Category Archives: Social Justice
Posted by hunterpauldrake
Social Justice for the Mentally Ill
Hunter P. Drake
University of South Florida, Saint Petersburg
Dr. Elisa Minoff
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. Likewise, the extreme stress created by external stigma can also lead to further mental illness.
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.” 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.
 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).
 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).
 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).
 Walzer, Michael. Interpretation and Social Criticism. Cambridge, Mass.: Harvard University Press, 1987. 20-27.