Monday, 24 March 2014

I Recorded a Podcast on Asylums for The Ontological Geek

I was a guest on the Ontological Geek's second podcast, which is posted here. I had a really great time recording it with Oscar, Aaron and my fellow guest Rowan and I think we covered a lot of interesting ground. Especially the bit about Zuma's Revenge. The lead topic for the episode is the depiction of asylums in games - a topic I will be writing about in more detail myself sooner or later - and so should be of interest to readers of this blog. I would like to thank Aaron and Oscar for inviting me to join them and especially Oscar for doing all the hard work of editing and in Aaron's case staying up til four in the morning to talk to us Europeans.

One of the things that became really clear to me during the course of the discussion, or rather was reiterated for me, was how crucial it is to avoid one-size-fits-all thinking when it comes to mental health issues. Despite the fact that they are both covered under the aegis of psychiatry and neuroscience, and are both often defined with recourse to the DSM, I think that it is clear to say that mine and Rowan's conditions (for want of a better word) affect us and our lives in very different manners. As such our fears and expectations of, as well as our hopes and requirements from, the mental health system are necessarily different in many respects and negotiating and teasing apart these differences is vital if we are to ensure that people get the support, help and the respect that they need and are entitled to.

The idea of neurodiversity is a serious one and should be considered in the same way as physical diversity, i.e. as a way of conceptualising that people have a range of different needs, rather than as a buzzword signifying yet another binary division. I discussed an earlier draft of this post with him and Rowan was very clear that he is Aspie and that that is a disability (in that it is something that abled society uses to deny him agency) whereas I view my depression as something closer to a recurring illness, as well as a madness, and that these are both valid ways of approaching these conditions.

Madness as anything undesirable.
We also discussed briefly the sort of people-first language which I delineated in an earlier post and how that is not relevant in the context of autism-as-disability. I had never really intended to cover, or to have this blog as something that could be viewed to cover, autism because I don't think that it can necessarily be described as a mental illness, although even now I’m not sure about this distinction. However, I hadn't really thought of it as a position that needed to be made clear, mainly because my knowledge of autism and of disability is so limited. As such, I still stand by my previous post but with the caveat that I'm talking about one thing but that people may be reading it as about something different. The history of institutionalisation is one that amply illustrates the way in which disparate and discrete categories can become conflated in both the public and the bureaucratic mindset to no-one's advantage.

There is a long history of, as part of and alongside the labelling and diagnostic project of psychiatry, a move towards hierarchising those with mental health problems and setting them against one another. Experiments such as Milton Rokeach's on the 'Three Christs of Ypsilanti', where three men who all believed they were Christ were grouped together and essentially left to fight it out, have entered the folklore of mental illness. A trope which we briefly mentioned in the discussion was that of asylum inmates, who have been clearly coded as mad, who profess that they are sane whilst everyone around them is not. Whilst this is sometimes done in order to present the argument that 'maybe everyone is really insane' it just as often serves to promote a race amongst these fictional patients toward the heavily normalised (and clearly rewarded, most frequently with freedom) end-state of being sane; a race that it is explicitly suggested is codified as zero-sum: you win it by throwing your fellow competitors under a bus. As with all tropes these ideas bleed through into common parlance and knowledge and are reinforced by then being shown again and again, taking on a truth value quite divorced from the original observation that will have led to the first usage.

Participating in this discussion, and working through the points it raised up, has helped me to come to realise how important it is to resist that, often internalised, competition. (Marketplaces of internalised competition and the damage they do to unity is a key part of feminist theory and I'm somewhat disappointed with myself that I've only just applied it to this situation now.) It has also helped me to understand and contextualise my own reactions to this competition arising in and affecting my life. These include things as simple and hidden as the sense that being on or off drugs, or in or out of therapy are more or less desirable states for any external reason to a person’s own well-being, as well as the more obvious badges of ‘honour’ such as never having been hospitalised.

