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Sanism, ‘mental health’ and social work/education: A review and call to action
Abstract
Sanism is a devastating form of oppression, often leading to negative stereotyping or arguments that individuals with 'mental health' histories are not fit to study social work. However, the term sanism is rarely used, understood, or interrogated in the social work academy, even in anti-oppressive spaces. Indeed, social work has been so loyal to the medical model that sanist aggressions, such as pathologizing, labelling, exclusion, and dismissal have become a 'normal' part of professional practice and education. We query the moral integrity of a profession that at its foundational core could play a role in such a discriminatory tactic as sanism. We wonder what the effect of this has been on social work and its education. We ask, who has been excluded, what has been silenced or denied because of the privileging of medical conceptualizations of madness, and how can we work toward anti-sanist social work today? In this paper we provide an overview of sanism. We offer a more critical review of the literature on 'mental health' and social work. We report on our anti-sanist participatory pilot research, and aligned with current Canadian rights work, we call for action with respect to how social workers theorize, research, and respond to madness now.
... This discursive power has also resulted in oppressive practices and ignorance of survival knowledge (Le Francois et al. 2013). Drawing on the works of Chamberlin (e.g., 1979), Poole et al. (2012) define this discursive power as 'sanism'. Sanism includes expectations and professional judgements that people with mental illness are incompetent, constantly in need of supervision and assistance, unpredictable, violent and irrational. ...
... Sanism includes expectations and professional judgements that people with mental illness are incompetent, constantly in need of supervision and assistance, unpredictable, violent and irrational. In addition, sanism is seldom overt but commonly suffered as multiple, everyday experiences of insults, injustices and indignities (Poole et al. 2012) and/or manifested as fear, social distancing, disgust and avoidance (Overton and Medina 2008). These practices of sanism also spill over on family members of people with SMI ( Van der Sanden et al. 2013). ...
... Regardless of the age of the mothers we interviewed, they all described in different ways how the everyday discrimination of people with mental illness, which Poole et al. (2012) define as sanism, also has spilled over into their lives. This became evident when their children firstly were diagnosed with a mental illness. ...
This study explores experiences of mothers in Sweden who care for their adult children suffering from severe mental illness.
Using 15 interviews with mothers from 40 to 80 years old, the article examines how predominant professional knowledge
and sanism constructs the mothers and their children as deviant and what counterstrategies the mothers develop as a response
to these experiences of discrimination. The findings show that the mothers’ experiences are characterized by endless confrontations
with negative attitudes and comments that have forced them to go through painful and prolonged processes of self-accusations for not having given enough love, care, support and help in different stages of their children’s life. But the mothers’ experiences also reveal important aspects of changes over the life span. As the mothers are ageing, the relationship between them and their children becomes more reciprocal and the ill child may even take the role as family carer.
... In terms of advancing ethical practices, we encourage occupational therapists to reflexively examine the attitudes, beliefs, and prejudices that tacitly shape practice contexts, and that may create obstacles to the provision of services that convey dignity and respect for our clients. This paper briefly introduces the concept of sanism, positing it as a matter of social justice-and thereby an important consideration for ethical practice-and echoes calls for a reflexive shift in our attention, attitudes and language regarding sanism, as has been advocated in fields such as social work (Holley et al., 2012;Poole et al., 2012, Poole & Jivrav, 2015, psychiatry (Large & Ryan, 2012), and disability rights law (Perlin, 2000(Perlin, , 2003. ...
... Sanism has been conceptualized as "an irrational prejudice of the same quality and character of other irrational prejudices that cause (and are reflected in) prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry" (Perlin, 2003, p. 536). Sanism is largely based on negative stereotype, myth, hyper-unusual events portrayed in the media, and popular misconceptions that reinforce pervasive negative prejudices (Perlin, 2003;Poole et al., 2012). Sanism "is conceptually dependent on, and reinforces the notion that [persons with mental health diagnoses] are fundamentally different from their 'sane' counterparts" (LeBlanc & Kinsella, 2016, p. 63), or are, in some way, "others." ...
... Sanism may take the form of blatant discrimination, for instance when health concerns-even those entirely unrelated to one's mental health-are dismissed or seen as being "in one's head." However, sanism is commonly expressed in the form of microaggressions (Poole et al., 2012;Chamberlin, 1990), which are defined as "everyday verbal, nonverbal, and environmental slights, snubs, or insults […] that communicate hostile, derogatory, or negative messages" (Sue, 2010, p. 3). Although sanist microaggressions may be communicated unintentionally or without malicious intent, and may seem insignificant when viewed as individual events, they typically occur on a regular and recurring basis, and their effects can be cumulative. ...
... After outlining our theoretical orientation and the literature that informs our work as a whole, we narrate our initial findings concerning the experiences of mad students in social work classrooms that claim to work from an AOP perspective. With a nod to the burgeoning field of Mad Studies (LeFrancois, Menzies, & Reaume, 2013) and our recent work on sanism 2 in social work (Poole et al., 2012), we outline where the inquiry has taken us and what needs to happen next in anti-oppressive social work education. ...
... From the beginning, we set our inquiry apart from a traditional, pathologizing orientation to "mental health and illness." Indeed, as we detail elsewhere (Poole et al. 2012), our inquiry has always been informed by AOP, intersectionality, and the social model of disability. According to Healy (2005), AOP is an approach that includes but is not limited to feminist and anti-racist social work. ...
... Mad people see madness not necessarily as a problem that needs treatment and but as a difference to be explored: "I don't need fixing, I need you to fix your attitude towards my difference and support me." 2 Sanism (or mentalism) is the subjugation of people who have received mental health diagnoses or treatment. Like racism, sanism may result in blatant discrimination, but will be most commonly expressed in insults and indignities known as micro-aggressions (see Poole et al., 2012). theorist Kimberlé Williams Crenshaw (1989) who, while thinking through how gender and oppression interact in Black women's lives, wrote: ...
