View source for Sanism

{{short description|Discrimination against people with mental conditions or impairments}}
{{about|a form of discrimination|other uses of Mentalism|Mentalism (disambiguation)}}
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'''Sanism''', '''saneism''', '''mentalism''', or '''psychophobia''' refers to the [[discrimination]] and [[oppression]] of people based on actual or perceived [[mental disorder]] or [[cognitive impairment]]. This discrimination and oppression are based on numerous factors such as [[stereotypes]] about [[neurodiversity]]. Sanism impacts individuals with [[autism]], [[Learning disability|learning disorders]],  [[attention deficit hyperactivity disorder]] (ADHD), [[fetal alcohol spectrum disorder]] (FASD), [[bipolar disorder]], [[schizophrenia]], [[personality disorder]]s, [[stuttering]], [[tics]], [[intellectual disability]], and other cognitive impairments.

Sanism may cause harm through a combination of [[social inequalities]], insults, indignities, and overt discrimination. Some examples of these include refusal of service and the denial of human rights.

Sanism does not only describe how individuals are treated by the [[general public]]. The concept also encapsulates how individuals are treated by [[mental health professionals]], the legal system and other institutions.

The term "sanism" was coined by [[Morton Birnbaum]], a physician, lawyer, and mental health advocate. [[Judi Chamberlin]] coined the term "mentalism" in a chapter of the book ''Women Look at Psychiatry''.

==Definition==

The terms "mentalism", from "[[Mind|mental]]", and "sanism", from "[[sanity|sane]]", have become established in some contexts, although concepts, such as [[social stigma]], and, in some cases, [[ableism]] may be used in similar but not identical ways. While "mentalism" and "sanism" are used interchangeably, "sanism" is becoming predominant in certain circles, such as academics. Those who identify as mad, mad advocates, and in a socio-political context where sanism is gaining ground as a movement.<ref name=PooleWard2013>{{cite book |last1=Poole |first1=Jennifer M. |last2=Ward |first2=Jennifer |date=2013 |contribution="Breaking open the bone": Storying, Sanism, and Mad Grief |contribution-url=https://books.google.com/books?id=BM2jTziyBtkC&pg=PR7 |title=Mad Matters: A Critical Reader in Canadian Mad Studies |editor1-first=B. |editor1-last=LeFrancois |editor2-first=R. |editor2-last=Menzies |editor3-first=G. |editor3-last=Reaume |location=Toronto |publisher=Canadian Scholars Press}}</ref> The movement of sanism is an act of resistance among those who identify as mad, consumer survivors, and mental health advocates.<ref name=PooleWard2013/><ref name=PooleEtAl2012>{{cite journal |last1=Poole |first1=Jennifer M. |last2=Jivraj |first2=Tania |last3=Arslanian |first3=Araxi |last4=Bellows |first4=Kristen |last5=Chiasson |first5=Sheila |last6=Hakimy |first6=Husnia |last7=Pasini |first7=Jessica |last8=Reid |first8=Jenna |date=2012 |url=http://journals.library.mun.ca/ojs/index.php/IJ/article/view/348 |title=Sanism, 'Mental Health', and Social Work/Education: A Review and Call to Action |journal=Intersectionalities: A Global Journal of Social Work Analysis, Research, Polity, and Practice |volume=1}} {{open access}}</ref><ref name=Poole2011>Poole, 2011{{Full citation needed|date=August 2011}}</ref> In academia evidence of this movement can be found in the number of recent publications about sanism and social work practice.<ref name=Poole2011/><ref name=PooleEtAl2012/><ref name=PooleWard2013/>

== Etymologies ==
[[File:Morton Birnbaum.jpg|alt=|thumb|150px|"Sanism" was coined by [[Morton Birnbaum]].]]

The term "[[wikt:sanism|sanism]]" was coined by [[Morton Birnbaum]] during his work representing Edward Stephens, a mental health patient, in a legal case in the 1960s.<ref name="Sane">{{cite conference |last=Ingram |first=Richard |date=May 2011 |title=Sanism in Theory and Practice |url=http://www.socialinequities.ca/wordpress/wp-content/uploads/2011/07/Ingram.Sanism-in-Theory-and-Practice.CI_.2011.pdf |conference=Second Annual Critical Inquiries Workshop |conference-url=http://www.socialinequities.ca/2011/07/critical-inquiries-presentations/ |publisher=Centre for the Study of Gender, Social Inequities and Mental Health. [[Simon Fraser University]] |location=Vancouver, Canada}}</ref> Birnbaum was a physician, lawyer and mental health advocate who helped establish a constitutional right to treatment for psychiatric patients along with safeguards against [[involuntary commitment]]. Since first noticing the term in 1980, New York legal professor [[Michael L. Perlin]] subsequently continued its use.<ref>{{cite journal |last=Perlin |first=Michael L. |date=1993 |title=ADA and Persons with Mental Disabilities: Can Sanist Attitudes Be Undone? |journal=[[Journal of Law and Health]] |volume=8 |issue=1 |pages=15–45 |url=http://engagedscholarship.csuohio.edu/jlh/vol8/iss1/4/}}</ref>

