The Politics of Coming Out: Stigma and Biomedical Models of Mental Disorder

Abstract

Drawing from philosophical, clinical, sociological, and activist literatures, my work critically analyses the deployment of biomedical models of mental disorder as a means of targeting stigma. I argue that “the stigma of mental illness,” when conceptualized within a biomedical framework, functions to 1) incite a multitude of discourses surrounding mental disorder, 2) extend the reaches of psychiatric surveillance and classification, and 3) streamline individuals and populations into particular modes of conceptualizing and disciplining the self. I argue that the rhetoric of stigma creates a series of new confessional venues, and determines the language and grammar through which mental disorder is made to speak. As a result of these scripts, counter narratives are outlawed, and their authors (i.e. consumer/survivor/ex-patient and Mad Pride activists) are routinely denied advantages accrued by socially authorized truth-tellers. I therefore conclude that the biomedical framing of anti-stigma rhetoric and discourse is, in part, complicit with the power relations that mark some individuals as mad. As such, anti-stigma discourse does not represent a radical break or historico-political rupture with “the stigma of mental illness” but is derivative of it. In light of these issues, I seek to develop an account of how we think about the functioning of, and relationship between, knowledge and power within anti-stigma discourse. My overarching concern, therefore, is not with what stigma is, but resides rather with what talking about stigma does.