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Sanism, ‘mental health’ and social work/education: A review and call to action

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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.

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... 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. ...
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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.
... 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: ...
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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.
... 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. ...
... '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). ...
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... 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". ...
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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. ...
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... 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. ...
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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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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.
Article
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)
Article
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.
Article
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.
Article
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)
Article
There is mounting evidence that British service users face pervasive discrimination in areas of life ranging from work to parenting, insurance to driving licenses. Some studies suggest that certain forms of discrimination have increased during the 1990s, perhaps because of saturation media coverage of the supposed- but not actual- rise in homicides committed by people with mental health problems. One of the key concepts used to investigate the problems that users of mental health services face in their relationships to other people, and to society at large, is 'stigma'. This concept is used to frame questions of public attitudes about mental illness, users' self-perceptions and the unfavourable treatment they receive. It is often stated or implied that if we can break down 'stigma' we can transform users' position in society, their opportunities and wellbeing. This paper examines the limitations of both the concept of 'stigma' and the way it is applied, and reviews the growing literature on discrimination, which is seen as a more promising model on which to base social change.