So, I want to pose a question: Is a mental health disorder a disability? I suspect the answer to this question hinges on how disability is contextualised. There are several ways of going about thinking about disability. I want to focus on the purely academic conversation out there in higher education today.
This framework casts disability and its study as a social construct. Mental illness, or a mental health disorder, from a purely academic lens, wouldn’t be an impairment but a divergence or neurodivergence from the ‘norm’.
These norms, many academics suggest centre around ‘ableism‘, or a belief within society that privileges the existence of power differentials that suppress marginalised members of society and their circumstances. Given this framework, there really is no such thing as a mental illness, is there?
There is only the disorder, which these academics believe is rooted in the medical normative narrative dominating what the social influencers make out to be good mental health. This is where my problem with disability studies and the predominant academic narrative surrounding mental illness is located.
Underneath this prevailing academic version of mental illness is a silent minority in the university. These are the very sick, the chronic mentally ill, who know that their suffering extends beyond what social apparatus define and fail to validate. These are the experiences of so many who understand their disorder for what it is, and still, hate their symptoms because they are very real, very disability, and are left without the support of the higher-ups in the discourse due to conflicting ideas of what illness, disorder, and disability mean.
Given that the disabilities narrative is extremely empowering in the same way a veneer of confidence serves someone who is truly self-critical and self-loathing. Sure, I get it. The disabilities studies notion of impairment as a social construct allows people to externalise their self-doubt, even feelings of difference and possible shame from having a possible lifelong stigmatising illness in a culture that privileges ability and means.
This is truly marvellous for some folks who: 1) will benefit from engaging in externalisation (a word of caution as externalisation can often be a way of avoidance or avoiding an issue directly that is causing more harm than good; 2) outside the walls of the academy and the university the disabilities narrative is often non-existent (people outside of academia simply don’t buy into the social construct theory due to the fact people have to live out their lives and with these impairments within their reality divorced of journal articles and spirited lectures in higher education.
So, this means people who are wheelchair-bound must deal with pavements without ramps and accessibility issues. Resource-deprived folks will encounter even more issues related to access and getting their hands on adaptive software or hardware to allow their disability to not control their life or how they go about living. These are just physical disabilities or impairments.
In the world of mental health, people in the public mental health system must deal with the realities of getting treatment within a system of care that doesn’t see them as individuals. This stigma exists. Just because disability studies refute the stigma and make it visible to small cliques in their university departments continue to reject the harsh realities for people with mental illness outside of higher education.
These are realities like stigma, discrimination, forced treatment, and all sorts of negative issues related to having a mental illness. These are issues impacted by social constructs; I’ll give the disabilities studies camp this much. However, social constructivism and its impact on the reality of our lives only explain so much in terms of how mental illness is contextualised by the public.
Other aspects of mental illness aren’t explained by social constructivism. These aren’t small or unimportant issues either. These are real issues for many people suffering from mental illness.
For example, according to disabilities studies, mental illness or serious mental health disorders is manifested by social conventions at work in the larger normative culture. If this is true, then must I live in a world that defies all conventions, and the world at large outside of the university, to feel OK and healthy? Must I live outside the realities of my life to feel like I am without a disorder? Is it really society that makes my disorder an illness? Well, let me tell you folks: I live in Yonkers, New York. You can look it up on a map. It’s there. It’s a real place. As real as geography and state lines get in a world where nationalism still functions and divides up the world.
The social security administration understands, thankfully, that my mental illness is an impairment. The Social Security Administration (SSA) and Disability Benefits Department don’t care about social constructivism. Why? Because SSA is not bound up in the metaphysical world. All of us here in the real world need money to pay bills, and medical care to pay for the treatment of our mental illnesses.
This is odd. If mental illness is really just a social construct, then why isn’t SSA out there doing social campaigns? Instead, they are dolling out necessary money for the treatment of serious illnesses.
Without my intramuscular injection, my illness would destroy everything I have ever rebuilt. I would return to a state of persistent delusions and other symptoms which are so intense and difficult to tolerate I would need immediate intervention – not from a disability studies university professor disputing my social constructions but a clinical therapist and expert in serious mental illness.
Because when my voices return, when my mania returns, no professor or academic will be able to help (I learned this first-hand from my break while enrolled as a student). I will need specialised interventions, and I would likely be so disordered, ill, sick, whatever, that I wouldn’t be able to survive outside of the hospital. With this said, thankfully academics don’t run the state benefit or hospital system.
Furthermore, I am also grateful for people like my therapist, and other clinicians who know social constructivism is only part of the picture. It is not an explanation for every aspect of divergence in culture, mental health, or otherwise. I am suggesting the disabilities studies contextualising of mental illness, disorder or problems is not only limited, but also monolithic in its nature, and very much limiting, and dismissive of the realities out there in the world outside the gates of the university.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.