[[File:Judi Chamberlin 2000 From Privileges to Rights.jpg|alt=|thumb|150px|"Mentalism" was coined by [[Judi Chamberlin]].]]
In 1975 [[Judi Chamberlin]] coined the term mentalism in a book chapter of ''Women Look at Psychiatry''.<ref>{{cite book|last1=Smith |first1=Dorothy E. |last2=David |first2=Sara J. |title=Women Look at Psychiatry |date=1975 |publisher=Press Gang Publishers |location=Vancouver |isbn=978-0889740006 |page=[https://archive.org/details/womenlookatpsych0000unse/page/44 44] |url=https://archive.org/details/womenlookatpsych0000unse/page/44}}</ref> The term became more widely known when she used it in 1978 in her book ''On Our Own: Patient Controlled Alternatives to the Mental Health System,'' which for some time became the standard text of the [[psychiatric survivor movement]] in the US.<ref name=Hev>{{cite news|last=Hevesi |first=Denis |title=Judi Chamberlin, 65, Advocate for Mental Health Patients |url=https://www.nytimes.com/2010/01/31/us/31chamberlin.html |access-date=1 March 2011 |newspaper=[[The New York Times]] |date=30 January 2010}}</ref><ref name="Timeline">{{cite web|url=http://isc.temple.edu/neighbor/ds/disabilityrightstimeline.htm |title=Disability History Timeline |year=2002 |work=Rehabilitation Research & Training Center on Independent Living Management |publisher=[[Temple University]] |url-status=dead |archive-url=https://web.archive.org/web/20131220065328/http://isc.temple.edu/neighbor/ds/disabilityrightstimeline.htm |archive-date=20 December 2013}}</ref><ref>{{cite web|title=Identifying and Overcoming Mentalism |url=http://www.counterpsych.talkspot.com/uploads/23542/uploadedDocuments/Mentalism_07_00.pdf |author=Coni Kalinowski and Pat Risser |date=July 2000 |access-date=16 December 2015}}</ref><ref name="Reaume2002">{{cite journal |last=Reaume |first=Geoffrey |date=July 2002 |title=Lunatic to patient to person: nomenclature in psychiatric history and the influence of patients' activism in North America |journal=International Journal of Law and Psychiatry |volume=25 |issue=4 |pages=405–26 |pmid=12613052 |doi=10.1016/S0160-2527(02)00130-9}}</ref><ref>{{cite book|last=Weller |first=Penelope |title=New Law and Ethics in Mental Health Advance Directives: The Convention on the Rights of Persons with Disabilities and the Right to Choose |year=2012 |publisher=[[Routledge]] |isbn=978-1136159565 |page=55 |url=https://books.google.com/books?id=PzR2t__ZOeEC&pg=PA55}}</ref> People began to recognize a pattern in how they were treated, a set of assumptions which most people seemed to hold about mental (ex-)patients regardless of whether they applied to any particular individual at any particular time&nbsp;– that they were incompetent, unable to do things for themselves, constantly in need of supervision and assistance, unpredictable, likely to be violent or irrational etc. It was realized that not only did the general public express mentalist ideas, so did ex-patients, a form of internalized [[oppression]].<ref name="Chamberlin">{{cite journal |last=Chamberlin |first=Judi |date=Summer 1990 |title=The Ex-Patients' Movement: Where We've Been and Where We're Going |journal=The Journal of Mind and Behavior |volume=11 |issue=3 |pages=323–336 |url=http://www.power2u.org/articles/history-project/ex-patients.html}}</ref>

As of 1998 these terms have been adopted by some consumers/survivors in the [[United Kingdom|UK]] and the US, but had not gained general currency. This left a conceptual gap filled in part by the concept of '[[Social stigma|stigma]]', but this has been criticized for focusing less on [[institutionalized discrimination]] with multiple causes, but on whether people perceive mental health issues as shameful or worse than they are. Despite its use, a body of literature demonstrated widespread discrimination across many spheres of life, including [[employment]], [[parental rights]], [[Home|housing]], [[immigration]], [[insurance]], [[health care]] and access to [[justice]].<ref>{{cite journal|last=Sayce |first=L. |date=1998 |url=http://www.ingentaconnect.com/content/apl/cjmh/1998/00000007/00000004/art00002 |title=Stigma, discrimination and social exclusion: What's in a word? |journal=[[Journal of Mental Health]] |volume=7 |number=4 |pages=331–343|doi=10.1080/09638239817932 |pmid=29052478 |url-access=subscription }}</ref> However, the use of new "isms" has also been questioned on the grounds that they can be perceived as divisive, out of date, or a form of undue [[political correctness]]. The same criticisms, in this view, may not apply so much to broader and more accepted terms like 'discrimination' or '[[social exclusion]]'.<ref>{{cite book|last=Sayce |first=L. |date=2000 |url=https://books.google.com/books?id=lPQOm76J6QYC |title=From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion |publisher=[[Macmillan Publishers]] |isbn=0-333-69890-8 |pages=16–17}}</ref>

