Rule Two for diminishing a self: create the illusion of "stigma" and teach it repeatedly, repetitively, redundantly, until the group begins to teach itself, and the society teaches itself as well. For the concept of a "stigma" to survive, every member of a society must accept it as reality.

Today a majority of you reading this article teach that concept to and about persons with mental illnesses, as you have each been taught. A majority of you reading this would no longer dare argue there is a "stigma" for African Americans, or for women who have survived the crime of rape, yet would insist there is a "stigma" for me. Society has taught us that well.

Rule Three for diminishing a self: accept the prejudices of a society without question, without self-examination; accept the lessons learned in school, at college, at university, and act upon the inaccuracies, the falsehoods, in those lessons. This is of course the reason for segregated schools: Denied access to learning, no group can defend itself. Denied access to teaching about itself, no group can defend itself.

Women were denied access to education, African Americans were denied access to education, and a great untruth could survive unchallenged for scores of years, centuries. It is patently simple to assess the power of such segregation: No woman, no African American has ever risen to the level of president. Few have risen to the level of high political office. Equality for segregated groups remains a distant dream.

Universities teach the concept of "stigma" to students, with no regard for the effect on those students, or on the students in the classes about whom they teach.

Imagine sitting in a class where a professor is teaching that you carry a "stigma"! Please, each of you, feel the shame.

Rule Four for diminishing a self is to impose segregation from process, segregation from every level of process imaginable.

Recently several conferences on self-directed care have taken place, and in each the great majority of people in attendance, people presenting, people permitted to speak, were your peers. Mine were in small minority, and were generally observers not participants in any meaningful manner. At a recent conference in Washington we were even refused the right to participate; we were considered "unqualified". One of the written conclusions of that conference was that we should be present in greater numbers. This is regularly one of the conclusions of conferences from which we are segregated. But it has never translated into integration. It has not translated into full participation in the conference.

At a conference on self-direction in Texas, the same paradigm of exclusion prevailed. One of the results of that conference was a series of articles that appeared in a journal I edited, The Psychiatric Rehabilitation Journal (Yes, some few of us achieve integration on the level of our ability.).

I took great exception to our segregation, and to the language of those people permitted to contribute articles. My voice did not carry; the issue was published. One author, Judith Cook, refused me even the opportunity to edit her language. She simply denied any response to my contact. I do not know her fears.

I was able to eliminate a few prejudicial metaphors from the issue, but only a very few. I was able to establish a professional relationship with but one author.

Among my most interesting interactions was one with an author whose article was originally titled, "Training for Mental Illness." He at first argued the title had been assigned to him by the guest editor so he could not alter it. When I pointed out to him it made no grammatical sense whatsoever, he relented, and altered his title to match his article. The article was about helping people with schizophrenia. We had no further interaction after that small victory. He declined interaction.

Recently in the New York Times I encountered that metaphor again. Mikhail Baryshnikov was studying "mental illness" for a role he was to play. Ironically, my response to the journal author had been, "Are you training for a stage role, are you an actor?"

The metaphors of a profession transfer to the media, to the public. Baryshnikov was most certainly not studying "mental illness"; he was studying the specific illness of the character he was preparing to play. Greta Garbo did not study "physical illness" to play Camille, she studied tuberculosis.

Rule Five for diminishing a self: stereotype every aspect of that self. Here the techniques become far less obvious, far more subtle:

Deny personhood and every metaphor related to personhood. Nazis assigned numbers so no person would have to refer to people Nazis wanted to diminish by name. Indeed, people could be punished for so doing. Severely. People who rode on the trains to the gas chambers were "items." People with disabilities were "worthless eaters", "consumers" -- in other words, not producers. Does that sound vaguely familiar?

No, I am not a "consumer," a "recipient" or any other abstraction. I am I. I am a person, I am a self.

At the close of World War II the judges at Nuremberg freed most of the medical murderers, those doctors and nurses who had participated in the murders of people in institutions, exonerating them -- for they had not "really" murdered people, it was said. We were to the judges uniformly "empty shells." For us the war had had no effect.

What's in a name? Everything.

Lois Curtis and Elaine Wilson are the two women who brought a lawsuit against the state of Georgia which was decided in 1999 by the U. S. Supreme Court and which we today know by the name "Olmstead v. L.C. and E.W." The women took their suit all the way to the Supreme Court, and prevailed. Why do people not know them as they know Rosa Parks? No one refers to Rosa Parks as R.P. No one has ever reduced Rosa Parks to initials She retained self and name from the onset of her complaint, when she refused to move to the back of the bus, to its resolution at the Supreme Court a year later, when the court ruled segregation illegal.

