At the end of term last spring, Jijian Voronka stood before 120 people at Ryerson University and clicked the play button for a short video made by a former student in her History of Madness course. Ms. Voronka watched the audience of mainly Ryerson staff and faculty as the student’s over-sized words scrolled across a video screen: “I only got four hours of sleep again” and “I’m not depressed.” The student had made the film about herself and titled it “A little slice-of-life video about madness and why a girl isn’t looking for the light at the end of the tunnel,” tracking herself on camera as she spiralled into exhaustion. When Ms. Voronka clicked the stop button at the end of the video, no one said a word.
Ms. Voronka, a sessional instructor in Ryerson’s school of disability studies and a PhD candidate at the University of Toronto’s Ontario Institute for Studies in Education, had faced challenging audiences during events like this one; she was hoping this audience wouldn’t “pathologize” the student. The talk, offered with two colleagues, was called “Making Mad Studies,” and it was part of a series on diversity at Ryerson.
Mad studies is an emerging, interdisciplinary field, mainly in the social sciences and humanities, that expresses a radical new voice in academe about madness. Ms. Voronka often speaks to academics and professionals about mad studies and says she expects most listeners to be steeped in 150 years of psychiatric biases about madness, or as a colleague puts it, “clogged with sanism.”
After Ms. Voronka finished, Jennifer Poole, an associate professor in Ryerson’s school of social work, defined sanism for the audience this way: “A belief system that makes it okay to pick on, make fun of, discriminate, reject, silence, discredit, pathologize, de-centre, kindly undermine and commit violence against the mad. Sanism is an oppression, it is the reason for stigma, and it can happen even with the best of intentions.”
That day, the audience was receptive to the definition and presenters. Instead of asking “patronizing” questions about people with mental illnesses, such as “Why do they go off their meds?”, this audience focused on how to create safe environments and better supports for students, faculty and staff. In Ms. Voronka’s opinion, this was progress.
Mad studies is based on a simple idea: listen to mad people and look at madness from their points of view. More than 10 years ago, Ryerson’s school of disability studies and York University’s graduate program in critical disability studies pioneered mad studies. It’s not yet a program, but a series of courses that deconstructs medical models of “schizophrenia,” “psychosis” and madness in general and puts them in historical context. The courses look at different concepts of madness, surveying social, medical, political, economic, cultural and religious factors that influenced madness from ancient times to the present.
“Mad studies doesn’t reject medical models of madness [but it puts] them into a historical trajectory, one that shows that psychiatry isn’t an absolute interpretation of human mental states,” says Kathryn Church, an associate professor of sociology and director of Ryerson’s school of disability studies and the third speaker at the presentation.
Afterwards, Ms. Voronka disclosed in an interview that she was a “mad professor,” the same description she uses when she introduces herself to her students in the History of Madness course. She offers this label to summarize a part of her identity that started in her 20s when she was poor, living in a rough neighbourhood and seeing a psychiatrist every second day. Madness is still part of her identity, she says.
“Some students immediately have a problem with the word ‘mad,’” she says. “Students will ask, ‘Why do you use that word? It’s so negative.’” The word changes how she teaches and also highlights one of the purposes of the course: to offer knowledge from mad people themselves.
Students, says Ms. Voronka, “start to think about their own bodies, genders, races, sexualities, and if they’re sane or mad.” They start to think about the power dynamics and language around madness as a social issue, rather than madness as only a medical problem within an individual.
“The language is political and represents a radical new voice,” offers Dr. Church. Mad people are reclaiming the word “mad” the way gay people did with “queer” and “gay” in the 1970s and 1980s, showing the context, history and oppression surrounding human distress and extreme mental states, she says. “‘Mad’ makes you stop and say, ‘What?’ And in that space of sudden confusion, there’s a chance we could change the subject.”
Soon after Ryerson and York launched mad studies courses in the early 2000s, similar courses began in Simon Fraser University’s department of sociology and anthropology, and more recently at Memorial University’s school of social work, Queen’s University’s school of kinesiology and health studies, and the history departments at Trent University and the University of Winnipeg. A few universities in England, Scotland and the Netherlands launched courses in the past two years, using Canadian courses as models.
“Students are asking for [mad studies],” says Pam Cushing, associate professor in disability studies at King’s University College, affiliated with Western University. “There’s a cultural change. Students are much more comfortable with mental-health topics,” she says, adding that roughly one-third of university students will experience a mental health issue and want to find out more about it.
At Ryerson, 300 students enrol annually in the history of madness course from a wide variety of disciplines, including political science, economics, dance, cultural studies, journalism, social work, nursing, and a disproportional number of students from accounting and business, says Dr. Church.
Mad studies grew out of civil rights, identity politics, cultural studies and anti-psychiatry movements in the 1960s, explains Dr. Church, and this was especially so after the publication of works like Ken Kesey’s One Flew Over the Cuckoo’s Nest in 1962 and Michel Foucault’s Madness and Civilization: A History of Insanity in the Age of Reason in 1964. Kesey’s novel follows characters in a mental hospital as the staff torment them, and Foucault’s book shows how the meaning of madness changed since the Middle Ages. Both authors drew on their experiences of working in asylums and both depict mental wards as instruments of oppressive forces in society.
Back then, Mel Starkman, a former archivist at the University of Toronto who spent 12 years in and out of asylums, became one of the first people in Canada to write about madness from the perspectives of mad people. Dr. Church says that mad studies instructors usually ask their students to read his 1981 essay about Dr. R. M. Bucke who, in Canadian asylums in the 1890s, performed gynecological operations on women to relieve them of hysterical symptoms. (“Hysteria” derives from “hysteron,” the Greek word for “uterus.”) In those days, when women were rebelling against prescribed social roles, a “wandering womb” left you vulnerable to being called mad, and as a result, women were five times more likely than men to be locked away.
