Unintended Consequences of Neuroscientific Explanations

René Magritte, Les Amants (1928)

In Madness and Civilization, French philosopher and activist Michel Foucault wrote that, “from the fifteenth century on, the face of madness has haunted the imagination of Western man.” Foucault argues that the concept of ‘madness’, at least in the 1800s, was characterized as a loss of ‘reason’ – the essential mental faculty which made human beings distinct from other animals. Those who lacked reason (which all rational beings possessed) were perceived as a threat to humanity. Eventually barriers were raised – both literally and figuratively – which separated these ‘irrational’ individuals from the rest of humanity.

Such stigmatizing and social-distancing attitudes towards those living with mental illness are still deeply enmeshed in the social and cultural norms of many industrialized nations. In the 1960s, sociologist Erving Goffman spoke of stigma as a “spoiled identity;” more closer to us Bruce Link and Jo Phelan conceptualize stigma as occurring when “elements of labeling, stereotyping, separation, status loss, and discrimination occur in a power situation that allows them.” A related concept, social distance, is defined as the degree of proximity an individual is comfortable with in relation to an individual who is living with mental illness, particularly as it relates to the perceived dangerousness or unpredictability of that individual. Prevailing views amongst the public see the behaviour of individuals living with mental illness as volitional; at times these individuals might be considered ‘lazy’ (in the case of major depression and the ethical values tied to participation in the workforce), and so, intuitions about mental illness are believed to be justified blaming these individuals, or perhaps even punishing them.

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Tobacco Denormalization and Stigma

Toronto’s Centre for Addiction and Mental Health (CAMH) – Canada’s largest addiction and mental health research and treatment facility – recently announced that come July 2010, three of its principle sites will be entirely smoke free. This announcement appears to be the next step from CAMH’s 2005 non-smoking policy,  in which smoking was prohibited in all buildings and in the designated smoking rooms on inpatient units. Clients, staff and visitors were still able to smoke in designated areas on the grounds.

Justification for the new policy is based on the following argument:

“This is first and foremost part of CAMH’s commitment to transform care for our clients…we should not accept a lower quality of life for people with mental vs physical illness. This decision is equally motivated by health and safety – CAMH has a legal and ethical obligation to provide a safe, hazard-free treatment setting and workplace for our clients, staff, volunteers and visitors. In 2009 the primary cause of death in mental health and addictions populations was tobacco-related medical illness…”

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