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5 Common Microaggressions Against Those With Mental Illness

by Monica A. Frank, Ph.D.
"Microaggressions are subtle behaviors or reactions that diminish the recipient in some way."
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Those struggling with mental illness often report that others don't understand the problems they experience. In addition, others treat them differently in very subtle ways but that are clearly apparent to the individual with mental illness. Not only that, but when those with mental illness complain, they are ignored, their mental illness is blamed, or they are told they are imagining the problem due to excessive sensitivity.

face hidden by towelAlthough overt discrimination such as occupational inequities has been opposed through legislation such as the Americans With Disabilities Act (ADA), these types of microaggressions still plague those with mental illness. Microaggressions are subtle behaviors or reactions that diminish the recipient in some way.

The problem with microaggressions, similar to indirect passive-aggressive behavior, is the behavior is often so subtle that the perpetrator can easily deny the intention or even blame the recipient. Sometimes the perpetrator may even be unaware of their underlying attitudes that are being expressed in this subtle manner. However, the recipient is very much aware of the difference in how they are treated.

Through interviewing individuals with mental illness, researchers Gonzales and colleagues (2014) found five themes of microaggressions against those with mental illness:

1) Invalidation

Many people with mental illness report that others tend to dismiss their illness or symptoms through minimizing their experience, symptomizing their normal experiences, and patronizing. All of these behaviors show a lack of education and/or understanding of the mental illness.

Minimizing. Often others will minimize the symptoms someone experiences such as believing that because they can function in certain ways the mental illness must not be severe. Frequently, when I've had clients who needed to take a leave of absence from work, they are afraid to be seen in public because others will think they are just playing hooky from work. “I saw her shopping at the mall. She could work!” or “He was out riding a bike. I don't think there's anything wrong with him!”

However, with depression or anxiety a person might look fine on the outside but the pain they're suffering can't be seen. For instance, the treatment for depression is to do normal activities they would usually enjoy but are avoiding, so it actually may be quite hard for them to be in the mall or riding a bike. Yet, if they isolate themselves in their home (or a room) the depression is less likely to improve. A proper response if you see someone who is depressed but doing a pleasant activity is: “It's so good to see you out! I know it must be hard.”

Also, certain triggers could be causing the problem. For instance, that person shopping at the mall may be having a panic attack but is trying to face the anxiety of being around others so that she can return to work. The fear of others minimizing their problems can often prevent people with mental illness from doing the treatment methods that can help them get better. In this instance, not only is she worried about having a panic attack but then she has to be concerned about what others might think.

Even other people with mental illness may not understand and tend to minimize the problem if it is not the same as what they experience. “You can't really be depressed if you are able to work. I couldn't get out of bed or take a shower when I was depressed!” Mental illnesses present in many different ways and just because it might have the same name doesn't mean it will be the same experience.

Symptomizing. Sometimes others will over-interpret normal emotions when someone has mental illness. This can be particularly confusing because it can seem like genuine concern but still leaves the individual feeling frustrated and even doubtful of their own emotions.

For example, someone with depression is grieving the loss of their pet and is cautioned, “You better see your doctor about your depression because it is getting worse.” Or, someone with an anxiety disorder is nervous because of a normal situation such as an upcoming job interview might be told “Oh, no, you're feeling anxious again! Maybe you shouldn't do this interview.”

Patronizing. Sometimes others try to show genuine support but it may appear to be condescending. For the individual with mental illness, it can be unclear whether they are truly trying to be supportive or if it is intended as a put-down. “You are really brave to speak up about your mental illness and not be worried others will see you as weak.” Such a statement could be a back-handed (passive-aggressive) compliment indicating an underlying view of mental illness as weakness.

2) Assumption of Inferiority

Most people with mental illness have experienced directly or indirectly the attitude that those with mental illness are inferior to others. Again, this shows a lack of understanding of mental illness. Do we think someone with cancer is inferior to others? No, we see that person as a normal person with an illness. Mental illness should be thought of in the same way. It does not mean the person is inferior. In fact, as I tell clients, they have to deal with all the ordinary problems of life AND manage the symptoms of mental illness. That takes a great deal of strength.

Assumption of lower intelligence. Many times if others know that someone has mental illness, they will be more solicitous as if they are speaking to someone who has lower intelligence. I've even had clients who reported their health professionals will speak to them as if they were a child—very slowly and deliberately. Or, may convey a sense of irritation with someone who is anxious, “This is a simple procedure! I would be done already if you would stop asking questions!” Of course, this type of response only makes the anxiety worse. It would be better to say, “I know you are anxious. I'll take my time and coach you through it.”

Assumption of incompetence. People with mental illness may be treated as if they are less competent than others. For instance, they may be given work duties that are below their capability: “We don't want to overly stress you.” Although the intention may be to aid the person on the work site, it should be determined by the individual with the mental illness (and their mental health professionals) what they can handle and not handle.

Assumption of not having control. Sometimes others will assume that an individual with mental illness doesn't have the control to function normally. Unfortunately, the most severe cases of mental illness are often most publicized which give people the impression that everyone with mental illness is unable to control their behavior and are unable to participate normally in society.