There had always been mad men and women in Canadian universities, but they had hidden their histories for fear of losing jobs and credibility. Their voices became louder in the 2000s. Dr. Church wrote about her own breakdown as part of her sociology PhD, defended in 1993. She began as a research associate at Ryerson in 2002, around the time her institute hired historian Geoffrey Reaume, the first academic in Canada to start a university history course from the point of view of mad people. The course, Mad People’s History, drew from his experiences as a psychiatric patient in the 1970s and his frustration at the near absence of patients’ voices in the history of psychiatry.
“Once I had my PhD, I had the cachet to teach the course,” says Dr. Reaume, now an associate professor in York’s faculty of health. “People with PhDs had oppressed mad people throughout history. I wanted to help liberate this history from the shackles of the medical model.”
He faced resistance immediately. At U of T, a well-known scholar in the field of the history of psychiatry told him that the writings of patients were nothing more than a sign of their pathologies. Dr. Reaume, who at the time was researching his PhD at U of T, thought it was arrogant “to conduct research on people with psychiatric histories and dismiss their views as not having any meaning, other than as psychoses.” He describes U of T as “conservative” at that time but, to his surprise, Ryerson’s and York’s disabilities studies programs (not their history departments) accepted the course in 2002 and 2004 respectively as a permanent part of their curriculums. The courses were about mad people – their experiences, viewpoints and lives – and he says that the first-hand accounts in the courses constructed “radically creative ways of thinking about matters of the mind.”
In 2008, he joined dozens of academics and activists at a conference at Simon Fraser University about madness. It led to a groundbreaking book, Mad Matters: A Critical Reader in Canadian Mad Studies, published in 2013 by Canadian Scholars’ Press. Many of the 30 academics and activists in the book, including Dr. Reaume and Ms. Voronka, met at the conference, and Mad Matters is now required reading in many mad studies courses.
A dominant theme in the book and in courses is how psychological oppression is part of modern capitalism and, more specifically, how “societies are identifying more and more of their citizens as abnormal and defective, while being less and less prepared to spend money on supporting them in their difficulties,” write the editors of the book.
As an example, “complicated grief disorder” and “persistent complex bereavement disorder” identify as abnormal someone who grieves too much. Kwame McKenzie, a psychiatrist, professor and co-director of the division of equity, gender and population in the department of psychiatry at U of T, says he understands why mad studies questions such disorders: “I would prefer to create spaces for people to be people, rather than be on the side of trying to tell people that there’s not time for their grief.”
There are similar controversies around attention deficit hyperactivity disorder. Dr. McKenzie notes that some psychiatrists argue that ADHD is a label applied mainly to disruptive boys, and other psychiatrists say there’s an over-diagnosis of ADHD among disruptive African-American boys.
“Psychiatric diagnoses are concepts,” Dr. McKenzie explains. “They are observations of symptoms, what we think may cause the symptoms, how long they last, and what works to improve them.”
The problem, he adds, “is that psychiatry is descriptive. People have taken a long time trying to describe schizophrenia, work out the symptoms, and then work out how to train people accurately to make the diagnosis.” The diagnosis is far from perfect, he says.
On the other hand, Don Addington, a professor of psychiatry at the University of Calgary and board chair of the Canadian Psychiatric Association, says that there have been critiques of psychiatry for decades, mainly from people who had been committed to mental institutions. “There’s nothing new about looking at the sociological, religious, historical and current attitudes and ideas about mental illness,” he says. “And there’s nothing new about criticism of psychiatry, either critiques in the treatment of mental illness or the more recent critique in respect of diagnostic criteria.”
He distinguishes between treatments of madness in the classic sense (for schizophrenia, bi-polar disorder and other mental illnesses that may require medication and hospitalization) and treatments for a broader range of problems (such as ADHD and other struggles that don’t require hospitalization). He says he understands why there are controversies with the latter, but he believes the former are more serious and that psychiatrists do their best as they work with police and governments to help those in jail and on the streets. He objects to people blaming psychiatry for 150 years of incarceration and other accusations. “We get Scientologists demonstrating at the annual Canadian Psychiatric Association meeting,” he says, “marching up and down with banners saying ‘Psychiatry kills.’”
Comments like those rile mad studies researchers, because the words dismiss anyone critical of psychiatry by lumping mad studies with Scientology, whose adherents oppose psychiatry. “I’ve been working in the field for 20 years now, and for 20 years I’ve heard, ‘Oh, never mind them, they’re Scientologists,’ and, of course, it’s not true,” says Brenda LeFrançois, a professor in the school of social work at Memorial and an editor of Mad Matters. Even worse, she says, are the connections to jails and street violence, both of which have little to do with madness.
A lot of the disagreements between psychiatrists and mad studies scholars revolve around how to define sanity, especially when faced with extreme human experiences. In fact, the term “sanity” itself might be at the root of the disagreement. “How do we work against this?” asked Dr. Poole during the presentation at Ryerson last spring. Each year, the students in her courses respond with answers similar to what she relayed to her colleagues:
“Get involved,” Dr. Poole recited. “Educate yourself. Share your experiences of madness, of pride, of shame, of strength. Listen deeply. Don’t critique or fix, just listen. Believe your students. Believe their realities. Change the language. Be flexible. Offer the incomplete grade. And be kind.”
Everyone faces extreme distress at some point in their lives, she says. This is part of life for every human. “It’s not if, but when.”