Breath & Shadow

A Journal of Disability Culture and Literature


Consumers: an Opinion by Julie Greene

Political correctness has swept the field of medicine from dermatology to pediatrics, and certainly psychiatry has had its share of terminology-laundering. As a mental patient, I face the PC question on a daily basis: "Loony-bin," "funny farm," and "nut case" are out, for obvious reasons, but some very, very sensitive people, with an eye for anything offensive, have declared that "mental patient" and "mentally ill" are out as well; the words are ugly and shameful. These folks think they're doing us a favor by inventing another, more pleasant word for what we really are: "Consumers."

"Consumer" is a euphemism, and because of this, the user of the term is implying that our illness is of minimal importance; instead, our role in the economics of medicine is of more concern. But let's face it: "Consumer" has nothing to do with mental health. It means Consumer Price Index or Consumer Reports. A consumer is protected by Ralph Nader, not the Hippocratic Oath. A consumer buys a car, a computer, carpeting, or coffee. Do we call cancer patients "consumers"? Certainly not. Consumers of what? CAT scans? Chemo? Who really does the buying here? The drug companies market to doctors, not to patients. For the most part, we have little choice regarding services; we use what's covered on our insurance.

Okay, "consumer" implies one who discerns, makes decisions regarding acquiring something. A consumer needs or wants something and chooses what to buy, where to buy it, and by what means. A new TV. Gloves. Chocolate. We don't even get to choose insurance. We take whatever insurance we can get, from the workplace or from the state or federal governments. Most of us aren't even insured. Very few patients choose their health care plan; it is decided for them - which means we are not consumers but recipients of health care, inadequate care or no care at all.

The inventor of the term "consumer" wanted to emphasize the pick-and-choose aspect of mental health care, implying that patients are discerning and proactive. As if calling us "consumers" makes all those discerning choices real for us. Truthfully, mental patients, as a subset of patients in general, are the least able to make choices about their care. The looming terms of "involuntary treatment," "locked ward" and "privileges" drive my point home here. Why should we cover up the fact that it is the lack of choices that defines us? Pink paper. Section 12. Restraints. I don't know if Patty Duke uses the term "consumer" to describe herself, but I do know she makes it no secret that she has bipolar disorder. Abraham Lincoln, Winston Churchill -- "consumers"? You've got to be kidding. They also had bipolar disorder, both of them. And I wouldn't be caught dead calling Michelangelo, Ernest Hemingway, or Anne Sexton "consumers."

"Consumer" tells the world nothing about the pain I have endured and continue to feel. "Consumer" won't tell you that when I first became mentally ill, I lost all of my friends because no one wanted to associate with a "mental patient." A "consumer" might take medication, but a "mental patient" suffers the side effects of sunburn, dizziness, dry mouth, and constipation. "Consumers" drive prices up and down; "mental patients" live and die.

There was only one time I was allowed to make a choice about my care. Due to the unreliability of Medicaid cabs, I had to stop seeing my therapist Dr. Barbara R, a fine psychologist who helped me immensely. I was given a choice: Dr. Elsa R, or another therapist whose name I forget. On Barbara's recommendation, I chose Dr. Elsa R, one of the biggest treatment mistakes I've ever made. So much for choices and the good they do.

I choose to be called a mental patient, a person with a mental illness, a person with schizoaffective disorder, a person with an eating disorder. I have been hospitalized for a mental illness; I have been affected by mental illness; I have mental problems; I have a psychiatric disorder; I am mentally ill; I'm in therapy; I see a shrink. I choose to be called by all these terms because they are accurate and unsentimental.

The most important choices a person with a mental illness ever has to make are the choice to seek treatment, the choice to cooperate with treatment, and the choice to be willing to heal. The meaning of the term "consumer" doesn't include this willingness. "Patient," on the other hand, specifies a person who is a recipient of medical care. "Mental patient" is a person receiving mental health care. Not all mentally ill people are patients; sadly, many do not enter treatment. But people who recognize their illnesses generally are those in treatment or seeking treatment, those who should be proud to be mental patients, and those proud enough to shove away the hands of those who pat our heads, beam with token pride, and call us their little "consumers." God help us.

Julie Greene's essay, "Consumers," was previously published in Pitkin Review. She has also been published in SWAMP. She lives in Watertown, Massachusetts, and studies creative writing at Goddard College's low-residency MFA program in Port Townsend, Washington. When she is not studying, she enjoys writing in her blog at blog.juliegreene.name, and knitting sweaters for her dog, Puzzle.

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