disease. They can be as a result of poor hygiene or maladaptive behavior leading to dire physical consequences. More often the presence of mental illness takes on behavioral traits such as talking to one’s self or having a particular ‘tick’. Because the symptoms of mental illness are behavioral, people tend heap blame rather than compassion on PWMI.

Secondly, blame and fear from the public at large cause the creation of an external social stigma. Media outlets proliferate news stories about the “insane gunman” or the “crazed killer” almost daily. Books, movies, cartoons, and television shows are also culpable in fostering the sense of fear and mistrust that creates stigma. Very few examples, outside of the medical/psychological arena, are available to the public of the real experiences of PWMI. There is the occasional book or movie that might tug the heartstrings to elicit a desire for deeper understanding, but the overwhelming volume of social misinformation serves to undermine any truth that might come from such works. All of this tripe breeds fear and ignorance among the general population of otherwise “normal” people. There are instances of PWMI whose behavior becomes dangerous to themselves or others, but they are exceptions, not the majority. There are more examples of otherwise mentally healthy people who commit heinous acts under the influence of drugs, alcohol, anger, passion, or even religious fervor. Stigmatization of PWMI leads otherwise rational and well-meaning people to ostracize those labeled “crazy”. Ostracization has a myriad of effects. It can result in the loss of one’s family, friends, job, self-esteem, and purpose. It can be the cause of loneliness, poverty, homelessness, and hunger. Studies have shown that factors created by this type of stigmatization, like poverty, can even lead to worsening mental conditions.[1] Likewise, the extreme stress created by external stigma can also lead to further mental illness.[2]

Thirdly, external social stigma often leads to internalized stigma. This type of maladaptive self-evaluation is potentially the most damning. PWMI can start to believe all of the hurtful things that others say about them or can internalize unspoken reasons for other’s treatment of them. Internalized stigma can cause PWMI to feel an acute sense of hopelessness. This sense of feeling alien, less than human can lead to crippling despair. PWMI often experience a sense that they do not deserve to get better or that it is a lost cause. This can lead PWMI not to seek treatment or to a lack of compliance with treatment. Violent outbursts or even suicide can be the tragic outcome for persons wrestling the demon of internalized stigma. When this happens it feeds back into the cycle of fear that produces external stigma, as people begin to blame PWMI for not being proactive or not caring enough to get better.

There are ways to alleviate, or at least mitigate, the vulnerability of PWMI and provide a modicum of social justice to this population. The first issue at hand is to be sure to provide equal access to quality mental healthcare to everyone regardless of socio-economic status. As it stands today, mental health care is a luxury reserved for the wealthy and well-insured. By this, I in no way mean to trivialize the mental health issues of the rich, but to point out a drastic social inequity. And, as the media so tenaciously hammer home, albeit, for the wrong reasons, mental illness is a public health concern that needs to be addressed on all fronts. No one is immune to mental illness. Everyone can become a danger to themselves or others. Therefore, for the overall social benefit, all PWMI, regardless of socio-economic status should have equal access to equal care. By equal access to equal care, I mean to say that there is a divergence in the quality of care as well as access to care and that it is geometrically similar and proportional to the wealth gap. The rich are afforded swanky, private facilities in which to recover. Outpatient facilities for the poor are understaffed and overwhelmed. They offer limited services, often only ten-minute observation and medication management. In some cases, the poor are treated no better than livestock and are often remanded to prisons or prison-like facilities to meet their mental health needs. Inside “the system”, physical violence and rape are not uncommon. And, more often than not, there is little to no recourse for the victims. The disparity of mental health outcomes mirrors the treatment style in most cases. The rich are offered the option of recovery; while the poor are sentenced to management.

There are other pieces of a complete social justice solution. Megan-Jane Johnstone may have put it best, “Until the stigma of mental illness can be overturned, the rights of the mentally ill will continue to be marginalized, invalidated, violated, and ignored.”[3] She advocates, as do I, that education may be the largest piece of the solution. Education changes attitudes and a change in attitudes can change lives. Multi-issue diversity courses need to include the mentally ill as people suffering from systematic oppression alongside the issues of race, immigration, and socio-economic-political disparity. Media outlets need to become more sensitive and report more accurately the news. Not every shooter is “crazy”. Not every person with mental illness is dangerous. Doctors, clinicians, and social workers need to be taught to see PWMI as more than just their diagnosis. Medication, counseling, and comprehensive case management need to work hand in hand to treat the whole person and address all of the causes of mental illness, as it is often the result of multiple causes. Compassion should replace pity and understanding should replace fear.  Michael Walzer addresses how and where to begin this process in Interpretation and social criticism,

