Disability Rhetoric

disabling writing, in a good way

The Medical Model Controversy in Disability Studies

This recent blog post comes from N. Renuka Uthappa (renuka.uthappa@wayne.edu), a Ph.D. student at Wayne State University in Detroit. Uthappa is a scholar whose personal experience “puts her firmly within the medical model of mental illness at the same time as that model faces what seems like a fair amount of resistance within the disability community that deals with mental illness. (Catherine Prendergast notes in an essay that she feels awkward explaining that she considers schizophrenia a disease in the face of her own ‘post-structuralist leanings.’ She worries that her opinion “makes me sound at best conservative and at worst, theoretically unsound.”)”

I look forward to posting more, and as always, contact me at dev.k.bose@gmail.com if you’re interested in being a guest blogger for the site, or would like to joint the DS-Rhet listserv. —Dev

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“Like you, I wear many hats in my life. I am a Ph.D. student, a teacher, a wife, a sister, etc. But I’m here today talking to you because I am a person with a mental illness, specifically bipolar mood disorder.” This is the way I have been starting the presentations I give to high school psychology classrooms as part of my membership in a local group known as the Speakers Bureau. Made up of people with a variety of mental illnesses, the Bureau seeks to “put a face on mental illness, developmental disabilities, and substance abuse to overcome stigma and discrimination by sharing successful stories of hope and recovery.” I joined the group in order to research their rhetorical efforts from the inside and to contribute to their fight against stigma.

In the course of my initial research into disability, disability and rhetoric, and the particular rhetorics of mental illness, I find myself in a tricky position. I am steeped in the medical model of mental illness, a model not much in favor outside the mainstream. My decades long acceptance of the psychiatric assessment of a chemical imbalance in my brain and a genetic predisposition to mental illness, as well as my use of medication to successfully treat what I view as a biological illness place me in opposition to at least certain aspects of the consumer/survivor/ex-patient (c/s/x/) model of mental illness.

In her chapter of James Wilson and Cynthia Lewiecki-Wilson’s collection, Embodied Rhetorics: Disability in Language and Culture, Catherine Prendergast states: “For an academic such as myself with generally poststructuralist leanings, to think of schizophrenia as a “disease” makes me sound at best conservative and at worst theoretically unsound.” I can understand her concern. As a fledgling disability and rhetoric scholar, how can I acknowledge and stay open to the well-argued viewpoints of the c/s/x or Mad Pride movement while still living within my conviction that I have a disease that requires specifically medical intervention? How can I say a simple “No!” to their contention that states of what they call “mental distress” represent ways of being on the spectrum of human existence or even natural responses to external factors such as modern isolation or materialism?

At a Speakers Bureau workshop about how to craft one’s story of mental illness, the leader cautioned the group, “Don’t promote broken brain theory.” When I asked her about this statement later, she brought up the idea that certain “states of being” can be considered life experiences rather than “symptoms” and noted that there are varying opinions as to what mental illness is. Is it a medical illness, she asked, or a part of living? Her commentary raised my hackles. I found myself wanting to argue against the idea that mental illness could be considered just another way of being. This idea rang false against my experience of both mania and especially depression, where I found the depth of sadness and hopelessness absolutely incommensurate with anything going on in the outside world. Given that the ultimate endpoint of untreated depression for many is suicide, I found this new (to me), alternative perspective frustrating.

Later on, I told the workshop leader that my experience of deep depression had been incommensurate with anything going on in my life and asked “Doesn’t that suggest that the cause must be biological?” She replied “The purists would say you had not looked hard enough for a source for your sadness.” Slap! We let the matter rest there, but inside I was seething, not at the group leader, who I respected and liked, but at the “purists” who would dare lay their interpretation over my crystal clear experience. (It has not escaped my attention that I am doing the same thing to their experiences!)

Those experiences, I know, have included the reality that people with mental illness diagnoses can in many states be involuntarily hospitalized and legally forced to take medication. I can only imagine the terrifying experience of being forced into a hospital against my will or the frustration of having to take medications in a similar fashion. On the other hand, as someone who worked at one time providing supportive services for mentally ill adults living independently in the community, I have seen instances of very negative personal results when people suddenly stop taking their medications. And I have seen the positive results that hospitalization can sometimes provide once it helps a severely ill person stabilize.

