The Othering Gift

Gifts of Light is a popular donation program offered by the Centre for Addiction and Mental Health (CAMH) in Toronto. This program allows for donors to select and buy items and activities for mentally ill patients. The donor browses through twenty-six different gifts on the Gifts of Light website (CAMH 2016), separated into categories like “New in 2016”, “Patient Care”, “Health & Fun”, and “Education & Career”. The gift, after purchase, is given to the patient, and a card is given to a loved one of the donor – the donation is made in lieu of a gift to the card-recipient (the donation is made on their behalf).

While browsing the Gifts of Light website, I came across the following: “Funds in excess of those needed to support Gifts of Light initiatives will go towards the hospital's highest priority needs.” Why not have donors give directly to those higher priority needs? Why even have the giver select from an array of individual gifts in the first place?

Figure 1: The Issue and the Solution

The puzzles above can be explained in part by the intent of the program, summarized in a graphic divided into two parts - The Issue and The Solution (Figure 1). The Issue contains statistics about the stigma surrounding mental illness:

“The Solution,” (Figure 1) outlines the activities of CAMH as an institution. Here, we read, “HOW YOU HELP: GIFTS of LIGHT… The Gifts of Light program offers hope and comfort to our patients and lets them know that people care.” The problem Gifts of Light is meant to solve is that of stigma against those with mental illness (as represented by the statistics listed above), through the deliverance of hope and happiness to the patient. Stigma is framed as broad, quantifiable, and reducible.

Whitley (2014) identifies three main ways by which anthropologists might contribute to the study of mental health: critique, context, and catalyst. This paper is a critique of the Gifts of Light program design. I argue that the stigma-reduction goals of the program are mitigated by its marketing - which creates a monolithic Other out of the recipient of the gift, and its mechanics - which maintain social distance between giver and recipient. In response to these issues, I propose some potential modifications to the program, while ultimately considering the possibility that its flaws might be inherent to charity.

The representation of the mentally ill in the Gifts of Light campaign website produces an Other worthy of care. This process is not unlike the creation of a monolithic, imagined “Africa” as a recipient of global aid (Richey and Ponte 2008:713). The complex world of mental illness is effectively flattened into a single category. As in the case of the African AIDS epidemic, simplistic representations of a group’s suffering and its causes (if determinants are even discussed) are favoured over any complex representation of lived experience.

There are two common cultural propositions implicitly made in the Gifts of Light campaign. The first, more complex proposition is what we might dub the “Christmas sufferer”. It is the notion that around the time of Christmas, those who suffer will suffer more. An ad campaign for Gifts of Light features images of a pair of socks accompanied by text reading: “Who needs an extra pair of socks for Christmas? We do.” 

On the Gifts of Light website, under the section “How it works,” we read:

The increased suffering of the already unfortunate around this time of year is a familiar trope. Fictional depictions of this phenomenon include the lonely bartender Moe Szyslak of The Simpsons threatening to end his life on Christmas Day, as well as more spiteful characters like The Grinch and Ebenezer Scrooge who are reminded of their own isolation during a time of celebration. It is worth noting that statistically, in the United States Christmastime does not see a rise in suicide - December is the month with the lowest suicide rate (CDC 2013). Real or imagined, Christmas as a time of exacerbated suffering is a cultural narrative which underpins the entire Gifts of Life campaign, so much so that we could call this an imagined determinant of health. As in the Product (RED)tm campaign, which gathers funds for AIDS treatment, there must be a “construction [of] worthy recipients” – this narrative is part of that construction (Richey and Ponte 2008:713).

There is another parallel between the Gifts of Light narrative and some of the aforementioned fictional narratives, in which almost every Christmas sufferer has a moment of personal redemption or social salvation. The notion of the mentally ill person as isolated is integral to this message. The helpless sufferer is warmed, illuminated, saved, by the charity of others, and ultimately has a Merry Christmas (as we see in the various photos of smiling patients on the website).

