Jul 22, 2013

Stand your social distance or I’ll shoot

It’s the subjective element of Stand Your Ground laws that makes them come out racist. Any self-defense case involves a tragedy – but when convictions turn on the killer’s subjective impression of who is threatening, the people who get killed are more likely to belong to racial minorities and other out-groups, including people with disabilities.

Human encounters are affected by social distance, a measure of relatedness, a bundle of concepts ranging from familiar, approved, trustworthy and safe, to strange, different, suspicious and unsafe. People are said to be closest to those they trust and know best, typically those who are most like them. Social distance can be seen today playing out in a benign fashion in restaurants, stadiums and other public spaces. More people gather in same-group clusters than in more diverse clusters, even when everyone in the larger setting abides peacefully and even shares interests, attitudes, educational background and motivation for gathering.

The notion of relative safety connected with one’s own family and tribe, and higher perceived risk when encountering strangers, is an artifact of human evolution built into DNA and human nature.

From our earliest moments, we construct mental models, learning who is safe, who to avoid, and how to obtain what we need. We develop and rely on patterns, lumping similar things (or similar types of people) together. Mental models are working theories of the world, approximations of what we have learned, that incorporate what we see and hear from others as well as what we experience ourselves. Mental models connected to social distance may be useful and accurate, or dead wrong. Fortunately, mental models are subject to revision as we get to know people, and as we  learn and navigate the world.

Social distance becomes embodied in social policies and plays out in individual actions. No one is immune to its effects. In American society we are expected to manage and adjust our mental models so raw prejudice doesn’t cloud our judgment or taint our actions. Each generation tends to do better at this. However, Stand Your Ground laws validate prejudice and social distance, giving everyone a license to kill.

Consider how social distance has affected people with disabilities. Human society has always included people who could not see, walk or hear, and people with limited mobility, intellect or other reduced functioning, yet the concept of disability as a phenomenon that might itself be studied or discussed arrived relatively recently to Western society, in the mid-19th century. People initially spoke of conditions that were “natural” or “normal” and contrasted these with what was considered “monstrous” or “defective.” As scientists cataloged the variations in people’s bodies and capacities, they made judgments about the value of the lives of the people they studied. In the 19th century, as the theory of evolution mixed with the era’s crude racial stereotypes, researchers began to describe both nonwhite races and disabled people as regressions or throwbacks. For example, the physician who first identified Down Syndrome called it Mongolism because he understood it as a biological reversion by Caucasians to the Mongol racial type. This mode of thought, called Social Darwinism, set the stage for the eugenics movement and the Nazi Holocaust, and also played a role in immigration laws that forbade entry both to members of ethnic groups thought to be prone to criminality or deformity and to people with mental or physical defects. The mission of state institutions for people with mental illness and developmental disabilities also changed. Promoted in the 1840s as moral reforms, by the early 20th century the institutions were more frequently described as a means of social control. They kept members of productive society safe and separated ordinary citizens from those now described as sub-normal. People receiving care in these institutions suffered a type of social death.

Even today, disability connects with stigma, an “attribute that is deeply discrediting” and that reduces the bearer “from a whole and usual person to a tainted, discounted one” in the words of sociologist Erving Goffman.  Stigma originates from a process that involves labeling, linking to negative stereotypes, separation of “us” from “them”, and status loss and discrimination that leads to unequal outcomes.

Ultimately, stigma leads to partial or complete disempowerment, and now, even increased risk of death. The rhetoric of the gun lobby is doubly disturbing to disability advocates. We see people encouraged both to fear people with mental illness and "stand their ground" against whoever is perceived as threatening.

Jul 8, 2013

Extraordinary Popular Delusions and Madness in America

One of my favorite books is Extraordinary Popular Delusions and the Madness of Crowds, written in 1841 by Charles Mackay. It’s about the herd behavior of humans: fads and crazes and financial market follies. It covers witch trials, alchemy, superstitions. The book also covers the 17th Century “tulip bubble,” when flowers were currency, more valuable than gold. The lesson in the book is that once the populace gets convinced of something that turns out to be plain wrong or completely irrational, bad things happen. People die at the stake. Awakening to the realization that your tulip bulb investment is as worthless as a sack of onions is no picnic either.

There are signs that the world of mental health is in the midst of this sort of wake-up. The ruthlessness and greed implicit in the pharmaceutical industry’s marketing strategies is undermining the credibility of medication efficacy claims. The authority of the mental health’s secondary prevention model (early detection and treatment) and tertiary prevention model (treatment forever) is being confronted by research that shows better long-term outcomes on a whole-population basis when people do not use as much medication. The DSM is even becoming untethered from neuroscience.

I think the most significant development is that we now realize that people with mood problems, delusions and hallucinations deserve to be heard when they assert that what they experience has meaning. It means that writing people off is abusive and unethical. Someone with a mental health problem is not an irrational sub-human, but a valued person, no matter what he may be experiencing. We are also learning that social support is powerful on its own. It helps people with difficult symptoms stay on course.

As I see it, here is what we are waking up to.

Authority over madness is shifting to people with symptoms and away from experts and keepers. Despite symptoms a person may have, his life remains meaningful and valid. People can tolerate some level of chronic recurring symptoms and live safely, even flourish. People deserve opportunities to figure out what works and what is tolerable, and to choose an option that is presented accurately and supports their wishes. Nearly everyone wants normalcy anyway. Expertise is important, but should be advisory, not directive.  Mental illness, practically speaking, is not that complicated. Ordinary people, friends and relatives and neighbors, are perfectly capable of supporting the people they care for. They are already doing it, in every nation and every culture on earth.

There are certainly some tough cases and more difficult situations, but even these require individualized approaches. We say we do that now, but if we have been applying bad theory, it’s time to face up to that, and reckon with society’s folly.

Jul 4, 2013

Building a life despite tough symptoms

Barbara Altman’s memoir of a life affected by mental illness, set in the latter half of the twentieth century in the American Midwest, tells about what many people experience. Trauma is connected with substance abuse and is embedded in family life. Accomplishments also play out in intimate settings: homes, schools, churches and workplaces. Ms. Altman’s book tells the story of a someone who faced challenging mental health issues but still discovered meaning and success, and a life of grace, service and dignity.

Ms. Altman writes about her life from childhood to the middle of her sixth decade. She tells of a difficult home life centered around an alcoholic father. She experienced her father’s harsh temper, and possibly worse. At age 15, Ms. Altman became aware of vague nonspecific memories of sexual trauma when her father admitted to having sexual thoughts about young children.

As Ms. Altman worked through anxiety, psychosis, eating disorders and depression, she discovered her talent for music, and built a career in music education and music therapy. She writes about finding meaning and a place in the world through the support of other people and the consolation of her Christian faith. Overcoming anxiety was a matter of exposure in small increments. She writes about facing challenges deliberately, building up courage bit by bit, at a pace she could tolerate. It took a year for her to learn to swim a complete lap in an indoor pool, but she did it.

I like this book. It describes experiences common to many, recounts personal growth and service to others, and talks about what helps.

Recovering from Depression, Anxiety and Depression: My Journey through Mental Illness, by Barbara Altman is available through Amazon. Learn more about Barbara Altman at .