I am hoping the existence of multiple views about the ontology of mental illness does not require me to decide on an absolute definition. In some ways, at present, it seems to come down to a sense of how experiences influence one’s sense of identity. Because I have had mostly good experiences within the medical model, and because it makes sense to me, I use the term “mental illness” and identify as a “person with a mental illness.” This phrase attempts to put distance between my “self,” or my essence, and my medical condition. The more I read, however, (Susan Gabel, thank you for “Depressed and disabled: some discursive problems with mental illness.”), the more I find myself open to questioning my current sense of identity. Thanks for the great scholarship, everyone, and I look forward to any and all responses to this, my first ever blog!

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3 responses to “The Medical Model Controversy in Disability Studies

  1. Margaret Price September 9, 2015 at 2:47 am

    This is really awesome! Thank you, Renuka and Dev! It’s a really great question–one without an easy answer. (I think a similar question exists for many forms of chronic illness, especially those that involve a lot of pain and/or distress that arises (or seems to arise) from the condition itself, rather than from social responses to / failure to accommodate the condition.)

    Is there any way the references could be linked?

  2. stephanielynnkeil November 10, 2015 at 11:39 pm

    I’ve always had trouble with the social model of disability, to be honest. I suffer from chronic pain and that isn’t something society can accommodate. I’m supposed to use a wheelchair but don’t because of inconvenience so I understand it from the point of view that society needs to be more accommodating but I need medication for pain and can’t stop it. I also suffer from depression and it isn’t something I want to have but that I consider to be a disability because it impairs me. Perhaps I shouldn’t use the word disability for depression but “mental illness.” But I do because it disables me. I need to start a blog of my own for these issues.

  3. L. N. January 14, 2016 at 11:53 pm

    Thank you so much, in part for being willing to out yourself, but also for this blog as a whole. I am a dev Ed and composition teacher at a community college, and I am also bipolar, along with having undiagnosed but real dyscalculia and synesthesia. More and more, I have been thinking about these issues as I work with a wide variety of disabled students and read about the growing autism community.

    Right now I think that I think bipolarity and other neurodiversity can be seen not as a disease, but as a medical condition. For me, it’s a condition that requires medical management; I would not be alive, much less degreesd, if it weren’t for medicine and therapy. So how is that different than a disease? Diseases are curable, not integral. You can’t subtract the bipolarity out of me–nor would I want you to. I am well aware that I am not neurotypical, and that As a result I have deficits and weak areas. However, as a result, I also have areas of atypical giftedness. These aren’t separate.

    I think of us as being a bit like a low-level superman in a world full of Kryptonite. That’s not quite right. Let me try again. If you’ve looked at the Myers Briggs, you may know that the types aren’t equally distributed. According to centre for confidence about 48% of the British pop falls into the Sj or guardians designation, people who value and guard social traditions. On the other hand only 9% are rationalists. The split between S and N, which seems like it should be 50/50 is more like 75/25. And this makes sense, because Ns are often reformers and idea people, and society needs fewer people who want to spend all their creating new systems or renovating old ones, than people who want to take care of existing institutions and systems. A strong S will miss the forest for the trees, but a strong N will be so busy contemplating the greater ecosystem that they stumble into a hole and break a leg. Bipolars, autistics, etc., seem a bit like those rarer personality types, in that we offer important gift sets to society. If we can get functional and stable.

    (On a composition note, many if not most writing teachers are Ns, and the writing process as described is essentially an N J process of big ideas to little details. I am the aforementioned N in the forest, myself. If we aren’t careful though, we neglect the way our students actually process the world.)

    Wow, this was a long response. And I haven’t settled, so I may change my mind about all this tomorrow. Mostly, I am grateful this blog exists.

    On a side note, I have a fully blind student for the first time and am somewhat uncertain about how to best accommodate that. I draw a lot of pictures and charts on the board, and use a lot of spontaneous examples. To stop doing that would alter my teaching style completely. Any thoughts?

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