However, the truth is that most people with mental illness wouldn't even be recognized by others as having a problem unless they shared their experience with others. In fact, many focus on over controlling the mental illness to the extent that it may be harmful for them. For example, a person with depression may work extra hours at work even though other employees refuse to do so because the individual doesn't want to be seen as weak and controlled by the depression. However, this fear prevents that person from taking good care of him or herself and managing stress that could make the depression worse.

3) Fear of Mental Illness

Some people fear those with mental illness because they believe they may be dangerous or unpredictable. Again, the media tends to play up these notions by the focus on mental illness when crimes have been committed. However, the impression that is created is quite wrong. Only a very tiny percentage of people with mental illness are dangerous or commit crimes. In fact, there are many more crimes committed by people who are not considered mentally ill.

As a result of this fear, however, people with mental illness are often shunned or isolated. Unfortunately, such a reaction can cause a worsening of the illness, and for those who may be predisposed to violence, it may contribute to causing the violent reaction. If, as a society, we treated people with mental illness better, we would likely have fewer violent reactions. It is important to think of violence as the interaction of the illness and the environment but not necessarily caused by the illness.

In fact, if we could truly recognize that “it takes a village” we could solve many of the problems with mental illness because the problems aren't due to the mental illness but due to how we treat those with mental illness. For instance, the town of Geel, in Belgium, has been taking in those with schizophrenia for over 700 years. Instead of treating them as “sick” or “crazy,” they have made them valued members of the community. This model has been very effective in helping those with schizophrenia function in productive ways.

4) Shaming of Mental Illness

Due to others' responses, those with mental illness often feel others see them as weak or that they should hide their mental illness. Telling them they shouldn't let others know about their mental illness implies something is terribly shameful about mental illness. Making them feel bad about their reactions only makes the situation worse: “Get ahold of yourself!”

In addition, this attitude continues to perpetrate the stigma. As long as the only people who are in the public eye with mental illness are those who are so dysfunctional that they are immediately apparent, then the public continues to believe the myths about mental illness. The public needs to become more aware of the many faces of mental illness because those faces are 1 in 3 of your family and friends.

I think that the new reality TV fad of using mental illness as entertainment only contributes to this stigma. I understand some people say they are trying to bring attention to the problems. However, when the conversation around the water cooler is “Did you see the show where the hoarder had only a tiny path to move through his home and was even saving bottles of his urine?” the stigma is reinforced by making everyone with mental illness seem odd and very different from others.

5) Second Class Citizen Attitudes

Many people with mental illness report being treated as if they don't have the same rights as the dominant (re: “normal”) group of society. Their opinions are ignored as if they were children and not taken into account when making decisions that will affect them. It is as if the “normals” think “We need to take care of them” which may have a good intention but it results in controlling other human beings capable of decision-making. When anyone, even a mental health professional, believes they know what is best for an individual with mental illness, they may not only be wrong but even potentially harmful to the individual.

For instance, those with mental illness know themselves and their reactions better than anyone else. However, frequently they are told they are wrong when they experience an undesirable effect from medication. In this case, the medical professional assumes they know what is best. Or, an individual might be told they have to think in a different way to be acceptable to society. In my practice, I try to validate how people think, yet provide them with an understanding of how that thinking might affect them or their relationships. By doing so, it provides them with a choice. This is how we treat adults in our society--not by telling them what they should do but helping them examine their options.

What Can You Do About Microaggressions?

1) Education.
Recognize that microaggressions are often not intentional but are due to a lack of education. When you observe a microaggression, try to educate the person (or the public) about how it impacts someone with mental illness. Even if you believe the behavior is intentional, try to give the person the benefit of the doubt and provide education as a first step.

Unfortunately, even if people aren't intentional in their behavior, they may still react defensively. People don't like to be told they are acting in insensitive ways. Therefore, be careful how you approach someone. For instance, instead of saying “You're shaming me!” say “You might not be aware of this, but when you say I should hide my mental illness, it feels as if I should be ashamed of being mentally ill.

2) Don't personalize.
If you discover that someone does have harsh beliefs about mental illness such as believing that you are weak or inferior in some way, recognize that it is not about you. For whatever reason, this person has bigoted beliefs and is not receptive to education, but it doesn't mean such beliefs are truth. Don't doubt yourself just because of someone's demeaning attitudes. It is best to try to dissociate from such people as much as possible and establish relationships with those who are more understanding.

3) Advocacy.
If microaggressions are part of an institution, work towards changing the institution. For instance, if a treatment program for mental illness takes away your choice unnecessarily in a way they wouldn't do for those requiring physical treatment, inform them of the discrepancy and how changes could be made.

REFERENCES

Gonzales, L., Davidoff, K. C., Nadal, K. L., & Yanos, P. T. (2014, November 17). Microaggressions Experienced by Persons With Mental Illnesses: An Exploratory Study. Psychiatric Rehabilitation Journal. Advance online publication. DOI: 10/1037/prj0000096




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