There is also the umbrella term [[ableism]], referring to discrimination against those who are (perceived as) disabled. In terms of the brain, there is the movement for the recognition of [[neurodiversity]]. The term 'psychophobia' (from [[psyche (psychology)|psyche]] and [[phobia]]; lit. irrational fear or aversion of the mind) has occasionally been used with a similar meaning.

== Social division ==
Sanism at one extreme can lead to a categorical dividing of people into an empowered group assumed to be normal, healthy, reliable, and capable, and a powerless group assumed to be sick, disabled, crazy, unpredictable, and violent. This divide can justify inconsiderate treatment of the latter group and expectations of poorer standards of living for them, for which they may be expected to express [[gratitude]]. Further discrimination may involve labeling some as "high functioning" and some as "low-functioning"; while this may enable the targeting of resources, in both categories human behaviors are recast in [[Pathology|pathological]] terms.<ref name="Kalinowski&Risser">Coni Kalinowski (psychiatrist) and Pat Risser (former recipient of mental health services) [http://www.newmediaexplorer.org/sepp/Mentalism.pdf Identifying and Overcoming Mentalism] InforMed Health Publishing & Training</ref> According to Coni Kalinowski (a [[psychiatrist]] at the University of Nevada and Director of Mojave Community Services<ref>{{cite web |title=medicinenevada.com |url=http://www.medicinenevada.com/find_a_doctor/app-doctors/1/184/ |access-date=17 December 2015 |publisher=medicinenevada.com}}</ref>) and Pat Risser (a mental health consultant and self-described former recipient of [[Psychiatric hospital|mental health services]]<ref>{{cite web |last=Russ |first=Jeff |date=20 August 2011 |title=Off to Hollywood: Local mental health advocate to receive award |url=http://www.times-gazette.com/local%20news/2011/08/20/off-to-hollywood-local-mental-health-advocate-to-receive-award |url-status=dead |archive-url=https://web.archive.org/web/20131111235018/http://www.times-gazette.com/local%20news/2011/08/20/off-to-hollywood-local-mental-health-advocate-to-receive-award |archive-date=11 November 2013 |access-date=17 December 2015 |publisher=[[Times-Gazette]]}}</ref>).

The discrimination can be so fundamental and unquestioned that it can stop people truly [[Empathy|empathizing]] (although they may think they are) or genuinely seeing the other point of view with respect. Some mental conditions can impair awareness and understanding in certain ways at certain times, but mentalist assumptions may lead others to erroneously believe that they necessarily understand the person's situation and needs better than they do themselves.<ref name="Kalinowski&Risser"/>

Reportedly even within the [[disability rights movement]] internationally, "there is a lot of sanism", and "disability organisations don't always 'get' mental health and don't want to be seen as mentally defective." Conversely, those coming from the mental health side may not view such conditions as disabilities in the same way.<ref>Anglicare Tasmania (2009) [http://www.sswahs.nsw.gov.au/mhealth/content/pdf/Experts_by_Experience.pdf Experts by experience: strengthening the mental health consumer voice in Tasmania] {{webarchive|url=https://web.archive.org/web/20120415083253/http://www.sswahs.nsw.gov.au/mhealth/content/pdf/Experts_by_Experience.pdf |date=15 April 2012 }}</ref>

Some national government-funded charities view the issue as primarily a matter of stigmatizing attitudes within the general public, perhaps due to people not having enough contact with those (diagnosed with) mental illness, and one head of a schizophrenia charity has compared sanism to the way racism may be more prevalent when people don't spend time together throughout life.<ref>Arlen Kasdorf [http://uniter.ca/view/5661/ Discrimination against mental illness on the rise] June 2011, The Uniter, Vol.16 No.15</ref> A psychologist who runs [[The Living Museum]] facilitating current or former psychiatric patients to exhibit artwork, has referred to the attitude of the general public as psychophobia.<ref>John Clark [https://www.latimes.com/archives/la-xpm-1998-jul-12-ca-2840-story.html Art Museum of the Mind] Los Angeles Times, 12 July 1998</ref>

== Clinical terminology ==
Sanism may be codified in clinical terminology in subtle ways, including in the basic [[Classification of mental disorders|diagnostic categories]] used by psychiatry (as in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]] or [[International Statistical Classification of Diseases and Related Health Problems|ICD]]). There is some ongoing debate as to which terms and criteria may communicate [[contempt]] or inferiority, rather than facilitate real understanding of people and their issues.

