Just like any other illness.

This is something I've been meaning to write about for a while and loosely fits in with Pity Protest Blogswarm in so far as it is about the Charity Model of Disability and its failings.

I wrote a little piece on the Ouch! Blog today about Awareness Campaigns and their limitations. One example where such information campaigns are particularly unsuccessful is in the area of mental health. A month or so ago, they announced a new one, a £16m drive to tackle the stigma of mental ill health. I read the very first sentence of the article about this funding

"In the biggest attempt yet to change the public perception of conditions such as depression and schizophrenia, three major charities are to run a TV campaign showing that many conditions thought of as incurable are treatable."

and my heart sank. These anti-stigma campaigns keep failing because they try to work around perceptions of disability that exist in this culture instead of challenging them head-on. Instead of arguing that impairment is a morally neutral aspect of the human condition, that medical facts belong to the individual and the medical staff working with them, and that society needs to work on accepting and respecting all of its members regardless of their health, they cry "Look! We can squeeze ourselves into this mold as well!"

And it fails. Why? Because no chronic illness sits comfortably with the dominant models of disability and mental illness sits least comfortably of all. The problem?

Sympathy.

When the respect and acceptance of a society is not on offer, sympathy is the only thing disabled people can hope for. And sympathy makes demands; the recipient must prove themselves innocent in their peril and worthy of our pity.

For a long time, mental ill health has come up against two obstacles in this regard. The first is the perception that much mental ill health is merely an absence of moral fibre; these people fail to cope, they are weak and cowardly and thus not innocent or worthy victims. The second is the perception that the other group of people with mental ill health are so very much out of control that they are a threat. We struggle to sympathise with something we fear.

Anti-stigma campaigns have generally approached this problem by proposing a biogenetic or shit happens model of mental ill health. People just get sick, it's biological, genetic, it's just one of those things. A person is walking down the street one day and kerplunk, they develop major depression. It is, they say, just like any other illness.

This hasn't been entirely ineffective with the label of Bipolar Disorder or Manic Depression, as we have established that there is a significant genetic component at workd. At the same time, Manic Depression has long been associated with the stereotype of artistic genius, which also helps ( not that people with BD/MD don't still face enormous stigma, nor are such stereotypes without their own problems).

Unfortunately, there are very many mental health conditions which we know have been triggered by life events such as stress and trauma and many more where life events are likely to have played a major role (if that can't be said for all mental illness). And that's much more difficult as far as this issue of sympathy is concerned because you failed to cope when someone else might have coped.

In reality, this is nonsense. There are always reasons why people get sick, but these reasons are always complicated and often elusive. A person's neurological and psychological response to trauma is no less complex than an immunological response to a viral infection - perhaps more so. There is never one simple answer as to why an event effects a person in the way it does, that stuff happens far below a conscious level and nobody ever chooses to get sick, nor do they choose not to get better. In all these regards, it is just like any other illness, but not because it is in any way simple.

At the same time, anti-stigma campaigns attempt to deal with the second problem, the fear of "psychos", by pushing forward the idea, as alluded to in the quote above, that these problems are treatable. In reality, the people who suffer the most from the stigma of mental ill health are those with chronic and severe conditions which can be managed but are basically incurable. And whilst psychiatric medicine has progressed a great deal in recent years, some treatments still present users with very difficult decisions; decisions made more difficult by the prevailing idea that if it is treatable it should be treated.

However, the central mistake made by anti-stigma campaigns is the idea that any of the facts of mental ill health are relevant. At least none of this ought to be relevant to society's response to a person with mental ill health or any other impairment. Impairment is a morally neutral fact, like sex or skin-colour; it just is. People do not need to meet any kind of criteria in order to qualify for our sympathy; everybody qualifies for our respect by virtue of having blood in their veins. Whereas if you have custard in your veins, I won't give you the time of day.

Being the longest blog post I've written in several weeks, I've no idea if any of this makes sense.