Madness, distress and the politics of disablement

Both the topic and multiple perspectives taken by Madness, Distress and the Politics of Disablement are long overdue and incredibly timely. For the last 15 years the complicated and contested relationship between the study of madness and disability has been primed for a deeper examination and understanding.

In terms of structure the book is separated into five parts, the first of which examines the disjunction of disability and madness, stating that ‘there is an unsettled relationship between madness and disability which has rarely been acknowledged’ (1). The second section unpacks the theory of distress and disablement, and the third explores the application of the social model of disability to mental health. The fourth section is an exploration of some of the attempts to universalise disability policy, and the final section entitled ‘Meeting Places’ examines the intersectionality of mental health with neurodiversity and the potential for other alliances.

The book begins with an examination of the historical power asserted by the medical model and how it is experienced by mental health service users in the real world. The power of the psychiatrist has often acted as a singularity. Defining madness is always going to be difficult; in particular, attempting to marry it to the social model of disability is inherently problematic. The social model of disability in its simplest incarnation is based on the distinction, false or not, between impairment and disability. Disability does not exist without impairment but it appears that madness might exist without an equivalent. On page 6 the authors thoughtfully write ‘Given the lack of consensus over terminology we have tried not to impose false certainty, but to reflect the diversity of opinion that exists among our contributors and elsewhere.’ This is both fair and realistic. They go on to characterise madness as deeply interpersonal and behavioural in nature and concede that if madness and distress are to join with disability there needs to be agreement in a number of key areas.

Further into the book I am not totally convinced about the inclusion of the trial of Oscar Pistorius in Chapter 3, because it does not seem to add anything useful to the developing argument. In comparison, the presentation of the ‘capabilities approach’ was a really welcome addition in Chapter 6, providing a refreshing way of considering old but key issues. Yet another contested concept in mental health is that of recovery. Jan Wallcraft and Kim Hopper ask the question of what are people actually recovering from; an illness, stigma, use of services? In addition, who decides when someone has actually recovered; the service user, clinician or carer? They essentially state that ‘Recovery is the possibility of reclaiming a real life’ (91).

Chapter 7 provides a useful examination of mental distress, disablism and impairment, if unfortunately at one point the applied value of difference with difference itself is confused. Further on I am not sure about the use of the verbatim interviews in two chapters as the most useful structure for communicating within a book. Chapter 9 explores issues around race and madness; the historical treatment of mental health has been an expression of racism as one among many forms of oppression. Racism here can be considered as causing mental illness. The chapter goes on to reflect on a number of key complexities, providing a warning against falling into ‘silo thinking’ and/or ‘hierarchies of oppression’. This section finishes by stressing the importance of fully integrating any developing theories and not just bolting them on to existing ideas.

The book provides evidence for a number of really stimulating debates; I particularly liked Chapter 10 with its examination of sexual distress providing new ground for further intersectionality. In Chapter 11 the view of suicide as a ‘crisis of self’ also opens the door on further important critical work. Later in Chapter 16, Steve Graby considers neurodiversity highlighting the tensions around madness being directly aligned with other movements. For example, can we view autism as ‘real’ as opposed to a social creation? Graby stresses that there is ‘no normal state of the human brain’ (235). He concludes that neurodiversity could potentially build some theoretical bridges between mad and disability studies.

Peter Beresford’s Chapter 17 acts in some way as an early conclusion for the book. I particularly like his optimism in the possibilities for future theoretical developments and productive alliances in the area. The authors in the final chapter honestly concede that the book has omissions and areas that need to be included in future discussion. One of these being around learning disabilities, for me more precisely the concept of ‘challenging behaviour’ seems to offer an interpretive behavioural framework analogous with that of madness and distress.

This book enriches an existing field which contains work such as LeFrançois, Menzies, and Reaume (2013) Mad Matters: A Critical Reader in Canadian Mad Studies and Coles, Keenan, and Diamond (2013) Madness Contested: Power and Practice. It is interesting that the authors choose not to brand the book under review as a UK Mad Studies text, it being as yet unclear whether this new area of study will flourish. Madness, Distress and the Politics of Disablement is significant and a must for undergraduates and postgraduates in the fields of sociology, social theory and social policy. The book is also an important read for those working in mental health and disability, those engaging in activism and basically anyone seriously interested in mental health and disability theory. This book is an open, vibrant, positive work that signals numerous directions for future research and writing. It advocates solidarity and mutual support in mental health which is currently under heavy attack from neoliberal agendas. I only hope that this constructive approach continues and grows. In the field of distress, madness and mad/disability studies this is a landmark work which I have been waiting to read for years. I now look forward with renewed energy to future work in the area.

Toby Brandon
Department of Social Work and Communities, Northumbria University, Newcastle upon Tyne, UK
[email protected]
© 2016 Toby Brandon
http://dx.doi.org/10.1080/09687599.2016.1208984