The Forgotten Illnesses: The Mental Health Movements in Modern America
III. Organizations, Strategies, and Agendas of the Mental Health Movement
Although the first major mental health SMO was Mental Health America (MHA), founded in 1909 by former psychiatric patient Clifford Beers, it was not until the 1960s that mental health SMOs began having a notable impact on society. The opportunity structures provided by academics supporting those suffering from mental illnesses and the precipitating events of popular depictions of stereotypes surrounding the mentally ill provided the MHM a firm foundation to create SMOs. The National Schizophrenia Fellowship, now named Rethink Mental Illness (RMI), formed in 1972 as an English charity for those suffering with schizophrenia.
According to the RMI website (n.d.), the major precipitating event that caused the formation of RMI was a letter submitted to and published by the editor of The Times by the father of a young man struggling with schizophrenia while in college. This letter not only brought public awareness to the issue of mental illness, it also brought together other families struggling with similar situations. A similar organization, the National Alliance on Mental Illness (NAMI), began in the United States in 1979. Though NAMI does not divulge the precipitating event that caused its formation, the NAMI website (2015) describes their goals as to educate the public of the realities of mental illness, to help those suffering from mental illnesses, and to advocate for the mentally ill on the national level. Unlike RMI, NAMI works in the political landscape through lobbyists to create legislation for the benefit of those struggling with mental illnesses.
The importance of the vast majority of mental health SMOs goes beyond their political influences. These SMOs gave individuals with mental conditions the chance to form networks with others who were struggling with similar issues and who found themselves disenfranchised by the same institutions. Networks created in SMOs allowed people to find others who had an identity of mental illness thrust upon them by society and allowed them to cope together. While not all members of these organizations shared the same mental illnesses, experiences, or stigma from society, they were able to form a meaningful community that transcended a political network operating to reform the way society framed mental illnesses (Whittier, 2015: 123).
Strategies for the MHM tend to not be diverse for two major reasons: the stigma that surrounds mental illnesses and the general support from legislation. Shame acts as an obstacle for individuals who would like to propel the movement forward but are afraid of the visibility that activity in the movement demands. Discrimination in the workplace is a legitimate fear for many people who do not want to risk their livelihoods, which eventually resorts to an inadvertent free rider situation (Corrigan 1998: 202). However, because there is little pushback from the government towards the movement, the tactical repertoires of this movement do not need to vary as they do in other movements. The MHM has had relative success in passing legislation, especially in comparison to civil rights movements involving race and gender. Therefore, there is little necessity for the MHM to put resources towards tactical innovations when the government is not overtly attempting to quell the movement.
The stigma surrounding mental illnesses also became a collective identity for those who lived with mental conditions. Identity became central to the movement, as a collective identity was formed around a shared characteristic. While some movements found a faltering of fervent support due to strict boundaries, the MHM does not intend to exclude people from its ranks (Whitter, 2015: 119). Instead, they have worked to do the opposite by enlarging their boundaries to include larger groups of people. This is attained by including a broad range of mental conditions that range from minor disorders that scarcely impact aspects of life to serious disorders that can greatly disrupt daily life. By doing this, the movement increases the number of people who can benefit from action on the part of the MHM. This inclusiveness also allows people without mental illnesses to act as conscience constituents who may have the biographical availability that is lacked by those with more severe mental conditions.
Due to the fact that mental illnesses are often viewed as rare and detrimental to society, it becomes essential to the movement to emphasize how commonplace mental conditions are. This tactic has become incredibly beneficial for the MHM in recent years. Accentuating the proportion of Americans who experience mental illnesses both expands the potential ranks of the MHM and shows individuals that mental illnesses do not need to induce fear in the public but instead require acceptance from society. One example of this tactic in practice is Obama’s (2015) overt acceptance of the statistic that one in five Americans suffers from a diagnosable mental condition. Because Obama is a visible individual whose concerns are heard across the United States and the world, his recognition of the legitimacy of mental health as a genuine concern that affects a vast quantity of Americans has been incredibly beneficial for the movement.
Currently, members of the MHM are attempting to recover from some of the consequences of the neoliberal age of deinstitutionalization (Morrow et. al., 2008: 2).Though advances towards legitimizing mental illnesses and the agency of those struggling with such conditions were made, it is presently essential to the agenda of the MHM to discuss the potential of re-institutionalization. Morrow et. al. (2008: 3) argues that current neoliberal politicians are considering re-institutionalizing mental health in order to reduce the number of homeless individuals visible on the streets. There are others who believe that neoliberal ideas of leaving people to their own affairs, even those who need state support, has been detrimental to those with mental conditions and their family members (“Know the Laws, 2015). It would appear that the support of deinstitutionalization is waning, even if a plethora of mental health advocates still stand firmly against involuntary commitment.