I want to mention briefly a specific piece of writing by Jordan Erica Webber, in issue 3 of Five out of Ten magazine. I reread it in preparation for the podcast but it has also been playing on my mind in a nagging fashion since I first read it a few months ago and I single it out not to attack the writer but because I think it illustrates perfectly what I have been talking about just now. Webber, who has Asperger's Syndrome, describes discovering something about an important character in Borderlands in what is for the game itself an apparently throwaway aside.
"... we’re using our headsets to abuse the characters rather than each other. In this case, we’re undertaking missions for Patricia Tannis, whom we hate because her mental instability caused her to betray us in the previous game. She deals out our next task with a typically psychotic comment, and the mission description itself – which doesn’t come from her – reads:

How did an insane introvert with Asperger’s manage to survive in Sanctuary?

My body reacts like I’ve seen a horrible accident too far away to intervene."

What is interesting to me is that the exact same feeling of sickness that Webber goes on to describe is what I myself felt reading the article. It feels as if, whilst invoking the psychiatric system she has been a part of since childhood, Webber separates her own condition from a morass of conditions that can be described without much reflection as insanity and which are presented as valid reasons to hate or devalue the experience of a character. It is only when the specific diagnosis is given that she seems to make the leap toward association and wants to elevate the character from stigma and stereotype, ending the article with the note that Tannis is ‘partly unlikable, partly insane, and partly a bit like me.’

I spoke to Webber and she was dismayed to discover that this was what I took away from the piece. On the subject of having a ‘valid reason to hate’ Tannis she remarked that it was the betrayal that she had been referring to and that the the reason for the betrayal is being presented as a valueless aside for imparting extra information relevant to the thrust of the argument. However, I could only read the sentence quoted above as implying the ‘mental instability’ to be a causal factor in the betrayal that heightens rather than lessens the sting of it. In other words, I read it as saying that to be betrayed because of an illness is worse than being betrayed for the sound and logical reasons of the betrayer being a nasty piece of work. This stung because there is a long history of representation of mental illness as a moral failing or as being synonymous with evil or malice that the text, here, seems to me to be uninterested in countering.

Webber was clear that the article was about her internalised feelings of negativity about her own mental illness rather than any attempt to place herself above or to compete with other sufferers and I accept and am happy to stress that. I must also stress that I did enjoy and do recommend the article and its exploration of ambivalence to and acceptance of characters that are imperfect or offensive representations of the labels that have been used to define you. I also think, however, that this is an illustration of the internalised, and therefore often invisible, nature of the competition that I attempted to tease out above - an imposition of hierarchy which I myself have been, and no doubt am still, guilty of. Even the fact that I reacted like that, believing that Webber was until that point putting herself above ‘the typically psychotic’ Tannis is evidence of that.

As is Webber's eventual relationship to Borderlands, my relationship to her article is now ultimately fraught with contradiction. We are both glad for the opportunity to relate and for representation to be at least somewhat advanced, but reminded of the hold that the structures that seek to erase or delegitimise our experience still have. I am glad also that Webber took the time to speak to me about my concerns and to clear up the intention behind the words. Maybe the goal, the escape from the asylum as it is constructed both physically and metaphorically, should not be sanity as such; a badge and with it a special dispensation to join the outside world. Instead we need a meaningful engagement with and discussion of what either madness or neurodiversity, in all of their multifarious forms, might actually be.

Friday, 7 March 2014


The absolute key here is that, when you are talking about real people, especially in reportage or descriptive prose, you talk about the person first. These guidelines for journalists and other media workers from Time to Change are a good resource, especially the Mind Your Language page, but if you take one thing away from this post it should be this: a person who suffers from an illness is not defined by that illness and you have no right to so define them when you refer to them. If an illness or condition or whatever is essential to an article or to a point that is being made then, with their consent, you should describe someone using a formula along the lines of '[person] with [diagnosis]', otherwise, there's just no need to mention it.

Of course, it gets more complicated than that, so I'm going to delineate a little bit my own position and some of the issues around it. But, if you are in any doubt remember that you're talking about people so your default position should be one of respect and compassion. (That goes for all issues of representation and terminology, actually, not just when talking about health issues.)

