Sanism
Sanism, saneism, mentalism, or psychophobia refer to the discrimination against and oppression of people based on actual or perceived mental disorder or cognitive impairment. This discrimination and oppression are based on factors such as stereotypes about neurodiversity. Sanism impacts individuals who have learning disorders, attention deficit hyperactivity disorder, fetal alcohol spectrum disorder, bipolar disorder, schizophrenia, personality disorders, tics, or intellectual disability, are autistic, or experience other cognitive impairments.
Sanism may cause harm through a combination of social inequalities, insults, indignities, and overt discrimination. Examples include refusal of service and the denial of human rights.
Sanism does not only describe how individuals are treated by the general public. The concept also encapsulates how individuals are treated by mental health professionals, the legal system and other institutions.
The term "sanism" was coined by Morton Birnbaum, a physician, lawyer, and mental health advocate. Judi Chamberlin coined the term "mentalism" in a chapter of the book Women Look at Psychiatry.
Definition
The terms "mentalism", from "mental", and "sanism", from "sane", have become established in some contexts, although concepts, such as social stigma, and, in some cases, ableism may be used in similar but not identical ways. While "mentalism" and "sanism" are used interchangeably, "sanism" is becoming predominant in certain circles, such as academics. Those who identify as mad, mad advocates, and in a socio-political context where sanism is gaining ground as a movement. The movement of sanism is an act of resistance among those who identify as mad, consumer survivors, and mental health advocates. In academia evidence of this movement can be found in the number of recent publications about sanism and social work practice.Etymologies
The term "sanism" was coined by Morton Birnbaum during his work representing Edward Stephens, a mental health patient, in a legal case in the 1960s. Birnbaum was a physician, lawyer and mental health advocate who helped establish a constitutional right to treatment for psychiatric patients along with safeguards against involuntary commitment. Since first noticing the term in 1980, New York legal professor Michael L. Perlin subsequently continued its use.In 1975 Judi Chamberlin coined the term "mentalism" in a book chapter of Women Look at Psychiatry. The term became more widely known when she used it in 1978 in her book On Our Own: Patient Controlled Alternatives to the Mental Health System, which for some time became the standard text of the psychiatric survivor movement in the US. People began to recognize a pattern in how they were treated, a set of assumptions which most people seemed to hold about mental patients regardless of whether they applied to any particular individual at any particular time – that they were incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational, etc. It was realized that not only did the general public express mentalist ideas, so did ex-patients, a form of internalized oppression.
As of 1998 these terms have been adopted by some consumers and survivors in the UK and the US, but had not gained general currency. This left a conceptual gap filled in part by the concept of 'stigma', but this has been criticized for focusing less on institutionalized discrimination with multiple causes, but on whether people perceive mental health issues as shameful or worse than they are. Despite its use, a body of literature demonstrated widespread discrimination across many spheres of life, including employment, parental rights, housing, immigration, insurance, health care and access to justice. However, the use of new "-isms" has also been questioned on the grounds that they can be perceived as divisive, out of date, or a form of undue political correctness. The same criticisms, in this view, may not apply so much to broader and more accepted terms like 'discrimination' or 'social exclusion'.
There is also the umbrella term ableism, referring to discrimination against those who are disabled. In terms of the brain, there is the movement for the recognition of neurodiversity. The term 'psychophobia' has occasionally been used with a similar meaning.
Social division
Sanism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent. This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express gratitude. Further discrimination may involve labeling some as "high functioning" and some as "low-functioning"; while this may enable the targeting of resources, in both categories human behaviors are recast in pathological terms. According to Coni Kalinowski and Pat Risser.The discrimination can be so fundamental and unquestioned that it can stop people truly empathizing or genuinely seeing the other point of view with respect. Some mental conditions can impair awareness and understanding in certain ways at certain times, but mentalist assumptions may lead others to erroneously believe that they necessarily understand the person's situation and needs better than they do themselves.
