E-Kantipur

The term mental disability is quite controversial and relatively new in public discourse.  There are people who believe believe in the existence of mental disability and those that don’t. But, the truth is that mental disability exists. There are millions of people in the world who suffer the consequences of mental disability every day. Therefore, this issue must be debated and discussed in the public domain.  

 We all experience the consequences of mental disability in one way or other in our life time. But, for a section of the population, it becomes a lasting tragedy. We all suffer but the proper number of people who suffer the most still remain invisible. There is a lack of reliable research to provide convincing data on mental disability.

In defining disability, the UN Convention of the Rights of Persons with Disabilities (CRPD) says, “Persons with disability include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”. This way, CRPD clearly establishes the existence and the rights of people with mental disabilities including people with intellectual or sensory impairments.

Despite huge numbers of people suffering from mental disability, in the absence of clear public understanding and communication, mainstreaming mental, intellectual or sensory impairments into human rights advocacy and education has remained a huge challenge. It is not easy for us to discuss mental disability in public spaces.

Vikram Patel, professor of International  Mental Health at London School of Hygiene and Tropical medicine recently told me, “The question about mental disability is the basis for much discussion and debate. In essence, my view is that mental disabilities and mental illness/health problems overlap are not the same. Thus, while some mental health problems such as psychoses produce disabilities which may be enduring for longer periods, others (like depression) produce temporary disabilities which recover when the problem is over”.

Professor Patel further explained to me, “In this sense, if we compare schizophrenia to severe lung disease, then depression is like the common cold. Using this analogy, I would not lump depression with schizophrenia in a discourse on mental disability. Then, at the other end of the spectrum, we have mental disabilities like intellectual disability which are not mental illness/health problems at all, as they are first and foremost a disability. However, it must be said that these boundaries between illness and disability blurred in everyday life”.

Professor Patel’s argument indicates that “mental disability” can represent all types of disabilities that originate from mental health problems including those like intellectual disabilities which are not mental health problems but disabilities foremost. I am always open for discussion, however, like Professor Patel, I prefer to use “Mental Disability” as an umbrella term that represents the whole array of mental and intellectual disabilities. So, it becomes easier for us to mainstream mental disability rights under the single umbrella term.

On understanding mental disability, a couple of months back, I had an in-depth discussion with Mr. Oliver Lewis, Director of the Mental Disability Advocacy Centre, a leading European mental disability rights organization based in Hungary.  Mr. Lewis perfectly agrees that there is a need to explain “mental disability” clearly.

While explaining mental disability, Mr. Lewis suggests that “we should explain the rights of people with mental disabilities as covered by international human rights law, and specifically by international disability rights law (Art. 2, CRPD). This is quite uncontroversial although some people—including some users of mental health services, as well as some mental health professionals—say that people with mental health problems can recover and argue they are not disabled”.

Mr. Lewis further explains that “such an argument misses the point of the social, environment, economic and political disablement which people suffer from as a direct result of how other people than themselves view their illness/disability/impairment/problem, rather than understanding the complexities and perspective of people with mental disability”.

Here, Mr. Oliver raises the most important point that generally mental health professionals and the general public fail to understand the real life challenges of people with mental disabilities. Here, the fear of Mr. Oliver is if the term “mental disability”can be a reminder of the social outcomes of mental health problems. It is a genuine concern.

Therefore, in tackling the term, “mental disability”, the position of World Network of Users and Survivors of Psychiatry (WNUSP) is different. Though, WNUSP agreed to use the term mental disability in CRPD, they have been using term “psychosocial disability” as an official term in their documents.

“Mental disability” will remain an ongoing debate for some years more. In its implementation manual of CRPD, WNUSP strongly favors the term “psychosocial-disability”. It says, “The word psychosocial refers to the interaction between psychological and social/cultural components of our disability.  The psychological component refers to ways of thinking and processing our experience and our perception of the world around us. The social/cultural component refers to societal and cultural limits for behavior that interact with those psychological differences madness as well as the stigma that the society attaches to labeling us as disabled”. In this description, the biological and medical root of mental health problem is unclear for me.

Definitely, the term “mental disability” requires serious debate. Interestingly, in a couple of documents, UN Special Rapporteur on Right to Health uses the term “mental disability” to explain an array of mental disabilities including intellectual disabilities. In the line of UN documents, I strongly prefer the term “mental disability”, because it is catchy and easy to use. What do you think about it?

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