Some oppose the entire process as [[Labeling theory|labeling]] and some have responded to justifications for it&nbsp;– for example that it is necessary for clinical or administrative purposes. Others argue that most aspects could easily be expressed in a more accurate and less offensive manner.<ref name="Kalinowski&Risser"/>
[[File:David-william-oaks.jpg|thumb|right|150px|David Oaks, 2009]]
Some clinical terms may be used far beyond the usual narrowly defined meanings, in a way that can obscure the regular human and social context of people's experiences. For example, having a bad time may be assumed to be [[decompensation]]; [[incarceration]] or [[solitary confinement]] may be described as treatment regardless of benefit to the person; regular activities like listening to music, engaging in exercise or sporting activities, or being in a particular physical or social environment ([[milieu therapy|milieu]]), may be referred to as therapy; all sorts of responses and behaviors may be assumed to be [[symptom]]s; core [[adverse effect]]s of drugs may be termed side effects.<ref name="Kalinowski&Risser"/>

The former director of a US-based psychiatric survivors organization focused on rights and freedoms, [[David Oaks]], has advocated the taking back of words like "mad", "[[lunatic]]", "crazy" or "bonkers". While acknowledging that some choose not to use such words in any sense, he questions whether medical terms like "mentally ill", "[[psychotic]]" or "clinically depressed" really are more helpful or indicative of seriousness than possible alternatives. Oaks says that for decades he has been exploring the depths of sanism and has not yet found an end, and suggests it may be the most pernicious 'ism' because people tend to define themselves by their rationality and their core feelings.<ref>David Oaks [http://www.mindfreedom.org/kb/mental-health-abuse/psychiatric-labels/not-mentally-ill Let's find language more inclusive than the phrase "mentally ill"!] MindFreedom International. Retrieved 12 December 2011, when stating Last Modified 9/9/11</ref> One possible response is to critique conceptions of normality and the problems associated with normative functioning around the world, although in some ways that could also potentially constitute a form of sanism. After his 2012 accident breaking his neck and subsequent retirement, Oaks refers to himself as "PsychoQuad" on his personal blog.<ref>[http://www.davidwoak.com David Oaks' personal blog]</ref>

British writer Clare Allen argues that even reclaimed slang terms such as "mad" are just not accurate.{{Citation needed|date=September 2022}} In addition, she sees the commonplace mis-use of concepts relating to mental health problems&nbsp;– including for example jokes about people hearing voices as if that automatically undermines their credibility&nbsp;– as equivalent to racist or sexist phrases that would be considered obviously discriminatory. She characterises such usage as indicating an underlying psychophobia and contempt.<ref>{{cite news|first=Clare |last=Allen |url=https://www.theguardian.com/society/2007/dec/05/guardiansocietysupplement.mentalhealth |title=Loose-talking psychophobes show nothing but contempt |work=[[The Guardian]] |date=5 December 2007}}</ref>

== Blame ==
[[File:Mental health advocacy service graffittied.jpg|thumb|Graffiti on a mental health advocacy service]]{{More citations needed section|date=September 2022}}
Interpretations of behaviors, and applications of treatments, may be done in a judgmental way because of an underlying sanism, according to critics of [[psychiatry]]. If a recipient of mental health services disagrees with treatment or diagnosis, or does not change, they may be labeled as non-compliant, uncooperative, or treatment-resistant. This is despite the fact that the issue may be the healthcare provider's inadequate understanding of the person or their problems, adverse medication effects, a poor match between the treatment and the person, stigma associated with the treatment, difficulty with access, cultural unacceptability, or many other issues.<ref name="Kalinowski&Risser"/>

Sanism may lead people to assume that someone is not aware of what they are doing and that there is no point trying to communicate with them, despite the fact that they may well have a level of awareness and desire to connect even if they are acting in a seemingly irrational or [[self-harm]]ing way. In addition, [[mental health professionals]] and others may tend to equate subduing a person with treatment; a quiet client who causes no community disturbance may be deemed improved no matter how miserable or incapacitated that person may feel as a result.<ref name="Kalinowski&Risser"/>

Clinicians may blame clients for not being sufficiently motivated to work on treatment goals or recovery, and as [[acting out]] when things are not agreed with or are found upsetting. But critics{{Weasel inline|date=September 2022}} say that in the majority of cases this is actually due to the client having been treated in a disrespectful, judgmental, or dismissive manner. Nevertheless, such behavior may be justified by characterizing the client as demanding, angry or needing limits. To overcome this, it has been suggested that power-sharing should be cultivated and that when respectful [[communication]] breaks down, the first thing that needs to be asked is whether mentalist prejudices have been expressed.<ref name="Kalinowski&Risser"/>

