About Unconscious Ableism Around Mental Health November 12, 2024 3:57 PM Subscribe
We have had previous Metas around ableism and conflicting needs here on the grey. And we've gotten better on how we discuss mental health. But as someone living with a mental health condition, it appears that many discussions that implicate mental health on Metafilter are still touched with a lot of stigma: I would like us to do better still.
I think that we are getting better at understanding neurodivergence when it comes to things like autism, or ADHD - ways that people process the world differently. We are getting better at how we understand depression as a condition rather than a choice, for example. But discussions of some of the more stigmatized mental health conditions - levels of anxiety high enough to prohibit work, nonconsensus realities, paranoia, borderline personality, severe post traumatic stress - still wind up often displaying a lot of the stigma expressed in the broader world, as well as some common myths and misunderstandings.
Some misunderstandings I have seen here on Metafilter -
- that people who have these conditions can't function without medication
- that people who have these conditions are inherently destructive or 'dangerous' to 'normal' people
- that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
- that people with these conditions shouldn't have access to support or resources until they are 'cured'
- that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods
- that family members should separate themselves from people with these conditions for their own safety
While seeing some recent comments has spurred me to make this MeTa, I am specifically not linking to any individual comments because I don't want to make this about individuals, but rather broadly about how we discuss these issues overall. I know that seeing these types of comments hurts me, and makes me feel as though the people in the discussion do not see me or the people I live in community with on a daily basis - both medicated and unmedicated- who have caused me, overall, far less harm than people part of the dominant and normative majority living without such conditions. I would like to ask us to try to consider this and reframe our thinking.
I think that we are getting better at understanding neurodivergence when it comes to things like autism, or ADHD - ways that people process the world differently. We are getting better at how we understand depression as a condition rather than a choice, for example. But discussions of some of the more stigmatized mental health conditions - levels of anxiety high enough to prohibit work, nonconsensus realities, paranoia, borderline personality, severe post traumatic stress - still wind up often displaying a lot of the stigma expressed in the broader world, as well as some common myths and misunderstandings.
Some misunderstandings I have seen here on Metafilter -
- that people who have these conditions can't function without medication
- that people who have these conditions are inherently destructive or 'dangerous' to 'normal' people
- that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
- that people with these conditions shouldn't have access to support or resources until they are 'cured'
- that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods
- that family members should separate themselves from people with these conditions for their own safety
While seeing some recent comments has spurred me to make this MeTa, I am specifically not linking to any individual comments because I don't want to make this about individuals, but rather broadly about how we discuss these issues overall. I know that seeing these types of comments hurts me, and makes me feel as though the people in the discussion do not see me or the people I live in community with on a daily basis - both medicated and unmedicated- who have caused me, overall, far less harm than people part of the dominant and normative majority living without such conditions. I would like to ask us to try to consider this and reframe our thinking.
Every time the mental state of the incumbent US president comes up I brace myself. Yes he is a horrible person, yes his actions have and inevitably will do untold harm to billions of people and the planet as a whole. But by connecting all of that shittiness to his mental health it both reflects harm onto people who live with those challenges and excuses his choices. It’s like when people make fun of his weight, grooming, or posture. These things have no correlation to morality. Political threads will continue to be incendiary I assume, so maybe the occasional reminder about that would be wise.
posted by Mizu at 6:34 AM on November 13 [10 favorites]
posted by Mizu at 6:34 AM on November 13 [10 favorites]
corb, thanks for starting this discussion.
posted by brainwane at 7:25 AM on November 13 [3 favorites]
posted by brainwane at 7:25 AM on November 13 [3 favorites]
Thank you for starting this thread. I'm already so exhausted seeing the mental-health ableism.
posted by maryellenreads at 8:42 AM on November 13 [1 favorite]
posted by maryellenreads at 8:42 AM on November 13 [1 favorite]
I thought about my comment last night and remembered that recentering discussion on caregivers is a constant pet peeve in mental health conversations. So I wanted to quickly come back and clarify what perspective I'm coming from: I am/have been the person with the mental health conditions, not the caregiver.
posted by capricorn at 9:46 AM on November 13 [5 favorites]
posted by capricorn at 9:46 AM on November 13 [5 favorites]
(is it dumb not to have noticed what you're talking about here in threads? i understand corb not wanting to call out specific examples...but is this stuff happening over in ask? on the blue?)
posted by mittens at 9:56 AM on November 13 [3 favorites]
posted by mittens at 9:56 AM on November 13 [3 favorites]
I need specifics to this post. I'm not sure if you are referring to generalizations about people with mental health conditions or specific statements about individual situation. Generalizations about any wide group of people are not great, and tend to lead to poor discussion quality. However, the "misunderstandings" you specify are not universally false - they are often true in specific situations [1]. Further, at least Ask MeFi tends to have those specific situations pop up more than common, given that folks in more or less reasonable situations rarely have a need to post to an internet site about their situation.
It's not useful to generalize folks with mental health conditions broadly. It's also not useful to ignore the effects of mental health on other perople.
[1] with the exception of the "personal weakness" statement and the possible exception of the "no access to support/resources" (stated as possible because I'm not sure what the context is for that).
posted by saeculorum at 10:04 AM on November 13 [2 favorites]
It's not useful to generalize folks with mental health conditions broadly. It's also not useful to ignore the effects of mental health on other perople.
[1] with the exception of the "personal weakness" statement and the possible exception of the "no access to support/resources" (stated as possible because I'm not sure what the context is for that).
posted by saeculorum at 10:04 AM on November 13 [2 favorites]
So from what I've seen, I've seen this happening both in Ask and on the blue, and in a number of ways. Yes, generalizations about wide groups of people, but also assumptions about individual people's mental health conditions and what are needed for them that aren't directed by the impacted individual and are largely unsympathetic to the affected individual.
So for one example, I see a big difference between a person with a mental health condition saying, "I personally can't function without my medication" and someone talking about another person with a mental health condition saying, "They need to be on medication." Medication is one way that some people find helpful, but is not universal, and there are many disability rights activists that find the effects of psychiatric medications worse than the benefits they receive, or don't think that they are necessary.