We have to start from where we are […] and step forward into the thicket of moral experience […] We do not have to discover the moral world because we have already lived there. We do not have to invent it because it has already been invented […]. Insofar as we can recognize moral progress, it has less to do with the discovery or invention of new principles than with the inclusion under the old principles of previously excluded men and women. And that it is more a matter of (workmanlike) [sic] social criticism and political struggle than of (paradigm shattering) philosophical speculation.[4]

[1] Vijayalakshmi, Poreddi1, et al. “Impact of Socio-Economic Status in Meeting the Needs of People with Mental Illness; Human Rights Perspective.” Community Mental Health Journal 50, no. 3 (April 2014): 245-250. Social Sciences Full Text (H.W. Wilson), EBSCOhost (accessed December 5, 2015).
[2] MCNAMARA, DAMIAN. “Hormonal Changes In Chronic Stress Can Rewire Brain. Neuroendocrine factors’ role in depression.” Clinical Endocrinology News, January 01, 2006, 1,3, ScienceDirect, EBSCOhost (accessed December 5, 2015).

[3] Johnstone, Megan-Jane. “Stigma, social justice and the rights of the mentally ill: Challenging the status quo.” Australian & New Zealand Journal Of Mental Health Nursing 10, no. 4 (December 2001): 200-209. Academic Search Premier, EBSCOhost (accessed December 5, 2015).

[4] Walzer, Michael. Interpretation and Social Criticism. Cambridge, Mass.: Harvard University Press, 1987. 20-27.

 

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Cosmopolitanism vs Communitarianism as Expressed in the Contemporary Immigration Debate

Hunter P. Drake

University of South Florida, Saint Petersburg

IDH 4000:601F15

Dr. Elisa Minoff

November 22, 2015

     The current presidential election cycle brings immigration policy to the forefront of the American political landscape. An important question to ask while examining the immigration policies espoused by any given candidate is, “What are the fundamental beliefs or principles behind the specific policy proposals as outlined by the candidate’s public statements?” There are many polarizing topics in the contemporary immigration debate, as can be seen in the presidential campaigns run by Republican frontrunner Donald J. Trump and Democratic frontrunner Hillary Clinton; examining their policies through either a moral cosmopolitanism or communitarian lens can be useful to explore their immigration policies.

To begin a discussion on such policies it would be good to describe cosmopolitanism and communitarianism. Seyla Benhabib is a contemporary advocate of cosmopolitan federalism. According to Stanford University scholars Pauline Kleingeld and Eric Brown, cosmopolitan federalists “… favor a federal system with a comprehensive global body of limited coercive power…”[1] She breaks down her beliefs on cosmopolitanism into several aspects. The first is that the world should be seen as a global community. “The world community, I want to suggest, should be viewed as a global civil society, in which peoples organized as states are major players, but by no means the only players.”[2]  Secondly, she draws from Kantian thought that peoples organized in such a way are bound by interdependence, “…’if the actions of one can affect the actions of another,’ then we have an obligation to regulate our actions under a common law of freedom which respects our equality as moral agents.”[3]  Furthering her point on interdependence she notes, “I want to argue for the interdependence of peoples in a world society. Interactions among human communities are perennial and not the exception in human history.”[4] On issues of immigration specifically, Benhabib states,

I argue that a cosmopolitan theory of justice cannot be restricted to schemes of just distribution on a global scale, but must also incorporate a vision of just membership. Such just membership entails: recognizing the moral claim of refugees and asylees to first admittance; a regime of porous borders for immigrants; an injunction against denationalization and the loss of citizenship rights; and the vindication of the right of every human being “to have rights,” that is, to be a legal person, entitled to certain inalienable rights, regardless of the status of their political membership. The status of alienage ought not to denude one of fundamental rights.[5]

In essence, to flesh out her cosmopolitan ideals on immigration, she breaks apart the idea of national citizenship through a methodology she calls “the disaggregation of citizenship.”[6] This concept enables her to transform some of the pieces of “citizenship” into separate, more universal rights and offer them to non-citizens. “We are facing today the ‘disaggregation of citizenship.’ These are institutional developments that unbundle the three constitutive dimensions of citizenship, namely, collective identity, the privileges of political membership, and the entitlements of social rights and benefits.”[7] Benhabib’s cosmopolitan perspective on state borders can be drawn from her critique of Rawlsian theory as presented in A Theory of Justice and The Law of Peoples.

His (Rawls’) own understanding of the person should lead him to view societies as much more interactive, overlapping, and fluid entities, whose boundaries are permeable and porous, whose moral visions travel across borders, are assimilated into other contexts, are then re-exported back into the home country, and so on.[8]

States, peoples, and cultural influences evolve and change through migration. In cosmopolitan thought, borders are permeable to peoples, morals, and cultures via a moral imperative; an extension of Kant’s natural rights.

