What to Do About Depression: The Limits of the Social Model

My sophomore year of college, I went through the worst depressive episode of my life. Making it to class – not even participating, just getting myself there – was a victory. I could barely leave the apartment, and some days, I couldn’t even leave my room. Pulling out details is difficult – most of the year is still submerged in a thick fog – but I remember sleeping through a psychology exam in November. The next day, I went to see my professor, sobbing hysterically in her office as I tried to explain why I had slept through two alarms. Abstractly, I knew what depression was, but as I sat there under her unsympathetic gaze, I didn’t feel like I was suffering from an illness. I felt like I was just lazy, weak, a bad student. A failure. My professor was hesitant to give me a makeup test. Her anger felt physically painful to me, but it was a pain I felt certain I deserved.

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All my other professors that year were lovely, kind and accommodating, sharing their own experiences of college and grad-school depression, but this particular moment, with this particular professor, seemed to make more sense to me than the sympathy I’d received. Somehow, I made it through the semester. I hoped that second semester would be better, but things got worse. The last week of semester, during finals, my mind went blank; I could barely form words, let alone write papers. I got a month-long extension to finish everything, and, critically, got on anti-depressants. They didn’t make everything better – pills aren’t magic – but I got my mind back. I could read, I could write, I could leave bed in the morning. I finished sophomore year, got a summer job, and went into junior year feeling like myself.

Villette-Page_n8.jpgSeven years later, I began work on my Master’s Thesis. I set out to write about my favorite Victorian novel, Charlotte Bronte’s Villette. The narrator, Lucy Snowe, struck me as deeply depressed, and I thought her depression shaped not only the story she told, but the way she told it. I was fascinated by her unreliability, by her fluctuation between openness to and hostility towards her reader. I decided to put Villette in the context of modern “mental illness” memoirs, tracing structural similarities. As I began my research, I figured I ought to do due diligence to Disability Studies, the field that examines the way disability is represented through a critical lens. But the more I read, the more frustrated I became.

Disability studies largely centers around something called the “Social Model,” that is, the idea that “disability” as such only exists when impairments meet an unaccommodating world. For example, someone wheelchair-bound has an impairment. When they are not given access to ramps, elevators, etc., or when they are judged as weak or less-than, that impairment becomes a disability. This model has been incredibly important in the disability rights movement, and in deconstructing the idea of what “normal” is. But it also has a lot of problems, particularly, at least in my research, when it comes to mental illness. Lennard Davis, a prominent figure in the field, questions the very existence of many mental illnesses as “impairments,” suggesting that they might not exist at all without being socially constructed.

Important to this distinction is the push against a longstanding idea of disability as “personal tragedy,” replete with suffering. Suffering is seen as an inherent evil; destigmatizing disability, then, requires separating it from “suffering,” and seeing “suffering” as something imposed by the world, not by one’s own impairment. But this approach erases the experiences of many people, myself included. In addition to erasing the suffering of many individuals, disability studies – particularly mental illness activism and its related theoretical work – has two tendencies I find deeply troubling. The first is a tendency to draw on comparisons between disability and race, gender, and sexual orientation. Many theorists argue that sexual orientation is the most relevant analogy, because  “most people with disability, like most queers, do not share their identity with immediate family members and often have difficulty accessing queer or crip culture,” and that, further, “unlike dual or multiple labels such as male or female, and [racial labels], the labels of nondisabled and heterosexual are always already presumed ‘unless otherwise stated’” (Ellen Samuels). 

Yet analogizing any node of identity to any other is always problematic; white feminists have long been criticized for using race as an analogy for gender, thus erasing the intersectional identity and particular struggles of women of color – so too can analogizing disability to race or queerness erase those who are disabled and black and/or queer. Furthermore, this analogy rests on the assumption of the social model. While the oppression of women, people of color, and people on the LGBTQ spectrum have been (for the most part) socially created, both by a long history of abuse and by current systemic inequality, disability is more complicated in that even in the most egalitarian and accommodating of worlds, there are those who would still suffer.