Some also view mental health conditions as situated “not as faulty brains, but in the context that we live in a world that is not healthy for us.” So for example, in such situations, there is a question of whether the focus should be on removing or mitigating the oppressive structures that cause additional harm, or whether the focus should be on the person with the mental health condition to adjust themselves for the oppressive structure. The assumption that it should always be the latter is, in my view, itself an ableist assumption.
So for example, if someone with a mental health condition feels that engaging in capitalist work is harmful to them, feeling that being 'functional' should require their participation in that work I would think would be problematic.
posted by corb at 5:10 PM on November 13 [4 favorites]
So for one example, I see a big difference between a person with a mental health condition saying, "I personally can't function without my medication" and someone talking about another person with a mental health condition saying, "They need to be on medication." Medication is one way that some people find helpful, but is not universal, and there are many disability rights activists that find the effects of psychiatric medications worse than the benefits they receive, or don't think that they are necessary.
Some also view mental health conditions as situated “not as faulty brains, but in the context that we live in a world that is not healthy for us.” So for example, in such situations, there is a question of whether the focus should be on removing or mitigating the oppressive structures that cause additional harm, or whether the focus should be on the person with the mental health condition to adjust themselves for the oppressive structure. The assumption that it should always be the latter is, in my view, itself an ableist assumption.
So for example, if someone with a mental health condition feels that engaging in capitalist work is harmful to them, feeling that being 'functional' should require their participation in that work I would think would be problematic.
posted by corb at 5:10 PM on November 13 [4 favorites]
Respectfully, I think the list above combines too many issues associated with mental health, neurodivergence, and ableism. I don't think the general question is bad, but AskMe (for instance) is one place where people can pay their $5 and ask about all sorts of simple and complicated shit that they may not have the vocabulary or experience to discuss in the way that you want them to discuss. I'm thinking particularly of the folks who treat it as place for answers to deeply complicated questions, offering multi-thousand-word writeups of situations that seem to me so complicated, there is no useful way to discuss them without dwelling deeply in topics you find inherently hurtful.
I don't want to see you, corb, or any other MeFite hurt by discussion here. I also don't think there's a way to wholly avoid that and have a functional discussion site. As people have said elsewhere on MetaTalk, I do think MetaFilter is in a hard spot right now. Whether it's "dying" or not depends on a lot of things, but I think there is a terrible echo chamber effect here that is exacerbated by concerns about microaggressions and "appropriate" language. If everyone sits around and jerks off about how enlightened and respectful and sensitive they are, that is not conversation, nor is it useful when people actually, yes, do need (or actually have said they want!) to hear contrary opinions.
For one example, "- that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods" seems like a really good test case to me. I don't know what the answer is there, but occasionally I read AskMes about this topic. Sometimes the people who post questions about this are at very difficult points, as reflected in their explicit statements. Were the mods here--wrongly, in my opinion--to lean into your take on this, they would potentially tamp down discussion about what a parent or guardian is supposed to do about children, wards, etc. with "serious mental health conditions" when they have run out of at-home treatment options. I don't think it would be OK for the official position here to be "you need to just shut up and handle this, and not talk about this topic because institutionalization or residential inpatient treatment is tyranny."
The crux of the point above is "need," in my mind. I think reasonable MeFites may vary in their opinions on such things, but as the law tends to be a blunt tool, so policy also is often a blunt tool. We have discussed here repeatedly gross failures of moderation, sometimes from mods of good will who were trying their best or operating on reduced schedules or whatever, and I think that pattern is likely to repeat. With all of the same consequences, from drama to buttonings. To the point of moderation, I feel obliged to mention (this is not an attack on any mod; we all know the staffing situation) that we have all seen threads, and not fast-moving ones, where shitty comments have been left to sit for hours or days, without removal. That's not a "reframing our thinking will solve this" issue, but a consistency, clarity, fidelity, and transparency of moderation and moderation philosophy issue.
I know that seeing these types of comments hurts me, and makes me feel as though the people in the discussion do not see me or the people I live in community with on a daily basis - both medicated and unmedicated- who have caused me, overall, far less harm than people part of the dominant and normative majority living without such conditions.
Do you think this is people genuinely not seeing you? Are you troubled by people who have thought through these issues and have different opinions than you? Or are people being casually rude, you think? I am trying to understand whether this is a matter of truly differing informed opinions, or a matter that would be solved by a shift in language.
To one of your points above:
So for example, in such situations, there is a question of whether the focus should be on removing or mitigating the oppressive structures that cause additional harm, or whether the focus should be on the person with the mental health condition to adjust themselves for the oppressive structure. The assumption that it should always be the latter is, in my view, itself an ableist assumption.
I disagree wholeheartedly. What you are describing is, in my view, the existence of reality. Most societies that exist today are oppressive structures, for all the good that they may provide. I think we should be able to discuss ideals here, to blue sky possibilities for a better world, but that should not prevent the discussion of reality or strategies for dealing with it. Your experience and voice should not be disrespected or silenced here; nor should the experience or voice of parents, guardians, or caregivers. There are many discussions, on the green and otherwise, by people (patients or their caregivers) who are facing a menu of bad options, who are in a terrible place, and yet frame their questions with a laundry list of caveats in order to try to avoid attacks from fellow MeFites who disagree with their opinion or even the existence of their post or question. I don't think that should happen.
posted by cupcakeninja at 5:15 AM on November 14 [20 favorites]
I don't want to see you, corb, or any other MeFite hurt by discussion here. I also don't think there's a way to wholly avoid that and have a functional discussion site. As people have said elsewhere on MetaTalk, I do think MetaFilter is in a hard spot right now. Whether it's "dying" or not depends on a lot of things, but I think there is a terrible echo chamber effect here that is exacerbated by concerns about microaggressions and "appropriate" language. If everyone sits around and jerks off about how enlightened and respectful and sensitive they are, that is not conversation, nor is it useful when people actually, yes, do need (or actually have said they want!) to hear contrary opinions.
