What is the BizOMadness Blog?

This blog is devoted to raising critical awareness of psychiatry generally. It is likewise devoted to the antipsychiatry research projects, publications, and related activities of Dr. Bonnie Burstow. Especially foregrounded are The Psychiatry Project, The Madness Project, and "Psychiatry and the Business of Madness". Related to one another, The Psychiatry Project and The Madness Project involve hundreds of interviews, a dozen focus groups, analysis of several hundred documents and their activation, and dedicated periods of institutional observation. The culmination of both as well as of decades of related interviews and activities is "Psychiatry and the Business of Madness" (timely updates on its publication will be provided)--a cutting edge book in which psychiatry is investigated from multiple angles and which begins to tackle the inevitable question: So if we get rid of psychiatry, where do we go from there?

For the Events page to find events related to this research or this book, see
http://bizomadnessevents.blogspot.ca/

To check out reviews of Psychiatry and the Business of Madness and related publications, see http://bizomadnessreviews.blogspot.ca/

Sunday, November 19, 2017

Creeping Fascism: The Universities’ “Unfit to Study” Policies


I am being put on medical leave by my college due to a number of long standing mental health issues…. I am . . . devastated….I have nowhere to go.” (private correspondence, October 30, 2017)

I was declared “unfit to study” by my college over a year ago. It took the ground out from under me; and I doubt that I will ever get back my life. Dr. Burstow, how can they just do things like this to people? (private correspondence, November 6, 2016)

These are excerpts from two of the many letters that I have received over the last couple of years from students who have left their respective universities involuntarily. Called “mandatory leave” the students subjected to these measures are categorized as “unfit the study”, and such policies are sweeping the globe, with the UK demonstrably taking the lead. Examples of UK universities that have adopted “unfit to study” policies are Oxford, Bradford, Bristol, Brunel, Cardiff, Leeds, London, Reading, and Queen’s University Belfast (see http://www.idras.ac.uk/designing-a-better-system-for-dealing-with-complaints/is-there-a-dispute/fit-to-study-dealing-with-problem-students/). Many universities in North America have similarly adopted them, and the most prestigious university in Canada—University of Toronto—appears to be poised to pass just a policy.

So what exactly are these policies? How are we to understand them? And as people concerned about human rights, decency, and social justice, what should we be doing about them?

On a simple level, they are provisions whereby the university administration can compel a university student to take a “leave of absence”. While the university’s code of conduct is frequently cited, breaking the code of conduct is neither a necessary nor sufficient condition to be placed on mandatory leave. What is pivotal is the university being uncomfortable with the student—oh yes, and that magical term “mental illness”.

Being of danger to self or other is generally how this is understood, though thrown into the mix as well are what would appear to be primarily academic considerations. The policy currently being actively considered by University of Toronto, for example, reads (http://www.governingcouncil.lamp4.utoronto.ca/wp-content/uploads/2017/09/a1005-6i-2017-2018ab.pdf):

The threshold for intervention encompasses two potential scenarios:

Scenario 1: A Student’s behaviour imposes a risk of harm to self or others . . .
Scenario 2: While not posing a risk of harm to self or other as described in Scenario 1, the Student is unable to engage in the activities required to pursue an education at the University not withstanding accommodations.

Scenario 2 is curious, for it appears to preclude at least one possible obvious explanation which is that either the services are insufficient or the university is fostering a toxic or less than accepting environment that is taking its toll on students (e.g., rigid rules, snap tests, the systematic ignoring of the impact that life circumstances inevitably have, a lack of openness to people who think or act differently or not as those around them expect).  One has to wonder why this does not occur to administrators? One also has to ask, how failures generated in part by the university itself have been miraculously transformed into a “health” or to be more precise “mental health” issue besetting the student? More generally, what we seem to be seeing here is a grab-all category which allows universities to get rid of students viewed as troublesome or otherwise not up to the mark. As these expulsions are defined as temporary, they appear benign to the administrators. The problem is that they circumvent choice; they ignore circumstances, they invisibilize the university’s own role in what is happening; they take negotiation out of the hands of both students and faculty; they deeply stigmatize the students subjected to them, and they utterly disrupt the student’s life.

To see how the two scenarios described in U. of T.’s proposed policy work together—it is situations like the one depicted in scenario 1 which allow the policy in its entirety to be seen as about “mental illness” and which is the essence of what most universities appear to have in mind. Note the strategic use of words here like “harm to self or others”— words that echo the phrases found in involuntary committal protocols (see Burstow, 2015). In turn, scenario 2 widens the net, thereby enabling more people to be caught up by the policy. To put this another way, Scenario 1 defines how we are to understand the policy while Scenario Two greatly expands its application.

