Invisibility, Visibility, & Stigma

One of the main questions we have to ask when thinking about mental disability in relation to “physical” disability is the dichotomy of invisibility and visibility.  I use the term “physical” loosely because more and more studies are finding that mental illness is a result of physical abnormalities in the brain and that it, too, is bodily.  Nonetheless, mental illness is often something we can’t see.  It can alter one’s behavior and mood, but these things aren’t quite as tangible as an actual disfiguration of the body’s surface (such as a missing limb, scars, etc.).  

I’m interested in how this difference between the invisibility of mental illness and visibility of “physical” illness relate to stigma.  I turn to the OED, which defines stigma as: 

• A mark made upon the skin by burning with a hot iron (rarely, by cutting or pricking), as a token of infamy or subjection; a brand

• A mark of disgrace or infamy; a sign of severe censure or condemnation, regarded as impressed on a person or thing; a ‘brand’.
• Marks resembling the wounds on the crucified body of Christ, said to have been supernaturally impressed on the bodies of certain saints and other devout persons. 

All of these definitions imply a distinct visibility, one that is marked by surface.  Those with “physical” disabilities often have clear visual markings that suggest that they’re impaired—missing limbs, bodily disfigurations, etc.  Mental illnesses generally can’t be seen and are often assumed to be a failing or simply a lack of willpower on the part of those who have them.  Although there still remains misunderstanding and stigmatization, we’ve learned to accept that any type of “physical” abnormality is not one’s choice and seem to recognize (at least on the surface) the severity of its impediment.  However, issues of mental health can often be different story.  If you don’t have a mental illness yourself, it’s hard to understand the people that do.  I’ve been wondering, is it because mental illness often remains unseen that it is more stigmatized and less understood?  Is surface our only access point for empathy?  

I’ve just started reading Susanne Antonetta’s Travels in a Neurodiverse World.  In the book’s second chapter she describes the trial of Kyle Anderson, a teenager who lives in her neighborhood and brutally killed a little boy.  Having suffered from manic-depressive illness herself, Antonetta assumes an interesting perspective in relation to Kyle, one that seems to constantly shift.  Much of what she explores throughout the chapter and the book as a whole is:  how do we understand a mind that’s not our own?  She hates Kyle so much that she imagines “cutting into him like a razor, into his uncaressed nakedness” (57) and as a mother, she can’t imagine her own son being killed by a boy like Kyle.  Antonetta attends each of Kyle’s trails and tries to understand the complexity of his crime.  Much of her focus is on the back of Kyle’s neck, which faces her during each of the hearings.  I find the neck to be an interesting point of fixation.  Connecting the head to the body, the neck suggests the bridging between Kyle’s mind and actions.  The brain sends a message and the body performs its request.  Does the neck, as the channel between Kyle’s mind and hands ignite his crime?  Antonetta sees the neck as both a point of innocence and guilt, projecting both hate and compassion onto its surface.     

Since the Tucson shooting, I’ve been thinking a lot about mental illness—about what constitutes being mental ill, about the divide between those we perceive as “sick” and “healthy”.   Jeff Bell, in his blog “Beyond the Doubt” for Psychology Today, worries that Jared Loughner’s face will become the face of mental illness.  Having suffered from obsessive-compulsive disorder for years, Bell worries that those struggling won’t find help, that they’ll feel even more stigmatized by the term “mentally ill” because someone like Loughner has become the poster boy for mental health gone awry.  I agree with Bell that the media fixates on cases like Loughner’s, cases that are extreme and aren’t necessarily an accurate representation of the average person living with a mental illness.  But I also find Bell’s standpoint to be problematic.  Like Antonetta’s initial wish, he wants to see the dividing line between himself and the murderer.  Antonetta writes, “Maybe more, I wanted someone to explain Kyle to me and separate him from me” (63).  Disability studies work to break down this binary between “sanity” and “insanity” and opt instead for continuum that encompasses a wide variety of states—both disabled and abled.  The problem is that Loughner is mentally ill and Bell’s distancing himself from Loughner is, in a sense, re-stigmatizing.  Distancing in disability studies, is seen as problematic.  In the introduction to Disability Studies Enabling the Humanities, it says, “In stigmatizing and distancing ourselves form disability, we participate in late-capitalist culture’s relentless attempt to standardize and stabilize the body” (2).  Even though we’re not working so closely with the body because we’re talking about mental health, Bell nonetheless seems to be acknowledging the tendency to standardize, to suggest that some are “crazy” and others “normal.”  He seems to be opting for this continuum of health, but nonetheless reinforces the binary of “normal” and  “crazy.”  He wants to be defined as a “normal” person, one that just happens to have a mental illness.

Antonetta’s brother Chris once said, “The hardest thing in the world to understand is that other people are just as real as you are” (53).  At points in the narrative, Antonetta feels compassion for Kyle and comes to juxtapose her own narrative of illness against his.  When she sees Kyle, a kid who “picked his nose constantly, rarely bathed” (53), she also sees herself:  “my half-shaved legs, my overgrown toenails, and bra straps that stick out” (53).  She wonders if she, too, could bring herself to Kyle’s own state.  She asks, “Did I have a time when I could have been—neuroatypical as I was, my mind pushed around by itself and by what I fed into it—something like this boy of the sad, unlovable neck, not in his actions but in some deadness inside?” (54).  From a personal standpoint, I look at Loughner and I feel angry, but I also feel badly.  From my own experience with OCD, I know the outrageous power of the mind, the way it seemingly takes over the body—how it pushes you to places you never wanted to go, makes you do things you never wanted to do.  I’ve spent hour after hour engaging in rituals to reduce my anxiety and hurt my family because I couldn’t stop when they told me to.  So I do see myself in him.  I don’t see myself committing the atrocities he did, but I don’t suffer from the illnesses that he does.  I can’t enter Loughner’s mind just as Antonetta can’t understand Kyle.  We just can’t know.    

It frustrates me that professionals in the media are suggesting that the Tucson shooting is a wake-up call that we, as a society, need to be more invested in providing individuals with adequate mental health resources.  But going back to this tension between visibility and invisibility, how do these supposed “warning signs” become evident?  How do we recognize that someone like Loughner is struggling?  From Antonetta’s perspective, all we see is Kyle’s white cable-cord sweater, blue t-shirt, and fleshy white neck.  She can’t seem to move past surface.  Even when she imagines slicing his neck with a knife, she can’t access his pain; she can’t come to see his disability.  There’s no marking like the stigma that the OED defines.  To see is to potentially understand, but to be robbed of the certainty of seeing is to fail to apprehend.  What is visible is the fact that both Kyle and Loughner ruthlessly murdered innocent people.  Again, it’s the external (& outward behavior) that is the point of focus, that is the source of stigmatization.  But what’s going on inside?  What is it that we can’t see?