For one example, "- that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods" seems like a really good test case to me. I don't know what the answer is there, but occasionally I read AskMes about this topic. Sometimes the people who post questions about this are at very difficult points, as reflected in their explicit statements. Were the mods here--wrongly, in my opinion--to lean into your take on this, they would potentially tamp down discussion about what a parent or guardian is supposed to do about children, wards, etc. with "serious mental health conditions" when they have run out of at-home treatment options. I don't think it would be OK for the official position here to be "you need to just shut up and handle this, and not talk about this topic because institutionalization or residential inpatient treatment is tyranny."
The crux of the point above is "need," in my mind. I think reasonable MeFites may vary in their opinions on such things, but as the law tends to be a blunt tool, so policy also is often a blunt tool. We have discussed here repeatedly gross failures of moderation, sometimes from mods of good will who were trying their best or operating on reduced schedules or whatever, and I think that pattern is likely to repeat. With all of the same consequences, from drama to buttonings. To the point of moderation, I feel obliged to mention (this is not an attack on any mod; we all know the staffing situation) that we have all seen threads, and not fast-moving ones, where shitty comments have been left to sit for hours or days, without removal. That's not a "reframing our thinking will solve this" issue, but a consistency, clarity, fidelity, and transparency of moderation and moderation philosophy issue.
I know that seeing these types of comments hurts me, and makes me feel as though the people in the discussion do not see me or the people I live in community with on a daily basis - both medicated and unmedicated- who have caused me, overall, far less harm than people part of the dominant and normative majority living without such conditions.
Do you think this is people genuinely not seeing you? Are you troubled by people who have thought through these issues and have different opinions than you? Or are people being casually rude, you think? I am trying to understand whether this is a matter of truly differing informed opinions, or a matter that would be solved by a shift in language.
To one of your points above:
So for example, in such situations, there is a question of whether the focus should be on removing or mitigating the oppressive structures that cause additional harm, or whether the focus should be on the person with the mental health condition to adjust themselves for the oppressive structure. The assumption that it should always be the latter is, in my view, itself an ableist assumption.
I disagree wholeheartedly. What you are describing is, in my view, the existence of reality. Most societies that exist today are oppressive structures, for all the good that they may provide. I think we should be able to discuss ideals here, to blue sky possibilities for a better world, but that should not prevent the discussion of reality or strategies for dealing with it. Your experience and voice should not be disrespected or silenced here; nor should the experience or voice of parents, guardians, or caregivers. There are many discussions, on the green and otherwise, by people (patients or their caregivers) who are facing a menu of bad options, who are in a terrible place, and yet frame their questions with a laundry list of caveats in order to try to avoid attacks from fellow MeFites who disagree with their opinion or even the existence of their post or question. I don't think that should happen.
posted by cupcakeninja at 5:15 AM on November 14 [20 favorites]
Thank you Corb. If I can add another example I've noticed (thankfully not as much lately, but I also generally stay out of the politics threads so...):
The idea that all the people with brain fog and other neurological issues caused by Long COVID are going to somehow cause society to fall apart. There's this assumption that if folks aren't thinking as quickly, or have problems remembering words, we're going to turn into this undifferentiated mass that's just ripe for manipulation.
I know we're a group that's self-selected for words being important to us, but oof. Folks are saying a lot about how much they use "intelligence" as a stand in for moral worth without even realizing it.
posted by Gygesringtone at 10:57 AM on November 14 [6 favorites]
The idea that all the people with brain fog and other neurological issues caused by Long COVID are going to somehow cause society to fall apart. There's this assumption that if folks aren't thinking as quickly, or have problems remembering words, we're going to turn into this undifferentiated mass that's just ripe for manipulation.
I know we're a group that's self-selected for words being important to us, but oof. Folks are saying a lot about how much they use "intelligence" as a stand in for moral worth without even realizing it.
posted by Gygesringtone at 10:57 AM on November 14 [6 favorites]
I think it is hard to discuss this without specifics. While I'm 100% in favor of reducing callous comments and attitudes, I don't think we should be limiting the range of opinions people offer here. Especially in the green, when people ask for advice, other members should be able to offer advice, ideally based in their professional or life experience. Some people may disagree. Some people may offer other advice. That's part of what's great about Metafilter.
posted by Winnie the Proust at 6:25 PM on November 14 [3 favorites]
posted by Winnie the Proust at 6:25 PM on November 14 [3 favorites]
While I'm 100% in favor of reducing callous comments and attitudes, I don't think we should be limiting the range of opinions people offer here.
O.k. but, the problem is that's either so broad as to be useless as a rule, or has specifically de-marked exceptions that need to be hashed out. In which case we'd need to discus the ways ablism is built into our culture and if that's something Metafilter should take a stand against, and we're back here.
Also, I get that having concrete examples helps make discussions less vague and can help it feel more actionable, but at the same time that kind of thing opens the door to a lot of "well, this wasn't EXPLICITLY defined as ablism by the Ecumenical Council, so I should be able to say it"ing. And like, at some point, if we're taking ablism seriously as a thing we don't allow, we need to listen if the people experiencing it are saying "no, this is a problem in this community" without demanding they recount specific incidents before we're willing to address it.
So I don't know, maybe if folks are on the fence about if this is a problem, they should be open to the idea that they wouldn't necessarily notice it if it was. That's just human nature, you don't necessarily notice the problems you aren't having.
posted by Gygesringtone at 7:05 PM on November 14 [2 favorites]
O.k. but, the problem is that's either so broad as to be useless as a rule, or has specifically de-marked exceptions that need to be hashed out. In which case we'd need to discus the ways ablism is built into our culture and if that's something Metafilter should take a stand against, and we're back here.
Also, I get that having concrete examples helps make discussions less vague and can help it feel more actionable, but at the same time that kind of thing opens the door to a lot of "well, this wasn't EXPLICITLY defined as ablism by the Ecumenical Council, so I should be able to say it"ing. And like, at some point, if we're taking ablism seriously as a thing we don't allow, we need to listen if the people experiencing it are saying "no, this is a problem in this community" without demanding they recount specific incidents before we're willing to address it.