==Neglect==

Sanism has been linked to [[negligence]] in monitoring for adverse effects of medications (or other interventions), or to viewing such effects as more acceptable than they would be for others. This has been compared to instances of maltreatment based on [[racism]]. Sanism has also been linked to neglect in failing to check for, or fully respect, people's past experiences of [[abuse]] or other [[Psychological trauma|trauma]]. [[File:Recovery Fair 2010.jpg|thumb|150px|T-shirt intended to show the possibility and individuality of recovery]] Treatments that do not support choice and [[self-determination]] may cause people to re-experience the helplessness, pain, despair, and rage that accompanied the trauma, and yet attempts to cope with this may be labeled as [[acting out]], [[Psychological manipulation|manipulation]], or [[attention-seeking]].<ref name="Kalinowski&Risser"/>

In addition, sanism can lead to "poor" or "guarded" predictions of the future for a person, which could be an overly pessimistic view skewed by a narrow clinical experience. It could also be made impervious to contrary evidence because those who succeed can be discounted as having been [[Misdiagnosis|misdiagnosed]] or as not having a genuine form of a disorder – the [[no true Scotsman]] fallacy. While some mental health problems can involve very substantial disability and can be very difficult to overcome in society, predictions based on prejudice and stereotypes can be self-fulfilling because individuals pick up on a message that they have no real hope,<ref name="Kalinowski&Risser"/> and realistic hope is said to be a key foundation of [[recovery model|recovery]]. At the same time, a trait or condition might be considered more a form of [[individual difference]] that society needs to include and adapt to, in which case a mentalist attitude might be associated with assumptions and prejudices about what constitutes normal society and who is deserving of adaptations, support, or consideration.

== Institutional discrimination ==
{{POV section|date=September 2022}}

[[File:Label for property of dept of mental hygiene.png|thumb|150px|An institutional label]] This may be apparent in physical separation, including separate facilities or accommodation, or in lower standards for some than others. Mental health professionals may find themselves drawn into systems based on bureaucratic and financial imperatives and [[social control]], resulting in alienation from their original values,{{Clarify|date=July 2023}} disappointment in "the system", and adoption of the cynical, mentalist beliefs that may pervade an organization. However, just as employees can be dismissed for disparaging sexual or ethnic remarks, it is argued{{By whom|date=July 2023}} that staff who are entrenched in negative [[stereotype]]s, attitudes, and beliefs about those labeled with [[mental disorder]]s need to be removed from service organizations.<ref name="Kalinowski&Risser"/> A related theoretical approach, known as [[expressed emotion]], has also focused on negative interpersonal dynamics relating to care givers, especially within families.{{Citation needed|date=July 2023}} However, the point is also made{{By whom|date=July 2023}} in such views that institutional and group environments can be challenging from all sides, and that clear boundaries and rights are required for everyone.{{Clarify|date=July 2023}}

The [[mental health professions]] have themselves been criticized.{{By whom|date=July 2023}} While [[social work]] (also known as clinical social work) has appeared to have more potential than others to understand and assist those using services, and has talked a lot academically about [[anti-oppressive practice]] intended to support people facing various -isms, it has allegedly failed to address sanism to any significant degree.{{Citation needed|date=July 2023}} The field has been accused, by social work professionals with experience of using services themselves, of failing to help people identify and address what is oppressing them; of unduly deferring to psychiatric or biomedical conventions particularly in regard to those deemed most unwell; and of failing to address its own discriminatory practices, including its conflicts of interest in its official role aiding the social control of patients through [[involuntary commitment]].<ref>[http://www.olc.edu/local_links/socialwork/OnlineLibrary/Wilson%20%26%20Beresford,%202000,%20Anti-oppressive%20practic,%20emancipation%20or%20appropriation.pdf 'Anti-oppressive practice': emancipation or appropriation?] A Wilson; P Beresford British Journal of Social Work; Oct 2000; 30, 5; Research Library
pg. 553</ref>

In the [[consumer/survivor/ex-patient movement|"user/survivor" movement]] in England, [[Pete Shaughnessy]], a founder of [[mad pride]], concluded that the [[National Health Service]] is "institutionally mentalist and has a lot of soul searching to do in the new Millennium",{{Clarify|date=July 2023}} including addressing the prejudice of its office staff. He suggested that when prejudice is applied by the very professionals who aspire to eradicate it, it raises the question of whether it will ever be eradicated.<ref>Tom Mason, Caroline Carlisle, Caroline Watkins (eds) (2001) [https://books.google.com/books?id=pO0NAAAAQAAJ Stigma and Social Exclusion in Healthcare] Chapter 17: Not in my back yard: Stigma from a personal perspective. Routledge {{ISBN|0-415-22200-1}}</ref> Shaughnessy committed [[suicide]] in 2002.<ref>{{cite news|first=Mark |last=Olden |title=Obituary: Pete Shaughnessey |work=[[The Guardian]] |pages=22 |date=23 January 2003}}</ref>