One budding agenda for the MHM is that of burnout in the modern American worker (O’Donnell, 2014). This issue stems from studies of an overuse of emotion work, or the portrayal of emotions not felt by an individual, in the modern service industry (Hochschild, 1983). As depression has increased over the past decades, Hochschild and others propose that this abundance of emotion work is detrimental to the mental health of the individuals who are required to employ this emotion work in their day-to-day jobs. This eventually becomes an issue of how the MHM will “stay current” (O’Donnell, 2014). While symptoms and issues do not seem to change, it is no longer simply depression that is affecting people, but a vast array of types of depression that branch from various sources
An interesting modern agenda for the MHM is addressing the phenomena of the layperson’s diagnoses of mental illnesses (Henderson, 2000). Due to advances in technology and the availability of information concerning mental illnesses, individuals now have the ability to self-diagnose for different disorders. This, in many ways, has been a blessing and a curse for the medical community (Henderson, 2000: 24). Instead of relying on professional diagnoses, which can often cost hundreds or thousands of dollars, people can now do personal research on the symptoms of mental conditions and “at-home” curative techniques to employ. However, for those who do have money, the option of going to a professional and presenting lay self-diagnoses is prevalent. Henderson argues that this creates a potential “exaggerated estimate” epidemic, where doctors who are unwilling to blatantly challenge self-diagnoses out of a fear of potential lawsuits or the consequences of not diagnosing a true mental condition give in to the assertions of their patients. The MHM tends to favor the patients’ side due to the possible consequences involved in not diagnosing treatable conditions. Still, this issue is one that the MHM must address due to public concern that exaggerated reports of mental illnesses stand to prove that they should not be taken seriously.
IV. Potential Paths of the Mental Health Movement
Throughout history and up to the present day, the MHM has had its greatest successes in working with governments to create legislation to support those suffering from mental illnesses. The British government has made it one of their objectives to reduce the number of people who develop mental health problems by supporting wellness over British individuals’ lifetimes (Lawton-Smith and McCulloch, n.d.: 10). For those that are already dealing with mental health problems, the government has proposed that it will help these individuals recover, keep good physical health, prevent avoidable harm like self-harm, and reduce the stigma behind receiving care (Lawton-Smith and McCulloch, n.d.: 2010). These lofty goals do attempt to address the core of the MHM’s discussions, though they do so in an intentionally vague fashion. In the United States, President Barack Obama (2015) made a similar proclamation, stating that he wishes to see the 60 million Americans who suffer from some form of mental illness profit from the benefits and parity protections provided by the Affordable Care Act. Both governments made specific comments towards suicide prevention, implying that suicide is given a high priority in terms of mental illnesses. Due to the highly visible nature of suicide and the support from state systems to deal with this issue, suicide prevention and counseling have great potential to remaining as a top priority for mental health advocates.
Though the MHM has achieved much in working with state legislatures for the support of the mentally ill, continued success will rely largely on combating stereotypes and changing the public perceptions of what mental illness can mean. Negative perceptions of serious mental illnesses as dangerous, incurable diseases that cripple those whom they afflict lead to discrimination and unwarranted fear of those who are often otherwise innocuous (Corrigan, 1998: 202). The movement will need to continue to dedicate time and resources towards eradicating stigma. While support from figures such as Obama and legislation passed by the state do work to legitimize mental illnesses in society, they do not solve the issue of fear and shame that still continue to haunt individuals with mental conditions.
Current political opportunity structures are bringing the MHM to consider a transition back towards re-institutionalization, as well. After the alleged failure of deinstitutionalization as a treatment for mental disorders, there are some in government who are considering reinstituting laws that would call for the commitment of individuals with mental illnesses (Morrow et. al., 2008). Interestingly, according to Morrow et. al., these prospects of re-institutionalization are coming from neoliberal figures who had previously worried about the costs of government-funded asylums. This paradoxical situation is one that the MHM may eventually have to face, as it will have to choose whether to support continued deinstitutionalization or consider the possibility of broadening allowances for the involuntary commitment of those with mental illnesses.
Stigma has been one of the greatest obstacles to the acceptance of the MHM and those suffering from mental illnesses. Multiple mental health organizations are focusing their resources towards the eradication of the stigma surrounding mental illnesses and those suffering from them. The difference from past attempts at reducing stigma is that mental health organizations such as NAMI are working with the ideals and beliefs of other social movements. One of NAMI’s current campaigns is the “StigmaFree Pledge,” which calls for the end of all stigma by working to “promote acceptance and actively challenge social stereotypes” (“Stigmafree Pledge,” 2015). This method of one movement working together and encompassing the struggles of other movements has become an important way of forwarding the cause of one movement and increasing the resources of otherwise isolated movements (Whitter, 2015: 118).
This movement is unlikely to disappear in the near future. As modernity continues to place difficult requirements on individuals, mental illnesses will thrive. However, this does not imply that they are a burden upon society and those within it. The MHM will have successes in the future if it can focus its resources on the eradication of stigma surrounding mental illnesses. If the movement continues to thrive in its ability to work as an assimilative structure within society, it will not likely find itself short of support in the government, either. Because questions of institutionalization, agency, funding, and cultural stereotypes are not likely to dissipate in the near future, the MHM will continue to have a place in modern American society.
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