I originally contacted David Oaks, Director of Mind Freedom International (MFI), to learn about the rationale for his organization’s adoption of the term ‘mad’ - as used, for example, in their Mad Pride campaign, an annual celebration of the struggles and triumphs of people who live with “mental illness” or who have come up against the mental health industry.
Because I’d mentioned a concern about accepting any sort of labelling, Oaks sent me a link to his essay “Let’s find language more inclusive than the phrase ‘mentally ill’.” His intention in sending the link was to dissuade the view that he or MFI supports labelling.
This is a response to that essay.
Oaks begins by suggesting some “replacements” for the term mentally ill. I’ve rearranged the order of his suggestions for ease of response.
- Mental health consumer
- Mental health client
- Person labelled with a psychiatric disability
- Person diagnosed with a psychiatric disorder
- Psychiatric survivor
- Person with a mental health history
- Person with mental health issues
- Consumer/Survivor/eX-inmate (CSX)
- Person who has experienced the mental health system
- Psychiatrized
- Neurodiverse
- Person experiencing severe and overwhelming mental and emotional problems, such as despair
- Person our society considers to have very different and unusual behavior, such as not sleeping
Oaks cautions that his suggestions are “not about perfection or correction.”
Regarding perfection, I assume this means we shouldn’t suppose there aren’t better substitutions out there. “Correction” I don’t quite know how to take. Perhaps that we should not view Oaks as saying his terms are better than terms we may be using (with reference to) ourselves or that, if we are using other terminology, it’s ipso facto wrong and should be replaced by one of his suggestions. In other words, Oaks is suggesting what might be used, not what should be used. Fair enough.
A clue to the composition of Oaks’ list is this, written early in his essay:
How can we try to be more inclusive with our language in the mental health field? How can we show those who have been marginalized by psychiatric labels that we are listening and welcoming?
Contrast it with this:
The term ‘mentally ill’ is very much a medical model... When people use the phrase ‘mentally ill’ ..., the implication is that since an illness is the problem then a doctor ought to be part of the solution. ‘Mental illness’ also says since the problem is like a materialistic physical illness, then perhaps the solution ought to be physical too, such as a chemical or drug or electricity. [my emphasis in both quotes]
In the first instance Oaks looks to be writing from the perspective of someone in, or representing, the mental health industry. In the second instance he correctly weds ‘mentally ill’ with the medical model.
Both mental health and mental illness are terms used by the psychiatric industry either to refer to itself - as in mental health professionals - or to its area of purported expertise: illness or “disorders” which are distinctly mental. Granted, psychiatrists loathe the use of the term mental illness (though they’re not so loathe to use mental health). However, they do use “disorder,” and the adjectives preceding disorder are always in the mental or behavioural sphere: e.g, manic-depressive disorder, obsessive-compulsive disorder and anxiety disorder.
For mental health to be meaningful, there must be mental sickness.
Consider the reporting of the state of one’s (physical) health. Surveys commonly ask respondents to rate their health from excellent to poor. A report of less than optimum health means we have one or more diseases, disorders, disabilities, or deteriorations of one or more parts of the body.
Now consider reports on the peculiar state of the body which is, according to the mental health industry, uniquely mental. A person would be, according to the medical model of mental health, either mentally healthy or mentally diseased, disordered, disabled, ill or sick. In other words, any report of less than optimum mental health means we have one or more disorders of ... what?
The body? The physical organ which is the brain?
If yes to either of these questions, then the illness isn’t mental, it’s physical - which brings us back to health, unqualified, and thus a collapsing of any purported distinction. If the answer is no, then these “disorders” have no association with the field of health.
Returning to Oaks, he says his intention is not to oppose any “particular model.” Rather, his opposition is to the medical model being the dominant one “in this complex field” and he pleas for the “bullying in mental health care” to stop.
Oaks clearly accepts the legitimacy of the mental health industry itself. What he doesn’t accept is certain of its practices,
such as the use of words and phrases like ‘patient’ and ‘chemical imbalance’ and ‘biologically-based’ and ‘symptom’ and ‘brain disease’ and ‘relapse’ and all the rest of the medical terminology when we are speaking about those of us who have been labelled with a psychiatric disability. [my emphasis]
Oaks accepts the phrase ‘psychiatric disability’, but not other medical terms.