The [[psychiatric survivors movement]] has been described as a [[feminist]] issue, because the problems it addresses are "important for all women because mentalism acts as a threat to all women" and "mentalism threatens women's families and children."<ref>{{cite book|first1=Wendy |last1=Chan |first2=Dorothy E. |last2=Chunn |first3=Robert J. |last3=Menzies |date=2005 |title=Women, Madness and the Law: A Feminist Reader |publisher=[[Routledge]] Cavendish |pages=257 |isbn=1-904385-09-5}}</ref> A psychiatric survivor and professional has said that "Mentalism parallels sexism and racism in creating an oppressed underclass, in this case of people who have received psychiatric diagnosis and treatment". She reported that the most frequent complaint of psychiatric patients is that nobody listens, or only selectively in the course of trying to make a diagnosis.<ref>Lindow, V. (1995) "Power and rights: the psychiatric system survivor movement", in Jack, R. Empowerment in Community Care. London: Chapman and Hall. Cited by Kelly, A. Disability and Social Exclusion. University of Canterbury</ref>

On a society-wide level, sanism has been linked to people being kept in [[poverty]] as second class citizens; to [[employment discrimination]] keeping people living on handouts; to interpersonal discrimination hindering relationships; to [[stereotypes]] promoted through the media spreading fears of unpredictability and dangerousness; and to people fearing to disclose or talk about their experiences.<ref name="Kalinowski&Risser"/>

== Law ==
With regard to legal protections against discrimination, sanism may only be covered under general frameworks such as the [[disability discrimination act]]s that are in force in some countries, and which require a person to say that they have a disability and to prove that they meet the criteria.

In terms of the legal system itself, the law is traditionally based on technical definitions of [[sanity]] and [[insanity]], and so the term "sanism" may be used in response. The concept is well known in the US legal community, being referred to in nearly 300 law review articles between 1992 and 2013, though is less well known in the medical community.<ref>{{cite journal |last1=Perlin |first1=Michael L. |date=October 2013 |title=Sanism and the Law |journal=Virtual Mentor |volume=15 |issue=10 |pages=878–885 |url=http://virtualmentor.ama-assn.org/2013/10/msoc1-1310.html |doi=10.1001/virtualmentor.2013.15.10.msoc1-1310 |pmid=24152781|url-access=subscription }}</ref>
<!-- Deleted image removed: [[File:Michael L. Perlin.jpg|alt=|thumb|200px|Michael L. Perlin, leading proponent of the legal use of the term]] -->

Michael Perlin, Professor of Law at [[New York Law School]], has defined sanism as "an irrational prejudice of the same quality and character as other irrational prejudices that cause and are reflected in prevailing social attitudes of racism, sexism, homophobia, and ethnic bigotry that permeates all aspects of mental disability law and affects all participants in the mental disability law system: [[litigants]], [[Trier of fact|fact finders]], [[counsel]], and [[Expert witness|expert]] and lay witnesses."<ref name="Perlin09neuro"/>

Perlin notes that sanism affects the theory and practice of law in largely invisible and socially acceptable ways, based mainly on "[[stereotype]], [[myth]], [[superstition]], and [[deindividualization]]." He believes that its "corrosive effects have warped [[involuntary commitment|involuntary civil commitment]] law, institutional law, [[tort law]], and all aspects of the criminal process (pretrial, trial and sentencing)."<ref>{{cite book|last1=Perlin |first1=Michael L. |date=2008 |url=https://books.google.com/books?id=NSewrw9g8coC |title=Competence in the law: from legal theory to clinical application|publisher=Wiley |isbn=9780470267905 }}</ref> According to Perlin, judges are far from immune, tending to reflect sanist thinking that has deep roots within our culture. This results in judicial decisions based on stereotypes in all areas of [[Civil law (common law)|civil]] and [[criminal law|criminal]] law, expressed in biased language and showing contempt for [[mental health professionals]]. Moreover, courts are often impatient and attribute mental problems to "weak character or poor resolve".<ref name="Perlin09neuro"/>

Sanist attitudes are prevalent in the teaching of law students, both overtly and covertly, according to Perlin. He notes that this impacts on the skills at the heart of lawyering such as "interviewing, investigating, counseling and negotiating", and on every critical moment of clinical experience: "the initial interview, case preparation, case conferences, planning litigation (or negotiation) strategy, trial preparation, trial and appeal."<ref>{{cite journal |last1=Perlin |first1=Michael L. |date=2003 |url=https://ssrn.com/abstract=336121 |title=Sanism in Clinical Teaching |journal=[[Clinical Law Review]] |volume=9 |pages=683–730}}</ref>