Let us turn to another cultural concept which, in a way, collapses the first. Gifts of Light's message hinges on a near-universal binary of dark (representing ambiguity and danger) versus light (representing goodness and clarity), the latter being preferable to the former. If the Christmas sufferer’s pain is masked and heightened by the holidays, they are in the dark. The solution, then is to bring them light – here in the form of the gift. The mentally ill Other dwells in the darkness, while the healthy majority stands in the light. Through flattening representations of suffering and isolation, the mentally ill people are cast as dark people in the popular imagination. Through charitable action, the healthy saviour is able to grant the sufferer this light. In this way, a hierarchy is formed between the healthy and the Other.

Othering of the mentally ill is based on an existing power dimension. The mentally ill are in a marginal position – stigmatized and largely invisible. Gifts of Light builds on this pre-existing power dimension. And it is all too easy to do so, considering the specific nature of the institution, which, like Africa, seems a great mystery to those outside. The building segregates the ill for treatment. For everyone on the outside, those inside appear flattened and generalized.

As a person with a diagnosed mental illness, I find the representation of the mentally ill within Gifts of Light inaccurate. Having worked in marketing myself, I understand the need to distill a message into something punchy and simple. In CAMH's campaign, I see the inherent limitations of marketing. Marketing relies on generalization, flattening, and Othering. It is the language of an alienating consumer culture. Gifts of Light is in competition with all the other charities vying for Christmas donations, relying on consumerism. The Othering of patients seems almost inevitable in a humanitarian mode.

I turn to the mechanism of the gift here. Gifts of Light differs from some humanitarian programs in that the donor can choose precise forms of aid given to the recipient. What I imagine to be a benefit of this approach is the connection between the two parties. We might turn here to theories of the gift in order to better understand the Gift of Light. Here, I follow the common distinction between the commodity and the gift:

The rhetoric of Gifts of Light seems to strive towards a Maussian gift – wherein a social relationship forms between the giver and recipient. The Gifts of Light are supposed to be meaningful to the giver and the recipient, who knows that there is someone out there who cares about their suffering. But this is not a Maussian exchange between donor and patient. There are two recipients – one is the patient-recipient who receives the gift. The other recipient is the friend or family of the donor, who receives a card. Gifts of Light differentiates the card and the gift, but I argue that the card itself functions as a second gift. The Maussian exchange only exists here – the card acts as a normal Christmas gift would, and social ties are strengthened between giver and recipient.

The gift between donor and patient, however, is not a Maussian one – the bureaucratic constraints of the philanthrocapitalist model render this impossible. The patient-recipient of the actual gift is not able to reciprocate with, or interact with the giver. The walls of the institution disable the potential social relations which could arise between these individuals. Here, I speculate that the recipient’s social debt is, then, to the institution, rather than the donor himself – their entitlement to the gift being contingent on fulfilling a certain patient subjectivity (presumably) and participating in CAMH as the suffering subject. I should also note that the relationship between donor and patient is complicated still by the fact that, as I have mentioned, the gift is given in someone else's name rather than their own. The implications of this are unclear, but this would, in theory, further distance the donor from the patient.

Finally, it is worth noting that the donor is engaged in commodity exchange, which, while alienating, is a “thoroughly socialized thing” (Appadurai 1986:6). As in the Product (RED)tm campaign, Gifts of Light is rooted in consumerism, wherein a “consumer-citizen” works for social justice (Richey and Ponte 2008:712). This sentiment is echoed on the Gifts of Light website, which compels us to “Enjoy shopping meaningfully!” The consumer’s dollar is supposed to be a catalyst for social action, and there is an element of conspicuous consumption at play in the donor demonstrating to others that they have done something good (ibid:713).

To summarize, there are two social relationships that exist prior to the donation/purchase, and those are the social relationships that are enforced. The gift between donor and patient is alienable – it is essentially a “free” gift. The card, however, is an inalienable gift, and enforces a social relationship between the donor and their loved one. Distance between the patient and the world outside the institution is maintained, while existing relationships are enforced.

Whitley (2014:501) argues that “a credible anthropology of mental health intending to make a societal contribution should offer no opposition without proposition.” I would like to offer some solutions based on my arguments, but I recognize that the very nature of a large bureaucratic institution like CAMH creates a structural limitation on the types of stigma-reduction possible. We should not be relying on monolithic cultural tropes which put people into a suffering slot. Marketing that generalizes a population and makes certain groups the object of pity robs individuals of dignity and will only exacerbate stigmatization.

