The Oppression of Mental Illness

 

Abstract

Those experiencing mental illness is prevalent in the United States, but not often discussed as an oppressed group. According to Young (1990, as cited in Allen, 2008), there are five faces of oppression—economic exploitation, social marginalization, powerlessness, cultural imperialism, and violence. Those suffering with a mental illness encounter at least three of these “faces” (Young, 1990, as cited in Holley, Stromwall, & Tavassoli, 2013)—marginalization, violence, and cultural imperialism. These issues regarding mental illness have been present throughout history, even though the discussion of oppression has been silenced. Society is currently taking great strides towards change and advocacy due to a number of nonprofit organizations.

Literature Review

Group History of Oppression

            The history behind mental illness and its oppression demonstrates that the disorder itself is not a new concept. Negative presumptions have often been imposed on those experiencing mental illness. Yet, progressive attempts have been made with more appropriate approaches, treatments, and diagnoses. Most recently, organizations and research have created a platform to positively advocate for mental health and destigmatize early historical concepts that remain in society. The Public Broadcasting Service (PBS) provides a fundamental timeline of the history of mental illness through the accredited series, American Experience.

Mental illness has been documented since 400 B.C., when Hippocrates, a Greek physician, introduced a new approach to mental disorder—treating the illness separate from religious affiliation (American Experience, n.d.). Still, in the Middle Ages, people were labeled witches or demonic, instead of acknowledging mental disorder. The early 1400s brought the first institution (in Europe) designated for mental illness (American Experience, n.d.). Even so, by the 1600s, Europeans began dehumanizing and isolating the mentally ill. Advocacy against mistreatment of those institutionalized took place in the 1700s, but had minimal affect (American Experience, n.d.).

Dorothea Dix had the greatest impact on reform. She spent 40 years establishing dozens of hospitals suited for those with a mental illness (American Experience, n.d.). The late 1800s into the early 1900s brought developments in diagnoses (Emil Kraepelin), firsthand experiences (Nellie Bly and Clifford Beers), and psychoanalytic therapies (Freud and Jung). These advancements in research prompted innovative treatment approaches within mental health facilities—treatments like drugs, electro-shock therapy, and lobotomies (American Experience, n.d.).

At this point in history (1930s), progress was a dance—moving one step forward and two steps back. Seemingly, people did not know what exactly to do with the information being discovered. Oppression of the mentally ill was taking hold in society; no one was rejecting harmful assumptions or challenging perceptions of mental health.

By the 1940s, the government became more actively involved. President Harry Truman initiated the National Mental Health Act in 1946, and the National Institute of Mental Health (NIMH) was officialized in 1949. The NIMH, still prevalent today, was established to research and reduce mental illness—a more scientific approach to treatment was applied (American Experience, n.d.). Regardless of these more definitive methods, the number of those institutionalized in the United States peaked at 560,000 (American Experience, n.d.).

The following decade brought various publications sharing different perspectives and philosophies regarding mental illness (American Experience, n.d.). One notable publication is Ken Kesey’s One Flew Over the Cuckoo’s Nest (1962). Kesey based his novel off experiences he encountered working in a psychiatric ward and discovered that patients didn’t necessarily display mental illness, and instead their behavior was unacceptable in society’s standards (American Experience, n.d.).

Deinstitutionalization began in the mid-1960s and by 1980 the number of individuals within mental facilities dropped from the previously stated 560,000 to 130,000 (American Experience, n.d.). Reasons for this may stem from research, anti-psychotic drugs, and awareness of poor facility environments and care. Further supporting deinstitutionalization was the assumption that those with mental illness would pursue treatment independently if necessary (American Experience, n.d.). While the intent of this movement may have meant well, the consequences had a substantial impact, still relevant today. First, the homeless population increased—in the 1980s, approximately one-third of the homeless population had a diagnosable mental illness. Secondly, rates of criminal incarceration increased (American Experience, n.d.).

Detrimental Demographics

            History continues in current demographics. The National Alliance on Mental Illness (NAMI) compiled a list of demographical statistics pertaining to mental illness gathered from sources such as The National Institute of Mental Health (NIMH) and Substance Abuse and Mental Health Services Administration (SAMHSA). General statistics depicting the prevalence of mental illness is necessary to understand the extent and effect of oppression. Approximately 18.5% adults in the United States experience mental illness within a given year (NAMI, n.d.). Further, approximately 4.0% adults encounter a serious mental illness disrupting life activities (NAMI, n.d.).

