31 May 2008

Growing up in a labelled world

I write this in response to the paper "Framing Disease," by Robert Aronowitz, and to the associated commentaries and rejoinder, which appear in the July 2008 issue of Social Science & Medicine. I would like to relate that SSM discussion to a personal account of how labelling and exposure to someone who sought labelling affected me from a very young age...

I was raised on psychobabble. My mother, rejecting one psychiatrist after another and likely still doing so, had gone through 14 of them when last I spoke with her, which was 15 years ago. I learned at my mother's knee what 'psychiatrist' meant, and the psychological jargon of the day, such as 'nervous breakdown' and 'emotionally disturbed'. In this respect I was set up to absorb doubts about my own emotional health, particularly given that life was hell at home.

Thing is, I knew better than anyone that my mother was not sick. She was egocentric, manipulative and cruel, i.e., her personality deviated negatively from the norm. For the burgeoning field of psychiatry, this made my mother an excellent candidate. For her, being labelled played into her egocentricity, which was why she sought out psychiatrists in the first place. My mother became addicted to psychiatry.

Thus made aware, by the age of five, that a harsh childhood could result in psychological damage, I swore to myself on a particular day that my mother would not destroy me, that I would protect myself, my yet-to-be-formed identity, against damage.

I've always called this my "promise day." On that day, as my mother stood before me screaming down abuse, I looked up at her and said to myself: "You won't kill me, you won't kill me, you won't kill me."

The repetition was to pound the resolve into me, to make it stick. I understood "me" to be my identity, not my body. The "won't" represented my determination that my mother would not succeed in transforming me into her own ideal. I understood I was in a triple danger, hence the repetition of three: of being imminently threatened, of my future identity being threatened, and of my future self being the subject of psychiatrists. To be the latter was to be like my mother, something to avoid at all costs. It was my mental health I was swearing to protect, although I didn't use or know that term. (I don't think in the 50s it was in fashion yet.)

For fifty years more, I resisted mental illness labelling. Then came the 18 months around the time I wrote my story, formed WISE (a former group and national movement of low-income women), and ran the project for and published the book Policies of Exclusion, Poverty & Health: Stories from the front. My mental illness buy-in is evident from the first lines of my story, the story of Chris in the book. I regret my lapse and acceptance of the label and have since rejected it. In other words, I've come back to my senses. The bare facts of the story stand on their own; the labelling does nothing but add salve to the mental health industry.

The pressure to accept mental illness labelling was enormous, not least because a good friend, my only friend at that time, was using it and applying it to me. With so much to deal with - an escalating slide into poverty and imminent homelessness - I was in too weakened a state to keep the promise to my 5-yr-old self. It didn't help that funding for the project was more likely if the lead researcher accepted the lingo, rather than not.

I do not blame my friend. The temptation to diagnose, and in the language of current 'wisdom', is hard to resist. She was right that I was distraught almost out of my mind. But the sickness wasn't in me. It was all around me. My distraught reactions were my healthy body's desperate attempts to warn me of a looming threat, of living in circumstances that risked my survival.


I suspect that the unquestioned adoption of mental illness labels has grown. My story is but a single example. But it seems to me that a whole generation has grown up with mental illness labels as part of everyday discourse. Now, if one simply accepts a label, all sorts of things can happen. People living on very low income have learned that exposing ourselves to the mental health industry and accepting a label can mean the difference between getting a housing subsidy or not, between getting employment assistance or not; listen to the story of Anna. For criminals, accepting a mental illness label can mean time spent in a psychiatric hospital rather than in jail. For overworked, stressed employees it can mean dispensation for time off.

More people are reported experiencing mental illness. I interpret this as either more people are getting labelled with mental disorders or more people are experiencing distress. Given the ascendancy of the mental health industry and the power dynamics of neo-liberalism, globalization and market capitalism, likely both are at play. But rather than look to causes (over-zealous labelling; manmade sociocultural, socioeconomic and physical environmental conditions threatening people's health), we focus on the individual.

It's the blame-the-victim approach. And the victims, rarely from other than the plebes, being immersed in this society and absorbing its messages, eventually accept the blame by adopting sickness labels and converting into feelings of shame the stigma imposed by the elite classes and adopted by society's wannabes.

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