Two Mental Healths

One of the most common criticisms of "housing first" initiatives (programs to provide housing for unhoused people unconditionally without gatekeeping) is that housing first "does not improve mental health." 

Now, let's set aside for the moment that this criticism is irrelevant -- the purpose of housing is to provide shelter, not to "improve mental health" -- what definition of "mental health" could possibly make this true? As much as I try to critique and deconstruct the social construction of "mental health," how could it possibly be true that having a safe, assured place to live would not result in greater happiness, greater inner peace, less depression, less anxiety, less negative emotions, than living on the street? 

What possible definition of "mental health" would not be improved by being housed rather than unhoused?

Answering this requires unpacking the wildly different, almost completely unrelated, definitions of "mental health," one applied to relatively privileged people, and one applied to oppressed people.

For relatively privileged people, the concept of "mental health" is centered on emotional well-being, introspection and self-awareness, and the mitigation or management of negative emotions like pain, depression, anxiety, and anger.

For oppressed people, the concept of "mental health" is centered on compliance, obedience, and productivity.

Like most privilege disparities, this isn't binary. For most people who are privileged in some ways and marginalized in other ways, "mental health support" will include some degree of the emotional support given to privileged people, and some degree of the compliance and productivity training given to oppressed people, with the proportions varying on where exactly each person falls on various privilege axes.  All children are oppressed by ageism, so all children's "mental health" has some elements promoting compliance, obedience, and productivity. But relatively privileged children may also receive some emotional support mixed in, while children of color, children in poverty, and children with existing neurodivergence labels will receive a much higher ratio of compliance training to emotional support.

One of the clearest illustrations of this disparity is the contrast between the "self-care" recommended to privileged people, and the "meaningful days" imposed on oppressed people.

Relatively privileged people are often told, by therapists, doctors, mental health culture, and self-help books, that they are working too hard and need to rest more. They're told that for the sake of their mental health, they need work-life balance, self-care, walks in the woods, baths with scented candles. Implicit in these recommendations is that the reason these people are working too hard is because of internal factors, like guilt or emotional drive, rather than external factors, like needing to pay the bills and not being able to afford a day off.

By contrast, unhoused people, institutionalized people, people labeled with "severe" or "serious" or "low-functioning" mental disabilities, are literally prescribed labor. Publicly funded "mental health initiatives" require the most marginalized members of society to work tedious jobs for little or no pay, under the premise that loading boxes at a warehouse will make their days "meaningful" and thus improve their "mental health." And unlike the self-care advice given to relatively privileged people, the forced-labor-for-your-own-good approach is not optional. People are either forced into it directly by guardians or institutions, or coerced into it as a precondition to access material needs like housing and food.

The form of "mental health" applied to relatively privileged people has some genuinely useful and beneficial elements. We could all stand to introspect and examine our own feelings more, manage our negative emotions without being overwhelmed by them, have self-confidence. We all need rest and self-care.

Still, privileged mental health culture, even at its best, is deeply flawed. At best, it tends to encourage a degree of self-centeredness and condescension. It's obsessed with classifying experiences as "trauma" or "toxic." It's one of the worst culprits in feeding the "long adolescence" phenomenon and generally perpetuating the idea that treating people as incompetent is doing them a kindness. Even the best therapists serving the most privileged clients have a strong tendency towards gaslighting and "correcting" people about their own feelings and desires.

But perhaps the worst consequence of privileged mental health culture is that it gives cover to the dehumanizing, abusive, compliance-oriented "mental health care" forced upon the most marginalized people. Privileged people are encouraged to universalize their experiences with sentiments like "We all deal with mental health" or assume that the mild, relatively benign "mental health care" they experienced are the norm, so what are those silly mad liberation people complaining about?

Tonight, I listened to a leader from an agency serving unhoused people talk about how "Everyone struggled with mental health during the pandemic"... and then later mention that their shelter categorically excludes people with paranoid schizophrenia diagnoses.
So perhaps "everyone struggles with mental health," but only certain people are categorically excluded from services, from shelter, from autonomy, from basic human rights, because of how their brains happen to work.

As always, it seems like so much effort in the mad liberation/ neurodiversity/ antipsychiatry movement is spent holding the hands of relatively privileged people receiving relatively privileged "mental health care" and reassuring them that we're not trying to take it away from them. Fine, it's great that you like your antidepressants and anti-anxiety medication and your nice therapist who listens to you and your support group. Great. Go live your best life. But that has nothing to do with our fight against forced drugging, forced labor, forced institutionalization, forced poverty. It's not even close to the same "mental health."

Human rights on a case-by-case basis

 

People really, really need to stop discussing autonomy (especially for young people, poor people, or disabled people) with concepts like "it depends on the individuals" or "on a case-by-case basis."

"It depends on the individuals" or "on a case-by-case basis" are valid concepts for assessing whether an individual choice is a good idea, or the right choice for the circumstances. Whether something is a good idea is almost always context-dependent. Sure.

But when the question is whether someone should have the right to make a choice, or when the question is whose choice it should be, the context doesn't matter. The individual doesn't matter. The circumstances don't matter. Autonomy is a human right. Cognitive liberty is a human right. Our rights should not be determined on a case-by-case basis. Our rights should be universal and absolute.

This comes up a lot in medical contexts, especially as mad pride and anti-psychiatry spaces place more emphasis on "medication is bad" than on "coercion is bad," and the vague rebuttal is that medication can be good or bad "depending on the individual" " on a case-by-case basis." This still bypasses the central issue of autonomy and coercion.

Is taking prescribed medication a good idea? Maybe. It depends on the individual. Decide on a case-by-case basis.

