Tuesday, February 06, 2007

Mental Illness and Metaphor

Here's the back story, to get you caught up. Hanging out with a group of Indian women, I met their children. One little boy is clearly autistic, in the classic "no social affect" way. This interests me not so much for professional reasons -since I know very little about it and can't help, anyway- but for personal reasons. I know some autistic little boys fairly well, so the situation catches my attention.

You also have to know that my Hindi skills are beyond woeful (much closer to nonexistent than merely woeful, truth be told), so when I ask about this I stumble on the word for "autism". As courteous people will, the mother supplied the word -"deaf." He's clearly not deaf. He doesn't respond to people, so much, but he hears and acknowledges every car, every airplane, every truck. His speech does sound like a deaf person's speech, a little, but his ears clearly work. He's not deaf.

So, I assume I've made a language mistake and try again. The interchange repeats itself. The poor mother is probably wondering if she has a mentally impaired social worker on her hands. Slowly, slowly, the light dawns. They frame their understanding of this thing I call autism differently.

Everybody knows Susan Sontag's work with illness as metaphor. She looked at cancer, AIDS, and tuberculosis. Her basic argument is "Oh for heaven's sake, it's just a disease." There's no willed victim-hood; the disease is not about repressed emotions. Nor are these diseases mere social constructs to explain dysfunctional behavior.

But, mental illness can't (yet?) be entirely explained by anything so convenient as a virus or a neoplasm. So I tend to put autism in the mental illness category. "Mental" and "illness" then each inform any treatment or intervention strategies I come up with. The mom thinks of deafness as a physical issue and, like many deaf people in the United States, not really as an impairment at all. Some people are deaf, in the sense that their ears don't work. Other people are deaf, in the sense that they are tone deaf to social nuance and social exchanges. Since no one really knows in a definitive way what this array of symptoms (conditions? experiences?) is, all we have is metaphor.

OK, this is possibly intellectually interesting. Or not. But why should other people care? Other than for the obvious reason that thinking about it keeps Andrea off the streets, I mean. A diagnosis of mental illness necessarily implies that someone (else) has a role in enforcing normal behavior. And the second that two people are involved in one person's behavior and decisions, we have politics. What happens if we look again at the metaphors we use for mental illness? I'm wondering now whether -or how much- the metaphors have changed over, say, the last 8-20 years with the growing conservatism in the U.S. Are we thinking of, perhaps, domestic violence, schizophrenia, even poverty, differently, and thus justifying more punitive interventions for the people involved? Are we calling more and more things mental illness? Should we, perhaps, look at extending Sontag's thinking to mental illness and work at reframing public language about it? I guess it's pretty obvious that I have a hypothesis, but no real evidence just yet.

I'll get back to you.

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