Stigma, measured in crass statistics, could possibly be reduced through a true, inalienable gift between the giver and suffering recipient. There could be some modification of current gifting model in order to this – it would necessarily involve dismantling the current, impersonal model, in favour of an organic system of exchange. I find it more likely, however, that humanitarianism, even in its most benevolent forms, is inherently hierarchical (and thus not appropriate for the project of fighting stigma). We should be mindful that “empowerment is still, in short, a relationship of power” (Li 2007:275), and that a gift itself can reinforce a power relationship or create one. Perhaps the division between donor and recipient, mediated by the institution, creates insurmountable boundaries for the stigmatized, and further entrenches their Otherness. Simply opening up the program, and allowing for more genuine interaction between patients and outsiders might create situations in which the patient must “perform” their Otherness, as Ticktin has observed in the case of immigrants admitted on the basis of illness in France (2006:43-44).

I must note that due to the complexity of the program, my analysis has not focused on individual gifts or their effects. Some of the gifts might have better stigma-reducing effects than others.  Similarly, my critique of the gift might be complicated by the Group Gifts and Matched Gifts options available in the program, which require the cooperation of multiple donors – in-person through the former, or anonymously and mediated by the institution in the latter. The analysis is complicated further still by options to add customized cards to a gift, which might mitigate or reduce its alienation.

    I do not believe that Gifts of Light is entirely ineffective. Surely, there is some inherent value in public awareness garnered by this program and others like it. As well, receiving gifts, if from strangers, is not without its obvious benefits for patients. But these benefits come at a cost, in the form of further stigmatization - symbolic Othering which manifests itself in real, material consequences.

    Through Gifts of Light we see the limitations of an institutionally-mediated charity in creating real societal change. A thoroughly alienated gift, sent via institutional means and bought out of consumeristic urge, will never foster real connection between people. Marketing for charity reproduces the most problematic representations of the suffering subject. Gifts of Light is part of a broad shift described by Ticktin (2006) from human rights to humanitarianism, wherein care is not guaranteed. Care is contingent on the compassion of the donor towards a suffering Other, who must be produced and maintained. To make people diagnosed with mental illness the object of charity relegates them to a marginalized position. The mechanisms of the program exacerbate (or at least maintain) this effect through physical and symbolic borders, as well as through a gift that does not necessitate meaningful social connection. Ultimately, stigma is worsened by these elements of the program. Though whether these issues are inherent to humanitarianism itself is unclear, they seem to be endemic to it.

Note: this paper was originally written in 2015. Some of the emphasis in the Gifts of Light campaign has changed since (from stigma-reduction to individual benefits), but all material referenced is still live, on their website.

Appadurai, Arjun. 1986. The Social Life of Things.

CAMH. 2016. Gifts of Light. give.camh.ca/Gifts_Of_Light.

CDC. 2013. Holiday Suicides: Fact or Myth? http://www.cdc.gov/violenceprevention/suicide/holiday.html

El-Haj, Nadia Abu. 2005. Edward Said and the Political Present. American Ethnologist 32(4):538-555.

Herrmann, Gretchen M. 1997. Gift or Commodity: What Changes Hands in the U. S. Garage Sale? American Ethnologist 24(4):910-930.

Ticktin, Miriam. 2006. Where ethics and politics meet. American Ethnologist, 33(1): 33-49.

Li, Tania Murray. 2007. The Will to Improve. Duke University Press.

Richey, Lisa Ann and Stefano Ponte. 2008. Better (Red) than Dead? Celebrities, Consumption and International Aid. Third World Quarterly, 29(4):711-729.

Whitley, Rob. 2014. Beyond Critique: Rethinking Roles for the Anthropology of Mental Health. Cult Med Psychiatry 38:499-511.

Henry Lee Heinonen is a meme page administrator, musician, and graduate student in sociocultural anthropology at the University of Toronto. His research centres on the struggle and activism of Indonesian migrant domestic workers in Hong Kong. He can be contacted here.