            Oppression towards mental illness as a group are unique to other oppressed groups—mental illness can happen to anyone for any number of reasons (“Mental Health” Oppression and Liberation, 2016). This makes mental illness a prime candidate for intersectionality, or multiple layers of oppression. In other words, mental illness itself does not discriminate, and specific demographics are based on reported information. Factors contributing to this limitation (of reported mental illness) fall under access to health care and stigma (Benbow, 2009). Still, there are some basic demographics at slightly greater risk—women between the ages of 26 to 49 (SAMHSA, 2014). Those who identify with two or more races have double the risk of encountering mental illness (SAMHSA, 2014).

            These statistics easily overlap in other socially oppressed groups. Approximately 20.2 million adults experience substance use disorder—over half also have a co-occurring mental illness (NAMI, n.d.). This spills over intersects into homelessness. For individuals who reside at homeless shelters, 26% experience serious mental illness. The prevalence of homeless co-occurring substance abuse disorder is estimated to be 46% (NAMI, n.d.)

            A major consequence of the deinstitutionalization movement was the transference of mentally ill into correctional facilities. According to the Bureau of Justice Statistics (2006), state prisons incarcerate 56.2% who have any mental health problem, and 64.2% are imprisoned in local jails. Of those who reported a mental health problem, an average of 75% demonstrated substance dependence or abuse, and an average of 15% had been homeless a year prior to arrest (James & Glaze, 2006).

            Beside social implications, basic necessities are more unattainable for those experiencing mental illness. Many of these obstacles are rooted in history and demonstrate systematic oppression towards mental health. Issues regarding housing originated in the 1600s when Europeans (perhaps inadvertently) criminalized those who had mental illness by housing them with those disabled and delinquent (American Experience, n.d.). This continued when Dorothea Dix got involved upon noticing individuals with mental illness were incarcerated with criminals, and was further exacerbated by the deinstitutionalization movement and is still quite the case today (American Experience, n.d.).

The historical impact lingers not just on housing opportunities, but also retaining employment and receiving adequate medical care, regardless of legislature. Problems acquiring housing, employment, and health care include stereotyping, stigma, discrimination (Benbow, 2009; Charles, Holley, & Kondrat, 2017; Holley, Stromwall, & Tavassoli, 2013; Scheyett, 2006), microaggression, and marginalization (Charles et al, 2017, Holley et al, 2013)—and intersectionality only reinforces such oppression. For example, according to a study by O’Flaherty (2005) landlords are hesitant to rent housing to those with a mental illness (as cited in Benbow, 2009).

Regarding employment, Tugwood, McManus, Burke, and Forchuck (2007) discovered that employers did not want to endanger staff or customers by hiring someone with a mental illness (as cited in Benbow, 2009). Sadly, to perceive someone with a mental illness as “dangerous” negatively categorizes them as a “criminal” who has “committed a crime” and therefore, it is assumed others are at risk (Benbow, 2009). There is a constant threat of being institutionalized, whether mentally or criminally (“Mental Health” Oppression and Liberation, 2016). Oppression from medical providers is arguably the most damaging. Providers are often invalidating, patronizing, assuming, degrading, and also perceive individuals with mental illness as lower class (Charles et al, 2017), incapable of recovery, (Holley et al, 2013) and resistant or even responsible for their own mental illness (Scheyett, 2006).

Unfortunately, all these limitations perpetuate the cycle of mental illness. Individuals with a mental illness often internalize these elements of oppression. What is ironic is that at the core of mental illness is the human mind.

Additional Stressors

            Intersectionality, or experiencing overlapping roles of oppression, was previously mentioned regarding demographics of mental health. Any form of mental illness may be intensified if the individual is also a member of another oppressed group (e.g. race, ethnicity, gender, sexuality, etc.) (Charles et al, 2017; Holley et al, 2013). Historically, when slavery was standard in the United States, African-heritage individuals attempting to escape were diagnosed mentally ill based on the fact that they did not want to be enslaved (“Mental Health” Oppression and Liberation, 2016).

