On #WorldMentalHealthDay, talking about stigma and internalized ableism

I had a conversation with my (fairly new) therapist recently. I was talking about a situation that had triggered my internalized ableism around my mental health in particular. I used the words internalized ableism. She was confused. Said she understood what internalized ableism is, but didn’t get how it applied in the situation. Turns out she thought of ableism as being about physical disabilities (which I had discussed in therapy before). She said, “Oh, you mean mental health stigma.”

This is the word that is commonly used. Stigma. There are campaigns to end mental health stigma. It is not an inaccurate term, in some ways. Stigma is a real thing, a thing that is studied in psychology and sociology, and that research is useful and important. For example, folks are still using the frameworks laid out in Goffman’s book from the 60s to understand how stigma works with regards to intimate partner violence. I saw a presentation on that at a conference fairly recently. The research on stigma, and the framework that it offers, is probably helpful to a lot of people like my therapist. I get that. This is a framework that helps people understand the experiences and behaviors of folks with potentially concealable stigmas, folks like me. (I am a mentally ill survivor of intimate violence who has multiple chronic illnesses, is autistic and often passes somewhat as nuerotypical, is Jewish but often passes inadvertently as gentile. I am also queer, kinky, poly and trans. And I write dirty books. Lots of potentially concealable stigma there.)

For myself, the stigma framework is not particularly helpful, much of the time. I think and talk about this in terms of oppression. Stigma feels like it barely gets at some of the picture, partly because it ignores structures, but also because it removes responsibility on an interpersonal level, and gives me fewer tools for thinking about internalization and passing. Stigma is more external, and also just seems to kind of float there and belong to nobody and nothing. Oppression, on the other hand, feels more concrete and grounded, and gives me tools for thinking about internalization and passing. Thinking about this in terms of oppression helps me fit my experience into a larger framework that I know well and that I use to understand both the world and myself, and have been using for over 25 years. Thinking about the ways structural oppression of disabled people includes structural oppression of mentally ill people also gives me a broader more complex way to think about ableism, which I find really helpful. I draw connections that I might have missed, if I were just thinking about stigma.

And the thing is, I still really struggle with internalized ableism, particularly around psych disability stuff. I was raised in a family that was full of mental illness and was also incredibly intensely ableist around mental illness. It was one of the most intense forms of oppression that was constantly maintained in my family, on par with the level that my fat family constantly maintained and taught me fat oppression. But, I was politicized around fat oppression in the early 90s, and have been grappling with my internalized fat oppression for about 25 years. My analysis of ableism came later, and I am still doing a lot of unpacking of my internalized shit, especially around psych disability.

 

I keep uncovering new pockets of it, and that is partly because I have spent many years investing in passing as not mentally ill, something I learned to do as a young child. My family taught me to be deeply afraid of a certain level of mental illness, both in myself and in others, and so I learned to mask signs that I might be that kind of “crazy”. Those lessons and the constant reinforcement of them run really deep, and definitely contribute to the hidden pockets of internalized ableism I keep finding.

Ironically, I worked in the trauma field full time for a decade, while being closeted about having PTSD, because there was so much prejudice in my workplace (and the field in general), and folks who were out about being trauma survivors were not trusted in their work or their expertise. While that job helped me access a lot of information about trauma and treatment options, it did not help me grapple with my internalized ableism around my own mental illness; it reinforced it. One of the main reasons I left the field three years ago was because I could not tolerate that particular closet anymore, not while working in a field that was trauma-focused.

So, I have a lot of unpacking left to do. And my experiences of unpacking other forms of internalized oppression helps me do that. It doesn’t make it easy, but it makes it a bit easier, because I have ways to notice and discern oppression at work, tools and practices that I can apply.

And I need to unpack my internalized ableism, because it has been a destructive force in my life. Internalized ableism made it hard for me to try psych medications. Internalized ableism made it hard for me to accept and recognize my own mental health crisis. Internalized ableism made it hard for me to leave an abusive relationship. Internalized ableism made it hard for me to seek psych treatment when I needed it. Internalized ableism has created so many obstacles for me, those are just the starkest largest examples. There are also the daily struggles, where part of what I manage, when I work toward taking care of myself and managing my PTSD, is my own internalized shit around psych disability. My fear and my judgment and my shame are part of this struggle, and they are not easy to disrupt and unlearn. I’m working on it. Just like managing my PTSD, unpacking my internalized ableism is a lifelong project, that has rougher and smoother patches.

One of the things that helps me is connections and relationships with other mentally ill people, particularly folks who are politicized around ableism. It also helps me to read #ownvoices work by other mentally ill people, particularly work that is interested in challenging ableism. Work like RB Lemberg’s Geometries of Belonging (which I wrote about at length), an anti-cure narrative that centers a character who is mentally ill, and a healer, and invested in the consent of those he heals. I loved this story for so many reasons, and one of the biggest ones is that Parét is clearly and openly mentally ill, and taking action in his life to avert war, honor his D/s relationship, and heal those who wish for healing. I need stories like this, where characters are mentally ill and doing things, taking care of themselves, caring for others, taking action in the world, seeking their desires. I am excited for Lemberg’s upcoming novel The Upholding, which also centers Parét, at an earlier time in his life when his mental illness is particularly intense. In it, he works together with other mentally ill queers to save the world.

It is also helping me to write mentally ill characters. My current work in progress, Shocking Violet, is a queer kinky polyamorous romance novel which centers multiple characters with PTSD, many of whom are disabled in other ways as well. Working on this book (which is not about mental illness, but centers mentally ill characters doing activism and building relationships with each other) has helped me ground in daily reality of managing trauma symptoms, and the diversity of ways that we approach this. This work, honing my intent to write a story that feels real and is hopeful, integrating and using my deep knowledge about trauma both from my own experience and my career in the field, has a continual impact on me personally. It is a practice that is about honoring myself, and challenging my own internalized ableism, and I am grateful for the ways that it is rippling out in my life.