What’s best: an “anti-stigma” campaign, or a political campaign?

There’s been a long, long gap between this post and the last, you’ll note, even though they’re on related topics. That’s partly because I found myself being misrepresented and strawmanned in a few places in the blogosphere (and a bit on twitter, I think, although as someone without an account it’s not easy to keep track of what happens on twitter). As always, I found that an initially frustrating and subsequently dispiriting experience, and something that’s thoroughly inimical to what I’m interested in doing with this blog – participating in a rational discussion in which we all try and respond honestly to what each other have actually said.

Since it was obvious that my interlocutors elsewhere weren’t interested in doing that – since they preferred to pretend that I held entirely different views to those I had actually expressed, and to loudly denounce me for writing things I hadn’t – there seemed little point in my getting involved. It’s partly that I didn’t want the hassle, but it is also a literal waste of time. If someone has reached a point where they simply refuse to engage honestly with opposing views then they’ve reached a point where they can no longer be persuaded by rational discourse. Long and painful experience has taught me that, if someone strawmans an argument once, they will do so endlessly, and without limit: they’re just not interested in anything but “being right”, and will twist themselves through the most extraordinary intellectual contortions (arguing that “hot” means cold would be nothing) to maintain that they are.

So I figured nothing worthwhile would be lost in waiting a little while before I responded to the more sensible responses my post had attracted. Some of the surge of temporary readers might have wandered off, but I was confident the rational folk who read my blog regularly – people who disagree with me, when they do, on the basis of what I actually wrote – would still be around, and we could carry on the discussion after the others had left to build their strawmen in somebody else’s wheat field. With that in mind, let’s finally discuss the legitimate point that has cropped up most often in sensible criticism of my last post: that “stigma” is a serious problem because it costs mentally ill people their jobs, or prevents them from getting a job in the first place. My position on this is that, while it may be partly true (and only partly true), an “anti-stigma” campaign is still the wrong way to tackle the problem.

As far as I can see, what mentally ill people who are capable of working actually need is a piece of legislation that makes it illegal for current and potential employers to discriminate against them. Sure, it would be nice if employers were not prejudiced against mentally ill people (that is to say, if they did not form pre-emptive judgements on the basis of inaccurate or incomplete information) but what actually matters is that they’re not free to discriminate on the basis of those prejudices. Luckily we have just such a law, or at least a weak, imperfect version of one: the 2010 Equality Act, which prevents discrimination against people who have a ‘mental impairment’ that ‘has a substantial and long-term effect on […] normal day-to-day activities’. (‘Long term’ is defined as longer than 12 months, and it is explicitly noted that a person is to be regarded as impaired even if they are receiving treatment that stops the impairment from being obvious – exactly the situation that many mentally ill people whose symptoms are controlled by medication will find themselves in.)

Of course it would be lovely if employers – and everyone else – had a positive attitude towards mentally ill people. But when push comes to shove what really matters is how employers act towards their mentally ill employees or prospective employees, and the threat of legal action is by far the swiftest and surest way of making sure they act in a reasonable manner. That’s because it threatens their bottom line, money. An “anti-stigma” campaign implicitly relies on appealing to an employer’s better nature, but some employers don’t have a better nature and plenty of others regard “doing the right thing” as a luxury that they can’t afford. An anti-discrimination law, on the other hand, relies on their instincts for economic self-preservation, and that’s a much more universal attribute in the business world.

For the record, I’m not sounding off about something that has never affected me here. I was once fired because of mental illness – and, in fact, went on to lose my flat when I couldn’t pay the mortgage – but that doesn’t mean I was a victim of an ill-defined but supposedly all-powerful “stigma”. On the contrary, my managers and (most of) my colleagues were sympathetic, and saw me as a person with strengths and positive attributes, not just a walking diagnosis. But I was ill, which made me a less efficient employee, and so the company disposed of me.

