Mentalism or sanism is a form of discrimination
and oppression against a mental trait or condition
a person has, or is judged to have.
This discrimination may or may not be described
in terms of mental disorder or cognitive impairment.
The discrimination is based on numerous factors
such as: stereotypes about neurodivergence
(e.g. autism spectrum, learning disorders,
ADHD, bipolar, schizophrenia, personality
disorder diagnoses), specific behavioral phenomena
(e.g. stuttering, tics), or intellectual disability.
Like other "isms" such as sexism and racism,
mentalism involves multiple intersecting forms
of oppression, complex social inequalities
and imbalances of power.
It can result in covert discrimination by
multiple, small insults and indignities.
It is characterized by judgments of another
person's perceived mental health status.
These judgments are followed by actions such
as blatant, overt discrimination which may
include refusal of service, or the denial
of human rights.
Mentalism impacts how individuals are treated
by the general public, by mental health professionals,
and by institutions, including the legal system.
The negative attitudes involved may also be
internalized.
The terms mentalism (from mental) and sanism
(from sane) have some widespread use, though
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 and 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.
== Origin of terms ==
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 Chamberlain 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 (ex)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/survivors
in the UK and the USA, 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 (perceived
as) disabled.
In terms of the brain, there is the movement
for the recognition of neurodiversity.
The term psychophobia (from psyche and phobia)
has occasionally been used with a similar
meaning.
== Social division ==
According to Coni Kalinowski (a psychiatrist
at the University of Nevada and Director of
Mojave Community Services) and Pat Risser
(a mental health consultant and self-described
former recipient of mental health services),
mentalism 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.The discrimination can
be so fundamental and unquestioned that it
can stop people truly empathizing (although
they may think they are) 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, and one head of a schizophrenia charity
has compared mentalism to the way racism may
be more prevalent when people don't spend
time together throughout life.
A psychologist who runs The Living Museum
facilitating current or former psychiatric
patients to exhibit artwork, has referred
to the attitude of the general public as psychophobia.
== Clinical terminology ==
Mentalism may be enshrined in clinical terminology
in subtle ways, including in the basic diagnostic
categories used by psychiatry (as in the DSM
or ICD).
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 – as
the way a person may justify the use of ethnic
slurs because they intend no harm.
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
(milieu), 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 "normality"
and the problems associated with "normal"
functioning around the world, although in
some ways that could also potentially constitute
a form of mentalism.
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 an arrogant
unjustified way because of an underlying mentalism,
according to critics.
If a recipient disagrees or does not change,
they may be labeled as "non-compliant", "uncooperative",
"treatment-resistant".
This is despite the fact that the issue may
be inadequate understanding of the person
or his/her problems, adverse medication effects,
a poor match between the treatment and the
person's lifestyle, stigma associated with
the treatment, difficulty with access, cultural
unacceptability, or many other issues.Mentalism
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.
== Neglect ==
Mentalism has been linked to negligence in
monitoring for adverse effects of medications
(or other interventions), or to viewing such
effects as more acceptable than they would
be for others.
This has been compared to instances of maltreatment
based on racism.
Mentalism has also been linked to neglect
in failing to check for, or fully respect,
people's past experiences of abuse or other
trauma.
Treatments that do not support choice and
self-determination may cause people to re-experience
the helplessness, pain, despair, and rage
that accompanied the trauma, and yet attempts
to cope with this may be labeled as "acting
out", "manipulating", or "attention-seeking".In
addition, mentalism can lead to "poor" or
"guarded" predictions of the future for a
person, which could be an overly pessimistic
view skewed by a narrow clinical experience.
It could also be made impervious to contrary
evidence because those who succeed can be
discounted as having been misdiagnosed or
as not having the "real" form of a disorder
— the No true Scotsman fallacy.
While some mental health problems can involve
very substantial disability and can be very
difficult to overcome in society, predictions
based on prejudice and stereotypes can be
self-fulfilling because individuals pick up
on a message that they have no real hope,
and realistic hope is said to be a key foundation
of recovery.
At the same time, a trait or condition might
be considered more a form of individual difference
that society needs to include and adapt to,
in which case a mentalist attitude might be
associated with assumptions and prejudices
about what constitutes 'normal' society and
who is deserving of adaptations, support,
or consideration.
== Institutional discrimination ==
Offensive and injurious practices may be integrated
into clinical procedures, to the point where
professionals no longer recognize them as
such, in what has been described as a form
of institutional discrimination.
This may be apparent in physical separation,
including separate facilities or accommodation,
or in lower standards for some than others.
Mental health professionals may find themselves
drawn into systems based on bureaucratic and
financial imperatives and social control,
resulting in alienation from their original
values, disappointment in "the system", and
adoption of the cynical, mentalist beliefs
that may pervade an organization.