So I don't know, maybe if folks are on the fence about if this is a problem, they should be open to the idea that they wouldn't necessarily notice it if it was. That's just human nature, you don't necessarily notice the problems you aren't having.
posted by Gygesringtone at 7:05 PM on November 14 [2 favorites]
Okay, since we don't have examples, let's look at Corb's misunderstandings:
> - that people who have these conditions can't function without medication
That is true for some people but not for other people. I don't know which conditions Corb is referring to, but I've never heard anyone on Metafilter say, "everyone with ADHD needs meds or they can't function," or "everyone who has depression needs meds". People often recommend medication as an option in response to questions, but I haven't heard blanket statements like that. Maybe I just filter them out, but I don't recall it.
> - that people who have these conditions are inherently destructive or 'dangerous' to 'normal' people
I have not seen this attitude expressed, except when talking about particular people who are manifesting a condition in a certain way.
> - that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
I haven't seen this attitude expressed on Metafilter in many years.
> - that people with these conditions shouldn't have access to support or resources until they are 'cured'
I don't recall seeing this attitude expressed on Metafilter. This is a very pro-support / pro-resources community.
> - that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods
There is a lot of serious mental illness in my family. As a child I witnessed my mother's suicide attempts. She described other suicide attempts to me in graphic detail, when I was a child. When she was having a psychotic break, she needed to be hospitalized. The only other choice was death. Is that an ableist thing to say?
I have visited multiple siblings in psychiatric hospitals. They are not happy places. They are horrible in many ways. But sometimes, for some people, they are necessary places. Maybe in a different world or a different society they wouldn't be. But in the world we live in now, sometimes some people need them. Is saying that anathema?
> - that family members should separate themselves from people with these conditions for their own safety.
I have not heard people on Metafilter say, "separate yourself from all family members who have condition x". I've heard lots of people say, "separate yourself from that family member who has condition x." I don't think it's bad for people on Metafilter to encourage others to set boundaries for their own health. I don't always agree, but often I do.
Maybe I'm misunderstanding what's being suggested here, or maybe I'm just not seeing the context. I'm sorry that Corb is seeing hurtful things on the site. But without some examples it's hard to understand exactly what's being suggested.
posted by Winnie the Proust at 7:48 PM on November 14 [8 favorites]
> - that people who have these conditions can't function without medication
That is true for some people but not for other people. I don't know which conditions Corb is referring to, but I've never heard anyone on Metafilter say, "everyone with ADHD needs meds or they can't function," or "everyone who has depression needs meds". People often recommend medication as an option in response to questions, but I haven't heard blanket statements like that. Maybe I just filter them out, but I don't recall it.
> - that people who have these conditions are inherently destructive or 'dangerous' to 'normal' people
I have not seen this attitude expressed, except when talking about particular people who are manifesting a condition in a certain way.
> - that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
I haven't seen this attitude expressed on Metafilter in many years.
> - that people with these conditions shouldn't have access to support or resources until they are 'cured'
I don't recall seeing this attitude expressed on Metafilter. This is a very pro-support / pro-resources community.
> - that people with serious mental health conditions need to be institutionalized or at the very least have long residential inpatient periods
There is a lot of serious mental illness in my family. As a child I witnessed my mother's suicide attempts. She described other suicide attempts to me in graphic detail, when I was a child. When she was having a psychotic break, she needed to be hospitalized. The only other choice was death. Is that an ableist thing to say?
I have visited multiple siblings in psychiatric hospitals. They are not happy places. They are horrible in many ways. But sometimes, for some people, they are necessary places. Maybe in a different world or a different society they wouldn't be. But in the world we live in now, sometimes some people need them. Is saying that anathema?
> - that family members should separate themselves from people with these conditions for their own safety.
I have not heard people on Metafilter say, "separate yourself from all family members who have condition x". I've heard lots of people say, "separate yourself from that family member who has condition x." I don't think it's bad for people on Metafilter to encourage others to set boundaries for their own health. I don't always agree, but often I do.
Maybe I'm misunderstanding what's being suggested here, or maybe I'm just not seeing the context. I'm sorry that Corb is seeing hurtful things on the site. But without some examples it's hard to understand exactly what's being suggested.
posted by Winnie the Proust at 7:48 PM on November 14 [8 favorites]
I'm not so sure we should dismiss this quite as quickly as some people might be above. I think I've probably been guilty of painting narcissism and sociopathy with a broad brush, while really just thinking about the more destructive examples of those conditions, and I'd bet doing so is pretty common here.
posted by nobody at 8:18 PM on November 14 [6 favorites]
posted by nobody at 8:18 PM on November 14 [6 favorites]
Borderline Personality Disorder, Bipolar Disorder, and Schizophrenia and other psychotic disorders tend to get pretty stigmatized here.
posted by lapis at 10:21 PM on November 14 [15 favorites]
posted by lapis at 10:21 PM on November 14 [15 favorites]
I don't know which conditions Corb is referring to, but I've never heard anyone on Metafilter say, "everyone with ADHD needs meds or they can't function," or "everyone who has depression needs meds".
I specifically said those conditions are ones that Mefites tend to be better about - I think perhaps because they are more 'normal-adjacent'. But as lapis notes, there are other conditions that many Mefites sort of casually tend to go in with assumptions of medication being necessary, or people being inherently destructive or dangerous, and often, I think that's because they do not have personal experience of someone who they love and sympathize with and still associate with having these conditions. Borderline personality disorder is a big one, schizophrenia as well, disassociative identity disorder. I appreciate nobody's thoughtfulness here, and I think that's often how it goes - people think of the most extreme or destructive example that is in their mind, and tend to universalize it broadly to the condition.
that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
I've seen this one expressed a lot in Ask, and I think it comes from a good place - people sympathize with the Asker, who is often a caretaker or has been unwittingly placed into a caretaker role. And so it is really common to say things like "if this person really cared about you, they would get treatment." But that's just not how things work necessarily. If someone has medical avoidance or trauma or even just a psychological inability to engage in certain ways, the Power Of Love (tm) isn't going to cure them - and to suggest that anyone failing to get treatment must not care about their impacted family is really, really inaccurate and harmful.