In this article, we introduce a pilot project at a Canadian school of social work, a project that asked whether this expressly anti-oppressive school was really open to Mad students (or those with mental health issues). Using principles of community-based participatory research, we interviewed eight students who identified as having had experiences with mental health issues and asked them to speak about their experiences in the classroom. Working with the data, we co-voiced next steps for pedagogy, research, and action around madness and social work.
... The way in which this epistemic injustice has been conceptualized by Mad Studies has been through Sanism. Sanism is understood as a system of oppression that is expressed on different levels in our society (POOLE et al., 2012). On one hand, it explains the mechanisms of discrimination and the set of prejudices and stereotypes associated with people who have been labeled with psychiatric diagnoses. ...
This article analyzes the emergence of Mad Studies as a research tradition that proposes critical theories and alternative methodologies in the production of knowledge from people who have been labeled with psychiatric diagnoses. For Mad Studies, the meanings surrounding madness express the relationship of forces and the forms of oppression that constitute the field of Mental Health, therefore, they emphasize the political nature of the investigations that are developed in this area and sustain a questioning of the claim of objectivity and neutrality of the biomedical model. In this framework, through a review of the academic literature and Netnographic as a research method, the growing role of communities that have received mental health care in Latin America to express their narratives in the public sphere is described, positioning themselves as agents of knowledge and political actors. Around these new grammars, Latin American Mad Studies is constituted as a research perspective towards the configuration of other ways of inhabiting madness and articulating their struggles for social emancipation in the contemporary regional scenario.
... La manera en que ha sido conceptualizada esta injusticia epistémica por parte de los Estudios Locos ha sido a través del cuerdismo. El cuerdismo se comprende como un sistema de opresión que se expresa en distintos niveles en nuestra sociedad (POOLE et al., 2012). Por un lado, explica los mecanismos de discriminación y el conjunto de prejuicios y estereotipos asociados a las personas que han sido etiquetadas con diagnósticos psiquiátricos. ...
El presente artículo analiza la emergencia de los Estudios Locos como tradición investigativa que propone teorías críticas y metodologías alternativas en la producción de saberes desde las personas que han sido etiquetadas con diagnósticos psiquiátricos. Para los Estudios Locos, los significados en torno a la locura expresan la relación de fuerzas y las formas de opresión que constituyen el campo de la salud mental, por lo tanto, enfatizan el carácter político de las investigaciones que se desarrollan en este ámbito y sostienen un cuestionamiento a la pretensión de objetividad y neutralidad del modelo biomédico. En este marco, mediante una revisión de la literatura académica y la netnografía como método de investigación, se describe el creciente protagonismo de las comunidades que han recibido atención de salud mental en América Latina para expresar sus narrativas en la esfera pública, situándose como agentes de conocimientos y actores políticos. En torno a estas nuevas gramáticas, los Estudios Locos Latinoamericanos se constituyen como una perspectiva de investigación hacia la configuración de otros modos de habitar la locura y articular sus luchas de emancipación social en el escenario regional contemporáneo.
... 'Troubled teens' are constructed through the converging social marginalisations of those labelled psychologically or behaviourally 'troubled' and those considered to be young, that is, 'teens'. In Mad Studies, 'sanism' is a term used to describe interpersonal discrimination as well as broader cultural, social and systematic subjugation of psychiatrised people (Perlin, 2013;Poole et al., 2012). Adultism refers to the social oppression of young people and children and the socio-cultural centring of adulthood (LeFrançois and Coppock, 2014). ...
In the United States, thousands of young people reside in private schools aimed at reforming ‘troubled teens’. These ‘troubled teens’ are young people who are considered to have emotional, behavioural and/or substance misuse problems. Therapeutic boarding schools are programmes that combine educational classes and group therapy in a self-contained residential facility that runs year-round. Case study interviews with former US-based therapeutic boarding school students demonstrate the role of sanism, adultism and epistemic injustice in constructing and regulating the ‘troubled teen’. The schools’ strict structure and surveillance culture could not override students will and their ability to find means to resist. The article’s central aim is to centre the perspectives of former students and critique social control of young people in therapeutic boarding schools.
... En este sentido, las terapeutas feministas compartían el discurso dominante de rechazo hacia la locura, bajo el predominio del "cuerdismo" (que Chamberlin denominó "mentalismo"), como forma de opresión. Al respecto, el cuerdismo es un conjunto de creencias que legitiman la intervención profesional en el sistema de salud mental, situando a las personas "locas" en espacios de silencio, conformidad y de sentirse "inferior" (Poole, 2012). Chamberlin (1994) sostuvo que esta perspectiva autoritaria constituía un desprecio hacia las mujeres sobrevivientes de la psiquiatría que habían luchado por su libertad e independencia contra el poder de la psiquiatría hegemónica y daba cuenta de la profundidad de la opresión hacia las mujeres "locas". ...
El presente artículo analiza el contexto político y cultural en que emerge el movimiento de ex pacientes o sobrevivientes de la psiquiatría en torno a la promesa emancipadora del feminismo de segunda ola en el campo de la locura. Posteriormente, desarrolla un cuestionamiento hacia las perspectivas reformistas de trato igualitario que se expresan en el ámbito de la terapia feminista como dispositivo neoliberal que ofrece soluciones individuales en el mercado terapéutico. Finalmente, se describen las contribuciones del “feminismo loco” para enriquecer los planteamientos de justicia de género en la salud mental contemporánea, en base al apoyo mutuo entre mujeres y la recuperación del activismo feminista como expresión de bienestar y autocuidado.