Reportedly even within the disability rights movement internationally, "there is a lot of sanism", and "disability organisations don't always 'get' mental health and don't want to be seen as mentally defective." Conversely, those coming from the mental health side may not view such conditions as disabilities in the same way.
Some national government-funded charities view the issue as primarily a matter of stigmatizing attitudes within the general public, perhaps due to people not having enough contact with those diagnosed with mental illness. One head of a schizophrenia charity has compared sanism to the way racism may be more prevalent when people do not spend time together throughout life. A psychologist who runs The Living Museum, facilitating art exhibitions by current or former psychiatric patients, has referred to the attitude of the general public as psychophobia.
Clinical terminology
Sanism may be codified in clinical terminology in subtle ways, including in the basic diagnostic categories used by psychiatry. There is some ongoing debate as to which terms and criteria may communicate contempt or inferiority, rather than facilitate real understanding of people and their issues.Some oppose the entire process as labeling and some have responded to justifications for it – for example that it is necessary for clinical or administrative purposes. Others argue that most aspects could easily be expressed in a more accurate and less offensive manner.
Some clinical terms may be used far beyond the usual narrowly defined meanings, in a way that can obscure the regular human and social context of people's experiences. For example, having a bad time may be assumed to be decompensation; incarceration or solitary confinement may be described as treatment regardless of benefit to the person; regular activities like listening to music, engaging in exercise or sporting activities, or being in a particular physical or social environment, may be referred to as therapy; all sorts of responses and behaviors may be assumed to be symptoms; core adverse effects of drugs may be termed side effects.
The former director of a US-based psychiatric survivors organization focused on rights and freedoms, David Oaks, has advocated the taking back of words like "mad", "lunatic", "crazy" or "bonkers". While acknowledging that some choose not to use such words in any sense, he questions whether medical terms like "mentally ill", "psychotic" or "clinically depressed" really are more helpful or indicative of seriousness than possible alternatives. Oaks says that for decades he has been exploring the depths of sanism and has not yet found an end, and suggests it may be the most pernicious 'ism' because people tend to define themselves by their rationality and their core feelings. One possible response is to critique conceptions of normality and the problems associated with normative functioning around the world, although in some ways that could also potentially constitute a form of sanism. After his 2012 accident breaking his neck and subsequent retirement, Oaks refers to himself as "PsychoQuad" on his personal blog.
British writer Clare Allen argues that even reclaimed slang terms such as "mad" are just not accurate. In addition, she sees the commonplace mis-use of concepts relating to mental health problems – including for example jokes about people hearing voices as if that automatically undermines their credibility – as equivalent to racist or sexist phrases that would be considered obviously discriminatory. She characterises such usage as indicating an underlying psychophobia and contempt.
Blame
Interpretations of behaviors, and applications of treatments, may be done in a judgmental way because of an underlying sanism, according to critics of psychiatry. If a recipient of mental health services disagrees with treatment or diagnosis, or does not change, they may be labeled as non-compliant, uncooperative, or treatment-resistant. This is despite the fact that the issue may be the healthcare provider's inadequate understanding of the person or their problems, adverse medication effects, a poor match between the treatment and the person, stigma associated with the treatment, difficulty with access, cultural unacceptability, or many other issues.Sanism may lead people to assume that someone is not aware of what they are doing and that there is no point trying to communicate with them, despite the fact that they may well have a level of awareness and desire to connect even if they are acting in a seemingly irrational or self-harming way. In addition, mental health professionals and others may tend to equate subduing a person with treatment; a quiet client who causes no community disturbance may be deemed improved no matter how miserable or incapacitated that person may feel as a result.
Clinicians may blame clients for not being sufficiently motivated to work on treatment goals or recovery, and as acting out when things are not agreed with or are found upsetting. But critics say that in the majority of cases this is actually due to the client having been treated in a disrespectful, judgmental, or dismissive manner. Nevertheless, such behavior may be justified by characterizing the client as demanding, angry or needing limits. To overcome this, it has been suggested that power-sharing should be cultivated and that when respectful communication breaks down, the first thing that needs to be asked is whether mentalist prejudices have been expressed.