The communitarian view of what constitutes justice, inclusive of discussions of immigration and distributive justice, is that “… the standards of justice must be found in forms of life and traditions of particular societies and hence can vary from context to context.”[9] Benhabib refers to the communitarian theorists as “the decline of citizenship theorists” and identifies Michael Walzer as “one of the foremost thinkers in this vein.”[10] Daniel Bell, of Stanford University, also points to Walzer as a contemporary communitarian thinker, describing how Walzer’s voice is extending modern communitarian thought. “Michael Walzer developed the additional argument that effective social criticism must derive from and resonate with the habits and traditions of actual people living in specific times and places.”[11] In this, one can derive that, to communitarians, borders are a realistic and natural consequence of territorial boundaries and cultural differences. As defined by Walzer, there is at least one common belief between communitarian and cosmopolitan thinkers. On the topic of borders, Walzer states,

She (Benhabib) says she is in favor of porous but not open borders. If “porous” means “not open,” then it must be the case that, at some level of political organization, there is a right “to control and sometimes restrain the flow of immigrants.” But that is my position, which she quotes in order to illustrate the “civic republican” position she means to dispute.[12]

There are two resounding takeaway ideas in above quote. One is that communitarians do not like to be called “civic republicans.” Walzer describes an example of civic republicanism in his response to Benhabib.

The U.S. also offers a nice illustration of authentic civil republicanism: the Know Nothing party’s proposal in the 1840s that 21 years of residency be required for naturalization. This was supposed to allow for the proper political education of immigrants coming from feudal and monarchic countries. [13]

In fact, Walzer further comments,

I argue in Spheres of Justice that, in democratic nation-states, resident aliens, guest workers, and any other groups that fit into the old Athenian category of the metic should be put as quickly as possible on the road to full citizenship.[14]

The second takeaway idea is that communitarians believe that borders, both political and cultural are intertwined and that states have a right to self-determination. Communitarians also believe that states are not cookie cutter in nature. To demonstrate the variance of the nature of states and the interconnection of the cultural and political aspects of a state Walzer offers,

All the world is not America. In nation-states like Denmark, the cultural nation and the political nation are closely connected, and it seems to me that the first of these has a right to (try to) sustain the connection when and if it is actually threatened. It is that kind of limiting case that establishes the right of closure.[15]

A communitarian would argue that disaggregating the aspects of citizenship, as Benhabib proposes, is not the only way to satisfy the obligation to accommodate universal human rights, as in the case of refugees or asylees. Walzer illustrates and explores the communitarian limits of a collective moral obligation through the parable of the Good Samaritan.

… Positive assistance is required if (1) it is needed or urgently needed by one of the parties; and (2) if the risks and costs of giving it are relatively low for the other party… Groups of people ought to help necessitous strangers whom they somehow discover in their midst or on their path. But the limit on risks and costs on these cases is sharply drawn. I need not take the injured stranger into my home, except briefly, and I certainly need not care for him or even associate with him for the rest of my life.[16]

A Walzerian communitarian could easily replace the “I” in the above quote with “Any nation.” For communitarians, it all seems to fall under the concept of self-determination. A succinct way of stating the communitarian view is that a nation has the right to defend its identity or personality to the extent that its culture and history implore it; this view is directly expressed in communitarian immigration policies. That is not to say that Walzerians disregard the obligation to help strangers if the risks are too high. They simply imagine that there are more ways to be of assistance to those in need than solely focusing on wholesale immigration; perhaps the moral obligation could be satisfied through foreign aid. With those general understandings of cosmopolitanism and communitarianism in hand, one can begin to examine the contemporary immigration debate.

Looking at the contemporary immigration debate in the current presidential election campaigns, you can see that neither of the frontrunner candidates is completely on the side of cosmopolitanism or communitarianism. In fact, Hillary Clinton’s immigration policy statements are a mixed bag of cosmopolitan and communitarian ideas. Donald J. Trump’s policy dictates are decidedly a lot of civic republican ideas with occasional communitarian reasoning. Hillary Clinton’s website lists five primary components of her immigration policy:

  • Fight for comprehensive immigration reform legislation with a path to full and equal citizenship
  • Defend President Obama’s DACA and DAPA executive actions
  • Do everything possible under the law to go further to protect families
  • Conduct humane, targeted immigration enforcement
  • Expand access to affordable health care to all families [17]