... Drawing explicit connections between mental health practices and social justice stands in contrast to the dominant and mainstream view of psychiatric services, which positions the mental health system as a context in which clinical issues are assessed and addressed by 'expert' medical professionals, based on objective facts about 'normal' and 'abnormal' human experience (Gambrill 2014). Poole et al. (2012) argue that the invisibilisation of mental health concerns within anti-oppressive spaces is informed by 'sanism'-the systematic exclusion of the voices of people who have been labelled with a mental health disorder, and the widespread acceptance of medical understandings of distress and 'madness', centred on diagnosing dysfunctions within individuals. In contrast, critical perspectives on mental illness challenge the idea that mental illness resides purely within a person's mind, at the level of neurochemicals. ...
The activist notion, ‘nothing about us, without us’, is a cornerstone critique of the narrow, individualising, and pathologising ideas about distress that are contained within biomedical constructions of ‘mental illness’. The inclusion of the experiential knowledge of people who have been on the receiving end of mental health services within mental health research has received widespread praise as an empowering and inclusive alternative to medical paternalism. However, the use of ‘lived experience’ narratives should not be seen as a panacea for socially unjust outcomes, and this chapter explores the limits of ‘participation’ in mental health research and educational contexts. A major hazard is the worrying tendency for the voices of service users to be co-opted by conventional professional agenda, reducing their radical and politicising potential.
... Furthermore, the very act of judging and labelling their experience as abnormal may produce shame. As the children's selfunderstandings were limited within the confines of psychiatric discourse, there is no way of knowing how much of their distress was caused by the experience of sanism (Perlin, 2004, 2003; Poole et al. 2012) and the loss of control associated with being labelled and treated as mentally ill. According to Derrida (1988, 1982, 1976), language fails to capture and describe the infinite realm of possible human experience, as it is too limited to portray the complexities of the self, the body and desire. ...
A queer theory informed analysis of the findings of an ethnographic study detailing the experiences of children in relation to diagnosis within a psychiatric hospital is provided in this article. The perspective of the diagnosing psychiatrist in relation to symptoms and diagnoses is compared to the children's understandings, along with an analysis of the consequences of the normative approach inherent to bio-medical psychiatrization. The dehumanising process of psychiatric diagnosis, which strips people of their dignity, leads to what we have termed psychiatrised abjection. The act of diagnosis is shown not only to categorize, but also to 'other', to make abject and to make queer.
Background
People living with HIV (PLWH) who use drugs in harmful amounts, types and/or modes of consumption (e.g., drugs from unregulated sources) experience barriers to accessing conventional healthcare services. The overall experience of PLWH who use drugs while admitted to hospital directly influences their treatment engagement. Members of interdisciplinary care teams within hospitals can shape the experiences of PLWH who use drugs by virtue of direct practice. However, little discussion in the research literature articulates the self-reported experiences of PLWH who use drugs specific to their time spent in hospital
Methods
Semi-structured interviews were conducted with participants who: i) self-reported HIV ii) had a hospital admission in the past year; and iii) used drugs at time of admission. A structuration theory-guided thematic analysis was used to understand the beliefs and practices identified by participants that affect their hospital admission experience
Results
Participants (n = 22) identified two sets of rules that influence their hospital admission; personal rules, used for navigating the admission, and hospital rules (i.e., “their rules”). Participants indicated that healthcare providers’ use of a constructed difficult patient identity shaped their experiences while admitted as hospital in-patients
Conclusion
Healthcare equity is not possible when all people are treated the same; social practices occurring during a hospital admission privilege some (e.g., healthcare providers) and not others (e.g., PLWH who use drugs) and will continue to dictate the hospital admission experience of PLWH who use drugs. Hospitalized PLWH who use drugs can change their actions, ergo altering social practices between themselves and health care providers leading to a positive effect on the overall hospital admission experience. However, barriers experienced by PLWH who use drugs limit the degree to which they can implement effective positive change.
People who have mental health diagnoses are often subject to sanist microaggressions in which pejorative terms to describe mental illness are used to represent that which is discreditable. Such microaggressions reflect and perpetrate stigma against severe mental illness, often held unconsciously as implicit bias. In this article, I examine the sanist attitudes that underlie sanist microaggressions, analyzing some of the cognitive biases that support mental illness stigma. Then I consider what responsibility we have with respect to microaggressions. I argue that all people share in a collective responsibility to engage in acts of epistemic resistance that challenge sanist attitudes so that it is easier for bystanders who witness microaggressions, and targets of microaggressions in particular, to identify microaggressions and to point out biased behavior. The act of pointing out bias is best understood as an act of epistemic resistance that is more effective and meaningful in the context of other acts of epistemic resistance. Ultimately, whether to point out bias is an individual decision that one must make after weighing the risks involved; engaging in a range of acts of epistemic resistance, on the other hand, is a moral responsibility everyone shares.
The aim of this chapter is to contribute to addressing issues of access and equity in social work education for people with mental health disabilities. The objective is to carefully consider the introduction of inherent requirements in universities, and particularly in relation to social work education, in Australia. A targeted review of relevant literature including legislation, policy, and practice standards frameworks identifies the parameters of inherent requirements and possible areas of discrimination. Consideration of the use of inherent requirements in social work education is from a human rights social justice perspective that acknowledges the strength and resources of people and communities and actively advocates for the protection of disability rights.
The use of simulated service users or ‘clients’ in social work education has lacked critical analysis in research and teaching. What is often overlooked are attentions to how constituting essentialised clients and simulating them advances historically entrenched forms of injustice in social work education and practice. This gap in research and literature in social work education should signal to the field an issue with the pervasiveness of the hegemonies of biomedical disciplinary knowledge in social work. This gap should also highlight the need to ask how, why and to what end is critical analysis an ongoing omission from a pedagogical practice that is proclaimed as very central and essential to social work practice skills education. This article explores some of these gaps in the literature within the social, historical, and political contexts that shape how neoliberalism/colonialism influence the perpetuation of these omissions in social work education. Specifically, this article explores how the use of client simulation in social work works to reproduce ideas of an innocent professional self and a pathological Other, while ejecting or separating social and political analyses of social problems, marginalising and obscuring critical perspectives, and forgoing attentions to social justice and epistemological nuances within social work.