If you follow me on twitter you may have noticed that in my profile I call myself a 'depressed games blogger', in stark contravention of my advice above. This is partly because it's my space and I can do what I want within it. Part of what I use my twitter account for is to talk about my depression and my games blogging about being depressed so it is a relevant introduction to what you might find in my feed. Bios like that are always invented personalities, highlighting what the (auto)biographer considers relevant and informing the reader as to the implied author for a given body of work. The definition-first convention that has appeared in many social media  profiles is also, I think, part of that process of negotiating the constructed nature of people's online personalities. This is not to say that these constructs are false or artificial either, just that they are in effect an edited highlights package for a particular (implied) audience. By bullet-pointing self-definitions you can unobtrusively set out what sort of person you intend to be within a given online space, in lieu of the visual and social cues that might be available to you in an offline space.

There are for example a number of other mini-bios for myself floating around out there and in the majority of those I don't mention depression because it isn't relevant to what I use those spaces to talk about. Which leads into another important point about self-definition in distributed and discrete spaces; just because you see someone use a term (or allow a term to be used) to describe themselves in one context it doesn't automatically make the term relevant in all contexts.

Mental Health terminology should not be used pejoratively. That really ought to go without saying, but unfortunately it still needs repeating. Terms like 'psycho' and 'schizo' are stigmatising and inaccurate, while even the correct terms, for example schizophrenic, need to be handled with care. This is especially important considering the tendency for people to use those terms within a moral framework; i.e. when discussing criminality and evil or unpleasant acts. Having a mental illness is not a reliable explanation for these acts and as such mental illness diagnoses should not be used as synonyms for them. Similarly, saying someone did something that you dislike because they are 'insane' is damaging because it suggests that the insane are inherently dislikable, whilst simultaneously normalising your own preferences under the banner of 'sanity'.

On the other hand, I'm not sure I agree with the (extreme) position in mental health advocacy and discourse that would like to excise words like 'mad' and 'crazy' from the language completely. That should be at least partly clear from the title of this blog, as well as from the way I talk about those concepts. There are two main reasons for my view on this. The first is that I think the concept of, especially, madness is one that goes beyond the concept of mental health and that to lose it would be to inescapably fall into the diagnostic trap I have talked about elsewhere in this blog. It's not that the diagnosis and categorisation of mental states is a bad way of talking about these concepts, on the contrary, it is just that it should not be the only way. The second reason is more personal, in that I like the explanatory power of the terms; I am sometimes crazy, and I have had days that, objectively, have felt insane.

There is a fine line between stigma and description here, but I think that in this particular case it is a place for negotiation rather than proscription, but I cannot speak for everyone.Recently, Zoya Street asked the following question on twitter:

I think that the responses that he got are instructive and it is worth clicking through to the tweet to see the entire discussion. You can see as well how my gut response changed as the nature of the context in which the word was being used came out. I also think that the term sociopath, similar to the term psychopath which I discussed in a previous post, is a slightly different case to the diagnostic labels I mentioned a few paragraphs ago anyway. As I understand it it is, even more so than most psychiatric labels, a cultural construction for talking about certain types of behaviour and is less likely to be used in a clinical setting than popular culture would have you believe. I still don't think it's healthy to label someone a sociopath just because you don't agree with them or they don't care about you, but it can be useful when you need to talk about emotional response, and there remains a useful fictive power in the idea.

Given that this is my position, I'm not always going to get things right, although I do think carefully about my usage of various terms in my writing. As this is a space where I write both descriptively and polemically I sometimes use constructions that cut close to the bone for emotional or political effect rather than comfort. Provided that the space is one where that sort of use can be reasonably expected, and the clear intent is to challenge rather than uphold stigmatising or offensive power structures then I would argue that this kind of use is legitimate. Again, however, it should not be considered a licence to throw around insults in any given situation or to describe real people in ways that they would not want to be described.

Except, in a blog that deals with fictions and artworks a lot of the time we are not going to be discussing real people, and that again changes the outlook somewhat. For a creator of fictional people the advice remains the same: they should be a person before they are a diagnosis. But when dealing with pre-existing characters, although you may try your best to view them as a person, sometimes they are clearly written only as a diagnosis. In this case, especially if you are focusing on the textual aspects of the character then you may find that you have no choice but to engage with them as the diagnosis. This is, in my opinion, fine as long as you remain aware that you are dealing with a fictional character and that if they are written that one-dimensionally then what they might be able to tell you about real people with the same condition is almost certainly very limited. And if you love that character and want them to be more than they are then my advice: kill that author, get metatextual and start writing fanfiction, even if it's just in your head.