To briefly cover a few other aspects of these policies, typically, an intricate procedure is spelt out which needs to be followed, with the procedure generally involving assessments by “mental health professionals”. An appeal process is likewise spelt out. And invariably, the mandated leave is described as not punitive but as a kindness to the student. Suicide is sometimes explicitly mentioned and indeed, the students most commonly subjected to the provisions are ones deemed “suicidal” and/or anxious. That said, window dressing aside, what are we actually encountering here?

On one level, we are encountering a profound human rights violation. It is one thing to remove students from their course of study on the grounds of them breaking the university’s rules of conduct—not that expulsion should ever be the default mode. It is quite another to throw them out on the grounds of being mentally ill. We are likewise encountering expediency. The university has an obligation to accommodate and provide service to students experiencing difficulty. The situation which the policy in essence sets up is minimal accommodation happening with the university thereby saving money—for if you kick out students whom you regard as high maintenance, you save a great deal of money on services. By the same token, a pathologization is happening, which similarly saves the university money. Note in this regard that instead of the university, for example, being faced with having to actually do something about the fact that it is creating an environment that leads to students becoming anxious and depressed, the university is identifying the students themselves—and only the students—as the problem and configuring “their problem” as grounds for mandatory leave—hence, the university need not take stock of how it is operating. At the same time, the policy is both actively drawing on and perpetuating stereotypes. The point here is, as has been repeatedly demonstrated, the so-called “mentally ill” are no more violent than anyone else (see Burstow, 2015). Correspondingly, we are seeing ableism and a human rights violation, moreover, a violation of other civil rights, including the right to an education. We are likewise seeing the universities intrude on personal matters which in the final analysis are none of their business.  Once again, as I have repeatedly stated elsewhere (e.g., see https://www.madinamerica.com/2016/04/75895/), while we might dearly wish for people to stay alive. people have a right to kill themselves.  Moreover, they have a right to think and act differently. We are additionally seeing a conduit into the psychiatric system being established both initially (note, in this regard,  “mental health services” are framed as something to try first, that is before a student is put on “mandatory leave”) and in the long run.  On top of which we are seeing a woeful lack of insight and abject cruelty, whether intended or not.

In this regard, the majority of students that are subjected to such policies never return to school or at very least, not to the school that has cast them out.  As numerous emails which I have received suggest, they are humiliated and traumatized by what has happened. Moreover, they typically find themselves at a loss, for they have been robbed of the routines on which they rely, of their way of coping, often of their housing, in short, of the life they have built.

Question: Why would anyone expect that banishing a “depressed” or “suicidal” person from our midst would do anything other than make them more depressed? More isolated? More “suicidal”?

If these policies are a disaster on the personal level—and for the most part they are—they are every bit as disastrous on the systemic level—and we need to keep our eye on this.  What is happening here is institutionalized sanism. Moreover, what is happening is nothing less than an extension of psychiatric rule into the operation of the university. “Mental health services”, which as most readers know, are themselves dangerous and can seriously harm—are being foisted on students.  Psychiatry—not students and faculty—will be deciding who gets to be university learners. And psychiatry to a large part will be dictating who gets to return after the students have been turfed out (it goes without saying that only those who have “availed themselves” of “mental health services” have much of a chance). 

There are very clear winners and losers here. So who wins? Psychiatry of course and by extension the entire mental health industry win for they are thereby colonizing yet another area and thereby securing yet another stream of steady “customers”. And who loses? Pathologized people, the vulnerable, indeed, all students at any risk of being subjected to these measures—and who isn’t? While most academics seem strangely unaware of this, I would add, academia also loses—and at that, profoundly. The point is, what is in effect being accomplished by these measures is the ceding of an important part of the governing of the university to the “mental health industry”. More generally still, society overall loses, for in enacting and applying such policies, we are marginalizing and harming large segments of our populace.

Is this really what we want for our universities? Is this really what we want for society?

The story which I am telling here, of course, clashes in significant ways with the official university narrative, that being a story of progress and of generosity. Which brings us to a series of myths and facts:

Myth: Mandatory leave policies benefit the students subjected to them.
Fact: Evidence shows that the students are not benefited. Rather the students in question are profoundly harmed.  

Myth: There are built-in safety mechanisms like the right to appeal that makes these policies reasonable, for students can always contest the mandatory expulsion.
Fact: The majority of the students are so overwhelmed that they never appeal. Correspondingly, as with issues of involuntary admission to a psychiatric institution, those who appeal almost never win, for the deck is stacked against them (see Burstow, 2015).  Moreover, why should anyone be faced in the first place with such stigma, with such a profound assault on their dignity and liberty? 

