Taking a Disability Studies View on School Mental Health

Purpose

This module will introduce a disability studies approach to what has traditionally been called mental illness. Through this approach learners will think about how the environment, intervention and the medical model may be the primary cause of disability. It is important to note that this is an introduction to disability studies and is in the TOT 2 course because it is tier 2 kids that are most impacted by the cause and interventions. Disability studies informed Interventions could be implemented school wide.

Retrieved from : TOT 2: Taking a Disability Studies View on School Mental Health (2019)

A google search about ADHD and classrooms results in a plethora of articles on how to “manage” ADHD behaviors or tips for managing kids with ADHD. Other articles talk about ADHD statistics, ADHD symptoms and medication management in schools. Some of the articles address changes that teachers can make in the classroom or in their teaching style. An thoughtful review of the search results really enforces the notion that intervention means finding ways to help the ADHD child fit into the normal classroom. The same could be said about children with autism and other mental health disorders. In TOT 1 we watched a TED talk by Shawn Anchor on positive psychology and work that highlighted this in a “graph.” I put the link here in case you don’t remember. https://www.ted.com/talks/shawn_achor_the_happy_secret_to_better_work

In the discussion, Shawn talks about how we structure our organizations to meet the needs of those who are statistically “average” and then we look for ways to bring the outliers into the fold - to bring them “in line.” Although he goes on to talk about the happiness factors that bring everyone into the average I would argue there is another way to look at the graph. This module will explore the idea that humanity is made up of lots of different kinds of ways to be in the world. When we only address the average, we are actually constructing those outliers. In other words, you only have a "normal" after you have defined what is "abnormal (McRuer, 2006).

In this module, you will read some articles that consider the critiques of rehabilitation – a science that has more often than not, devoted itself to helping people to become statistically more “normal.”

We will then think about how occupational therapy could be a leader in articulating a more nuanced and comprehensive view of psychiatric impairments and disability.

General Discussion Post

Before going any further take a moment and consider children with a psychiatric diagnosis (anxiety, or autism, ADHD, OCD maybe) that you have worked with or observed in schools. Clearly these children live every day with a brain that works differently from the typical child (what autistics like to call neurotypicals). Sometimes it isn’t the brain disorder that is most disabling however, sometimes the problem is the fit between the environment and the child. Go to the general discussion board and look for the discussion titled Environment and Disability. In your discussion post talk about a classroom situation that you may have observed. Think about how the environment either supported or got in the way of the child completing classroom learning activities and tasks. If you have not worked or observed in a school think about the hyperactive kids in your school when you were growing up.

I have not ever observed a typical classroom setting, but I did participate in a class in high school called Invitation to Teach, where I got to go three days a week to a community school and help in a special education room. This room was a one-on-one teacher to child ratio where the students learned skills that were being taught in the classroom, just at a slower rate. The teacher would work on handwriting, math, and spelling in a more controlled, quieter environment. The students I got to observe had relatively mild diagnoses, such as ADHD, Autism, or dyslexia. The student’s environment within the natural classroom setting was very distracting and hard to focus in, so by removing them from that environment and providing them the one-on-one time, they succeeded at rates much higher than if they did not receive that time. The school environment is not for every child, and children that do not fit the mold can begin to fall behind. Many times, teachers are busy dealing with so many other things that the children who need more assistance get lost in the crowd and are either embarrassed or do not know how to ask for help. They can fall behind without anyone realizing until it is too late. The school system is intended to target the “average” kid and their ability to participate within the school occupation. Unfortunately, that “average” is not beneficial for those student’s that do not fall within the typical range. When students who struggle with environmental sensitivities are removed from their typical classrooms, they then begin to fall behind in other significant areas of development as well, such as social skills, emotional regulation, etc. By taking the time to adapt the environment to benefit the students who may not fit the mold the school requires, it should be beneficial and help all of the school’s students improve. In my opinion, I believe that students who find themselves falling behind tend to lose self-efficacy and motivation cause are greater rift between person and occupation. If the reason that the child is not succeeding is due to environmental barriers, then it seems like it can be an easy fix to make sure the children are all succeeding.

I think some of the biggest environmental barriers within the school setting includes the ratio of student to teacher supports, the structure of the school day, and the amount of time spent focusing on one thing. The school day is intended to teach the kids by having the teacher lecture at them for extended periods of time at an age where they have high energy levels and their bodies are eager to move. The students are also punished for poor behavior or lack of listening skills, hindering their learning, rather than promoting the behavior of others or accepting the child’s behaviors and changing the way the student learns best. In recent years, I have heard that some schools that have the funding have been making small changes, such as adding the exercise balls to sit on or standing desks, as well as allowing fidget spinners and other adaptive equipment that is not distractive to other students to help those that need it to focus and remain on task. I think the barriers the teachers face is far more telling than the barriers the students endure. The teachers are overwhelmed, overworked, and underpaid, making the school environment hostile for most teachers. Teachers are only human and their main job is to educate the average child and get the other students the help they need, even if the help they need is outside of the typical classroom setting and can actually affect the child in more ways.