Lois and Elaine found a kind of representation in their suit from Atlanta Legal Aid, which decided it would abstract the two women to initials without so much as asking. When they finally decided to ask, the suit had already achieved a name, "Olmstead". Their suit for freedom is today titled, by default, with the name of their oppressor (Tommy Olmstead, the Commissioner of Georgia's Department of Human Resources, whom the women sued). No one at Atlanta Legal Aid has apologized. If you visit their site, nestled on the web at Emory University, you will find pictures of "L.C. and E.W.", unnamed to this day. As Olmstead wanted them buried behind the walls of an institution, Atlanta Legal Aid wants them buried behind their abstracted initials.

I introduced Lois and Elaine to the International Association of Psychosocial Rehabilitation Services conference, which was meeting in Atlanta. Why not honor Lois and Elaine, who live here, I thought. I tracked down their residence, their phone. IAPSRS' conference committee offered them an opportunity to be honored at a luncheon.

When I asked, however, to participate in honoring them, all communication from IAPSRS ceased. No one was to know that I, a mere abstraction, existed; had discovered the wrong done to Lois and Elaine. I was not permitted recognition. I filed an ethics complaint with its board, and two years later, the silent response rings in my ears. Olmstead buried Lois and Elaine, Legal Aid buried Lois and Elaine, IAPSRS buried me. My peer Peter Ashenden sits on IAPSRS' board. From him I have not heard my ethics complaint has been carried to the board.

Rule Six for diminishing self: deny name, deny recognition.

The Center for Mental Health Services is offering a training to "Eliminate Barriers" in mental health. In the training materials, Kathryn Power, the director, who is ultimately responsible for all products of the center, has approved the following:

"Nick is a computer programmer who enjoys sports. Sandy is a retired nurse who volunteers at her church and writes for local newspapers. Lisa is a public relations specialist who is earning high grades as an art history student. These people have a lot in common: They are productive. They are leaders. They make a positive difference in their communities. And they have recovered from a mental illness. They're the people we know at work, at school, in our families, and in our neighborhoods."

But "Nick," "Sandy" and "Lisa" are not people. They are abstractions, exactly as are "LC and EW." Real people have pride in their names -- both their names. Kathryn imposes the barrier of no-name, while claiming to eliminate barriers.

There are a great many people in this country very proud of our accomplishments. Kathryn chose people who wish to hide themselves from public view (I am assured they are real people) rather than choose those of us proud of our selves.

At a library in Anchorage, an exhibit of 60 poster-sized photos of elected gay and lesbian people proclaimed to all who came that real people succeed. Each photo proudly proclaimed its subject's full name. Do we not deserve the same, Kathryn?

In editing documents I often come across such editing of name by people in the mental health professions. In each instance I ask authors if they have a reason for not recognizing the humanity of the people they have reduced to abstraction, as they recognize their own. In some instances I have enlightened authors, and real names have been entered. In other instances I have asked for documentation that the people they abstract actually chose abstracting. One author responded that he had informed each they could choose a pseudonym. He had not informed them they could choose their own name, could honor their "self" as he honored his own. We are often offered such "choice", a disguised form of force.

Kathryn's training closes, as I will, with Lesson Number Seven. She presents a series of carefully chosen and carefully denied myths, a series of negative statements, and then negates them. The name of this technique, negating a carefully selected negative, is called a "Praeteritio." It is often employed in rhetoric for its acknowledged powerful effect.

Rule Seven for diminishing a self: Make negative statements about that self and negate those statements:

"I will not say my opponent is stupid."

And there it is. I did , and I got away with it.

No one needs to hear what I am not. They need to be educated as to who I am. If you have not comprehended the magnitude of the technique, I will leave you with the most offensive example I can imagine: teaching Americans that there is a particular word one should not employ in reference to people of African descent. I do not even have to speak the word, do I?

Nor does the Center for Mental Health Services have to instruct people which words are offensive to me. Nor should any state mental health program office accept such obviously prejudiced training. But to this date, not one state has offered a meaningful objection to Kathryn, nor has the National Association of State Mental Health Program Directors, or Mike Hogan, its chairperson. Hogan is also chair of the president's commission on mental health.

He sees it as an issue between me and Kathryn, one that I should address with her. She declines to acknowledge any contact from me. The local coordinator of the Barriers Program (the name is more apt than they intended, I'm sure) has also written her. Kathryn has so far not responded even to her.

And so we close the circle: To diminish a self, segregate that self, isolate that self, and deny that self recognition, conversation, confirmation as person.

Posted August 9, 2004

Harold A. Maio, Consulting Editor of the Psychiatric Rehabilitation Journal, heads The Mental Health Clearing House. This article is adapted from a speech he gave to the Florida Self-Directed Care conference.

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