Or is it that he does not take ‘psychiatric disability’ to be a medical term because of the adjective?
If so, then Oaks would be hard-pressed to find a psychiatrist who would agree with him. For one thing, psychiatrists go to medical school; they have to in order to prescribe drugs, order electroshock or administer other purported therapies directly done on or ingested by the body.
Accepting Labels Legitimizes Mental Health Industry
While Oaks questions some of the mental health industry's terminology and practices, I question the legitimacy of the mental health industry itself. This is why I take exception to the acceptance of labels. And returns me to the list of Oaks’ alternative suggestions for 'mentally ill’.
- Mental health consumer
- Mental health client
- Person labelled with a psychiatric disability
- Person diagnosed with a psychiatric disorder
- Psychiatric survivor
- Person with a mental health history
- Person with mental health issues
- Consumer/Survivor/eX-inmate (CSX)
- Person who has experienced the mental health system
- Psychiatrized
- Neurodiverse
- Person experiencing severe and overwhelming mental and emotional problems, such as despair
- Person our society considers to have very different and unusual behavior, such as not sleeping
First, given Oaks’ own rejection of the medical model, I recommend that he jettison all alternatives which include disability, disorder, mental, neurodiverse or psychiatric, with the possible exception of psychiatric survivor, which simultaneously speaks to a person’s strength in having endured the system and doesn’t let that system off the hook.
Of the choices in ‘h’, only survivor packs empowerment with it. Both consumer and ex-inmate focus on the individual as patient/passive rather than actor/active, and there’s no recognition of the mental health industry’s role.
Of the remaining options - j, k, l and m -, all but the first apply an adjective or adjectival phrase to a person, hence labels that person. The last option gives too much weight to societal norms, which are almost always shaped by elites. Among the latter, not coincidentally, are forensic psychiatrists who influence criminal cases and participate in establishing legal precedence.
Psychiatrized. While this is a label, it's of a peculiar sort. Psychiatrized is not a noun or adjective, but a verb in the past tense. It indicates something having been done to a person by another. And it has the flexibility of being understood in either a positive or negative light. For example, someone like me might adopt psychiatrized to cast aspersions on the psychiatric industry, while someone else might use it to indicate their belief in having been helped by that industry.
Points of Agreement
There are issues on which I agree with Oaks, including this:
To admit one has been officially labeled psychotic is perhaps one of the deepest closets to come out of, because the discrimination against those with that label is so immense. I prefer to talk about discrimination rather than stigma, because discrimination is something we can actually challenge and change... The word stigma comes from branded and implies that my identity as a psychiatrically-labeled person is inherently negative.
In my view, whatever stigma may be worn it should be by those who affix the labels, the so-called mental health professionals.
The adoption of ‘mad’
Returning to the reason I contacted Oaks, to learn why or under what context MFI was using ‘mad’, Oaks explained it to me in this way:
Now and again, some of us, myself included, like to have some fun and be outrageous, such as at MAD PRIDE events, where it is okay to be creative and reclaim language that has been used against us.
Certainly no person needs permission to apply self-descriptors, but that wasn’t my question.
In giving Mad Pride events as an example, Oaks makes my point for me. A whole movement or campaign, of which Oaks is a not an insignificant part, has chosen to adopt the term.
But why mad and not something else? I ask, because in adopting that term, the movement implicitly requires that any psychiatrized survivors who would like to participate in a Mad Pride event accept the adjective too.
In a later follow-up to my inquiry, Oaks told me that the Toronto Mad Pride organizers were using MAD as an acronym, to represent “Marginalized And Disempowered.”
Off the top of my head, I offer an alternative: eMpowered Affirmed Determined.
Without a doubt, there are better acronyms to give a positive meaning to MAD (or eMAD in the above case). The point is not to focus on the negative, which in the end puts the power to define us and our place in society into the hands of societal elites and potential oppressors.
Instead, focus on our strengths and on the message that, in coming together - and alone, as individual survivors - we take back our power, we affirm who we are, and we celebrate our difference and determination to fight against the mental health industry.
Of related interest: Growing Up in a Labelled World, Meanings - Belonging, Home, Community, and Mental Health and Religion: A comparison. For additional posts which touch on mental health/illness or the effects of the mental health industry on people's lives, search here.
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