“What a psycho!”, “They need to be locked up!”, “freak!”, “dumb”, ” nut”, “so insane! ”… as many insults that can be heard in everyday language, on TV or with friends. However, are they so innocuous? What is so special about them? Everyone will notice what they have in common: they all use insanity as a means of denigrating the other person. These insults are a common example of the phenomenon called “mentalism”.
This concept of mentalism was developed by Chamberlain (1990) to describe the oppression experienced by people with a mental illness or disorder. Mentalism can cover a range of behaviours from repeated micro-aggressions (e.g., insults; presupposition of professional incompetence) to mistreatment (e.g., denigration, neglect of physical suffering seen as a simple manifestation of the psychological disorder, dismissal etc.). The consequences are not insignificant for the persons concerned: loss of self-confidence, shame, fear of telling one’s story, lying to hide the psychiatric past, fear of losing one’s friends or job, feeling powerless, feeling worthless, feelings of guilt… Kalinowski and Risser (2005) explain the cause: over time, the persons concerned internalise discrimination.
Both authors point out that this internalisation is also due to the behaviour of health professionals. As psychologists, we are not spared by mentalism. It is therefore absolutely necessary to be able to question one’s practice and identify these behaviours in order to foster the recovery and well-being of patients. It is not about transforming words, creating a politically correct newspeak: it’s about changing our mind, assumptions and attitudes.
Kalinowksi and Risser (2005) clarify how this discrimination works. In professional language, they observe a splitting between ‘patient’ and practitioner, between ‘them’ and ‘us’, which leads to a mentalist reading of situations. This splitting allows the formation of a “power-up group” and a “power-down group”, with the former exercising power over the latter. Such a distinction also leads to a reduction in the quality standards of the care offered and sometimes to an aberrant reading of situations. To illustrate this Kalinowski and Risser (2005) present a meaningful situation:
If “we” were jumped upon by a group of people, taken down and forcibly injected with powerful medications, then locked up and tied down in isolation, it would be considered assault and battery, kidnapping, or torture. If we do this to “them” in a hospital, it is “treatment” for their own good. (p. 4)
In the same way, the same behaviour will receive a different response depending on whether one is in the power-up group or the power-down group. In this respect, the authors propose to imagine a psychiatrist in the midst of a rage against nurses who have made a mistake. An outside observer will think that this leader knows how to show his authority. Now imagine that the psychiatrist is in fact a patient. An outside observer will think that this patient needs better treatment to appease him or herself.
So it clearly appears that the power-up group has the possibility to reward but also to punish any member of the power-down group with the qualification of “treatment resistant”, for example.
Kalinowski and Risser (2005) invite us to identify the oppressor that we are. Faced with a patient denouncing a certain situation, they invite us to ask ourselves at least one question: would I accept this situation for myself? “If the answer is “No, but…” followed by any sort of justification, you have identified mentalism in practice”(p. 8) write the authors.
The proposed question has its importance: the authors warn against false empathic considerations such as “if I were in his/her shoes…”. Indeed, this only maintains the dichotomy between “them” and “us”, under the guise of fighting against mentalism. First of all, this pseudo-empathy reinforces the idea that the other is responsible for their situation. The formulation “if I were in his/her shoes…” often presupposes “… I will do something else better”. This implicitly leads to the thought: “They have the opportunity to do something else better, so they are responsible for the consequences of their illness”. Secondly, since the patient is responsible for their situation and I would act differently, then my analysis is more accurate than their. From then on, the patient’s word is perceived as inferior, unworthy of attention.
In addition to this first consequence, the initial assertion is posed as a very unlikely hypothesis (“if I were in his/her shoes…but of course, I never will be. » (p.8)). In this way, once again, the distance between the practitioner and the patient is strengthened, which can lead to illogical reflections. The
authors give the example of a clinician stating: “If I were homeless and mentally ill, I would want to be medicated involuntarily” (p.9). Since the situation is considered unlikely, it is possible to reach such conclusions, overlooking the complexity of the barriers to the acceptance of treatment in this situation. Thus, involuntary commitments appear legitimate, which, according to the authors, permits a strengthening of social control.
Language can, in itself, be the bearer of many mentalist oppressions, reinforcing the gap between ‘them’ and ‘us’. The authors take the term ‘decompensating’ as an illustration. This word implicitly underlines the superiority of the clinician, who does not decompensate, over the “sick client”. A simple description of the situation can be preferred to this term. Other linguistic uses are denounced, such as pathological labelling. A person becomes “a schizophrenic”. In addition to being dehumanising, such an approach not only reinforces the internalisation of the stigma but can also worsen the traumatic consequences of the illness. The recommendations of Kalinowksi and Risser (2005) are clear. Again, one need only ask: ‘Does the term I use help me to understand, help and respect the patient, or does it make me feel superior? “Would I be able to use the same terms for myself and with the patient? “Does this language help me to find solutions and to initiate positive change”? To these aims, clinical terminology must be precise, factual and complete with respect for the person’s singularity. Such changes can also make it possible to combat the mentalism in care organisations that can be observed through punitive attitudes when confronted with a disorder or negative anticipation based solely on the diagnosis.
In this way, it is also important not to neglect humility. Of course, every health professional has knowledge and skills relevant to the patient’s recovery, but in the field of mental health our knowledge is very limited. The authors point out that our real duty is to provide “a supportive, respectful, genuine helping relationship” (p.12). In this manner, it becomes possible to learn from the knowledge of patients, who are the main people concerned by the situation. Genuine collaboration in care, called “powersharing clinical relationship” (p.39) can then develop.
The power-sharing clinical relationship is defined as a relationship in which the clinician and the client, taking into account the capacities and possibilities of each, define common goals, values and concerns by means of effective collaboration. The clinician then appears as an authentic and competent consultant, providing the client with all the necessary resources to complete the empowerment care plan. This requires a real therapeutic alliance to also get through moments of conflict, relapse or difficulties
together. The benefits of a power-sharing clinical relationship are multiple:
- Respect for the values inherent in the profession of clinical care provider
- Strengthening empathy in the relationship
- Better understanding and response to the other’s need
- Better involvement of clients in the projects developed together
- Better adherence to the treatment plan- Better compliance with treatment
- Better crisis prevention and response
In light of these benefits, deconstruction work seems necessary. To guide us in this long process,
Kalinowski and Risser (2005) remind us of a simple rule: “we should treat people as we would want to be treated, with respect, dignity, and concern”. (p.10). As students or professionals in the socio-medical field, we have a duty to rethink the way we view mental health care, the recipients of mental health care or people with a psychiatric background in society. We also have a duty to promote their integration into society by fighting against the discrimination they suffer even within institutions whose initial purpose is to help them.
Chamberlin, J. (1990). The ex-patients’ movement: Where we’ve been and where we’re going. In Challenging the therapeutic statc [Special issue], Journal of Mind and Behavior, 11(3), 323-336
Kalinowski, C. & Risser, P. (2005). Identifying and overcoming mentalism. InforMed Health Publishing & Training.
Words we have learned
- To be locked up: être enfermé
- Mentalism: psychophobie
- To be spared by : être épargné par
- A newspeak : une novlangue