There is also widespread discrimination by jurors, who Perlin characterizes as demonstrating "irrational brutality, prejudice, hostility, and hatred" towards defendants where there is an [[insanity defence|insanity defense]]. Specific sanist myths include relying on popular images of craziness; an 'obsession' with claims that mental problems can be easily faked and experts duped; assuming an absolute link between mental illness and dangerousness; an 'incessant' confusion and mixing up of different legal tests of mental status; and assuming that defendants acquitted on insanity defenses are likely to be released quickly. Although there are claims that [[neuroimaging]] has some potential to help in this area, Perlin concludes that it is very difficult to weigh the truth or relevance of such results due to the many uncertainties and limitations, and as it may be either disregarded or over-hyped by scientists, lawyers or in the popular imagination. He believes "the key to an answer here is a consideration of sanism", because to a great extent it can "overwhelm all other evidence and all other issues in this conversation". He suggests that "only [[therapeutic jurisprudence]] has the potential power to 'strip the sanist facade'."<ref name="Perlin09neuro">Perlin, M. (2009) [https://ssrn.com/abstract=%201336521 'His Brain Has Been Mismanaged with Great Skill': How Will Jurors Respond to Neuroimaging Testimony in Insanity Defense Cases?] Akron Law Review, Vol. 42, No. 2, NYLS Legal Studies Research Paper (free full text)</ref>

Perlin has suggested that the international [[Convention on the Rights of Persons with Disabilities]] is a revolutionary [[human rights]] document which has the potential to be the best tool to challenge sanist discrimination.<ref>Michael L. Perlin (2013) [https://ssrn.com/abstract=2283279 'There Must Be Some Way Out of Here': Why the Convention on the Rights of Persons with Disabilities is Potentially the Best Weapon in the Fight Against Sanism] New York Law School, PSYCHIATRY, PSYCHOL. & L. 462 (2013)</ref>

He has also addressed the topic of sanism as it affects which sexual freedoms or protections are afforded to psychiatric patients, especially in forensic facilities.<ref>Periln, ML (1994) [http://heinonline.org/HOL/LandingPage?handle=hein.journals/nyuls20&div=25&id=&page= Hospitalized Patients and the Right to Sexual Interaction: Beyond the Last Frontier] 20 N.Y.U. Rev. L. & Soc. Change 517 (1992-1994)</ref>

Sanism in the legal profession can affect many people in communities who at some point in their life struggle with some degree of mental health problems, according to Perlin. This may unjustly limit their ability to legally resolve issues in their communities such as: "contract problems, property problems, domestic relations problems, and trusts and estates problems."<ref>Perlin, ML. [https://ssrn.com/abstract=345140 Looking at Non-Institutional Mental Disability Law Through the Sanism Filter] NYLS Law Review, Forthcoming</ref>

Susan Fraser, a lawyer in Canada who specializes in advocating for vulnerable people, argues that sanism is based on fear of the unknown, reinforced by stereotypes that [[Dehumanization|dehumanize]] individuals. She argues that this causes the legal system to fail to properly defend patients' rights to refuse potentially harmful medications; to investigate deaths in [[psychiatric hospitals]] and other institutions in an equal way to others; and to fail to properly listen to and respect the voices of mental health consumers and survivors.<ref>{{cite conference |last1=Fraser |first1=Susan |date=November 2008 |title=Sanism and the Legal Profession: Why Mad People Should Be Angry |url=http://www.lsuc.on.ca/media/eleventh_colloquium_suzan.pdf |conference=Eleventh Colloquium on the Legal Profession: Professionalism and Serving Communities |conference-url=http://www.lsuc.on.ca/with.aspx?id=1197 |publisher=[[Law Society of Upper Canada]]}}</ref>

== Education ==
Similar issues have been identified by Perlin in how children are dealt with in regard to [[learning disabilities]], including in [[special education]]. In any area of law, he points out, two of the most common sanist myths are presuming that persons with mental disabilities are faking, or that such persons would not be disabled if they only tried harder. In this particular area, he concludes that [[labeling theory|labeled]] children are stereotyped in a process rife with racial, class and gender bias. Although intended to help some children, he contends that in reality it can be not merely a double-edged sword but a triple, quadruple or quintuple edged sword. The result of sanist prejudices and misconceptions, in the context of academic competition, is that "we are left with a system that is, in many important ways, stunningly incoherent".<ref>{{cite journal |last=Perlin |first=Michael L. |date=Spring 2009 |title='Simplify You, Classify You': Stigma, Stereotypes and Civil Rights in Disability Classification Systems |journal=[[Georgia State University Law Review]] |volume=25 |issue=3 |pages=607–639 |url=http://readingroom.law.gsu.edu/gsulr/vol25/iss3/6/}}</ref>