Should an individual have the right to choose whether to take prescribed medication? Yes. Unequivocally. In every case. In every circumstance. It does not depend on the individual, because every individually is equally deserving of human rights. In this context, pro-coercion people are hiding behind the ambiguity of "it depends on the individual" to convey that some individuals should not have the basic human right to control their own bodies.

I've gotten into a lot of arguments recently about the brain maturity myth and young adults as "still children," specifically about young adults' freedom to enter romantic relationships of their choice, or have children if they choose to. But the strongest defense I regularly see of youth rights in these contexts is "it depends on the individuals."

Whether or not a given romantic relationship or family situation is a good idea, whether a relationship will lead to a mutually satisfying lasting partnership, whether it will lead to long-term happiness -- these things depend on the individuals. They are context-dependent, and different for everyone. The correct answer to "Should an 18 year old get married or have children?" is "It depends on the individual."

But the correct answer to "Should xe have the right to choose to get married or have children?" is always yes. It does not depend on the individual. It does not depend on whether this choice is a good idea or likely to lead to long-term success. Relationship autonomy and reproductive rights do not depend on whether something is a "good idea." They are simply human rights.

Arguments about institutionalization and adult guardianship also always devolve into "You don't know the individual" or "You don't know the whole situation" -- as though the right to control of one's own body and mind is situational. We don't have to know every individual or every situation, because the situation doesn't matter. The individual characteristics of the person being subjected to a human rights abuse aren't relevant.

In general, anything that shifts conversation to the specifics of a decision someone wants to make, when the issue at hand is their right to make the decision in the first place, is a harmful derailing. It's fine to be judgmental of someone else's life choice, or to think they're making a mistake, but that's not what's relevant. Your support for people's right to freedom of speech shouldn't depend on your agreement with what they're saying, and your support for bodily and cognitive autonomy shouldn't depend on whether you think someone is making "good choices."

In fact, consider taking the Signal Boost Someone Fighting For The Right To Do Something You Disagree With, WITHOUT Mentioning That You Disagree With It Challenge. Really. Try it. Denounce that group home not letting its inmates drink soda WITHOUT adding your opinion that soda is bad. Support that religious freedom case WITHOUT tacking on that you think the person's religion is wrong. Argue for that disabled young adult's right to move in with a partner against xyr parents' wishes WITHOUT weighing in on xyr partner or their relationship. Defend that pregnant person's right to give birth as xe chooses WITHOUT adding that xe's making the wrong choice. You might find that your opinion of other people's autonomy is less important than you think it is!

Functioning, pt 2

 The problem with "functioning" as a concept is not the indisputable fact that people have differing abilities, talents, and skills to differing degrees.

The problem is that some abilities, talents, and skills are classified as "functioning," and real or perceived deficiency in them is grounds for pathologization and denial of autonomy.

I can't play the trumpet, run a marathon, or dance on my toes. These are abilities that some other people have, but I don't. Yet no one is going to call me "low-functioning" or take away my rights because of this.

Okay, but those are hobbies, not necessary for survival. If you don't have abilities necessary for survival, surely that's low-functioning.

Except I also can't hunt or clean an animal for meat, forage for plants, or spin wool into warm clothing. I would be completely unable to survive without the structures of the society I live in. Yet I still do not face the legal consequences of being classified as "low-functioning." I am not denied human rights for this. Primitivists and fascists insult me for this (I don't care), but they have no legal power over me (yet).

Okay, but those skills aren't necessary for survival in my social context, a post-industrial capitalist society. Lacking abilities that are necessary life skills in my social context, that would definitely get me classified as "low-functioning", right?

Except, no, I'm not very good at post-industrial capitalism, either. I can't file my taxes without assistance. I'm hazy on what the stock market is. The complex interconnected computers I use to manage my life might as well be run by tiny elves in hamster wheels for all I understand them. People might make fun of me or look down on me for this. But they don't classify me as "low-functioning." They don't take away my right to make my own decisions about my own body.

But I have trouble filtering out different sounds, speech, and background noise. If I'm in a meeting or a crowded room, and people are have multiple conversations at once, I have no idea what's going on. I sometimes get a look on my face that others read as "confused."

This is what makes people question my "functioning." Because I "look confused," and they don't think I can think.

"Functioning" is not about what skills people have or how well they can survive. It's about how well they can perform normative behavior in their society, and about the assumption that people who do not perform normative behavior are less capable of thinking or decision-making.

"But what about people who can't take care of themselves?" Irrelevant. You can't take care of yourself either. You live in a building you didn't construct, powered by electricity you didn't install and probably don't understand, travel in a metal box powered by a combustion engine to get food you didn't grow and products you didn't build in exchange for tokens with no intrinsic value and spend most of your waking hours doing meaningless tasks in exchange for such tokens. You can't conceptualize what it would mean to "take care of yourself" -- no, not even if you have a small garden or a few animals you like to imagine constitutes "self-sufficiency" (it doesn't). Which is fine! Humans are an interdependent species who shouldn't have to "take care of themselves."

But the concept of "functioning" is not based on skill level. It is not based on "how much support someone needs" (which would be meaningless in the first place -- all humans need roughly the same amount of support; the differences arise in who has the social privilege to access it and whose human needs are framed as "special" or "extra").

The concept of "functioning" is based on the unchallenged cultural assumption that people with non-normative traits are less human, less reasonable, less thinking, less capable of decision-making.

As I wrote in this previous post, humans do not "function." Humans are not machines. Humans are thinking, feeling, decision-making beings. They do not need to fulfill any "function" in order to justify their existence or prove their ability to think, feel, make decisions. The right to exist, the right to communicate, the right to self-determination, do not depend on anyone's possession of any particular skill set.