October 2, 2013, by Warren Pearce

Is Asda right about mental health?

One an Other - Mental HealthThis is a guest post by Greg Hollin, doctoral researcher at the Institute for Science and Society, University of Nottingham.

The obvious answer to the question above is ‘no’; a finer example of Betteridge’s Law of Headlines is not easily found.  The decision by Asda – who sold a ‘mental patient fancy dress costume’ complete with torn white shirt, fake blood, and a plastic cleaver, and Tesco – who sold a similarly sensitive ‘psycho ward’ costume, was quite evidently misplaced.  These supermarkets’ actions, and their representations of mental health, were undeniably wrong whichever angle (ethically, factually, aesthetically) one believes to be the most important.  It is therefore not surprising that those involved in campaigns such as Time to Change were delighted that the costumes were removed from sale.  Nonetheless, the idea that the moralised pictured of mental health presented by Asda reflects not (only) misguided representations of mental illness but also something about the very nature of mental illness itself is an interesting one.  Considering Asda’s position, alongside those who have dismissed it, offers the possibility of a more nuanced consideration of what exactly mental illness is, as well as possible forms of response.

What is mental health?

As a campaign, Time to Change captures the essence of the criticism made towards Asda, their mission statement being to ‘end mental health discrimination’.  One portion of Time to Change’s website is entitled ‘what are mental health problems?’ and this section of the ‘site lists four myths and four facts relating to mental health.  One of these facts can be used, for current purposes, to work through issues of what exactly mental health is:

Nine out of ten people with mental health problems experience stigma and discrimination.

What can we learn from this statement?  Firstly, (and perhaps most sensibly) this statement tells us that the majority of individuals diagnosed with mental illness suffer in a way embodied by the costumes described above; they are assumed to be violent, and are subject to parody, abuse, and derogatory terminology.  A second claim here is that it is clearly possible for stigma and abuse to be entirely removed from discussions surrounding mental health: if one in ten people with mental health issues are able to avoid stigma and discrimination then it is demonstrably true that such value-based representations are not an inherent part of the classification itself.  Thus, within this sentence, there is actually a third claim about the relationship between mental illness and the society, namely, that the value-based representations of a society are not part of the disease construct itself which exists, in toto, outside of a cultural setting.  In the remainder of this blog I would like to, briefly, contest the second and third of these claims and suggest that society’s values define the very nature of mental illness by contrasting it with normality.

What is normal?

Where does the word ‘normal’ originate from?  The answer, as eloquently explained by Ian Hacking, is geometry:

It meant perpendicular, at right angles, orthogonal.  Norma is latin, meaning a T-square.  Normal and orthogonal are synonyms in geometry; normal and ortho- go together as Latin to Greek.  Norm/ortho has thereby a great power.  On the one hand the words are descriptive.  A line may be orthogonal or normal (at right angles to the tangent of a circle, say) or not.  That is a description of the line.  But the evaluation ‘right’ lurks in the background of right angles.  It is just a fact that an angle is a right angle, but it is also a ‘right’ angle, a good one.

Hacking, I., 1990. The Taming of Chance, Cambridge, UK: Cambridge University Press. p.162-3

When applied to mental illness, the description of someone as ill or abnormal, therefore, seems to entail a crossing of the fact/value divide, an objective statement about how a person is behaving and a subjective claim about how they should behave.

Georges Canguilhem, writing in the 1940s, claimed that this breach of the subject/object divide is not an avoidable entanglement of facts and values – as is suggested in claims two and three of Time to Change’s fact, above – but is rather an essential aspect of knowledge concerning the abnormal. InThe Normal and the Pathological, Canguilhem (1991, pp.162-3) stated that there “is no pathological disturbance in itself: the abnormal can be evaluated only in terms of a relationship.”  In relation to mental health this claim suggests that it is only within the bounds of acceptable conduct, as described by society, that various forms of psychological disorder become apparent.  To take a particularly obvious example, a classification like Attention Deficit Hyperactivity Disorder (ADHD) only becomes visible within the bounds of a society which expects children to sit still and pay attention in school (for example).  To say this of ADHD does not deny its reality, that suffering is caused, or even that therapeutic avenues should not be explored.  It does however suggest that ADHD is both, unavoidably, a description and a moral judgement; it suggests that stigma and discrimination are an inherent part of the classification itself.  This idea was memorably captured by Canguilhem (1991, p.186) when he stated that “the sick man is not abnormal because of the absence of a norm but because of his incapacity to be normative.”

Change society…change disease

Conceptualising mental illness as both subjective and objective does not just make us think in new ways about what mental health is, it offers the possibility of new forms of conduct.  An acceptance that Asda’s moral judgement is in some sense an essential part of any disease classification does not limit the critique of Asda’s representation of mental illness but instead offers the additional possibility of changing mental illness itself, suggesting the potential of configuring ourselves and our society in such a way that various forms of moral judgement cease so that suffering slips away or change shape entirely; without the expectations of the schoolroom the treatment and experience of ADHD would be very different.  By changing society, we can change disease itself.

Don’t somatise, organise!

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