However, just as employees can be dismissed
for disparaging sexual or ethnic remarks,
it is argued that staff who are entrenched
in negative stereotypes, attitudes, and beliefs
about those labeled with mental disorders
need to be removed from service organizations.
A related theoretical approach, known as expressed
emotion, has also focused on negative interpersonal
dynamics relating to care givers, especially
within families.
However, the point is also made in such views
that institutional and group environments
can be challenging from all sides, and that
clear boundaries and rights are required for
everyone.
The mental health professions have themselves
been criticised.
While social work (also known as clinical
social work) has appeared to have more potential
than others to understand and assist those
using services, and has talked a lot academically
about anti-oppressive practice intended to
support people facing various -isms, it has
allegedly failed to address mentalism to any
significant degree.
The field has been accused, by social work
professionals with experience of using services
themselves, of failing to help people identify
and address what is oppressing them; of unduly
deferring to psychiatric or biomedical conventions
particularly in regard to those deemed most
unwell; and of failing to address its own
discriminatory practices, including its conflicts
of interest in its official role aiding the
social control of patients through involuntary
commitment.In the "user/survivor" movement
in England, Pete Shaughnessy, a founder of
mad pride, concluded that the National Health
Service is "institutionally mentalist and
has a lot of soul searching to do in the new
Millennium", including addressing the prejudice
of its office staff.
He suggested that when prejudice is applied
by the very professionals who aspire to eradicate
it, it raises the question of whether it will
ever be eradicated.
Shaughnessy committed suicide in 2002.The
psychiatric survivors movement has been described
as a feminist issue, because the problems
it addresses are "important for all women
because mentalism acts as a threat to all
women" and "mentalism threatens women's families
and children."
A psychiatric survivor and professional has
said that "Mentalism parallels sexism and
racism in creating an oppressed underclass,
in this case of people who have received psychiatric
diagnosis and treatment".
She reported that the most frequent complaint
of psychiatric patients is that nobody listens,
or only selectively in the course of trying
to make a diagnosis.On a society-wide level,
mentalism has been linked to people being
kept in poverty as second class citizens;
to employment discrimination keeping people
living on handouts; to interpersonal discrimination
hindering relationships; to stereotypes promoted
through the media spreading fears of unpredictability
and dangerousness; and to people fearing to
disclose or talk about their experiences.
== The legal system ==
With regard to legal protections against discrimination,
mentalism may only be covered under general
frameworks such as the disability discrimination
acts that are in force in some countries,
and which require a person to say that they
have a disability and to prove that they meet
the criteria.
In terms of the legal system itself, the law
is traditionally based on technical definitions
of sanity and insanity, and so the term 'sanism'
may be used in response.
The concept is well known in the US legal
community, being referred to in nearly 300
law review articles between 1992 and 2013,
though is less well known in the medical community.Michael
Perlin, Professor of Law at New York Law School,
has defined sanism as "an irrational prejudice
of the same quality and character as other
irrational prejudices that cause and are reflected
in prevailing social attitudes of racism,
sexism, homophobia, and ethnic bigotry that
permeates all aspects of mental disability
law and affects all participants in the mental
disability law system: litigants, fact finders,
counsel, and expert and lay witnesses."Perlin
notes that sanism affects the theory and practice
of law in largely invisible and socially acceptable
ways, based mainly on "stereotype, myth, superstition,
and deindividualization."
He believes that its "corrosive effects have
warped involuntary civil commitment law, institutional
law, tort law, and all aspects of the criminal
process (pretrial, trial and sentencing)."
According to Perlin, judges are far from immune,
tending to reflect sanist thinking that has
deep roots within our culture.
This results in judicial decisions based on
stereotypes in all areas of civil and criminal
law, expressed in biased language and showing
contempt for mental health professionals.
Moreover, courts are often impatient and attribute
mental problems to "weak character or poor
resolve".Sanist attitudes are prevalent in
the teaching of law students, both overtly
and covertly, according to Perlin.
He notes that this impacts on the skills at
the heart of lawyering such as "interviewing,
investigating, counseling and negotiating",
and on every critical moment of clinical experience:
"the initial interview, case preparation,
case conferences, planning litigation (or
negotiation) strategy, trial preparation,
trial and appeal."There is also widespread
discrimination by jurors, who Perlin characterizes
as demonstrating "irrational brutality, prejudice,
hostility, and hatred" towards defendants
where there is an insanity defence.
Specific sanist myths include relying on popular
images of craziness; an 'obsession' with claims
that mental problems can be easily faked and
experts duped; assuming an absolute link between
mental illness and dangerousness; an 'incessant'
confusion and mixing up of different legal
tests of mental status; and assuming that
defendants acquitted on insanity defenses
are likely to be released quickly.
Although there are claims that neuroimaging
has some potential to help in this area, Perlin
concludes that it is very difficult to weigh
the truth or relevance of such results due
to the many uncertainties and limitations,
and as it may be either disregarded or over-hyped
by scientists, lawyers or in the popular imagination.