The aim of this chapter is to contribute to addressing issues of access and equity in social work education for people with mental health disabilities. The objective is to carefully consider the introduction of inherent requirements in universities, and particularly in relation to social work education, in Australia. A targeted review of relevant literature including legislation, policy, and practice standards frameworks identifies the parameters of inherent requirements and possible areas of discrimination. Consideration of the use of inherent requirements in social work education is from a human rights social justice perspective that acknowledges the strength and resources of people and communities and actively advocates for the protection of disability rights.
“Troubled‐persons industries” have been created to ensure that troubled people (to themselves or others) are brought into “the stream of ‘adjusted citizens’” (Gusfield, 1989, p. 433). At the crossroad is Mad Studies. This article seeks to resolve the inner tension felt by one troubled‐persons‐industry professional, as he reflects on what he and higher education professions can learn from Mad Studies.
In this paper, we explore ways in which social work educators
might respond to students who report that mental health issues
underlie their difficulty in meeting core competencies, or otherwise
use the language of mental health to describe their struggles
to succeed in social work programs. We discuss various trends in
policy responses in Canada, the US, the UK, and Ireland. While
there are general policy trends, it is clear that responding to these
kinds of issues requires the development of highly flexible and
situated policy processes that can respond to student realities,
concern for students’ rights and privacy, and an awareness of
potential discrimination against students. These processes also
need to meet the specificities of practicums, particular institutional
policies, the mandates of relevant professional bodies, and the
precise local legislative framework that shapes these situations.
Given these varying contexts, in this conceptual paper, we used
a framework on disability that is informed by critical theory to
engage existing school policies and propose a set of reflective
questions that can guide schools of social work to create an overall
responsive environment. These reflective questions are designed
to help social work educators balance the rights and needs of
students with the professional and institutional demands that
students meet core competencies in their education.
This report presents the findings of a study undertaken to examine the health impacts of precarious work on racialized immigrant women. There is an emerging consensus that precarious working conditions have become a determinant of poor health. The study seeks to understand this relationship in the case of racialized immigrant and refugee women who make up a growing proportion of those in precarious employment
Much existing research on ableism focuses on individuals whose disabilities are more apparent to others. Using a phenomenological approach, this study interviewed 14 participants, exploring how people with “invisible” physical disabilities experience ableism. In addition to multiple examples of microaggressions, emergent themes included the policing of bodies, tension in roles, a desire for justice, and internalized ableism. Many of the participants recounted experiences of having bodies and actions policed by others, and several struggled with their role in educating others about policies, needs, and accommodations. The theme of desire for justice included frustration at having to educate others, the energy this education took, and the desire for overarching justice regarding ableism. The theme of internalized ableism reflected both explicit experiences of individuals sharing their self-judgment and ableist statements during interviews. These findings indicate the need for a more nuanced understanding by social workers of how ableism is experienced by those with invisible disabilities as well as additional research on how to support these members of the community.
This literature review engages mental illness in adult education (AE) to locate what research exists and to suggest a research agenda moving forward. This structured review located research related to mental health issues published in the conference proceedings of the Canadian Association for the Study of Adult Education (CASAE) and the Adult Education Research Conference (AERC) and fourteen international AE journals. AE scholarship focused on identity construction, andragogy and classroom issues, public pedagogy, popular education and arts-based education, contesting psychiatric knowledge and sanism, and workplace.
This chapter explores two cases of bullying at UK universities, one involving a student, the other, a faculty member; in one case, the victim’s response to bullying having been labeled “mentally ill” and in the other, the bullying itself arising as a consequence of such a label. Using institutional ethnography and discourse analysis, the authors analyze the experiences and related texts and show how the reporting of bullying and harassment is reframed as incompetency and emotional vulnerability. Correspondingly, these similar and yet opposing cases are compared, and in the process, key discourses at play within the broader context of UK higher education are unveiled.
A critique of regulation in the helping professions, this chapter is a riveting investigation into the everyday practices by which able nurses are declared “unfit to practice.” The researchers trace the construction of two nurses as “unfit,” showing the conflation of “mental illness” with incompetence. In one of the cases, they additionally show how anti-Black racist prejudices became de-raced and reinscribed as “incompetence” because of “mental illness.”
In this chapter we present an overview of qualitative research in the mental health field. We provide an historical account of the vital role that qualitative methods have played in the development of theoretical and practice approaches of psychiatry, and their current use in contemporary mental health practice. We consider how different approaches to qualitative research are used to advance knowledge and understanding of mental health, mental illness, and related services and systems, as well as the contributions of qualitative research to the mental health field. We then provide a synthesis of evidence derived from qualitative research within the mental health sector, spanning four key areas: (1) recovery, (2) stigma, (3) employment, and (4) housing. We conclude this chapter with a review of the ongoing challenges facing qualitative researchers in this area.
In South Africa, careless implementation of child psychiatry's biomedical model of ‘mental disorder’ could stigmatise children and youth who have been made vulnerable by the lingering effects of apartheid — poverty and malnutrition, violence and abuse, and the HIV/AIDS pandemic. A focus on DSM-5 category changes — regarding post-traumatic stress disorder and ADHD — demonstrates that these psychiatric labels are impracticable and irrelevant in a post-colonial developing country, where mental health care is delivered in the context of scarce services and unequal access. A social constructivist perspective enables us to broaden policy decisions and suggest directions for research.