The first item, regarding a clear path to citizenship, is clearly espoused by both moral cosmopolitans and communitarians as evidenced by the previous discussion. The second item declares her intent to defend President Obama’s DREAM Act and its’ extension acts that defer deportation action and extend non-U.S. citizens residing in the U.S. temporary legal status.[18] Clearly, this has cosmopolitan leanings and is an excellent example of what Benhabib refers to as the “disaggregation of citizenship.”[19] The next item on her list leans a little closer to communitarianism; it relates to working from inside the law of a state to implement an accessible path to citizenship for DREAMers and their parents should Congress fail to pass comprehensive immigration reform. The fourth policy goal might find agreement from both Benhabib and Walzer, as it allows a state a reasonable amount of self-defense against elements that might cause the state harm. The fifth policy measure of looking to grant affordable healthcare to immigrants is fundamentally humanitarian, but agreed upon by both cosmopolitan and communitarian thinkers. The website of the Republican opposition frontrunner, Donald J. Trump has a three point plan for immigration reform that is decidedly closest in concept to the communitarian view. His plan for immigration reform is outlined as follows:

  • A nation without borders is not a nation. There must be a wall across the southern border
  • A nation without laws is not a nation. Laws passed in accordance with our Constitutional system of government must be enforced.
  • A nation that does not serve its own citizens is not a nation. Any immigration plan must improve jobs, wages and security for all Americans.[20]

Communitarian leanings, and even further, civil republican design, can be the only comparable model for such an immigration policy. Sovereign rights reign supreme in Mr. Trump’s ideal immigration package. His policies severely enforce the deportation laws and attempt to undo any provision for the DREAMers. In communitarian fashion, the policies regarding borders are clothed in a language of protecting American citizens from forces that wish to do the state harm. He cites factors from immigration’s effects on the economy to the possible immigration of terrorists as requiring such strict and harsh immigration policies.

It is unclear from an American perspective whether the world is ready to become more open or more closed concerning immigration. Biased and partisan pundits make strong cases for both sides of the debate. Certainly, there are more schools of thought regarding justice and immigration than cosmopolitanism and communitarianism and neither school of thought claims to have a foolproof solution. However, it is certainly beneficial to use those two schools of thought to analyze the contemporary immigration debate, as it provides at least some compass as to where America stands on immigration. On Election Day, America will prove the veracity of such a compass.

[1] Kleingeld, Pauline and Brown, Eric. “Cosmopolitanism”. The Stanford Encyclopedia of Philosophy (Fall 2014 Edition).  Edward N. Zalta (Ed.). http://plato.stanford.edu/archives/fall2014/entries/cosmopolitamism/

[2] Benhabib, Seyla. The Rights of Others: Aliens, Residents and Citizens. Cambridge: Cambridge University Press, 2004.104.

[3] Ibid.

[4] Benhabib, Seyla. The Rights of Others: Aliens, Residents and Citizens. Cambridge: Cambridge University Press, 2004. 73.

[5] Benhabib, Seyla. The Rights of Others: Aliens, Residents and Citizens. Cambridge: Cambridge University Press, 2004. 3.

[6] Benhabib, Seyla, and Eugene Meyer. 2006. Another Cosmopolitanism. Oxford,New York:Oxford University Press. p 45.

[7] Ibid.

[8] Benhabib, Seyla. The Rights of Others: Aliens, Residents and Citizens. Cambridge: Cambridge University Press, 2004. 87.

[9] Bell, Daniel. “Communitarianism”. The Stanford Encyclopedia of Philosophy (Fall 2013 Edition). Edward N. Zalta (ed.). http://plato.stanford.edu/archives/fall2013/entries/communitarianism/

[10] Benhabib, Seyla. The Rights of Others: Aliens, Residents and Citizens. Cambridge: Cambridge University Press, 2004. 73.

[11] Bell, Daniel. “Communitarianism”. The Stanford Encyclopedia of Philosophy (Fall 2013 Edition). Edward N. Zalta (ed.). http://plato.stanford.edu/archives/fall2013/entries/communitarianism/

[12] Walzer, Michael. “In Response: Support for Modesty and the Nation State.” The Responsive Community, Spring 2001. Vol 11. Issue 2. http://www.gwu.edu/~ccps/rcq/rcq_inresponse_walzer.html

[13] Ibid.

[14] Ibid.

[15] Ibid.

[16] Walzer, Michael. “Membership.” In Spheres of Justice: A Defense of Pluralism and Equality, New York: Basic Books, 1983. 33.

[17] “Hillary for America Starts Right Here | Hillary for America.” Hillary for America Starts Right Here | Hillary for America. 2015. Accessed November 17, 2015. http://hillaryclinton.com/issues/immigration-reform/.

[18] “DAPA & Expanded DACA.” National Immigration Law Center. March 2, 2015. Accessed November 16, 2015. http://www.nilc.org/dapa&daca.html

[19] Benhabib, Seyla, and Eugene Meyer. 2006. Another Cosmopolitanism. Oxford,New York:Oxford University Press.  45.

[20] “Immigration Reform.” Immigration Reform. 2015. Accessed November 16. 2015. http://donaldjtrump.com/positions/immigration-reform/

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