In 2005 AOTA published a special edition of AJOT dedicated to articles about disability studies. Gary Kielhofner edited that edition and he opened the edition with an overview of the disability communities critique of rehabilitation, including occupational therapy. Scholars - you read this article in Roles and Participation and will revisit it in Theory II. The article is included in the resources portion of the module.

Kielhofner’s review is a great introduction to the role of rehabilitation in constructing disability as a medical problem (Kielhofner, 2005). Kielhofner (2005) touches on how the disability community would be more interested in disability being understood as a normal variation of humanity – part of the normal human experience. Noman Kunc, in his interview with Giangreco (1996) really brings the point home. This article is also available for you to read in the readings and resources folder. As habilitation and rehabilitation providers, especially with children, we often assess children to determine if they meet the “norms.” From there we set goals and structure our therapy to help them be more in line with the normal population. Kunc helps us understand that process from the child perspective and challenges us to consider another way of thinking about our work with kids with impairments like CP, and I would argue we need to reconsider our approach with emotional impairments as well. Reading this WILL challenge you! What he has to say was not easy for me to hear the first time. I had to process it a bit…I have learned that I cannot ignore what I don’t like to hear. He has a very important point.

Medical Model of Disability

The medical model of disability presumes the problem is in the person. Disability is caused by the person’s affliction – CP is the cause of disability for Kunc, autism for Temple Granden, or schizophrenia for Eleanor Longden who you will watch shortly. Medical and rehabilitation assessment typically looks for the variations to the norm and labels them as the problem (s). In this case fixing the impairment is the goal of intervention – this could be eliminating or minimizing the symptoms or minimizing the difference between the disabled person’s performance and the norm through skill development and overcoming. Those who cannot obtain a cure or minimize the impact of their afflictions are expected to pass as close to normal as possible. Those who cannot pass find themselves pressed out of the inner circle into the social margins.

Social Model of Disability

The social model of disability starts with the idea that impairment is a normal aspect of life. It is the one minority we will likely all join at some point in our lives. The social model states that the impairment people experience is not what is disabling. What is disabling are the barriers people run up against every single day in their environments. Barriers can be many things such as social attitudes or a set of stairs for those who use wheels for mobility. There are many barriers for people with psychiatric disability. Norman Kunc was able to find support to live a life of his choice because his family didn’t accept institutionalization, yet he experienced many attitudinal barriers in society and that began in his therapy experience. The fact is, what he learned in therapy was that to have a normal life he needed to “walk well.” This was far more disabling for him than using wheeled mobility.

The following link includes a wonderful video about the impact of understanding the social model on people with disabilities. Scope is a British disability advocacy organization. http://www.scope.org.uk/about-us/our-brand/social-model-of-disability

Here is another really quick video that might help you to understand what the social model is trying to say. https://www.youtube.com/watch?v=9s3NZaLhcc4

Retrieved from : TOT 2: Taking a Disability Studies View on School Mental Health (2019)

Of course this is the million-dollar question. I believe it is and I am not alone. Not unlike people who experience physical impairments there is definitely something going on for people with psychiatric issues. Although the psychiatric disability community has yet to agree on a term we will use the term impairment to refer to the bipolar disorder, ADHD, schizophrenia or whatever it is. This is the term that the physical disability community repurposed to refer to their differences – spinal cord injury, CP, etc. One of the best examples of the impact of societal attitudes about psychiatric disorders and the medical model influence is a TED talk by Eleanor Longden. Pay close attention to her experience before and after her encounter with the medical community. When you are done watching you will post about what you think was most disabling for Eleanor. Consider this as we move forward with what to do about it.

https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head

Blog post on school shootings from a social perspective. He makes some pretty interesting points. Of more interest to me is the counterproductive approach we are taking to this issue.

https://www.madinamerica.com/2018/03/school-shootings-listen-shrinks/

Retrieved from : TOT 2: Taking a Disability Studies View on School Mental Health (2019)

Group Discussion Post

Go to your group discussion post and find the thread TOT2 Week 5 Voices in my Head. Talk about what you learned from her talk. What do you see as her impairment and what was the socially constructed disability. What was most disabling for Eleanor? What happened that changed her experience and her ability to recover? What do you see as her impairment and what was the socially constructed disability. What was most disabling for Eleanor? What happened that changed her experience and her ability to recover? ‘