== Oppression ==
A spiral of oppression experienced by some groups in society has been identified.{{Weasel inline|date=September 2022}} Firstly, oppressions occur on the basis of perceived or actual differences (which may be related to broad group stereotypes such as racism, sexism, [[classism]], [[ageism]], [[homophobia]] etc.). This can have negative physical, social, economic and psychological effects on individuals, including [[Stress (biology)|emotional distress]] and what might be considered mental health problems. Then, society's response to such distress may be to treat it within a system of medical and social care rather than (also) understanding and challenging the oppressions that gave rise to it, thus reinforcing the problem with further oppressive attitudes and practices, which can lead to more distress, and so on in a vicious cycle. In addition, due to coming into contact with mental health services, people may become subject to the oppression of sanism, since society (and mental health services themselves) have such negative attitudes towards people with a psychiatric diagnosis, thus further perpetuating oppression and discrimination.<ref>{{cite book |first1=Kamaldeep |last1=Bhui |date=25 April 2002 |title=Racism and Mental Health: Prejudice and Suffering |publisher=Jessica Kingsley Publishers |page=77 |isbn=978-1-84310-076-8 |url=https://books.google.com/books?id=WNahbFDhF0kC}}</ref><ref>{{cite conference |last1=Nair |first1=Roshan das |date=30 November 2005 |title=Metaminorities and Mental Health: A model of vulnerability for Black and Minority Ethnic Queer Folk |url=http://www.inter-disciplinary.net/ci/transformations/sexualities/s2/nair%20paper.pdf |conference=2nd Global Conference, Sexualities: Bodies, Desires, Practices |conference-url=http://www.inter-disciplinary.net/critical-issues/gender-and-sexuality/persons-and-sexualities/project-archives/2nd-global-conference-2005/}}</ref>

People suffering such oppression within society may be drawn to more radical political action, but sanist structures and attitudes have also been identified in [[activist]] communities. This includes [[cliques]] and [[social hierarchies]] that people with particular issues may find very difficult to break into or be valued by. There may also be individual rejection of people for strange behavior that is not considered culturally acceptable, or alternatively insensitivity to emotional states including suicidality, or denial that someone has issues if they appear to act normally.<ref>{{cite web |date=29 July 2005 |title=A Libertarian Perspective on Depression And Madness |website=The Icarus Project |url=http://theicarusproject.net/articles/a-libertarian-perspective-on-depression-and-madness |archive-url=https://web.archive.org/web/20130521090633/http://theicarusproject.net/articles/a-libertarian-perspective-on-depression-and-madness |archive-date=21 May 2013 }}</ref>

== See also ==
* [[Disability flag]]
* [[Franco Basaglia]]
* [[List of disability-related terms with negative connotations]]
* [[Mental health stigma]]
* [[Rankism]] (umbrella term for all forms of hierarchical discrimination)
* [[Social Darwinism]]
* [[Social model of disability]]
* [[Supremacism]]
* [[Violent behavior in autistic people]]
* [[Mortality of autistic individuals]]

== References ==
{{Reflist}}

== Further reading ==
* {{cite journal |last1=Large |first1=Matthew |last2=Ryan |first2=Christopher |date=November 2012 |title=Sanism, stigma and the belief in dangerousness |journal=Australian & New Zealand Journal of Psychiatry |volume=46 |issue=11 |pages=1099–1100 |doi=10.1177/0004867412440193 |pmid=23104928 |s2cid=206398076}}
* {{cite book |last=Parry |first=John Weston |date=26 September 2013 |title=Mental Disability, Violence, and Future Dangerousness: Myths Behind the Presumption of Guilt |publisher=[[Rowman & Littlefield]] |isbn=978-1-4422-2405-6 |url=https://books.google.com/books?id=EV8rAQAAQBAJ}}
* {{cite conference|last1=Risser |first1=Pat |date=14 May 2008 |title=Overcoming the Language of Oppression: Promoting Cultural Change with Words |conference=4th Annual Clinical Forum on Mental Health: Turning Knowledge into Practice. (North Dakota Department of Human Services)}}
* {{cite journal |last1=Wienera |first1=Diane |last2=Ribeiro |first2=Rebecca |last3=Warner |first3=Kurt |date=22 July 2009 |title=Mentalism, disability rights and modern eugenics in a 'brave new world' |journal=Disability & Society |volume=24 |issue=5 |pages=599–610 |doi=10.1080/09687590903010974 |s2cid=146463753}}
* {{cite journal |last1=Wolframe |first1=PhebeAnn M. |date=2013 |title=The Madwoman in the Academy, or, Revealing the Invisible Straightjacket: Theorizing and Teaching Saneism and Sane Privilege |journal=Disability Studies Quarterly |volume=33 |issue=1 |url=http://dsq-sds.org/article/view/3425/3200}}

{{Discrimination}}

[[Category:Ableism]]
[[Category:Disability rights]]
[[Category:Mental health activists| ]]
[[Category:Neurodiversity]]
[[Category:Prejudice and discrimination by type]]