When she was having a psychotic break, she needed to be hospitalized. The only other choice was death. Is that an ableist thing to say?
I think it is well-meaning, but may rest on a number of ableist assumptions, unless you are reporting her own thoughts and beliefs. Let me explain where I'm coming from here, as someone who has benefited from brief in-patient treatment.
When I was suicidal and chose to enter a hospital, I didn't have a lot of community support, and a hospital was really the only place I could go to get 24/7 support. It was really helpful for me to have those three days where I literally couldn't kill myself. But, having experienced that, and having had more experience in later life, I now recognize that it wasn't anything about the hospital itself that uniquely helped me. What helped me was having three days off of work, of having an excuse not to answer my cellphone or email for three days, and of having someone who would talk to me when I was agitated. I have since seen friends and comrades interrupt people's suicidal ideation without hospitals and medication and taking away your pencils and clothing, by simply staying with the person, by welcoming them into their home and bringing friends to surround that person with community until the ideation was over. By providing peer counseling, rather than professional counseling. People with mental health conditions are often uniquely equipped to help other people with mental health conditions. As it stands, if I have dark thoughts, I am much more likely to be helped by calling up someone close to me who also has that condition, than I am to be helped by calling a crisis line with trained professionals.
And so assumptions that someone who is resistant to hospitalization may 'need' to be hospitalized often causes a lot of traumatic encounters - people forced into hospitalization often do not do well and it sometimes makes them worse, especially if they have triggers around helplessness and control. And it ignores the reality that often people can be helped by mutual aid and community. I think in some ways, this is a self-protective statement, because the person may not feel like they have the mental or other resources to provide a similarly supportive environment, and if they allowed themselves to think of it as an equivalent resource, might feel guilty for not providing it. But it's still a statement that causes structural and personal harm.
While I'm 100% in favor of reducing callous comments and attitudes, I don't think we should be limiting the range of opinions people offer here.
The thing is - and to be clear, I'm not suggesting mod intervention, but rather, people just kind of looking at themselves and their assumptions - by not thinking about this, we are limiting the range of opinions people offer here. And we're limiting the utility of places like Ask to people who have mental health conditions. I would in a million years never feel comfortable asking for help with certain very real issues I have with friends and loved ones who also have mental health conditions, because I feel that it would attract a lot of stigma and just make me feel hurt and angry. So it's worth noting that people are self-silencing, even if they're not being Told Not To Say Things.
posted by corb at 3:38 AM on November 15 [7 favorites]
I specifically said those conditions are ones that Mefites tend to be better about - I think perhaps because they are more 'normal-adjacent'. But as lapis notes, there are other conditions that many Mefites sort of casually tend to go in with assumptions of medication being necessary, or people being inherently destructive or dangerous, and often, I think that's because they do not have personal experience of someone who they love and sympathize with and still associate with having these conditions. Borderline personality disorder is a big one, schizophrenia as well, disassociative identity disorder. I appreciate nobody's thoughtfulness here, and I think that's often how it goes - people think of the most extreme or destructive example that is in their mind, and tend to universalize it broadly to the condition.
that people with these conditions are displaying personal weakness when they don't 'cure' themselves or act in ways considered appropriate to people without mental health conditions
I've seen this one expressed a lot in Ask, and I think it comes from a good place - people sympathize with the Asker, who is often a caretaker or has been unwittingly placed into a caretaker role. And so it is really common to say things like "if this person really cared about you, they would get treatment." But that's just not how things work necessarily. If someone has medical avoidance or trauma or even just a psychological inability to engage in certain ways, the Power Of Love (tm) isn't going to cure them - and to suggest that anyone failing to get treatment must not care about their impacted family is really, really inaccurate and harmful.
When she was having a psychotic break, she needed to be hospitalized. The only other choice was death. Is that an ableist thing to say?
I think it is well-meaning, but may rest on a number of ableist assumptions, unless you are reporting her own thoughts and beliefs. Let me explain where I'm coming from here, as someone who has benefited from brief in-patient treatment.
When I was suicidal and chose to enter a hospital, I didn't have a lot of community support, and a hospital was really the only place I could go to get 24/7 support. It was really helpful for me to have those three days where I literally couldn't kill myself. But, having experienced that, and having had more experience in later life, I now recognize that it wasn't anything about the hospital itself that uniquely helped me. What helped me was having three days off of work, of having an excuse not to answer my cellphone or email for three days, and of having someone who would talk to me when I was agitated. I have since seen friends and comrades interrupt people's suicidal ideation without hospitals and medication and taking away your pencils and clothing, by simply staying with the person, by welcoming them into their home and bringing friends to surround that person with community until the ideation was over. By providing peer counseling, rather than professional counseling. People with mental health conditions are often uniquely equipped to help other people with mental health conditions. As it stands, if I have dark thoughts, I am much more likely to be helped by calling up someone close to me who also has that condition, than I am to be helped by calling a crisis line with trained professionals.
And so assumptions that someone who is resistant to hospitalization may 'need' to be hospitalized often causes a lot of traumatic encounters - people forced into hospitalization often do not do well and it sometimes makes them worse, especially if they have triggers around helplessness and control. And it ignores the reality that often people can be helped by mutual aid and community. I think in some ways, this is a self-protective statement, because the person may not feel like they have the mental or other resources to provide a similarly supportive environment, and if they allowed themselves to think of it as an equivalent resource, might feel guilty for not providing it. But it's still a statement that causes structural and personal harm.
While I'm 100% in favor of reducing callous comments and attitudes, I don't think we should be limiting the range of opinions people offer here.