The second tendency is much more specifically related to mental illness, but once again draws on the troubling “social model.” Many mental-illness activists and theorists are largely anti-psychiatry, and anti-medication. If mental illnesses are not illnesses but “differences,” then why would they need to “cured”? The implication that they do need to be cured suggests that everyone ought to gravitate towards a norm, or so the thinking goes. This line of thought doesn’t come from nowhere. After all, it was only in 1984 that “homosexuality” was fully removed from the DSM (Diagnostic and Statistical Manual of Mental Disorders), and the medical field is still dominated by white men whose views of “normal” and “aberrant” behavior may not take cultural difference into account. More sinisterly, diagnoses have in the past been used as a tool of oppression and silence, particularly against women. Yet, the existence of diagnoses is essential for those who need psychiatric help, and the troubling of diagnostic categories does little for those for whom lack of access to care, and not experiences within medical systems, poses the greatest difficulties.

willow weep for me.jpgI drew on several memoirs for my thesis, one of which I will touch on now. Nana-Ama Danquah’s Willow Weep For Me illustrates the dire importance of access (and is a great read, by the way). Danquah’s memoir recounts her experiences of depression as an often-poor, black, immigrant woman in America. The subtitle of the book is “A Black Woman’s Journey Through Depression,” but much of the memoir chronicles Danquah’s journey towards an acceptance of her illness as illness. It was years before Danquah even began to label her experiences. As she recalls:

Out of nowhere and for no apparent reason – or so it seemed – I started feeling strong sensations of grief. I don’t remember the step-by-step progression of the illness. What I can recall is that my life disintegrated; first, into a strange and terrifying space of sadness and then, into a cobweb of fatigue. I gradually lost my ability to function. It would take me hours to get up out of bed, get bathed, put clothes on. By the time I was fully dressed, it was well into the afternoon. (27)

At the time of her first major depressive episode – which lasted three weeks – Danquah was a twenty-two-year old writer living in LA; the city she had known for two years became disorienting and unfamiliar. Her days were narrowed and cramped, and consisted of barely managing to leave bed, get dressed, and feed herself. She disappeared from work and her friends, and eventually withdrew so completely from the world that when she emerged, she was surprised to learn that the Berlin wall had fallen. As far as she could tell at that point, her mood – she had yet to call it depression – came about for no reason.

During another encounter with depression, Danquah visits a doctor for a pregnancy checkup. Before going in to see her doctor, she nearly labels herself as depressed, but backs off at the last moment:

I specifically remember checking yes next to Depression and then being instructed to list medications and/or hospitalizations. Having, at that time, never been medicated or hospitalized for depression, I went back and scratched out my yes and placed a checkmark in the no column. (36)

When, instead of using the word “depression,” Danquah describes her symptoms to her doctor, he waves them off as pregnancy hormones, nothing to worry over. Danquah’s problem was not being unfairly labeled or put through “the system”; her problem was that the system did not exist in her world.

Though she was shut out by the system, and though after changing her “yes” to a “no” she did not use the word depression, Danquah knew something at this point: “I had been happy before. Keeping that in mind, it became imperative to try to find my way back to the person I had been inside that emotion.” What Danquah seeks here is not assimilation to the norms of society. She seeks a return to herself, as defined by herself.

But even this seemingly simple idea – that of the return to self – pushes against the positions disability studies takes towards mental illness. A major disability theorist, Lennard Davis, argues that the social construction of disability only became possible with the construction of the norm, which he locates in the eighteenth century. Turning briefly from physical disability toward mental illnesses, Davis first defines psychoanalysis as a process that “brings patients back to their normal selves,” then equates it with the very damaging model of gay conversion therapy, calling both processes “eugenics of the mind.” Yet, as Danquah’s “imperative” illustrates, and as my own experience corroborates, the return to self must be separated from any larger narratives of “normalcy.” Danquah, a black immigrant woman, would never fit within a mainstream American narrative, nor a Ghanaian narrative. Her outsiderness, as much as it might intersect with her depression, is different than her self-imposed isolation during her depressive episodes.