Myth: Other students feel unsafe with “these students” around.
Fact: Insofar as this is the case, that is a reason to engage in consciousness-raising, to take measures to counter sanism—not a reason to reinforce sanism by casting people out.

Myth: Were it not for mandatory leave measures, the “mentally ill” who break rules would be banned permanently.
Fact: Let’s not kid ourselves. That, for the most part, is what with these measures accomplish. Moreover, there is no law in any land compelling university administrations to remove students for any period of time who break rules. This is a university invention.  And the university quite simply needs to find more creative and more humane ways to deal with conflict. What adds insult to injury, the issue of whether or not someone is ‘mentally ill” is a “red herring”, is at very best irrelevant for rule-breaking and violence have no intrinsic connection with so-called “mental illness”.

Myth: Mandatory leave is a measure of last resort. It goes along with added support so that more students can stay in school.
Fact: While all administrations who adopt such policies make claims of this ilk, there is no evidence whatever that such practices function as measures of last resort. The point is that universities who have introduced such measures have historically not increased their services. In fact, most have cut back on their services. Which leads one to ask: Could not the desire to spend less on services actually one of primary motivations for introducing such measures? On top of which, the services offered are not just “offered”. There are forced on student and are a way of controlling students. Additionally, as already specified, so much of what is “offered” is incredibly harmful (see Breggin, 1991 and Burstow, 2015).

Nor is this all that is wrong with “unfit to study” policies.

On yet another level—and we fail to recognize this level to our peril—this expansion of psychiatric rule into academia is itself part of a larger and truly worrisome trend. Significantly, just as psychiatric ruling is being used to remove students from school, it is likewise being used to purge the “helping professions” of members that in any way trouble their colleagues. In this regard, being/being deemed “mentally ill” is progressively being seen as a sign of “professional incompetence” with mental illness discourse being leveraged to drive what are often perfectly capable social workers and nurses (especially those of colour) out of their professions (for a detailed analysis of this growing practice, see Chapman, Poole, Azevedo, and Ballen, 2016).

How does this happen? Each of the regulated professions have colleges or other similar bodies associated with them with which members must be in good standing if they are to continue practicing. The policies mandated by these colleges specify that for person to be a member in good standing they must be “competent to practice ” and the policies explicitly allow for the removal of members found to be “incompetent”. Now with mental status progressively dictating how competence is understood, a member’s colleagues, a member’s supervisor, and others in their workplace are progressively on the look-out for signs of “mental illness”.

A nurse’s confidentiality having been broached in that her supervisor mentioned to others that she was once diagnosed as bipolar, the nurse begins to be treated differently, whereupon she becomes noticeably uncomfortable with her colleagues. A social worker seems distraught one day when talking to some of her less than helpful other team members.  A precarious worker at some point is spotted in tears—and who does not know that precarity makes one’s life harder? All this can and indeed has served as ammunition to level against them, to deem them mentally ill and so incompetent and to deprive them of the right to practice. What makes matters worse, as shown by Chapmen, Poole, Azevedo, and Ballen, 2016, people of colour are in special jeopardy of having these policies applied to them.

Further insight into this worrisome trend can be gleaned by looking at the language employed. To whit, just as vulnerable students seen as mentally ill and accordingly thrown out of the university are called “unfit to study”, social workers and nurses thrown out of their profession on “mental health” grounds are called “unfit to practice.” 

There is a historical echo here that is unmistakable. While I am well aware that people applying these policies are not intending this echo and would indeed be shocked at the suggestion of it, as a Jew and as an authority on the Holocaust, on anti-Semitism, and on fascism, I cannot but notice that  “unfit to study” and “unfit to practice” are on a continuum with “unfit to live”—or, to use the more common designation “life unworthy of life” (see https://en.wikipedia.org/wiki/Life_unworthy_of_life)--a concept that ushered in the systemic murder of Jews, mental patients, and others during the Nazi era, with the eradication of the “mental patients” significantly, coming first, paving the way for the others.  (For one of the earliest and most influential articulations of this fascist concept, see Binding and Hoche,1920; for an analysis of what came of it, see Lifton, 1986).

Now to be clear, I am in no way equating these measures or indeed in any way comparing them—for the differences are enormous. Nor am I imputing what might be called “intent”.  However, I am suggesting that they exist on a continuum. I am likewise suggesting that with this extension of psychiatric rule into areas like academia and into professions like social work and nursing (both, not coincidentally, “regulated professions”), what we are witnessing is creeping fascism—hence the title of this piece.  