We reflect on our embodied experiences of living out the various layers of anti-Black racism in
our daily lives. Our starting point is our powerful gut reaction to the experiences of Black youth
in a research study exploring youth violence and healing in Canada. We were awed by the
intensity of anti-Black racism that youth wrestle with and their creative strategies of healing from
its violence. As researchers, we were stunned into reflexive realization that we were inextricably
woven into the tangled webs of anti-Black racism even as we were struggling to disentangle
ourselves and break free. We were astounded by how the tensions that grip Black youth were our
own tensions as well. In this paper, we ground ourselves in these tensions that we harbour deep
within our bodies as we explore the theoretical contours of anti-oppression. The stories we tell
emerge from our stepping back in critical self-reflection and following our powerful gut feelings
to their cultural and structural roots. We seek to critically engage our own anti-oppressive
practices in order to open up transformative possibilities for ourselves and those we work with.
Keywords: Anti-Black racism, oppression, anti-oppressive practice, youth violence
For many years, institutional psychiatry was a major tool in the suppression of political dissent. Moreover, it appears painfully clear that, while the worst excesses of the past have mostly disappeared, the problem is not limited to the pages of history. What is more, the revelations of the worst of these abuses (and the concomitant rectification of many of them) may, paradoxically, have created the false illusion that all the major problems attendant to questions of institutional treatment and conditions in these nations have been solved. This is decidedly not so. Remarkably, the issue of the human rights of persons with mental disabilities had been ignored for decades by the international agencies vested with the protection of human rights on a global scale. Within the legal literature, it appears that the first time disability rights were conceptualized as a human rights issue was as recently as 1993 when, in a groundbreaking article, Eric Rosenthal and Leonard Rubenstein first applied international human rights principles to the institutionalization of people with mental disabilities. For people with mental disabilities, in particular, the development of human rights protections may be even more significant than for people with other disabilities. Like people with other disabilities, people with mental disabilities face degradation, stigmatization, and discrimination throughout the world today. But unlike people with other disabilities, many people with mental disabilities are routinely confined, against their will, in institutions, and deprived of their freedom, dignity, and basic human rights. People with mental disabilities who are fortunate enough to live outside of institutions often remain imprisoned by the social isolation they experience, often from their own families. They are not included in educational programs, and they face attitudinal barriers to employment because they have not received the education and training needed to obtain employment or because of discrimination based on unsubstantiated fears and prejudice. Only recently have disability discrimination laws and policies in the United States and elsewhere focused on changing such attitudes and promoting the integration of people with disabilities into our schools, neighborhoods, and workplaces. The question remains, however: to what extent has institutional, state-sponsored psychiatry been used as a tool of political suppression, and what are the implications of this pattern and practice? After an Introductory section (Part I), I discuss, in Part II, the first revelations of the dehumanization inflicted on persons with mental disabilities, primarily (but not exclusively) in Soviet Bloc nations. In Part III, I discuss developments after these revelations were publicized. In Part IV, I weigh the extent to which the post-revelation reforms have been effective and meaningful. In Part V, I explain the meanings of sanism and pretextuality, and discuss how they relate to the topic at hand. Then, in Part VI, I raise questions that have not yet been answered, and that, I believe, should help set the research agendas of those thinking about these important issues. © 2006, Cambridge University Press and The Faculty of Law, The Hebrew University of Jerusalem. All rights reserved.
In this article, the authors discuss the importance of maintaining admissions standards in schools of social work despite a decline in enrollment during the past decade. The implementation of new, more stringent admissions criteria in one school of social work is examined. The results of the new requirements showed that students with bachelor of social work degrees had significantly higher undergraduate grade point averages and significantly lower Graduate Record Examinations scores than did applicants without bachelor of social work degrees. Implications for the advanced-standing program are discussed. The reactions of faculty, students, and professionals in the community to the more stringent admissions policy are described, as well as the impact of these requirements on minority enrollment and recruitment.
Distinguishes between recovery and rehabilitation. It is argued that psychiatrically disabled adults do not get rehabilitated, but rather they recover a new and valued sense of self and of purpose. Through the recovery process they become active and responsible participants in their own rehabilitation project. The experiences of recovery as lived by a physically disabled man and a psychiatrically disabled woman are discussed. Recommendations for creating rehabilitation environments that facilitate the recovery process are given. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
The concept of recovery has emerged as a significant paradigm in the field of public mental health services. This paper outlines how the concept is being implemented in the policies and practices of men- tal health systems in the United States. After a brief overview of the histori- cal background of recovery and a description of the common themes that have emerged across the range of its definitions, the paper describes the specific strategies being used by the states to implement recovery principles. The authors conclude by raising key questions about the implications of adopting recovery as system policy.
In this article, I shall give an overview of the emerging field of collaborative research between clinical academics and service users in the field of mental health, along with some examples of different kinds of collaborative research and the value they can bring to more mainstream studies. I shall
There are a growing number of students in higher education who experience mental health difficulties and have support needs. The behaviour of small numbers of students on social work programmes indicates also a need to examine the mental health difficulties and needs of social work students. There is only limited factual information on this topic. It is rarely discussed or written about. There is a danger of discriminating against those experiencing such difficulties, especially black or female students. Yet, at the same time, undertaking a social work programme is a demanding experience, as is doing social work itself. Furthermore, on courses leading to a professional qualification, such as social work, there is an obligation to protect the rights of, and assess possible risks to users, as well as to support students. Programmes should give particular attention both to the mental health difficulties and support needs of social work students at selection, during the programme itself and upon conclusion of the programme at a wide range of levels, both within the higher education system and outside that system.
Progressive social work perspectives that draw on both critical theories and postmodern thought, provide highly relevant and appropriate frameworks to inform social work practice in the mental health field. Despite this, the literature overviewed indicates that the majority of social work practice conducted in mental health settings reflects an uncritical embrace of the medical model of psychiatric illness, and therefore largely neglects social work approaches which utilize critical principles. The following article explores the possibilities for applying a critical model of social work practice to the mental health field, and argues the necessity for social workers to actively engage with critical practice, even in medically dominated settings, to effectively work towards the espoused social justice ethics and mission of the social work profession.
Scholars and activists working both within and outside the massive health-related machinery of government and the private sector and within and outside communities of color address the same fundamental questions: Why do health disparities exist? Why have they persisted over such a long time? What can be done to significantly reduce or eliminate them?
