Mental Illness and Microaggression

Not only do people with mental illness frequently encounter negative stereotypes in news, films, books and in everyday speech, others often give misguided advice or are dismissive towards their mental distress. Yet claims by people with mental illness to have experienced discrimination in the form of microaggression might also be too easily dismissed: could not mental distress lead to increased emotional sensitivity, leading them to overreact?

Microaggressions, the small slights regularly experienced by marginalised people, are near daily reminders that someone is an outsider or a second-class citizen. On their own they may be slight, but their cumulative impact is anything but.  As part of a wider social pattern of oppression, they are deeply harmful. Microaggression can be behavioural such as when a store security guard is more likely to accuse a black customer of shoplifting; verbal, such as when a racialised person is regularly asked where they are “really” from; or environmental, such as when all buildings are named after white people and whiteness is assumed as the norm. (Examples of microaggressions related to race, gender, sexuality can be found here.)

People with mental illness regularly encounter negative stereotypes about themselves. Consistently depicting a group negatively, with limited access to positive role models, is an example of environmental microaggression. In both news and fiction, people living with schizophrenia or bipolar disorder are often depicted as violent or as bad parents. In crime novels, the culprit is often mentally disturbed. In her autoethnographic essay documenting how repeated exposure to this material affects her, Jennifer Eisenhauer writes: “The ways in which mothers who have bipolar disorder are portrayed in popular media becomes part of my daily lived experience. This is not because I see these portrayals everyday, but because these images and narratives become part of how I see myself and how others view me.”

Beyond these common negative stereotypes, people experiencing mental illness often encounter comments and behaviour which are insensitive or unhelpful. The many lists and articles about “what not to say to someone with mental illness” can be seen as guides to avoiding microagression. The Australian mental health charity SANE recommends avoiding the following:

– “Get over it / snap out of it”
– “It’s all in your head”
– “Stop whinging”
– “You have the same illness as my…”
– “You don’t seem unwell”
– “They’re so OCD!”
– “Have you thought of trying this, that or the other?”
– “You don’t need medication”
– “You need to be honest”
– “Get a good night’s sleep, exercise and look for the positives”
– “Oh yeah, that’s quite common isn’t it?”
– “Time heals. It will get better”

While stating that a mental illness is quite common seems to indicate acceptance, it can be experienced as minimising one’s distress. “You have the same illness as my…” is not that different from telling a black person that you are ok with black people and are not a racist because you have black friends. Other apparently well-meaning comments are problematic because they place the responsibility for recovery on the sufferer. Telling people to “think positive”, “what do you have to be upset about when your life is so good” or assuming that taking up yoga and eating large quantities of blueberries will solve someone’s problems, make it sound as if people could simply “snap out of it” if only they could be bothered to try. Such examples of insensitivity and rudeness accumulate into a pattern of social assumptions that mental illness can be overcome with application and self-management. This, in turn, moralises mental illness – you would not be depressed if only you tried harder, you are not trying that hard, therefore you are doing something wrong. Such moralisation further undermines the confidence of those with mental illness.

Appeals to microaggression are often dismissed with the claim that people are simply oversensitive. The complainers are snowflakes, self-deluded by victim culture. This criticism appears even more forceful here, as people with mental illness are often prone to interpreting events in a negative light or ruminating on the comments of others. We need not go as far as assuming completely delusional thinking. Depressed people often feel disproportionate guilt, feel as if they have failed or feel unloved. Anxiety can lead us to blow the importance of things out of proportion, or to worry about events that are unlikely to occur. Even psychologists sometimes assume that those with mental illness primarily experience self-stigma and expect discrimination that outweighs the actual stigma and discrimination from others. They claim that the negative attitudes are mostly in people’s imagination. Given this background how can we be sure that experiences of microaggression are not simple misinterpretations of well-meaning acts?

This is where the work of philosopher Regina Rini comes in extremely useful (even though mental illness is not a case she discusses). In her book-length analysis of the concept of microaggression, she gives an “ambiguous experience account of microaggression: what makes an act or event count as microaggression is that it is perceived by a member of an oppressed group as possibly but not certainly instantiating oppression.” Her definition takes into account that microaggressions are both subtle and ambiguous. Part of the damage they do is to make already marginalised people suspicious of their own interpretation of events. While their own interpretations are not always correct, Rini argues that as long as on balance members of a marginalised social group are likely to correctly notice subtle discrimination, we should accept that microaggression does happen, even if we sometimes disagree about whether any individual case is an instance of it.

Are people with mental illness reliable in this way? They are usually knowledgeable about their symptoms, medications and medication side effects. Moreover, most people, even with chronic mental illnesses, are not always unwell and out of touch with reality. Even when unwell, mental illness does not affect all domains of thinking. Experiencing irrational guilt does not imply an inability to recognise condescending remarks. The extensive overlap among “what not to say” lists (not all of which are blatant copies of each other) also indicates a consensus over what constitutes microaggression for people with mental illness.

So, rather than worrying whether an individual instance counts as a microaggression, we should be concerned with identifying the most common forms of microaggression that affect people with mental illness. If people with mental illness identify a set of unhelpful and discriminatory remarks, behaviours or environmental factors, we can safely say that microaggression does affect people with mental illness, regardless of any tendency of some people with mental illness to find social slights particularly painful. Even in these cases, the painfulness of these experiences must not be discounted. Another strength of Rini’s account is that it puts the focus on the experiences of marginalised people. Even though they may at times be mistaken about their interpretation of events, we should still accept the word of those experiencing mental illness about how those events made them feel.

Research shows that microaggression does affect people with mental illness in systematic ways. For example, Yanos et al found that there were “three main categories of experiences in this regard: assumptions of inferiority (for example, statements indicating that it was assumed that the person is not capable of doing what most people can do), patronizing microaggressions (for example, dismissive statements suggesting assumptions that people with mental illness are child-like), and subtle behaviors indicating fear of mental illness (for example, moving away from a person who is known to have a mental illness).”

Thus, we have every reason to accept general claims of microaggression in the case of mental illness. What can we do about this? Rini recommends avoiding, or at least questioning, material with harmful stereotypes in order to avoid internalising these ourselves. For their own part, writers, whether of fiction, non-fiction or journalism, can reduce lazy stereotyping in their work. (There is plenty of advice available. As an example, philosopher Sofia Jeppsson has written a blog post on the common problems with the way mental illness is depicted in science-fiction.) We can follow the advice of “what not to say to people with mental illness” lists. We can assume that someone who lives with an illness has already tried all the obvious remedies. Most importantly, we should listen and if someone says something is unhelpful, accept this instead of trying to convince them that they are mistaken about their own experiences.