Zebra Rose blogs at KnkStriped, where she received a Top 100 Sex Blogs 2018 New Voices award for her brilliant writing. She posts deliciously hot erotica and as well as introspective essays and her own artwork. You should check out her work, and also follow her on Twitter, @ZebraRoseSub, where she often tweets photos of her beautiful kinky embroidery. She’s an incredible woman who I am honoured to call my friend, and I am incredibly excited to present a guest blog post from her today, all about mental health and disability.
“Pain is in the mind
For that is where the signals go
It doesn’t matter where the damage is
The mind is all we know
Pain cannot be seen
Or heard, or touched, or shared
That doesn’t mean that it’s not real
Or that it isn’t there
I think, therefore I hurt
From outside you might never tell
Just because I don’t look ill
Doesn’t mean I’m well”
I had a conversation with a friend recently, about labels, disability, identity politics and mental health. I might have lectured her a bit (sorry!) on how perception of mental illness as being somehow ‘separate’ or ‘different’ to any other kind of illness, is holding her back from accessing support and adjustments which could help her manage her health. I think the phrase ‘mental illness’ is often unhelpful, setting up a false comparison to ‘physical’ illness and reinforcing prejudice about conditions which lead to cognitive and emotional symptoms.
The body cannot live without the mind. Or rather, the central nervous system, of which the brain is a part. One thing is certain, if you remove someone’s brain from their skull, they will not survive. If you damage part of the brain, cognition, perception and function will be altered. As a species, we know a bit about brain damage and the effects that it has on physicality. We’ve learned from studying dementia, schizophrenia and other conditions, how differences in the underlying structure from the ‘norm’ can affect how people think and feel, perceive and act (ie; ‘personality’). Environment plays a huge part in our thinking, feeling and behaviour. Genetics has a contribution to make – not just heritability but chromosome damage and mutation also, and we’re only just starting to look at the implications of epigenetics as a factor in our lives. The most benign example of the inseparable tangling of mental and physical is being ‘hangry’ – the loss of cognitive ability and emotional regulation that comes from too long an interval since your last meal.
So, mental health has physical factors – such as neurochemistry, neuroconnectivity, gut bacteria, hormones, immune system responses – and environmental factors – work, home, family, weather, to name just a few. The complexity of these combined variables is a huge barrier to understanding and managing mental health difficulties. The old-fashioned theory of mind-body duality persists in many places, causing ‘mental health’ to be seen as something ‘other’ than physical health, and conditioning us to be suspicious or disdainful of the intangible.
The social model of disability characterises systemic barriers, negative attitudes and exclusion by society as the main contributory factor in disabling people. While physical, sensory, intellectual, or psychological variations may cause individual functional limitation or impairments, these do not have to lead to disability unless society fails to take account of and include people regardless of their individual differences.
If we look at this model, rather than the medical one (which is restricted to conditions we understand, can diagnose and can treat, therefore excluding vast numbers of people whose conditions medical science has not yet made sense of), it allows us to provide support on the basis of need, rather than diagnostic criteria.
So when do mental health problems become ‘disability’, and when should it be ‘acceptable’ to invoke the protection of law to access adjustments to help make the best of our lives? When we can see an anomaly on a brain scan or in a blood test? When someone becomes unable to function in the modern high-pressure workplace? When being too depressed to eat becomes starvation? Mental health problems can certainly be as much of a disability as an amputated limb, chronic asthma, impaired sight or hearing, whether the ‘reduced ability’ is an intrinsic factor (medical model) or has been imposed by others (social model).
Many countries have human rights-based laws against discrimination, which include disability as a criteria. In the UK, we have the Equality Act, which specifically refers to ‘mental impairment’ which has a substantial and long-term adverse effect on the person’s ability to carry out normal day to day activities’ as ‘disability.
My friend was reluctant to access support, despite quite clearly having a health condition which severely affects her day to day living. Why? Because being unable to point to ‘physical’ factors for her illness, she was afraid to misappropriate the label of ‘disability,’ and felt uncomfortable about not measuring up to the standard trope of ‘person in a wheelchair’ that media and common imagery have led us to expect of disability. I hope I was able to convince her that there is no question of misappropriation. Disability isn’t a competition or a fixed allocation. If she had learning difficulties, support would (theoretically) be available, as they would if she had epilepsy, or a brain injury or narcolepsy. Doctors may not yet be able to point to a tangible cause of my friend’s mental health difficulties, but those difficulties are real and significant nonetheless. She manages them as best she can but sometimes needs help – just as a person with asthma or diabetes needs assistance in managing their condition.
The idea that having a connective tissue disorder ‘allows’ me to reassure my friend about using the label of disability makes me uncomfortable. Why should my musculoskeletal wobbles give me any more gravitas or authority on the topic than my autism or severe depression? But for some reason, it does – because of that perceived division between ‘mental’ and ‘physical’.
Of course, fitting the legal criteria for disability is only the first part of the story. A right to adjustments to prevent discrimination is of limited value, if those adjustments are simply unavailable due to ignorance, cost, inconvenience or intransigence. This is why I believe it is important to challenge the ‘mental is different to physical’ narrative, to counter stigma about mental health, and to fight for each other’s rights.