What Is a Mental Illness Microaggression?

In recent months I have organized several “community conversation” events regarding mental health stigma. These events, attended by mental health professionals, recipients of mental health services, family members and general community members, have given me the opportunity to converse about stigma and how it impacts people’s lives in a way that I have rarely had to do in academia. Something that has come up repeatedly in these discussions concerns the best way to support friends and family members experiencing mental health problems. In the course of answering these questions, the concept of “microaggressions” has invariably arisen. Microaggressions (a term which I will concede is perhaps misleading) are characterized by Columbia University Professor Derald Wing Sue and colleagues as subtle communications of prejudice toward individuals who are members of marginalized social groups and include “communications that convey rudeness and insensitivity,” less overt forms of name calling, and “communications that exclude, negate, or nullify … psychological thoughts, feelings, or experiential reality.”

I didn’t hear the term microaggressions until sometime around 2008, but I immediately recognized what they were when I heard the term. As a teenager, I was educated about the concept through the song “Funny Vibe” by the band Living Colour. The song (written and performed by African Americans) challenged the band’s white fans to consider ways that they communicate fear toward black men:

No, I'm not gonna rob you
No, I'm not gonna beat you
No, I'm not gonna rape you
So why you want to give me that funny vibe

As is made clear by the song’s lyrics, behaviors communicating fear of African American men (such as moving away from someone in an elevator) are noticed and experienced as hurtful. The song communicated to me: don’t think we don’t notice how you react to us. It made me more conscious of the subtle ways that I might be expressing the racism that I had grown up around. Microaggressions can take many forms depending on the “marginalized social group” that one is a member of and the types of negative stereotypes that are related to it. For example, while behaviors communicating fear constitute microaggresions toward African American men, behaviors communicating “exoticization” have been found to be frequently experienced by Latina women.

This brings us to the topic of people diagnosed with mental illnesses. My colleague Lauren Gonzales and I explored whether people with mental illnesses experience microaggressions in a series of studies conducted over the last few years. These studies, which included exploratory focus groups with people diagnosed with mental illness, and structured surveys with community members and people diagnosed with mental illness, have provided strong support that microaggressions are experienced by members of this marginalized group. Our focus group research revealed 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). A good example of a patronization microaggression concerned the experience of a person with bipolar disorder who stated that family members reacted to any expression of enthusiasm or happiness that she demonstrated as an indication that she was becoming manic, as indicated by the question “did you take your medication?” Subsequent studies indicated that intended microaggressions are relatively commonly endorsed by community members, and that the perception of microaggressions from local community members has a negative impact on the community participation of people diagnosed with mental illness.

So what should a friend, family member or professional, who cares about helping someone with mental illness, but is influenced by the same prejudices that everyone has been exposed to, do to avoid expressing microaggresions? Here my recommendations parallel what my colleague Kevin Nadal stated in his book That’s So Gay! First, try to be aware of your own biases and how they can influence your behavior. If your bias is to think of people with mental illness as incapable, try to consider how that can affect your communications with your friend, family member or client. Second, try to be aware that language affects people. Terms like “psycho” are commonly used in society, but they are definitely hurtful toward people with mental illness, as they are inherently dehumanizing. Third, try to talk to people with mental illness about their experience to learn about it, or alternatively, read personal accounts where you can learn how such behaviors affect people from their perspective. For example, in her autobiography law professor Elyn Saks described how students (unaware that she had a mental illness) spoke disparagingly about receiving legal advice from someone with a psychiatric history. Reading about such scenarios can help to broaden one’s perspective.

I definitely think that it is counterproductive for the dialogue around microaggressions to be one in which people feel that they are being hounded by the “word police.” The point is not to make superficial adjustments to one’s language, but to try to understand how hearing a phrase like “that’s so gay” or “that dude was psycho” can affect a member of the target group. It all starts with introspection, and the recognition that we might be giving off a “funny vibe.”