This talk was interesting to learn about Eleanor’s perspective on her own experience. She was able to explain how her environment, both social and built, are disabling in their own rights. Her ability to talk the audience through her diagnosis and voices showed how far she has come over the years to truly beat her own mind. One of the biggest things I learned from this TED Talk is that a diagnosis does not define who you are as a person. For me, I have Marfan syndrome and at times I catch myself defaulting to what I cannot do because of my condition rather than embracing what I can do with it. For example, I am currently battling the city sports life while living in Chicago. I want to join a team to be social, but I am embarrassed to tell other people that I have a major heart condition and that is why I am so out of shape. I don’t want to be the worst or have to sit out at times because of it, so instead, I have been avoiding it. I’m sure once I join or find a sport that I do like and don’t have to sit out as much things will be fine, but it’s easier to play the Marfan card and avoid the entire scenario. I learned that having a label of a disability is one of the biggest things that I am afraid of. With the diagnosis comes sympathy, empathy, and stigmatizations. People typically feel sorry or try to understand, but those who can understand typically are afraid or judgmental about it. My diagnosis is not apparent to the common eye, nor does anyone know unless I choose to tell them. Mental health, however, although also not seen by the common eye is more noticeable and harder to hide when people are talking about paranoia thoughts that are circling their minds. Eleanor’s ability to control and add meaning to her thoughts is something that I found incredibly useful and impressive. It is hard to understand why our brains think certain ways. She found a way to limit the environmental input and construct a positive twist to her insane thoughts. Her ability to do so decreases the impairment, however, the social stigmatization and the way people react to mental health is a social construct developed solely on judgmental preconceived notions from movies, books, and stories told of people with schizophrenia. For Eleanor, the environment and social constructs developed were more debilitating then her actual diagnosis. Her fear of what others thought and her fear to tell others about the voices shows that she had doubts about what others might think. Eleanor’s ability to overcome all of the obstacles in her life, from the voices to the stigma surrounding mental health shows her ability to persevere and not allow others to control her life. It also shows how strong of a person she is and how willing she is to change her life for the better.

Alissa Quart ( 2013) writes about her experience meeting and learning from a young woman named Katie in her book The Republic of Outsiders. You will find the chapter about Katie, called Beyond Normal, in the reading and resources folder. Katie is one of a number of people who have been relegated to the outer margins of society because she is “autistic.” Katie, and others with autism, are starting to use the word autistic to indicate that autism is a part of who they are - their identity. Quart’s book explores a number of outsider groups who have formed communities through the internet. One of the most interesting things about the book is how these groups view social norms and the “normative” population. Quart points out that being in a marginalized position gives people important insights into how society functions. Another interesting idea in this chapter is that neurodiverse groups are using peer populated online communities as a what she refers to as shadow social services (Quart, 2013).

So we have arrived at the So What, Now What part of the module. How do we truly address those things that are disabling? When do we address the impairment? Are you confused yet?

I will be teaching more about these concepts in my disability courses at MWU later in the curriculum. When I do teach them I find there is ALWAYS a point where people who do not have disability (and have not been exposed to this information before) become upset, even angry with the information. Someday I want to understand that better and maybe people could speak to it in their posts if they are comfortable. For me, understanding this is part of compassion – Compassion means truly listening to and reflecting on people’s experiences of disability. Considering it from their viewpoint. Anyway, it is at this point where I usually tell everyone not to solve the problem yet. Just sit with this discomfort and think about it for a while. Pay attention in your daily lives, look for socially imposed disability in your school, grocery stores, Facebook. Try and find ways in your life that help you form a bridge to understanding.

If you want to explore this a little more do a search for Social Model of Disability. You will find lots of good material to read and learn from. I have posted a couple additional articles in the reading and resources folder on the social model and psychiatric disability – related to adults. I have searched and searched and found almost nothing on the social model related to children and psychiatric disabilities - so we are in uncharted territory.

The thing is, I think our focus on Occupation over impairment makes us the most qualified of all the professions working in the schools to address mental health disability.

This is a wonderful look at how some schools are rethinking the classroom. Although there are definitely going to be kids who still need medication for ADHD or still have challenges related to autism, classrooms like this go a long way to decrease disability. More importantly look how the adaptations and modifications that are good for both the neurodiverse kids and the neurotypical kids! Maybe we need to start our therapy approaches from the perspective of disability – What if everything we did in the world came started from the belief that everyone will experience disability at some point in their lives? Maybe when we make decisions about what we do – in therapy, in the classroom, in our workplaces - we include the voices and perspectives of those on margins.

Flexible Classrooms

https://www.edutopia.org/practice/flexible-classrooms-providing-learning-environment-kids-need

Retrieved from : TOT 2: Taking a Disability Studies View on School Mental Health (2019)

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