The thing is - and to be clear, I'm not suggesting mod intervention, but rather, people just kind of looking at themselves and their assumptions - by not thinking about this, we are limiting the range of opinions people offer here. And we're limiting the utility of places like Ask to people who have mental health conditions. I would in a million years never feel comfortable asking for help with certain very real issues I have with friends and loved ones who also have mental health conditions, because I feel that it would attract a lot of stigma and just make me feel hurt and angry. So it's worth noting that people are self-silencing, even if they're not being Told Not To Say Things.
posted by corb at 3:38 AM on November 15 [7 favorites]
As the author of the last meta on this, I agree there’s work to do. However I found the responses on my recent AskMe question - while some of them fell broadly into these categories - helpful ever though I’m sure some of them could be triggering.
I think both things can be true at once, that people can be trying to be mindful and responses can be hard to read for those of us who have disorders or neuroatypicalities that are sensationalized or badly understood. I think there’s room on all or both ends. I was careful to post my question at a time when I knew I could navigate my own responses, and could take the answers in the spirit in which they were generally intended. And they were really helpful overall, not because I’m rushing to try to commit my relative or insist on lithium (neither of which have any legal mechanism anyway) but because I have more language and resources for my next steps.
Also, and corb, I’m sure you’ve experienced this, there’s not full agreement on some of these things even within a specialized support community. The old in-patient vs. social model of disability was an extremely divisive topic in DID/MPD groups in the early 00s, and probably still is.
At the same time I think reminding people of the principles and thoughts in your post is helpful and I support it.
posted by warriorqueen at 5:10 AM on November 15 [5 favorites]
I think both things can be true at once, that people can be trying to be mindful and responses can be hard to read for those of us who have disorders or neuroatypicalities that are sensationalized or badly understood. I think there’s room on all or both ends. I was careful to post my question at a time when I knew I could navigate my own responses, and could take the answers in the spirit in which they were generally intended. And they were really helpful overall, not because I’m rushing to try to commit my relative or insist on lithium (neither of which have any legal mechanism anyway) but because I have more language and resources for my next steps.
Also, and corb, I’m sure you’ve experienced this, there’s not full agreement on some of these things even within a specialized support community. The old in-patient vs. social model of disability was an extremely divisive topic in DID/MPD groups in the early 00s, and probably still is.
At the same time I think reminding people of the principles and thoughts in your post is helpful and I support it.
posted by warriorqueen at 5:10 AM on November 15 [5 favorites]
Thanks lapis, corb, and warriorqueen for continuing the discussion.
Borderline personality disorder is a good example of a diagnosis that I've seen thrown around a lot here, often in conjunction with "get as far away as possible".
Corb, your discussion of when hospital stays and alternative options brings home to me that mental health conditions vary so greatly in severity. Having suicidal ideation that is helped by three days off from work is not the same category immersive paranoid delusions that include shocking (and shockingly creative) acts of self-harm. Not everything can be handled with a community model, and unfortunately many of our communities lack the integrity to help people.
My sister lives in a city far away from any family members, by her own insistence. There is no community to help her. She relies on government services, which thankfully have been sufficient to keep her alive and living with some level of independence. It would be great if there was a true community safety net that could help carry her along, but close communities like that are hard to find in this modern world. (And in my sister's case, she tends to isolate herself from even the most welcoming communities.)
I'm sure you already know the things I'm saying here. I appreciate the call to sensitivity. Just wanting to clarify that, for some of the things you mention as negative, there are times when it is the appropriate response.
posted by Winnie the Proust at 7:56 AM on November 15 [1 favorite]
Borderline personality disorder is a good example of a diagnosis that I've seen thrown around a lot here, often in conjunction with "get as far away as possible".
Corb, your discussion of when hospital stays and alternative options brings home to me that mental health conditions vary so greatly in severity. Having suicidal ideation that is helped by three days off from work is not the same category immersive paranoid delusions that include shocking (and shockingly creative) acts of self-harm. Not everything can be handled with a community model, and unfortunately many of our communities lack the integrity to help people.
My sister lives in a city far away from any family members, by her own insistence. There is no community to help her. She relies on government services, which thankfully have been sufficient to keep her alive and living with some level of independence. It would be great if there was a true community safety net that could help carry her along, but close communities like that are hard to find in this modern world. (And in my sister's case, she tends to isolate herself from even the most welcoming communities.)
I'm sure you already know the things I'm saying here. I appreciate the call to sensitivity. Just wanting to clarify that, for some of the things you mention as negative, there are times when it is the appropriate response.
posted by Winnie the Proust at 7:56 AM on November 15 [1 favorite]
I found it enlightening, as a therapist, to learn that outcomes for schizophrenia are better in "developing" countries, where worth is not as tied to productivity, where altered states of reality are often held up as religious/spiritual experiences, and where community and family support for people experiencing such states is considered normal. As Winnie the Proust points out, those conditions don't exist in many of the places MeFites are posting from, so I'm not trying to claim that we should pretend we live in an ideal world when we don't. But learning that when schizophrenia is not as stigmatized, then the delusions and hallucinations are often positive and do not create harm, helped me realize that schizophrenia is often considered scary because we, as a society, have chosen to make it scary, which then influences how people dealing with psychosis interpret their symptoms, which then influences the severity and quality of those symptoms.
Where I see that useful for Metafilter is in realizing that these disorders are not inherently dangerous, but have been made so by societal framing. As I said, I know we have to deal with the reality of what choices are available in a given situation, but I think we'd do better if we moved away from the idea of broken brains, basically.
posted by lapis at 9:13 AM on November 15 [6 favorites]
Where I see that useful for Metafilter is in realizing that these disorders are not inherently dangerous, but have been made so by societal framing. As I said, I know we have to deal with the reality of what choices are available in a given situation, but I think we'd do better if we moved away from the idea of broken brains, basically.
posted by lapis at 9:13 AM on November 15 [6 favorites]
I've often thought that my sister might have been much better off in a pre-industrial village setting, where she could have integrated into her community and contributed to the extent she was able, while her limitations were acknowledged and accommodated by her community. In the modern world that just wasn't an option and the stress of modernity led to all kinds of destructive spirals.