Mental illness tops the list of stigmatized conditions in current society, generating the kinds of stereotypes, fear, and rejection that are reminiscent of longstanding attitudes toward leprosy. Mental disorders threaten stability and order, and media coverage exacerbates this situation by equating mental illness with violence. As a result, stigma is rampant, spurring family silence, discriminatory laws, and social isolation. The pain of mental illness is searing enough, but adding the layer of stigma affects personal well-being, economic productivity, and public health, fueling a vicious cycle of lowered expectations, deep shame, and hopelessness. This title provides practical strategies for overcoming this serious problem, including enlightened social policies that encourage, rather than discourage, contact with those afflicted, media coverage emphasizing their underlying humanity, family education, and responsive treatment.
The quantitative research literature has found negative outcomes for the children of fathers diagnosed with mental distress. However, qualitative research exploring both the children and parents’ perspectives demonstrates mixed outcomes and more complex parent-child relationships. This article reviews the qualitative research literature, highlighting the expressed needs of family members. Recommendations for research and mental health policy are made with the aim of supporting positive relationships in families where a father suffers with mental distress.
Former BSW student: I’m really worried about this job interview. I know they are going to think I am too critical, too passionate, too much. How can I dumb myself down Jennifer? How do I get in the door so I can do the work I want to do? Maybe staying quiet will get me the job I need…maybe I should shut up about AOP? This was part of a conversation I had last week, with a passionate, anti-oppressive and critical former undergraduate student who had been told, on more than one occasion, that she was just “too much” for the ‘mainstream’ social work organizations to which she had been applying for employment. It was not the first time one of my graduates had shared such worries, for many had reported negative workplace reactions to their critical and anti-oppressive stance, nor would it be the last. As the literature reminds us, social workers are now labouring in a post-welfare context where critiques of power, racism, ageism, sexism, heterosexism and ableism will not make ‘best practice’ lists unless they also save money and increase productivity (Baines, 2007; Hugman, 2001). As Donna Baines writes
This article provides an overview of the gatekeeping process, including Council on Social Work Education (CWSE) requirements for gatekeeping, with an emphasis on small baccalaureate social work programs. Gatekeeping criteria, including admission to the social work major, admission to field instruction, and approval for graduation are reviewed. Also, criteria for the development and monitoring of termination policies are highlighted as well as legal considerations relative to due process, program liability, and serving students with disabilities. A sample gatekeeping policy used in one small baccalaureate social work program is provided.
The author traces the historical evolution of the concept of chronicity of mental disorders. She suggests that belief in chronicity is a social construction that developed as psychiatry moved toward a scientific model of mental disorder in the early twentieth century.
This book, by one of the leading theorists of social work, tackles a subject of crucial importance to students and practitioners alike: how social workers can enable their clients to challenge and transcend the manifold oppressions that disempower them (whether through poverty, disability, mental illness, etc.). It moves from a discussion of social work's purpose and ambitions to an exposition of theory and, from there, to the practice arenas of working with individuals, in groups, within organisations, and within a wider social and political context.
Stigma is a major barrier to recovery for individuals with mental illnesses. It interferes with community living and attainment of resources and goals and damages self-esteem and self-efficacy. Given that social workers provide much of the mental health care to individuals with mental illnesses, and that actions to reduce stigma support the social justice mission of social work, addressing stigma should be a focus of social work interventions. The goals of this paper are to explore stigma theory in general and for individuals with serious mental illnesses, discuss the implications of this stigma analysis for social work, and make recommendations for action in both practice and research.
The role and purpose of social work has been hotly contested since its inception. The diverse answers which have been provided can be categorised as follows into roughly three types:
therapeutic helping approaches;
‘maintenance’ approaches;
emancipatory approaches.
This paper presents an anti-stigma and anti-discrimination program for social work students. This educational module is designed to be incorporated into current courses on anti-discriminatory/oppressive social work practice, which are mandatory in Canadian social work education. The program is novel, as it builds on both mental health recovery values and critical social work.
This article explores the exercise of heterosexist-infused power relations within a Child and Adolescent Mental Health Services (CAMHS) inpatient unit in the UK. The ways in which heterosexism may wield its power within CAMHS in conjunction with the support of sexism, adultism, classism and sanism are discussed. That is, this article contributes to the understanding and subverting of heteronormativity in practice. With this focus in mind, other forms of intersecting oppressions are detailed to highlight the role they play in both controlling young people and teaching them about the workings of patriarchy and social norms. The aim of the article is to contribute to the disruption of the heteronormativity inherent in the arrangements within CAMHS and the dominant normative practice that produces multiple subjectivities in this setting.
This article addresses major educational issues related to the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990. Because students with disabilities are entering higher education in ever larger numbers, and with greater expectations for accommodation than those of a generation ago, social work educators and administrators should be aware of the implications of these two statutes and relevant case law for admissions, classroom accommodations, and field placements.
With the advent of the 2nd wave of the women's movement, numerous voices within social work academia called for the inclusion of gendered content in the curriculum. The subsequent addition of content on women was a pivotal achievement for the social work profession. However, gender is an increasingly slippery concept. A current call for re-gendering the social work curriculum includes continued emphasis on the importance of the concept of gender while acknowledging that men have a gender, too. The call for a more comprehensive understanding of gender includes new conceptualizations of women; more complex understandings of feminism(s); content on men, masculinities, and transgender issues; and methods for teaching a critical gender consciousness. Specific class exercises and film recommendations are included.