He believes "the key to an answer here is
a consideration of sanism", because to a great
extent it can "overwhelm all other evidence
and all other issues in this conversation".
He suggests that "only therapeutic jurisprudence
has the potential power to 'strip the sanist
facade'."Perlin has suggested that the international
Convention on the Rights of Persons with Disabilities
is a revolutionary human rights document which
has the potential to be the best tool to challenge
sanist discrimination.He has also addressed
the topic of sanism as it affects which sexual
freedoms or protections are afforded to psychiatric
patients, especially in forensic facilities.Sanism
in the legal profession can affect many people
in communities who at some point in their
life struggle with some degree of mental health
problems, according to Perlin.
This may unjustly limit their ability to legally
resolve issues in their communities such as:
"contract problems, property problems, domestic
relations problems, and trusts and estates
problems."Susan Fraser, a lawyer in Canada
who specializes in advocating for vulnerable
people, argues that sanism is based on fear
of the unknown, reinforced by stereotypes
that dehumanize individuals.
She argues that this causes the legal system
to fail to properly defend patients' rights
to refuse potentially harmful medications;
to investigate deaths in psychiatric hospitals
and other institutions in an equal way to
others; and to fail to properly listen to
and respect the voices of mental health consumers
and survivors.
== In education ==
Similar issues have been identified by Perlin
in how children are dealt with in regard to
learning disabilities, including in special
education.
In any area of law, he points out, two of
the most common sanist myths are presuming
that persons with mental disabilities are
faking, or that such persons would not be
disabled if they only tried harder.
In this particular area, he concludes that
labeled children are stereotyped in a process
rife with racial, class and gender bias.
Although intended to help some children, he
contends that in reality it can be not merely
a double-edged sword but a triple, quadruple
or quintuple edged sword.
The end result of sanist prejudices and misconceptions,
in the context of academic competition, is
that "we are left with a system that is, in
many important ways, stunningly incoherent".
== Multiple discriminations ==
A spiral of oppression experienced by some
groups in society has been identified.
Firstly, oppressions occur on the basis of
perceived or actual differences (which may
be related to broad group stereotypes such
as racism, sexism, classism, ageism, homophobia
etc.).
This can have negative physical, social, economic
and psychological effects on individuals,
including emotional distress and what might
be considered mental health problems.
Then, society's response to such distress
may be to treat it within a system of medical
and social care rather than (also) understanding
and challenging the oppressions that gave
rise to it, thus reinforcing the problem with
further oppressive attitudes and practices,
which can lead to more distress, and so on
in a vicious cycle.
In addition, due to coming into contact with
mental health services, people may become
subject to the oppression of mentalism, since
society (and mental health services themselves)
have such negative attitudes towards people
with a psychiatric diagnosis, thus further
perpetuating oppression and discrimination.People
suffering such oppression within society may
be drawn to more radical political action,
but sanist structures and attitudes have also
been identified in activist communities.
This includes cliques and social hierarchies
that people with particular issues may find
very difficult to break into or be valued
by.
There may also be individual rejection of
people for strange behavior just because it's
not considered culturally cool, or alternatively
insensitivity to emotional states including
suicidality, or denial that someone has issues
if they appear "normal".
== See also ==
Rankism, umbrella term for all form of hierarchical
discrimination
Social Darwinism
Supremacism
Social construction of schizophrenia
== References ==
== Further reading ==
Large, Matthew; Ryan, Christopher (November
2012).
"Sanism, stigma and the belief in dangerousness".
Australian & New Zealand Journal of Psychiatry.
46 (11): 1099–1100.
doi:10.1177/0004867412440193.
Parry, John Weston (26 September 2013).
Mental Disability, Violence, and Future Dangerousness:
Myths Behind the Presumption of Guilt.
Rowman & Littlefield.
ISBN 978-1-4422-2405-6.
Risser, Pat (14 May 2008).
Overcoming the Language of Oppression: Promoting
Cultural Change with Words (PDF).
4th Annual Clinical Forum on Mental Health:
Turning Knowledge into Practice.
(North Dakota Department of Human Services).
Wienera, Diane; Ribeiro, Rebecca; Warner,
Kurt (22 July 2009).
"Mentalism, disability rights and modern eugenics
in a 'brave new world'".
Disability & Society.
24 (5): 599–610.
doi:10.1080/09687590903010974.
Wolframe, PhebeAnn M. (2013).
"The Madwoman in the Academy, or, Revealing
the Invisible Straightjacket: Theorizing and
Teaching Saneism and Sane Privilege".
Disability Studies Quarterly.
33 (1).
== External links ==
John Weston Parry's Mental Disability Law
Reflections Blog.
Parry was Director of the American Bar Association’s
Commission on Mental and Physical Disability
Law, 1982–2012.