            These intersectional perspectives and beliefs gain the most media attention, which is shared constantly with millions of people worldwide. The media holds much responsibility for the spread of all forms of oppression, not only mental illness (Benbow, 2009). Media is subjective and reflective of the world—even news sources have lost validity—yet we cannot discern fact from fiction. Media platforms allow for opinions about mental illness to become “viral,” “reality”, or even “trendy,”—responses and speculation of mass shootings are a prime example (Holley, Stromwall, Tavassoli, 2013). Mass communications still leave those experiencing mental illness silent and invalidated.

            Intersectionality and the influence of media allow microaggressions and stigma to flourish. Microaggressions are understood as insults or slights that are invalidating (Charles, Holley, Kondrat, 2017), while stigma dehumanizes the oppressed (Vertilo & Gibson, 2014). What is unique to mental health is that these additional stressors worsen mental illness. Individuals who struggle with mental health are more susceptible to withdrawal and internalize, ultimately causing reluctance to seek treatment (Holley, Stromwall, Tavassoli, 2013; Scheyett, 2006; Vertilo & Gibson, 2014).

Strengths of Oppressed Group

            It is difficult to find self-reported strengths of those struggling with mental illness, for this is an element contributing to mental health. Ultimately, one can determine personal strengths or remain open to ideas from others. Mental health requires awareness, positive reframing, coping mechanisms, and social support (Vertilo & Gibson, 2014).

            A growing approach to identifying mental health strengths is positive psychology (Disabato, Kashdan, Short, Jarden, 2016; Vertilo & Gibson, 2014). Much like the strengths-based approach in social work, positive psychology concentrates on “promoting character strengths or traits that foster life satisfaction and strengthen individuals’ well-being,” (Vertilo & Gibson, 2014). Identifying these strengths is entirely subjective, but can be developed and learned. Vertilo and Gibson (2014) conducted a study assessing character strengths and their influence on mental health stigma. Specifically, the strengths included open-mindedness, social intelligence, kindness, and hope—open-mindedness would teach the individual to challenge internalized stigma; social intelligence would improve perspective and empathy in interaction; mental-emotional equality would be defined as kindness; and the strength of hope would encourage emotional optimism for the future (Vertilo & Gibson, 2014). Implementing these character strengths, among others (Peterson, Park, & Seligman, 2006 as cited in Vertilo & Gibson, 2014), require involvement from society as a whole.

            A promising strength of mental health is the constant movement towards progress, not perfection. Society and researchers increasingly focus on determining and implementing strengths, understanding implicit bias, and establishing a common ground regarding mental health. To an extent, it begins with promoting strengths and redefining values (strengths-based approach). A recent study determined that not only did “character strengths reduce depression, [but] depression does not significantly reduce character strengths,” which supports the value of instilling a strengths-based approach (Disabato et al, 2016).

Literature Themes

            Throughout this literature review, three significant themes regarding the effect of oppression on mental illness emerged— (1) internalization, (2) invalidation and shame, and (3) being silenced and invisible.

            Holley et al (2013) looks extensively into the socialization process that results in internalization. The cycle begins with social influence and personal interpretation of stereotypes, norms, and values. This interpretation then is reinforced by institutional powers—religious, educational, legal, and medical—and made acceptable by use of language and media. Consequently, oppression is internalized for those with mental illness, which is detrimental to functioning mental health (“Mental Health” Oppression, 2016). A form that Vertilo and Gibson (2014) highlighted is the assumption that an individual with a mental illness is perceived personally responsible for their diagnosis. To place blame on one struggling with mental health negatively internalize this and believe they are truly to blame. Anyone who blames themselves for a mental disorder tend to avoid medical professionals, who frequently insinuate that people suffering mentally are resistant to treatment (Scheyett, 2006; Vertilo & Gibson, 2014). Benbow (2009) summarizes the effect of internalization saying that, “Once negative perceptions are internalized, hope that struggles can be overcome is lost.”

