One of these things is not like the other...
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Opinion piece by Alaina Leary previously published by Everyday Feminism.
I’m a disability rights advocate, and I include mental health in my activism.
While I know that not everyone with a mental health condition considers it a disability, it’s important to me that my activism is inclusive.
In mental health circles, it’s common to talk about the ways that mental health is uniquely stigmatized and how ableism affects folks with mental health issues.
Ableism isn’t a one-size-fits-all form of oppression, and it’s just as complicated as other forms of discrimination.
Because disabled people, including mentally ill folks, are a wide and varying group, ableism comes in many shapes and sizes.
For people with physical disabilities that are commonly understood or that require some sort of visible aid (a wheelchair, a white cane, a prosthetic limb, a hearing aid, a walker), ableism can show up differently than for someone whose disability is rare, misunderstood, or largely invisible.
Is mental illness the same as physical illness?
In these discussions about mental health stigma, I’ll often come across the idea that we should start treating mental illnesses the way we treat physical illness.
Generally, these conversations hinge on the fact that we’re talking about curable, easily treatable physical illnesses – something like bronchitis or a broken leg.
The conversation looks something like this: “Why can’t we treat mental illness the same as physical illness? You wouldn’t tell someone with a broken leg not to take pain medications or tell someone with bronchitis that they’re faking their illness.”
I get it.
As someone who has PTSD, which is largely invisible and commonly misunderstood, I often feel like my mental health isn’t taken seriously and is uniquely stigmatized.
But the difference here mainly lies in the fact that when we’re talking about physical illnesses, we’re making the assumption that folks with physical illnesses don’t face ableism or stigma the way that folks with mental illnesses do.
And that’s not accurate.
Stop treating mental illness the same as physical illness
When we’re comparing short-term, treatable conditions, like a broken limb, to chronic mental health issues, we’re using the wrong comparison.
Folks don’t react to a short-term illness with ableism because it’s assumed that the condition is going to be easy to treat and will go away soon.
Sometimes, these conversations about physical illness do include more chronic and long-term conditions. People will say things like: “You wouldn’t tell someone with cancer that they just need a better attitude in order to feel well again. You wouldn’t tell someone in a wheelchair that they need to suck it up and walk.”
But the reality is that folks who have longer-term or chronic health issues and disabilities do face stigma and ableism just like people with mental illnesses do, even if it doesn’t always show up in the same way.
I have a lifelong physical disability that makes it hard to walk, stand, and balance, and I’ve had people ask me if I “really” need to use my cane, give me unwanted medical advice, and tell me that using a mobility aid means that I’m “giving up.”
Folks who are wheelchair users, especially if they’re able to walk a little or they previously walked with help from another mobility aid, are often told that they need to continue trying to walk, even if walking is painful, exhausting, or otherwise unmanageable.
It is a myth that people with a physical illness are always treated better
The myth that folks with physical disabilities are treated better also usually focuses on the idea that when we’re dealing with a physical problem, our complaints are taken seriously and it’s easy for us to get access to medical treatment.
That may be true for common ailments, but it likely might not, because lack of access to healthcare is an issue for many marginalized folks.
And it’s definitely hard for folks with physical disabilities to get access to healthcare, just like it is for those with mental health issues.
People with physical disabilities face ableism in the healthcare system.
From the way that health insurance companies can deny someone based on pre-existing conditions to the fact that many physicians miss signs of breast cancer in disabled people to the possibility that employers can force employees to undergo genetic testing.
This all affects disabled people who are multiply marginalized even more so.
When I was going through a month-long flare-up of extreme pain, migraines, and nausea that left me mainly bedridden, I was told everything from “You’re just stressed out” to “You need to let the ‘evil spirits’ out of your body” by healthcare professionals I spoke with.
Although my disability is physical and my symptoms were physical, I was treated with doubt and skepticism. I had to seek out several different physicians and specialists before finding someone who I felt was treating me with respect and taking my symptoms seriously.
When it comes to accommodation or medication is having a mental illness the same as physical illness?
There’s also ableism attached to asking for accommodations and treatment for physical health issues, just as there is for mental health issues.
It’s common for folks to be warned against taking medication for their disabilities, especially if there’s any pain medication involved – and disabled folks are often accused of faking their pain in order to gain access to addictive medications.
Folks also face barriers when they’re asking for accommodations or aids that will help them manage their disability.
This happens across mental illnesses and physical disabilities. We’re asked if we “really need” the aid or accommodation, and accused of letting an aid “become a crutch,” and becoming reliant on necessary accommodations and aids that allow us to be more independent and healthy.
This shows up differently for folks with mental health issues, and we all face ableism differently depending on our specific conditions and other marginalizations we face.
But it’s still a common problem to be denied access to treatment or accommodations that you need because you have a disability, whether it’s needing space because of a panic attack or asking for elevator access because you’re unable to climb the stairs.
“Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these).”
American Psychiatric Association
Ableism affects people with mental illness the same as physical illness
As someone who has both a mental illness and a physical disability, I know how awful it can be when you’re met with ableism. The best way to fight ableism is to work together, to fight ableism as it is used against people with mental health issues as well as physical disabilities (and all other kinds of disabilities).
By resorting to in-fighting over who is more oppressed, we’re just separating the community and reducing our collective strength. We’re stronger activists when we work together, and because intersectionality exists, plenty of folks belong to both categories.
I’m both physically disabled and mentally ill, and I feel extremely erased by conversations that assume people with physical disabilities are treated better than people with mental health issues.
For years, I’ve had my chronic pain, poor balance, and difficulty walking and standing shrugged off by doctors who don’t want me to use a cane or wheelchair to get around, even though those aids make me more independent and allow me to live my life more fully.
I’ve also been told different versions of “it’s all in your head” by different specialists, even though my medical history shows that this has been a lifelong inherited disability.
This is uniquely oppressive, because these doctors are brushing off my symptoms because they think they’re linked to mental health conditions – and that shows how dismissive they are of treating those issues.
It’s easy to fall back to the conversation “What if we treated mental illnesses like we treat physical illnesses?” because it’s an easy way to remind folks who don’t have mental illnesses that these illnesses are real, and that we deserve treatment, accommodations, and basic respect.
I’ve been dismissed for symptoms of my PTSD so many times that I don’t even bother telling people why I’m uncomfortable doing something – I just say “no, I can’t do that” to avoid having them completely undermine my experience.
But I don’t want to throw physical disabilities under the bus, because even though TV shows and movies make it seem that way, it’s not easy for folks with physical disabilities, chronic illnesses, or terminal illnesses to receive the care they need.
For many people, even something as simple as getting a cast for a broken leg or going to the ER for appendicitis can be the difference between paying the rent that month, or having enough money for food.
Other people should treat folks with mental illnesses and physical disabilities with respect, period. We’re all dealing with ableism in its many insidious forms, especially if you’re multiply marginalized.
We need to redirect our attention and move away from having conversations about how we can treat folks with mental illnesses more like we treat folks with physical illnesses or disabilities.
Instead, we should be talking about how we can dismantle ableism and systemic oppression against all people with disabilities.
We should be talking about how we can make healthcare more accessible.
We should be talking about how mainstream media representation fails people with disabilities, including mental illnesses, and how that representation leads to discrimination in real life.
We should be talking about how to train physicians to combat internalized ableism when dealing with folks who have mental illnesses, physical disabilities, or both.
We should be fighting for accessible buildings and employment equity.
We should be fighting ableism against folks who need accommodations and aids.
It’s not a game of who’s treated better when it comes to ableism and systemic oppression. We’re all combating stigma and discrimination, but we’re stronger when we combat them together.