The article considers the impact of the NHS and Community Care Act (1990), and the redefined role of `care manager', upon social work. It draws from a three-year ethnographic study of five area teams; one based in inner London and the others, including a hospital team, based in the north of England. Particularly it uncovers the considerable impact of intense bureaucracy, circumscribed budgets and the consequential removal of the care manager from the community. The article also questions any `seamless service' in work with other professionals and raises doubts as to whether need is even being partially met. Care managers are rarely able to utilize the skills that they develop during the Diploma in Social Work course. Frustration is felt on behalf of staff in the area office, who are now working under considerable strain, with little recognition, within what resembles a new emergency service. It is hoped the article is able to draw attention to the consequences of the continued deskilling of social work and retrenchment of what little remains of welfare.
Social worker educators in the UK are familiar with social issues of exclusion and marginalization, and are used to teaching about sexual abuse or sexual exploitation. However, many are less informed about work with gay people or with broader issues of sexuality. Adopting an auto-ethnographical perspective and using semi-structured discussion groups (which were audio taped, transcribed and analysed), this small group of gay and ‘straight’ practitioners and academics explored current social work practice and culture in the North East of England and reflected on their own learning and teaching experiences. They identified three key themes: differing opinions about what is regarded as an acceptable level of disclosure about personal information, disagreement about the use and meaning of key terms, and discomfort and defensiveness among social work educators, practitioners and students when addressing these issues. These findings are presented alongside some of the literature in this area, highlighting the links with professionals’ exclusion of gay people and the marginalization of gay and ‘straight’ issues in education and practice.
This study describes and analyses attitudes towards homosexuality among faculty in departments of three helping professions: social work, psychology and education. The sample consists of 235 faculty members in the five main universities in Israel. Out of 849 questionnaires that were sent to all faculty members of the relevant departments of social work, psychology and education, 103 were completed and returned from social work, 56 from psychology and 76 from education, representing a 27.7 per cent total response rate. The instrument used was the Index of Homophobia (IHP) (Hudson and Ricketts, 1980) in addition to professional background and demographic information. Findings show that, overall, members of academic departments of the helping professions present 'low-grade homophobic' attitudes (Hudson and Ricketts, 1980). Statistically significant differences surfaced among the three departments, with faculty members in schools of education emerging as most homophobic, followed by social work and psychology. Several explanations are put forward in an attempt to account for such differences, including the theoretical framework of marginality, the variables traditionally associated with homophobia, and professional training.
This article focuses on the Council on Social Work Education's (CSWE) efforts to fight racism and sexism within schools of social work. Against a backdrop of federal affirmative action policies, funding initiatives, and Supreme Court decisions, the archival records of the CSWE demonstrate strong and varied organizing among its minority and female members. Thus, the CSWE moved from an equal opportunity to an affirmative action approach, initiating changes in accreditation, student and faculty recruitment, and curriculum. Progress continued until the late 1970s-early 1980s when affirmative action policies nationwide met with resistance, or backlash, from nonminority groups.
The evaluation of student conduct and suitability during professional training is critical to ensuring that the profession is promoting its values, protecting the public, clients and practitioners, and providing good and valuable service. However, a factor such as the presence of a student's mental disability can present significant challenges in this regard. This paper considers the challenges related to students who may be unsuitable for the profession of social work because of a mental disability. In addition we reference human rights laws and their interpretation as they relate to the rights of students with disabilities and consider the application of human rights principles to faculties of social work given their duty to accommodate students with disabilities. We use a case study that involves a practicum student, his placement, his disability, and the breach of ethics that led to him failing the practicum. We illustrate the connection between his disability, the breach of ethics and human rights obligations that apply in this case as well as consider possible resolutions.
In this paper we reflect on the work in progress to maintain an active focus on the impact of racism in society, its implications for social work practice, and the development of anti-racist strategies within the whole spectrum of anti-oppressive practice in social work education. We look at some of the ways in which this is being tackled in social work training programmes nationally, and share some of the dilemmas and difficulties encountered in the South West, as well as the achievements so far. We wish to invite debate through a discussion of the processes, principles and context of four years' work to set minimum standards for anti-racist practice. Our aim is to move forward from identifying the problem [S. Collins, P. Gutridge, A. James, E. Lynn & C. Williams (2000) Social Work Education, 19(1), pp. 29-43] to implementing positive change in both content and method of integrating anti-racist strategies in social work and assessing student practice. At all stages of the development work care has been taken to avoid the separation of racism from other forms of oppression and to acknowledge the ways it reconstitutes the experience of service users from minority and majority ethnic groups [F. Williams (1989) Social Policy: A Critical Introduction (Cambridge, Polity)]. It is in this context that agreed standards for anti-racism within anti-oppressive practice are being articulated and adopted or considered by DipSW and Post Qualifying programmes within the Far South West of England. Local DipSW programme personnel in the region have worked consistently to achieve a positive, inclusive and dynamic approach to integrate anti-racist practice in social work education programmes. The authors write from the perspective of being White. We are members of a Forum for Anti-Racist Practice Development and are involved in the development work in different ways. This paper is our perspective of the work for which many individuals and institutions are responsible. We do not represent all those involved, and seek to celebrate rather than claim credit for the work.
This paper seeks to establish that hierarchies of oppression exist, that these are destructive, degrading and dehumanising, and that these hierarchies need to be understood in order to preclude unwitting collusion with hierarchical thinking and operating. The roles of hegemony and of attributes in hierarchies are outlined and discussed. Hierarchies of oppressive experiences are defined and denounced as inextricably emanating from the same destructive force as their inverse, hierarchies of oppression.
This article looks at the process of involving users in the production of the Open University course on mental health. There is increasing recognition of the need for partnership with service users in training provision as well as in professional practice, but there has been less attention to how this works out, and to the dilemmas faced by participants in such processes.‘Mental health and illness’ are highly contested concepts. Professional debates on appropriate frameworks for intervention mean that the promotion of user views in training courses may be derided as ‘antipsychiatry’. This is a particular risk for social work education. There are then dilemmas for educators on providing academic credibility and balance while being sensitive to user perspectives and critiques. However, academic criteria about what counts as knowledge are subject to change, and user views may have an influence here.