Willow Weep For Me illustrates both that mental illness intersects with race, class, gender, and nationality in ways that cannot be ignored, and that, largely related to this intersectionality, access to help (or lack thereof) is a much bigger problem than the idea that some people need help. It is also very important to note that for Danquah, for me personally, and for many others, money and geography are not the only barriers to access: the stigma of being “mentally ill,” of being “crazy,” of being in therapy and/or on medication, is enormous (it is decreasing, thankfully, but still quite real).

Stigma is one of the biggest dangers faced by the mentally ill. Stigma does not exist solely in the form of seeing people with mental illnesses as less-than, but in the form of seeing mental illnesses-–-and their accompanying diagnoses—as made up. “Buck up.” “Deal with it.” “I would never take medicine that interfered with my brain—I wouldn’t be myself anymore!” Much of the mental illness advocacy I read resonates, troublingly, with these harmful (mis)conceptions of mental illness and treatment. While no one should advocate abusive treatments—unnecessary use of force or restraints, chronic administration of overly-sedating medications, Bedlam’s historic atrocities—treatments that allow those of us with disabilities to join the world are necessary. It is not social stigma that prevents someone who has lost (or never had) the use of their legs from climbing up a set of stairs and thus needing accommodation; it is material reality. While mental illnesses are invisible, and while only a few have been located in specific parts of the brain or body, mental illness is a reality. However, some mental-illness activist groups argue that “virtually anyone at any given time can meet the criteria for bipolar disorder or ADHD,” and that everyone, at times, experiences “depression, anxiety, and sadness” (www.CCHR.org). The impetus to view all treatments for people with mental illnesses as oppressively “othering” fits disturbingly well with the trend to deny the existence of mental illnesses on a material level and associate them merely with “weakness” or “laziness.” Of course, rather than being associated with weakness or laziness, Mad Pride associates mental illness with positive difference; certainly a vast improvement, but still one that risks negative material consequences.

I, for one, am eternally grateful for my own ability to get help. While some medications have certainly had significant negative effects on my life, medication overall has helped me enormously. Over and over, I find myself locked in a battle with my own mind, and medications—along with therapy—have given me the tools I need to win that battle. I want to get up in the morning. I want to work. I want to read and write. I do not want to curl up in bed and stare at the wall for hours. I do not want to have panic attacks so all-encompassing my vision blurs or my body breaks out in rash. But that is what has happened when I am either unmedicated or incorrectly medicated. At times, my brain works in wonderful ways, but at other times, I wish nothing more than to be like other people. Not because I want to be socially accepted—that generally has not been a problem for me—but because I want to feel less pain, I want to be less wildly thrown by the tiny upheavals in life.

Mental illness is being discussed now more than ever, albeit in a wide range of ways. Allie Brosh of Hyperbole And a Half’s vivid description of her experience with depression was wildly popular, and from my perspective, achingly accurate. At the same time, “mental illness” conversations most often reach the national stage after a mass shooting, and recently, Bernie Sanders put his foot in it with his suggestion that GOP candidates might benefit from better mental health care (I’m all about providing mental health care to everyone regardless of income, but mental illness and the racism, sexism, and xenophobia all over the GOP have nothing to do with one another). There is, of course, a difference between how disability as a whole and mental illness specifically are discussed in academia and pop culture/the mainstream media, but the two bleed into one another, and it is worth examining both.

There is no single narrative for the experience of mental illness. Pushing past the stigma of mental illness is an essential step. But it is also essential that in our efforts to do so, we not overwrite anyone’s individual experience, whether or not it contributes to combatting stigma. A while ago, I wrote about the importance of sadness as an emotion; while the immense suffering that can come with many mental illnesses (and other forms of disability) is not necessary the way sadness is, it is as important to talk about. And as important as it is to remove shame and stigma from all disabilities, it is as important that we not demand pride, that we allow people to say “I suffer from this, and it sucks, and I really wish that I didn’t.” We need multiple, intersectional, and at-times contradicting narratives of mental illness, because only then will we begin to gain a complete picture.

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