A political philosophy of mental illness
By M.R Harnden
Key Themes: thesis, philosophy, mental health services, society, injustice
Current research shows that many people suffering from debilitating mental illnesses, in the United Kingdom and elsewhere, also endure additional types of hardship alongside the considerable trauma of their troublesome mental health. Not only must these afflicted people come to terms with a life-changing series of events that not all survive, they also face a new social reality that sees their expectations and prospects diminish to an alarming extent.
In the Introduction to this dissertation, I outline the nature of these additional hardships and source the telling research that demonstrates they exist.
In Chapter 1, I introduce the reader to some of the broader issues involving mental illness, within the context of debates surrounding personhood and citizenship. I then seek an explanation for the unfair state of affairs that research reveals by referring to certain prominent philosophers and their views on justice and injustice.
John Rawls’ A Theory of Justice is the subject for most of Chapter 2.
Throughout, I search Rawls’ distributive paradigm for any sense of the predicament of the mentally ill, hoping to learn if Rawls’ brand of distributive justice might be the appropriate means through which to address the concerns raised by the Introduction and Chapter 1 of this dissertation. I check Rawls’ work for direct reference to the mentally disabled and draw from his analysis the place that they occupy in his thinking. If his theory of justice were to apply to the type of circumstances the mentally ill face, and he offers a way forward for these people, I will be able to argue that the mentally ill do suffer unnecessarily from distributive injustice.
Alternatively, Iris Marion Young might offer a more coherent account of justice and injustice, via her work on oppression and domination in Justice and the Politics of Difference. This is the subject of Chapter 3. By the end of Chapter 3, I am in an informed enough position to decide if either Rawls or Young offer a reasonable account for the various inequalities that mental illness engenders.
I will ideally provide, in the Conclusion to this dissertation, philosophical assurance of the future alleviation of present injustices as they afflict the mentally ill; or at least a strong conviction as to how the most blatant instances of unfair treatment, at work, in the family and in society generally, can be largely reduced. It might prove the case that the mentally ill suffer unnecessarily from injustice but not necessarily that of the distributive kind.
About the Author
I was born in Aldershot in 1973. Following childhood and eight years of boarding school, I went to the University of Newcastle-Upon-Tyne where I enjoyed playing football for my hall of residence, going to stand-up comedy nights and painting the town too crimson. My chances of gaining a degree were scuppered by a severe bout of mood swings and during a second admission into hospital I was diagnosed with manic-depressive illness and prescribed lithium carbonate.
After two further, scary admissions I chose a different tack, relocated and spent two years studying performing arts at college in Gwent, co-writing and presenting a popular television show for HTV Wales and appearing in a number of well-received short films and theatrical productions. The highlight was growing to forty feet tall on the big screen at movie festivals around the UK and being featured in a BBC documentary about young film-makers.
By 2001 my health was still a concern to those around me though and medics concurred in now slightly more muted tones, signing me off work to attend coping strategies and self-management classes. A referral to undertake voluntary work led eventually to me being employed professionally as Public Relations Officer for the Manic-Depression Fellowship Wales. During this time I graduated with a BA (Hons) in Politics and Philosophy from the Open University and went on to earn an MA in Philosophy from the same institution, focusing on mental illness and social injustice.
I have recently been elected community councillor, for the second time, consistently active in local politics in the Newport area since 1999. Since 2004, I have played for Rogerstone Welfare Cricket Club and am also an ECB qualified youth coach with many commitments.
I have been a free-lance mental health educator since 2006 and have worked with Astrazeneca Neuroscience, Bath University, the University of Glamorgan, BBC TV, Penguin Books, the UK Psychiatric Pharmacy Group and the Royal Pharmaceuticals Society. A sixth-form education video I made in 1997 with MDF Wales is still currently advertised on the website of the Royal College of Psychiatrists.
I am functioning well now, according to experts, with a keenness to make the most of the years ahead without being cowed by some distant memories of chaotic, acute times. I am a versatile all-rounder hoping for the best and prepared to try and make it happen.
People who suffer from severe and enduring mental illnesses also experience such high levels of social, economic and political inequality that the notion of there being a fair and just society is absurd without fundamental change. The scale of deprivation affecting people with mental illness impacts upon their chances of continuing, physical survival. The longevity of mentally ill people is reduced by great inequalities in physical healthcare, relative to people without psychiatric conditions: ‘International evidence shows that people with learning disabilities or long-term mental health problems on average die 5 to 10 years younger than other citizens, often from preventable illnesses’ (Massie et al, 2006: 25).
Not only do people with mental illness live shorter lives, their lives are blighted in further, inter-related ways: ‘They also live with poorer physical health, which means people who are already exceptionally socially excluded—on every measure from education and employment to housing and social networks—often face the additional challenge of diabetes, heart disease or other long term physical illness’ (Massie et al, 2006: 25).
One combined effect of poorer physical health and the distress of mental illness is the increased incidence of sufferers occupying trivial roles in familial and commercial affairs. Poor health all-round ‘makes it harder to participate socially and economically and harder to play an active, valued role in family and community’ (Massie et al, 2006: 25).
In the UK, tackling the issues that have created a pattern of low levels of education, high unemployment, increased chances of physical illness and shorter lives has led to recommendations and legislation aimed at healthcare professionals, employers and those directly affected by mental illness. A philosophical matter is also raised by these instances of further deprivation suffered by the mentally unwell; does anything in our canon help explain how these inequalities have arisen and how they can be reduced? The main theme of this dissertation is to describe and discuss the philosophical context of the issues that identify the mentally ill as perhaps experiencing less than justice, concentrating upon John Rawls’ ‘justice as fairness’ and Iris Marion Young’s concept of ‘oppression’. By utilising the work of prominent thinkers on the subject of justice, it should be possible to learn how injustice can be understood with regards to the mentally unwell.