Pathologizing the Behavior of Victims

This may be a little disorganized and random, as I'm still processing my thoughts about it.

A close friend of mine recently accepted a job in Behavior Health Services (aka the psych ward) at a hospital. Obviously there are confidentiality concerns and employees are not supposed to talk about the patients outside of work. But the job is emotionally taxing at times, depressing, uplifting, sobering, etc. So people who work there do talk to their friends and families about it, withholding any names or details that would reveal the identity of the patients of course, because they need to "decompress" after work. So all of these fascinating and depressing stories of the individuals who find themselves there have been rolling around in my head, and here are some of the things I'm thinking.

It's disturbing to me that so much behavior that seems absolutely reasonable and normal to me, given the person's history, is pathologized. For example, most of the women who show up in BHS have been abused in one way or another. Some of them in extreme and disturbing ways. When you're in your mid-twenties and have several children by your own father, you have a right to be messed up. But although the abuse is acknowledged and taken into account by the therapists involved, this person is still diagnosed with a mental illness according to her symptoms. And this strikes me as problematic. To say that she's bipolar or schizophrenic or borderline personality suggests that something is wrong with her. Like there's something broken in her head. And this seems all wrong to me. The symptoms and coping mechanisms she's developed are just absolutely right given the violent and skewed environment she emerged from. She's not broken, her world is. Of course now she needs a lot of assistance and compassion to learn how to cope and function in the world outside of the warped one she grew up in. But that's her abusers fault, not hers. He's the one who's fucked up, but she gets labeled and stigmatized because of it.

Similarly, many young women who suffer from depression or suicidal thoughts have been systematically excluded in our culture that values women based on the beauty and usefulness of their bodies. These women are socially awkward and don't meet our strict beauty standard, so they've been cast aside and isolated by their peers. When they show up at BHS feeling lonely and sad, they're diagnosed as clinically depressed or borderline personality. Once again, the problem lies with them - they're broken; something's wrong in their heads. But I feel like this is deeply unjust. The culture they're submerged in, which can't see them and value them for who they are, is what's broken. Responding to isolation and neglect by feeling sad and lonely is not abnormal, it's not irrational, it doesn't make you sick. In fact, it's a more natural and healthy response than many other possible responses.

Men's behavior is often pathologized too. It seems like a lot of the men who show up at BHS have substance abuse issues and engage in inappropriate or violent behavior while under the influence. No doubt many of them have been abused too, but there's more stigma attached to abuse for a man than a woman in our culture, so the liklihood that they would have gotten help dealing with their abuse or PTSD is lower than for women. But substance abuse and violence are among the ways men are taught to cope with trauma, so these are the behaviors they tend to exhibit. And because of this they're often criminalized in addition to being institutionalized for mental disorders.

And many of these types, both male and female, display a lot of drug-seeking behavior and have learned what to say and how to manipulate staff to get the narcotics they crave. Of course, drug-seeking behavior is frowned upon, stigmatized, and shamed. And these patients are aware of the attitudes toward drug-seeking behavior and have internalized the associated guilt and shame. While I agree that drug-seeking behavior shouldn't be encouraged, I have real issues with the way we make it into this shameful and immoral thing. Using drugs to deal with the pain of abuse or other traumatic experiences is one coping mechanism among many. If I had experienced the kind of trauma they have, I don't doubt I would want to be drunk or high every day for the rest of my life too. It's a totally reasonable response. It's true that these people had the misfortune of seizing upon a particularly problematic coping mechanism, but we shouldn't shame them for it, but should rather see it as a simple coping mechanism and try to help them learn how to replace it with more healthy coping mechanisms. Because treating them for substance abuse and then returning them to their world without any more constructive ways of handling their pain and their issues is ineffective at best and counterproductive at worst.

I realize, of course, that the medical professionals who are dealing with these people on a daily basis have little control over the person's environment. Given this fact, it often makes sense to medicate them and make them as comfortable as possible. But this model is so limited and places so much of the problem and the stigma on victims' shoulders that it seems deeply unjust to me. Rather than taking a critical look at our culture and the way it so casually disposes of bodies and lives, we pathologize the behavior of victims and medicated them and shame them for their desire to numb the pain using substances that have been arbitrarily criminalized by the government while treating them with substances that have the government's stamp of approval because the right rich white guys are getting rich off of them. Instead of looking at the systemic causes of abuse, trauma, and the resulting "mental illnesses," we label the victims and put them in a neat little box, hoping they won't cause too much trouble or be too disruptive. And maybe, just maybe, they'll return to the gold standard of being a productive worker/consumer in our capitalist society. Because in a capitalist, patriarchal culture, the norm is established by appealing to hierarchical roles and expectations and cultural conceptions of healthy functioning, i.e. going to work everyday and being a good, non-disruptive little sheep. But that is another story for another post on another day...