Background and context
Ethics and values: autonomy - beneficence; utility - justice
Convention on the Rights of Persons with Disabilities
Perspective of the Disability Communityexpectations: http://en.wikipedia.org/wiki/Rosenthal_effect
beneficence (decisionally impaired) v autonomy
duty to step aside v duty to assist
common good v personal responsibility
assumptions about rationality
"We rely heavily on languages to make sense of our world. The language we use reflects as well as encodes the values, beliefs and prejudices of the culture or society to which we belong. In other words, to a large extent, our language is the cultural filter through which we see or construct and reinforce what to us is "real" or "normal".
Language not only reflects the discriminatory values and practices of our society, but also maintains them."
extract from Caras presentation to World Psychiatric Association, 2002
very brief history
Critcal analysis, listening, speaking, writing
Words that have been co-opted - alternatives, recovery, transformation, wellness, even consumer (consumer/family designation)
Words are political and rhetorical - examples:
suffer - dehumanises the person and emphasises powerlessness - http://www.policy.unsw.edu.au/policy/disdiscr.htm
prejudice and discrimination - http://www.peoplewho.org/readingroom/caras.discrimination.htm
stigma - campaigns increase demand on an already broken and understaffed system, result in California of dedicated dollars and the inevitable challenge to the restrictions on the funding; 'anti' embeds the idea argued against, shifts focus to individual thus ignoring system and community flaws - believing that "stigma" is a primary barrier to care allows us to not evaluate the care itself and the reasons people might have for choosing to avoid it, choosing the streets over the meds, choosing jails over the wards.
protection - "There is nothing historically and culturally to suggest that human beings must be protected from themselves and from each other in the ways bureaucracies in the United States have found to be most expedient." (De Danaan)
carve-out - every time the distinction between physical and mental health is underscored, the holistic seam unravels. Making the distinction invites comparison and renders mental health inferior. It helps to permit shame and shaming. It can allow the separating off of people who experience mood swings, fear, voices and visions - separating mental health from health, on the grounds only by carve-out will mental health be able to compete for funding, perpetuates the segregation and stigmatization of users of public mental health services. Inclusion, motivation, and good faith are key themes in the ongoing tension between order, freedom, beneficence, and autonomy in the ongoing public mental health philosophic dialogue.
human rights , mental health courts
physical and mental health - frames health as divided
common good v personal responsibility
'the' as in 'the mentally ill - ignores individuality, personhood by clustering only around deficit
Words are (not) scientific- examples:
need - http://peoplewho.org/documents/neeadandprevalence.htm
"I am uncomfortable with the presentation of incidence and prevalence data without sources which dispute the conventional wisdom that such a vast proportion of the population has mental illness. Incidence and prevalence could be one of the critical debate issues. Debaters need to be aware of the how incidence and prevalence data are created and manipulated to support an industry, a market. I think the entire methodology is specious. Do they follow standard epidemiological processes? I think they make huge assumptions about undiagnosed illness."
more on need
"Evidence-based policy insists on describing, compiling and analyzing past experience what has happened, with which resources, to whom, with which outcome but it does so, necessarily, by selecting and narrowing the basis of what is considered to be evidence. Mainly it is what can be counted and, therefore, what can be measured and managed. In throwing its evidence-based net as widely as possible, this kind of policy insists that everything can be compared, while carefully selecting the units of comparison. Standardization is a practice which strips away local contingencies and peculiarities. The results are considered more objective."
Hlega Nowotny, How Many Policy Rooms are There?, Science, Technology, and Human Values, 32:4, July:2007, p 481
question order skews results - http://www.aoapomp.net/pomp5/EWsurvey.pdf
best practices -
"Depending on which indicators one takes and what is defined as best, the results are bound to be different." Nowotny, p 483
consensus (best practice) v truth (real
medications tested for short times in control situations that don't replicate how they are actually used; data on adverse effects and deaths inadequately noted
treatment - frequent use innoculates citizenry against freedom depriving practices (De Danaan)
safe - depends on perspective
Words have layers of meaning
|the mentally ill||people who cope with mood swings, fear, voices and visions|
|brain disease||problems in living|
|assisted||forced if unwilling to be voluntary|
|evidence-based, best practices, needs, prevalence||childhood abuse, trauma, community|
|we can all agree ...||excludes users and survivors|
|mental health courts||discrimination on the basis of disability|
|we can all agree||Nothing About Me Without Me|
|parity||funds for involuntary treatment|