This study examined heterosexism among 409 Illinois school social workers. Heterosexism was found to be negatively correlated with “education about” and “positive contacts with” gay and lesbian individuals and positively correlated with “religiosity.” Most respondents showed some level of heterosexism with a few having very high levels. Only 15% were non-heterosexist. Respondents reported receiving little or no education about sexual minorities in their social work training. Most indicated that the training received was not adequate preparation for working with gay and lesbian individuals. Amount of education received increased with each of CSWE's educational mandates about sexual minorities but had no significant effect on heterosexism.
The gatekeeping role in social work education begins with the admissions review process. This article reports on findings from a 1995—96 national survey of MSW programs that focused on the nonacademic admissions criteria and procedures they use to assess applicants. Over 80% of the respondents identified nonacademic indicators used to assess the suitability of applicants; 100% reported using some form of screening procedure (e.g., reference letters, personal interviews); and 66% provided samples of admissions review materials. The authors assess the commonalities found among sample materials, describe challenges in using nonacademic admission criteria, and present a model for defining and assessing student suitability throughout the professional education process.
At one time or another, all social work faculty encounter a student who is not well suited for professional social work practice. However, finding ways to effectively screen students to ensure their suitability for a career in social work seems a formidable task for educators. This article reports the findings of a study on the current screening practices used by bachelor of social work programs for judging students' fitness for entry into the major and the field practicum. The findings raise several issues about the appropriateness of screening practices and policies currently in place at the bachelor's level; recommendations for addressing these issues are included.
Testimonial narratives of racialized women with disabilities bring into relief subjugated knowledge that reveal how the state constitutes and is reconstituted at the margins. Fahimeh’s case example, drawn from a larger study on immigrant Muslim women in metropolis Vancouver, shows how women resist and rework the stigmatized labels of disability and race from their social locations at the margins. Our analysis of particular events and critical episodes show how Fahimeh, speaking in a collective voice, implicates the state to bring home the message that racialized persons with disabilities are human. Their humanness (desire for a just world) is affirmed through blurring of boundaries of the private and the public, and everyday life and state institutions. Fahimeh’s testimonial shows that margins are not merely territorial; they are sites of practice that point to the makings of a just world.
The emancipatory project of progressive social work as it was developed in the 1970s and early 1980s in Anglo-democracies has been brought into question on two fronts. First, the changing nature of capitalism from a post-war centralised form to a global decentralised form has rendered irrelevant much of the earlier analysis of capitalism which had been used by progressive social workers to develop emancipatory theories and practices at both the personal and political levels. Second, postmodern and poststructural thought have discredited many of the concepts (meta-narratives), ideals (universalisms) and discourses that underpinned the modernist development of progressive social work. This paper represents an attempt to contribute to the reformulation or reconstruction of a progressive form of social work that addresses both these challenges. The following elements of a reconstructed form of progressive social work are presented and discussed: bridging what is positive and liberating in the tradition of progressive social work with a postmodernist deconstruction of its problematic elements to the point where reconstruction is possible; identification of human needs that are universal and transcultural; new social movement theory; a revitalised public sector; anti-oppression as the framework for progressive social work; challenging and resisting the dominant order; and the constructive use of anger.
This article addresses the question of how social work, despite its commitment to empowering practice, has come to be somewhat marginalised within the wider professional discourses that are currently shaping mental health practice and training. This is at the very time that the user movement has started to be heard in its own right as a stakeholder in relation to service development, and as service users are becoming more directly involved as contributors to mental health training. The article explores the need for a more clearly articulated understanding of mental distress from a social empowerment perspective, and examines some of the factors which have so far impeded this. Finally, it looks at how social work may now move on to find a more distinct and effective ‘voice’ within professional and educational discourses—one that connects with (but does not speak for) the concerns of service users.
Social work programs are faced with making difficult decisions when considering student admissions. Social work educators have the responsibility for first-line gatekeeping for the profession. This responsibility involves screening out the "unsuitable" applicant. Educators must exercise caution and be aware of the legal constraints affecting admissions and retention decisions. This study analyzes relevant court cases and reviews by a number of legal experts. Guidelines are developed to assist social work educators in the admission process.
Court litigation concerning the dismissal of undergraduate and graduate social work students who are academically, behaviorally, or ethically unsuitable to practice as social workers is reviewed. Substance abuse cases are included. Guidelines for educators for developing behavioral and ethical criteria for student suitability are offered. (Author/MSE)
This article identifies the challenges to incorporating an anti-oppressive practice approach in the field of mental health, which has traditionally utilized a discourse and perspectives of a bio-medical model. Schools of Social Work often teach anti-oppressive and social justice approaches which make it difficult for students to link theory and practice in fields such as mental health. In this article, seven principles of practice are presented as a framework for working with people with disabling conditions of mental health. Specific strategies for implementing these principles are presented.
The stigma experienced by mental health service users has been examined by many authors but is rarely found within the social work literature. Through interviews with mental health service users and social workers, this paper will explore the stigma experienced by service users within a social work context. The study considers the strategies employed by various individuals and groups seeking to challenge the effects of stigma, highlighting the need to include social work in this debate. The interviews with service users and social workers provide individuals' perspectives on some of the key concepts within the stigma discourse, on individuals' experience of psychiatric services, on the relationships between professionals and service users and the contribution of a recovery approach in addressing stigma. The paper concludes that local authorities need to play a much more prominent role in tackling mental health stigma and discrimination through policy developments, involvement of service users in planning and development of services, incorporating the experience of stigma within assessments and improving multi-disciplinary collaboration to tackle stigma and discrimination. Finally, the paper challenges social work academics to respond to the deficit of research in this area.
Reports how patients themselves are developing humane and effective methods of treating the "mentally ill." The case for patient-controlled facilities—voluntary, small, responsive to the community and its residents—is argued. The practical problems involved in setting up such facilities are discussed, and existing organizations are described. (5 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)