That wasn’t “stigma”, it was the inevitable consequence of a rational calculation. I was of less value to the company than a healthy employee, even after taking into account the costs of recruiting and training a replacement, and it made financial sense to get rid of me. No “anti-stigma” campaign in the world could have altered that, because they weren’t stigmatising me in the first place. What could have altered it was a law saying I couldn’t be fired – or, at least, that my employer had to take reasonable steps to try and accommodate my disability before they gave me the shove.*

Part of the problem is that we’ve been so carefully taught to think in such an apolitical way. For many of us, it simply doesn’t occur that discrimination against mentally ill people might be a political problem that requires a political solution. And if these problems aren’t thought about in political terms that leaves only one alternative. If we don’t think of the relationship between employer and employee as an unequal economic relationship in which interests are not always precisely aligned (i.e., what’s best for an employer is not always what’s best for their employee), then the only model that’s left is to think of it as a personal relationship. If we don’t think of an employer who fires a mentally ill employee as taking advantage of their economic power to pursue their own interests, then the only option left is to think of them as being unkind, in exactly the same way that a friend would be unkind if they said “I don’t want to talk to you any more cos you’re mental”.

It’s just such a mistake that leads to people thinking of “anti-stigma” campaigns as solutions to serious problems. If we think that employers who fire mentally ill people are simply being unkind then a campaign to persuade them to think more kindly about mentally ill people might seem to be a solution. But employers aren’t being unkind, or not simply being unkind – they’re also taking advantage of their economic power. So the solution is not to persuade them to look more kindly on the mentally ill, but rather to limit their ability to abuse their economic power. In other words, not to campaign against “stigma”, but to campaign for an anti-discrimination law. Mentally ill people are protected from unfair dismissal (insofar as they are protected: see footnote) because of people who campaigned for an anti-discrimination law, not people who campaigned against “stigma”.

There are a number of historical parallels that back this up. When women were campaigning against the systematic injustices they faced in the late 19^th and early 20^th centuries, they didn’t organise a “competency” campaign designed to persuade men that they were able to hold down intellectually demanding jobs outside the home and were capable of voting. On the contrary, they campaigned directly for the right to gain entry to the professions and to vote – they focussed on making sure that men treated them fairly, not on trying to change their minds. Black people in the segregated south of the USA didn’t organise anti-racism campaigns to persuade hostile white people to take a more positive view of them. On the contrary, they organised directly against the Jim Crow laws – they focussed on making sure that white people treated them fairly, not on trying to change their minds.

As with feminism and civil rights, so with rights for mentally ill people. We should be primarily concerned with making sure that sane people treat us fairly, not with changing how they think about us. That means a political campaign focussed on those things that unfairly affect us – the ban on mentally ill people serving as MPs, jurors and company directors (recently partially over-turned); the strengthening of employee protections for people with mental illnesses; fair funding of mental health services; reform of the benefits system so that it recognises the particular difficulties faced by people with mental illness; and so on. A vague war on an ill-defined concept like “stigma” might well be motivated by all those goals, but it’s an ineffective strategy for achieving them.

This is not to say that we give up altogether on changing hearts and minds. But it is to relegate that part of the campaign to its proper place, as what comes after the basics have already been achieved. The average man’s opinion of the capabilities of women has been transformed over the last century-and-a-bit – but that transformation came after the political changes that allowed women to flourish, not before them.

The assertion I made in my last post (that’s the assertion I actually made, not the misrepresented, strawman versions that you might have come across elsewhere) was that stigma only looms as a worry in the minds of people who have access to the basics they need to survive. That’s every bit as true for mentally ill people who are capable of working as it is for those who have no choice but to subsist on benefits. It follows that mentally ill people who can work need to secure their right to work – and that’s something that’s best achieved by a political campaign with clearly defined goals, not an “anti-stigma” campaign that has only vague aspirations to somehow change the way people think. Changing public attitudes towards mental illness may be a worthwhile goal, but it shouldn’t be a priority. Until we’ve made sure that all of us – those of us who can work, and those of us who can’t – have access to the basics, “stigma” will remain a relatively trivial problem.

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* – I actually wouldn’t have benefited under the 2010 Act (or the 1995 Disability Discrimination Act, which was in force at the time and contained similar provisions). This is because my employer fired me shortly after I received my diagnosis – i.e., before the 12-month rule specified in both Acts applied to me. This is a fairly obvious loophole, and it’s one of the reasons I believe the 2010 Act needs to be toughened.