I realize I'm romanticizing pre-industrial life. Half of my siblings wouldn't have made it out of childhood. But there are some beneficial aspects, especially in community and finding niches for people, that we've lost.
posted by Winnie the Proust at 9:25 AM on November 15 [3 favorites]
I realize I'm romanticizing pre-industrial life. Half of my siblings wouldn't have made it out of childhood. But there are some beneficial aspects, especially in community and finding niches for people, that we've lost.
posted by Winnie the Proust at 9:25 AM on November 15 [3 favorites]
And the pharmaceutical industry has made an enormous effort to spread the message that medications are necessary and the "educated" way to "treat" these "disorders," so I get that people who hear that message over and over again tend to believe it. But it's important to remember that it's a marketing message, that things like the "serotonin deficiency theory" have been debunked and were only ever pharmaceutical marketing ploys to begin with, and that things like strong social networks, stable housing, and food security are also important in keeping people stable emotionally and psychologically.
posted by lapis at 10:37 AM on November 15 [4 favorites]
posted by lapis at 10:37 AM on November 15 [4 favorites]
(None of what I just wrote is meant to imply that medications don't help, or can't help, various people. Just that they're not the panacea that Pharma would like us to believe.)
posted by lapis at 10:38 AM on November 15 [2 favorites]
posted by lapis at 10:38 AM on November 15 [2 favorites]
it's important to remember that it's a marketing message
I think what astonishes me (to the point that I wrote a whole screed about it a couple hours ago and then deleted it b/c it really misses the point of the metatalk) is that psychiatrists are still in this mindset. Like, it is no surprise that just ordinary non-psychiatrist, non-mentally-ill people out there might think meds are a good one-size-fits-all approach, the way you might prescribe antibiotics for strep throat.
Decades ago, docs were prescribing based on whatever the latest, most expensive hotness was in psych meds, and they don't appear to have learned anything in all that time. They're still stuck in this "we'll give you the latest pill, and when that doesn't work (because omg these pills have a terrible success rate) we'll add a few more, and a few more." I've been shocked at how much some acquaintances are spending on their meds. And they're not well! They aren't being helped!
It has made me really useless for talking about this topic with strangers. I have become too hardline on this: No to meds, yes to institutionalization. Not that hospitals are great--after all, the same docs who misprescribe and overprescribe in the community, are doing the same thing at the hospital--but at least it's a break, at least it cuts you off for some brief time from the troubles in your world. It's not the same as ongoing support--but for a lot of us, ongoing support wasn't on offer in the first place. (Another reason it's not a helpful suggestion is because it is so freaking expensive to go to the hospital, so why put that burden on someone, if they can survive at all at home...but the structure, oh I know it's not for everyone but I loved the structure so much. It's like a hotel where people get paid for listening to you complain!)
Anyway, again, sorry for the screed, it doesn't really address the topic at all, but I get so mad about it after so many years of psychiatric failures.
posted by mittens at 10:56 AM on November 15 [2 favorites]
I think what astonishes me (to the point that I wrote a whole screed about it a couple hours ago and then deleted it b/c it really misses the point of the metatalk) is that psychiatrists are still in this mindset. Like, it is no surprise that just ordinary non-psychiatrist, non-mentally-ill people out there might think meds are a good one-size-fits-all approach, the way you might prescribe antibiotics for strep throat.
Decades ago, docs were prescribing based on whatever the latest, most expensive hotness was in psych meds, and they don't appear to have learned anything in all that time. They're still stuck in this "we'll give you the latest pill, and when that doesn't work (because omg these pills have a terrible success rate) we'll add a few more, and a few more." I've been shocked at how much some acquaintances are spending on their meds. And they're not well! They aren't being helped!
It has made me really useless for talking about this topic with strangers. I have become too hardline on this: No to meds, yes to institutionalization. Not that hospitals are great--after all, the same docs who misprescribe and overprescribe in the community, are doing the same thing at the hospital--but at least it's a break, at least it cuts you off for some brief time from the troubles in your world. It's not the same as ongoing support--but for a lot of us, ongoing support wasn't on offer in the first place. (Another reason it's not a helpful suggestion is because it is so freaking expensive to go to the hospital, so why put that burden on someone, if they can survive at all at home...but the structure, oh I know it's not for everyone but I loved the structure so much. It's like a hotel where people get paid for listening to you complain!)
Anyway, again, sorry for the screed, it doesn't really address the topic at all, but I get so mad about it after so many years of psychiatric failures.
posted by mittens at 10:56 AM on November 15 [2 favorites]
I think what astonishes me (to the point that I wrote a whole screed about it a couple hours ago and then deleted it b/c it really misses the point of the metatalk) is that psychiatrists are still in this mindset.
I mean, they were the ones being marketed to, really. And are still being marketed to. And it takes a lot to go against the culture of your field and your training and your colleagues and the expectations of your clients. None of that's an excuse, of course.
I've found that therapists, at least, are on the whole very reluctant to address the harm that our field has historically caused and in many cases continue to cause, because we see ourselves as helpers (which is often a huge part of the problem, because saviorism pops up). It feels like we think if we just help harder than we can fix other people.
Which (trying to get back on topic!) I think is also what corb's talking about with non-professionals, too. We see someone suffering (or we think they're suffering), we try to fix them, it doesn't work because people don't need to be "fixed" and it's not ethical or possible to do it anyway, it backfires or doesn't work, and maybe there's a few more rounds of trying harder and it continuing to backfire or not work, so we throw up our hands and declare the person doesn't want help. And at that point we're burnt out and frustrated and so we assume that the problem is the other person, because we don't have the bandwidth to examine how the whole cycle is skewed and probably making things worse.
The peer support specialist Pat Deegan talks about needing to hold both a "duty to care" and a recognition of "the dignity of risk." We need to care about other people. They need to take risks and sometimes fail, not just be wrapped in bubble wrap and stuck in safe places, because taking risks and sometimes failing is part of what it means to be human. We (as a collective, or individuals in a helping role with an individual) have a duty to care about them even when they're failing, and part of that duty is not taking away their human dignity by taking away their ability to make decisions about their own lives. She's also pointed out, in trainings, that when people focus just on the duty to care without recognizing the dignity of risk, it leads to burnout and the helper disengaging entirely, in the "Well, they're just going to do whatever they want so why the fuck should I help them anymore?" I think that's where the impulse to cut off relationships, stay far away, force medications, let them hit "rock bottom," etc. all come from.
posted by lapis at 11:29 AM on November 15 [5 favorites]
I mean, they were the ones being marketed to, really. And are still being marketed to. And it takes a lot to go against the culture of your field and your training and your colleagues and the expectations of your clients. None of that's an excuse, of course.
