Vol. 11 No. 3 (March 2001) pp. 102-104.

UNEQUAL RIGHTS: DISCRIMINATION AGAINST PEOPLE WITH MENTAL DISABILITIES AND THE AMERICANS WITH DISABILITIES ACT by Susan Stefan. Washington: American Psychological Association, 2001. 405 pp. Cloth $39.96. ISBN: 1-55798-681-9.

Reviewed by Katherine M. Nagle, Department of Special Education, The University of Utah.

Susan Stefan is to be congratulated. In UNEQUAL RIGHTS she has woven a tapestry rich with detail yet powerful in the clarity and starkness of its message. This is a book that is long overdue. It uncovers the sad truth behind the facade society's acceptance of people with disabilities, which is at best conditional and at worst patronizing, demeaning and profoundly damaging to the people with disabilities. Taking a structuralist approach, Stefan reveals unpalatable evidence that society's traditional fear and intolerance of people with mental disabilities is so embedded in the nations psyche that the law implemented to protect all people with disabilities from discriminatory treatment can be construed as part of the problem. Moreover, it is Stefan's contention that the very law designed to end discrimination is frequently interpreted in ways that foster discrimination against people with mental disabilities.

The organization of the book facilitates the transmission of the overall message. In the opening chapters, Stefan embarks upon a powerful conscious raising effort as she discusses the origins and the longevity of discriminatory attitudes towards people with disabilities. The narrative then moves swiftly to the heart of the argument that despite and sometimes because of the ADA people with mental disabilities face a heightened level of discrimination and prejudice in all facets of their daily lives. This message is repeated throughout each subsequent chapter, with topics ranging from the tension between disability benefits and disability rights to the frequently reprehensible and discriminatory behavior of institutions of higher education and professional licensing boards.

In peeling away the layers of discrimination faced by people with disabilities Susan Stefan forcefully demonstrates the existence of a hierarchical structure of disability categories that favors people with sensory and physical impairments over those with mental disabilities in myriad ways. Probing even deeper, Stefan reveals the Janus face of prejudice towards people with mental disabilities that effectively divides this group into two mutually exclusive entities: the "cripples" and the "overcomers." This division benefits neither group as the "cripples" find themselves confined, many literally, to the waste bin of society, while the "overcomers" are forced to "pass" and internalize the shame and stigma directed by the dominant society against people with mental disabilities. One of the unfortunate results of this division is the inability of the two groups to come together, recognize their commonalities, and challenge the damaging stereotypes that render each individual with mental disabilities less than they could be.

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One of the great strengths of this book is Stefan's firm commitment to people with mental disabilities. It is clear that this identification is no chimera. Using honest and forthright language, Stefan leaves the reader in no doubt as to her strong sense of social justice and her willingness to stand up and be counted. In her legal career Stefan represented people with mental disabilities and learned first hand the degree of institutionalized discrimination that this group faces. It is hard not to conclude that by writing this book Stefan is taking the battle out of the courtroom and into the classrooms and offices of those who claim to work in the best interests of people who are mentally disabled.

Stefan's insider status in the legal profession makes her message all the more powerful and very difficult for her intended audience of lawyers, therapists, and professionals to ignore. This book is not an academic exercise for Stefan. It represents her frustration and anger with a society that pays lip service to the value of inclusion, complacently passing legislation to end discrimination without fully understanding what it means to be discriminated against. One particularly tangible example of Stefan's commitment to people with mental disabilities is her outright condemnation of the discriminatory practices within her own field and the field of medicine, for "[T]he medical and legal professions are hardly examples of inclusion and accommodation when it comes to lawyers and doctors with disabilities" (p. 317).

Stefan's understanding of the relational nature of mental disabilities is impressive. For example, she demonstrates that gender, race, and socioeconomic status, intersect with mental disabilities in very significant ways that affect how these individuals interact with society. Women with mental disabilities, people of color, and people from low socioeconomic backgrounds face a deeper degree of discrimination than do white, middle class men with mental disabilities. To illustrate, Stefan points out that some of the behaviors exhibited by women with mental disabilities are in fact coping strategies that have developed as a result of childhood sexual and physical abuse that rendered them powerless before authority figures. However, this explanation of their seemingly irrational behavior is rarely considered. As Stefan points out, given the confrontational nature of many interactions between women with disabilities and rehabilitation agencies, doctors, and employers it is not surprising that some women with disabilities revert to the behaviors that enable to cope with abusive situations. These women are then further pathologized by the very system that contributes to their behaviors.

In presenting her evidence Stefan adopts what could be described as a mix methods design. She uses traditional legal research, citing case law and judicial decisions to illustrate the legal ramifications of discriminatory attitudes by legislators and the judiciary. The evidence she presents would be convince on its own, but combined with qualitative data from survey interviews it makes for harrowing and compelling reading. Stefan's desire to include the voices of her participants is admirable and reflects a feminist perspective on the nature of research and the relationship between the researcher and the "other." For the reader, the inclusion of routinely excluded voices provides another dimension to the discrimination faced by people with mental disabilities. The devastating effects of discrimination and the impotence of the ADA to bring about change in the lives of real people are presented in stark relief

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against the backdrops of insurance, child custody, institutionalization, higher education and a variety of professions.

Stefan uses her sources very effectively and forces the reader far beyond his or her comfort zone. She provides penetrating and detailed analysis of legal cases brought under the ADA, while seamlessly interlacing the powerful testimony of those who are at the receiving end of these decisions. At times the legal justifications for upholding patently discriminatory legislation defy all reason given the ostensible purpose of the ADA to prevent discrimination. Most significantly, Stefan shows these decisions are not based on ignorance or paternalism. They are explicitly allowed by state and federal statute and frequently supported by judicial analysis of the ADA. For example, a challenge under the ADA to statutes that include incurable mental illness as a ground for divorce was unsuccessful in a state court in New York. The judge accepted unquestioningly the dominant view that women with mental disabilities were unfit to be wives.

A minor criticism that can be leveled at this book is one that is largely beyond the author's control. The length of time between writing and publication is often so long that the material discussed is out of date. Stefan devotes some time to the constitutional challenges to Title II of the ADA, which caused considerable concern to disability advocates in Spring 2000. However, after Unequal Rights went to press the cases were settled out of court and the immediate threat to Title II receded. This issue is likely to resurface given the current ideological bent of Rehnquist Court. As Stefan points out the ultimate resolution of Congress's right to abrogate state sovereign immunity will speak volumes to value that this nation places on the lives of its citizens with disabilities.

In UNEQUAL RIGHTS, Susan Stefan has pulled off a remarkable achievement. One of Stefan's aims for the reader was that by the end of the book he or she will understand what the word discrimination means. That it robs people with mental disabilities of their dignity, their personhood and their lives. Without doubt Susan Stefan achieves her aim. This is a beautifully written and poignant wake up call to all those who work with people with mental disabilities, advocate and service provider alike. Few would argue that laws alone could dismantle the barriers erected by a society that for centuries has feared and demonized its members with mental disabilities. Yet, as Stefan shows the ADA has not been applied in an even handed way and as a tool for change has been poorly used in the service of those it was designed to assist. The ADA has the potential to be a potent instrument for change, whether it will be depends on the bravery of people with mental disabilities and the willingness of lawyers, judges, and juries to embrace the rights of all people.