1. Sanism and the Mad Studies Project
Lancaster Disability Conference
10 September 2014
Brenda A. LeFrançois, PhD

2. Mad Studies Critical Disability Studies Mad Studies
Critical Psychiatry
Anti-Psychiatry
Radical Therapists
Psychiatric Survivors
Mad Community
Critical Disability Studies
Critical Disability Studies
Mad
Studies

3. Sanism Birnbaum coined in 1960s Judi Chamberlin – mentalism - 1978
Perlin 1990s to present
Diagnosis and labels of ‘mental illness’ themselves constitute sanism
Micro aggressions
Systemic sanism
Sanism or stigma?

4. Sanism in Health and Social Care
Psychiatrisation (diagnosis, treatment, biomedicalism)
Authoritarian vs participatory practice
Medical model and pharmaceutical focus
Forced treatment
Intersections:
class
sexuality
racialization
gender
age
Racialization – racism and sanism intersect with each other in complicated and telling ways within the mental system. This is a story of both under-inclusion and over-inclusion experienced in different ways in different spaces, and also relate to other social constructs such as age and gender. Black people in London; Black men in the USA; racialized children in Canada. In the case of this under-inclusion, this is a consistent form of racism that we see existing systemically across a number of social institutions. (One of the conclusions we can draw is that if we were to eliminate racism, we would eliminate sanist interventions that are based on racism, whether that intervention is about over-inclusion due to racial targetting or if it is about denying support to people in distress through under-inclusion of particular groups.
Gender – over-representation of women receiving ECT (links with depression); pathologization of typical life experiences (pre-menstrual period, post partum period, menopause); Gender Identity Disorder (pathologization of trans folk, a necessary diagnosis to obtain what many experience as life saving treatments – there are differences of emphasis placed on this psychiatrization in the trans community Ambrose Kirby and AJ Whithers)
Age – Sanism and ageism intersect in pernicious ways - hightened concerns about the number of elderly persons in nursing homes who are on psychiatric medications – the widespread psychiatrization of old age – with statistics up to 50% being prescribed in the first two weeks of admission (up to 90% with dementia diagnosis); elderly are 3.5 times more likely to have adverse reaction or bad side effects than middle aged adults. There are very few people who are talking about this and working toward stopping it. Widespread diagnosis of ADHD in children in North America. The statistics are not as high in the UK, but the numbers are increasing (Coronation Street now being used as a vehicle to socialize us around biomedical understandings of ADHD?). At the end of the day, we need to start asking the question about why it is that we are doping people up and in a sense seemingly trying to wipe away (or make invisible) both old age and childhood.
Researchers have further documented the effects of social inequities such as homelessness, racism, colonialism, homophobia, transphobia and poverty in terms of exacerbating existing distress or creating distress in the first place. So these social inequities, or socially disadvantaged subjectivities intersect with sanism in order to reinforce and reproduce distress which becomes a circular experience of sanism reinforcing stereotypes of people who are marginalized based on class, sexuality, gender, racialization and age.

5. Sanism in Our Communities
Critical Psychiatry
Anti-Psychiatry
Radical Therapists
Psychiatric Survivors
Mad Community
Critical Disability Studies
Centering professionals academics or other allies
Tokenism
Limiting membership
Denying common purposes or goals
Distancing from other marginalized groups
Empire building
If we are going to talk about sanism within mental health services and within the wider public, I think we also need to turn this gaze inward and look at the ways in which sanism may exist within our communties, within the different constituencies that make up Mad Studies.
Once we stop centering the knowledges and praxes of psychiatric survivors and mad-identified people or politicized service users, we reproduce authoritarian relations between mad folks and allies. Once we deny the primacy of lived experience, we lose track of our raison d’etre. And, I would like to suggest here that that is ultimately sanist (I am not saying that allies knowledges are not important, they are crucial even on some levels, but what I am talking about here is what gets centred). Losing that centre (or never having it in the first place) can lead to tokenism. We know how much that is happening already within service user involvement. (Give example of service user researchers/researchers with lived experience – ownership of data, permission to publish??? , labeling of RAs in a way that others). And maybe this shouldn’t just be called tokenism because there is some exploitation taking place here too, it seems.
Limiting membership – having rigid and limiting rules around who can be part of a particular constituency. This may be sanist, particularly it is about denying membership of mad people, or if it is about defining only some experiences as valid for membership and thus denying the importance of other types of experiences.
Denying common goals and purposes – Rather than opening up to working together within mad studies, focusing on the differences and denying common goals within the different constituencies. This is often used as a tactile for one group to deligitimize another group.
Distancing from other marginalized groups – I am thinking here specifically of the ways in which their may be racism or ableism at play within our own communities. In the Toronto based issue of Asylum Magazine last year there was a fantastic article by Rachel Gorman, Onar Usar and others on racism and they developed the Mad People of Colour Manifesto – I urge people to read it (or re-read it) because it is so vital in understanding how we reinforce sanism through racism (because of the ways the two already intersect and inform each other, and mutually constitute each other). This is a call for real Solidarity, and understanding no matter how painful that may be, how we may harm members of our communities – and to stop doing it! – whether that is based on racism or ableism or other social constructs.
Empire Building – this is really a caution about the ways in which some groups may try to dominate over others, and how some critiques may try to force a hierarchy. Do we want to replace biomedical psychiatry with another paternalistic and dominating system? I don’t think so. Again, for me this connects with the importance of centering the analyses that are derived from lived experience, so as to avoid tokenism, exploitation, and domination from within…

6. Anti-Sanist Praxis Alternatives to biomedicalism
Participatory practice
Respect for experiences
Deconstructing ‘normalcy’
Widening and socially reconstructing what constitutes human behaviour, thoughts and feelings
Attention to social aspects of distress, including child abuse and other forms of violence and trauma
Allowing people to have their own understandings of their experiences and to determine their life course
So when I talk about anti-sanist praxis, I am talking about our practice, and the thought that informs our practice, whether that practice is as a radical professional, mad academic, an activist, or a mainstream mental health worker or policy maker. What does it mean NOT to be sanist? To teach anti-sanist practice is to go well beyond anti-stigma education or campaigns, because it digs deep into how we view each other in the world, and what paradigms we follow in understanding or supporting each other. Here are some ideas: (listed on the slide)

7. Questions?