I've found that therapists, at least, are on the whole very reluctant to address the harm that our field has historically caused and in many cases continue to cause, because we see ourselves as helpers (which is often a huge part of the problem, because saviorism pops up). It feels like we think if we just help harder than we can fix other people.
Which (trying to get back on topic!) I think is also what corb's talking about with non-professionals, too. We see someone suffering (or we think they're suffering), we try to fix them, it doesn't work because people don't need to be "fixed" and it's not ethical or possible to do it anyway, it backfires or doesn't work, and maybe there's a few more rounds of trying harder and it continuing to backfire or not work, so we throw up our hands and declare the person doesn't want help. And at that point we're burnt out and frustrated and so we assume that the problem is the other person, because we don't have the bandwidth to examine how the whole cycle is skewed and probably making things worse.
The peer support specialist Pat Deegan talks about needing to hold both a "duty to care" and a recognition of "the dignity of risk." We need to care about other people. They need to take risks and sometimes fail, not just be wrapped in bubble wrap and stuck in safe places, because taking risks and sometimes failing is part of what it means to be human. We (as a collective, or individuals in a helping role with an individual) have a duty to care about them even when they're failing, and part of that duty is not taking away their human dignity by taking away their ability to make decisions about their own lives. She's also pointed out, in trainings, that when people focus just on the duty to care without recognizing the dignity of risk, it leads to burnout and the helper disengaging entirely, in the "Well, they're just going to do whatever they want so why the fuck should I help them anymore?" I think that's where the impulse to cut off relationships, stay far away, force medications, let them hit "rock bottom," etc. all come from.
posted by lapis at 11:29 AM on November 15 [5 favorites]
It's not the same as ongoing support--but for a lot of us, ongoing support wasn't on offer in the first place
I found it enlightening, as a therapist, to learn that outcomes for schizophrenia are better in "developing" countries, where worth is not as tied to productivity, where altered states of reality are often held up as religious/spiritual experiences, and where community and family support for people experiencing such states is considered normal.
I think just the nuance in discussing and being open about the fact that circumstances constrain choices is helpful, even if that's what people mean by their shorthanding to 'hospitalization is the only option'. I also recognize how privileged it is to be able to access a community of ongoing support especially in these hell times. I'm very fortunate in that I belong to a disability community of veterans, which have a lot of similarity to the conditions listed above that assist. Veterans by and large either have similar or adjacent mental health conditions or are familiar with them, have a lot of tight-knit bonds that make that community of care possible and trustworthy, and have access to a lot of time and finances to be able to help others. When a significant percentage of people live off disability payments with no stigma, and are thus able to take full days to care for each other, it's a very different experience. The 'full hotel experience' is not even unusual - cooking for each other, cleaning for each other, even following each other to the shower if need be. But as Winnie the Proust says, that kind of community is not common in the modern world.
mental health conditions vary so greatly in severity.
I think, from my experience, it's not so much severity as an issue but just specific aspects. Some people, for example, prefer to be around strangers when they are having a difficult episode. Others, however, want to be around people they know love them and still respect them. While I personally haven't had full on delusive episodes, I have friends and lovers who have had them, and I think that the discussion above about what that looks like in a destigmatized space is really relevant. When someone can say that they're seeing things inclining them towards destructive self harm, and have someone who isn't judging them, it makes it easier for them to talk about it and be talked down from it before the urge becomes overwhelming. But also - that's not something you can really fake.
posted by corb at 1:38 PM on November 15 [2 favorites]
I found it enlightening, as a therapist, to learn that outcomes for schizophrenia are better in "developing" countries, where worth is not as tied to productivity, where altered states of reality are often held up as religious/spiritual experiences, and where community and family support for people experiencing such states is considered normal.
I think just the nuance in discussing and being open about the fact that circumstances constrain choices is helpful, even if that's what people mean by their shorthanding to 'hospitalization is the only option'. I also recognize how privileged it is to be able to access a community of ongoing support especially in these hell times. I'm very fortunate in that I belong to a disability community of veterans, which have a lot of similarity to the conditions listed above that assist. Veterans by and large either have similar or adjacent mental health conditions or are familiar with them, have a lot of tight-knit bonds that make that community of care possible and trustworthy, and have access to a lot of time and finances to be able to help others. When a significant percentage of people live off disability payments with no stigma, and are thus able to take full days to care for each other, it's a very different experience. The 'full hotel experience' is not even unusual - cooking for each other, cleaning for each other, even following each other to the shower if need be. But as Winnie the Proust says, that kind of community is not common in the modern world.
mental health conditions vary so greatly in severity.
I think, from my experience, it's not so much severity as an issue but just specific aspects. Some people, for example, prefer to be around strangers when they are having a difficult episode. Others, however, want to be around people they know love them and still respect them. While I personally haven't had full on delusive episodes, I have friends and lovers who have had them, and I think that the discussion above about what that looks like in a destigmatized space is really relevant. When someone can say that they're seeing things inclining them towards destructive self harm, and have someone who isn't judging them, it makes it easier for them to talk about it and be talked down from it before the urge becomes overwhelming. But also - that's not something you can really fake.
posted by corb at 1:38 PM on November 15 [2 favorites]
I can give a specific, if we're looking for specifics: adults with mental health conditions and intellectual disabilities are adults. They are men, women, and people. They are not children or like children. They are not partial adults or failed adults. I would like to see comments that question, doubt, or deny the adulthood of people with mental health conditions flagged and/or deleted. If you currently use this language on MetaFilter or in other places, please reconsider.
posted by capricorn at 1:59 PM on November 16 [5 favorites]
posted by capricorn at 1:59 PM on November 16 [5 favorites]
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