Alas, it is all too easy for the fascistic nature of such measures to go undetected for it is not the blatant fascism that we hear about on the streets in Charlottesville.  It is not hatred. It is rather, to coin a phrase, “respectable fascism”.  Indeed, it bears all the marks of being kindly as well as responsibly intended. All the more reason we need to be on the alert.

What other groups will society start trying to control this way? What new modes of surveillance, control, and exclusion will be put into place?  These are larger questions that are beyond the auspice of what can be handled in this article, but as society progressively goes down this path, they are important to keep in mind.

That said, to hone in once again specifically on what is happening to students, so what can we do?

One thing we can do is rally students to mobilize their colleagues and the general public to sign petitions to stop these practices, to mount teach-in for students and others on the issue (both of which actions I currently involved in at University of Toronto). When taking part in any such activity, it is important to challenge sanism, to prepare myth/fact sheets, to systematically make visible the contradictions, and to help people see beyond the rhetoric of the university, or to put this another way, beyond the rhetoric of psychiatry—would that they were not currently overlapping so! Other actions that can be taken include legal challenges (for we are witnessing human rights violations here), the mounting of university-wide demonstrations, the insistence on real (and of course voluntary) services.  

On a broader and more philosophic level, we need to educate around sanism. More broadly speaking still, if we are help society arrive at a place where such policies would be unthinkable, we need to integrate what I have called “mad literacy” into school curriculums from the early grades onward (for details on what this might like, see Burstow, 2015, Chapter Nine). We need people growing up knowing that that there are many different ways of thinking and acting—rather than one right way. And we need them to be able to follow and value what is currently dismissed as “crazy”.

On an equally philosophical level, we need to help others recognize fascist thought when they see it or creeping fascism will inevitably continue. On a more basic level, students and faculty need to proceed from vision. More generally, we all of us need to defend freedom, know what it means to be in community, and everyone who cares about human rights and social justice need to announce unambiguously: We stand for inclusivity and accommodation. We stand for real community. We stand for learning from one another. And we affirm together: No one is “unfit to study”.

Make no mistake about—there is a huge fight ahead of us. Allies that can be meaningfully turned to in the fight ahead include psychiatric survivors and their allies, the autistic community, student unions, students from every sector of the university, progressive educators, progressive university staff, disability rights groups, lawyers, activists, advocates, ombudsmen, politicians, religious leaders, organizations of on-side parents. 

The task before us, as I see it, is to assemble as many allies as possible, to build a broad-based coalition, and not to cease in our labour until a) such policies are stuck down; b) university environments are safe for students, c) adequate accommodation is happening; and d) the oppression known as sanism becomes understood and instances of it are transparently treated as unacceptable—even when these arise from university governance  itself. To be clear, while of course the actions of some students may legitimately be seen as a problem by university administrators, this reality is no way justifies sanist and otherwise oppressive policies and processes.

In ending, to touch base once again on exclusionary policies more broadly, beginning with what is currently happening to besieged professionals, by the same token, while individual social workers or nurses may well be incompetent and best not be employed for any number of reasons (e.g., they are woefully hegemonic, lacking in skill, or just plain insensitive), as Chapman, Poole, Azevedo, and Ballen (2016) so astutely put it, “the human experience pathologized as ‘mental illness’” is decidedly not among these. Correspondingly, in accordance with the same principle, while there are people who should not be parenting, perhaps because they are abusive, perhaps because they are negligent, being saddled with a psychiatric diagnosis is likewise not among these.

The point here is that where marginalization, exclusion, and control on the basis of putative “mental illness” is happening and/or is starting to happen in any arena, or to any designated group—and who’s to say that university administrators won’t be next?—we need to oppose the institutionalized oppression and to stand in solidarity with those under siege. Just as we must do so with respect to students. Just as we must oppose “involuntary treatment” and incarceration more generally.

How else are we going to build a better world?

References

Binding, K. and Hoche, A. (1920).  Die Friegabe der Vernichtung Lebensunwerten. Lebens. Leipzig: F. Meiner.

Breggin, P. (1991). Toxic psychiatry. New York: St. Martins Press.

Burstow, B. (2016). Psychiatry and the Business of Madness. New York: Palgrave.

Chapman, C. Poole, J., Azevedo, J., and Ballen, R. (2016). A kind of collective freezing out.  In B. Burstow (Ed). Psychiatry Interrogated (pp. 21-40). New York: Palgrave.


Lifton, R. (1986). The Nazi Doctors. New York: Harper and Row.

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