            Invalidation, categorized as a microaggression, can also be understood as minimization or dehumanization (Charles et al, 2017). Typically occurring in the way of interaction, this theme tells people with mental illness that they are less than human because of mental disorder (Benbow, 2009) and is further maddening due to inhibited self-regulation and control (Vertilo & Gibson, 2014). Through invalidation, dehumanization can affect an already suffering identity questioning one’s competence and worth (Charles et al, 2017; Scheyett, 2006). Invalidation is a central theme for mental health because it invalidates a component of humanity—the mind (“Mental Health” Oppression and Liberation, 2016).

Mental disorder is an invisible oppression that prompts silence (“Mental Health” Oppression and Liberation, 2016). Foucault (1965 as cited in Scheyett, 2006) explains that the discussion between “Madness” and “Reason” has been halted and any research regarding mental health is focused now on the Reason for Madness. Silence is the result of continued internalization and invalidation (Benbow, 2009; Charles et al, 2017; Holley et al, 2013). Isolation and withdrawal are utilized as coping mechanisms (Scheyett, 2006; Vertilo & Gibson, 2014) and unfortunately only hinders opportunities for greater understanding. The silence makes mental illness oppression invisible and allows others to increase privilege and power (Holley et al, 2013).

 

Change Efforts

The National Alliance on Mental Illness

The National Alliance on Mental Illness (NAMI), a nonprofit organization, originated in 1979 in order to educate, advocate, listen, and lead the movement towards improving life for all impacted by mental illness (NAMI, n.d., About NAMI). NAMI is also committed “to raising awareness and building a community of hope for all of those in need,” and also “recognizes that the key concepts of recovery, resiliency and support are essential to improving the wellness and quality of life of all persons affected by mental illness,” (NAMI, n.d., Frequently asked questions).

NAMI’s mission statement is an extensive pledge towards quality, dedication, prevention, recovery, social engagement, and strengthening all affected by mental illness, while also being mindful of individual experience, and applying a combination of approaches that best fulfill these needs. NAMI offers a declaration:

(1.5.1) Together we can give each other strong support; (1.5.2) The illness is treatable;

(1.5.3) It's not anyone's fault; (1.5.4) You don't need to explain anything—we already know; (1.5.5) You can survive as an intact family; and (1.5.6) With dedication and unity, we have enormous strength through which we can accomplish constructive change (NAMI, n.d., Identity and mission).

NAMI has gained accreditation in extensive research, programming, and influence on public policy. The objective of research is to provide current information, discover effective treatments, and encourage support and validation. NAMI maintains a multidimensional approach in studying the development of mental illness, treatment response, and effect of challenges or success in recovery. Research is recognized as an element of hope in a persistent search for answers within mental health (NAMI, n.d., Research).

Evaluation of NAMI

            NAMI has gained credit—researching with the National Institute of Mental Health and Substance Abuse and Mental Health Services Administration—and has made great strides towards improving mental illness. Upon researching outside sources discussing NAMI, much speculation had been shared regarding NAMI’s funding coming primarily from pharmaceutical companies at nearly 75% (Grohol, 2009). While this is old news, it causes concern for the reliability of all movements, despite accreditation.

Future Change Efforts

            Increasingly today, mental illness is being given a voice. Further change efforts will require looking at the history of mental illness, being aware of the demographics and intersectionality that further isolate those with mental illness, and taking the time to understand the elements of oppression specific to mental illness, such as internalization, invalidation, and silence. Social work is pivotal in pursuing these change efforts—change is possible when the entire population is considered.

 

 

 

 

 

References

Allen, A. (2008). Power and the politics of difference: Oppression, empowerment, and

transnational justice. Hypatia, 23:3, 156-172. Retrieved from https://www.jstor.org/stable/pdf/25483202.pdf?casa_token=XBIEbtEXhcIAAAAA:LME7vQbDUHusDUzRtezkdj2uIKFGiBXEWXFuB9crn-7zrObhTT0PltiV9xKFt0TReGLubZj8iM_JN9ie-MfDYOSOpmyOQviRhymhhgITkTwjV-8QEvVj

American Experience. (n.d.). Treatments for mental illness. Public Broadcasting Service (PBS).

Retrieved from https://www.pbs.org/wgbh/americanexperience/features/nash-treatments-mental-illness/

Charles, J. L. K., Holley, L. C., & Kondrat, D. C. (2017). Addressing our own biases: Social

work educators’ experiences with students with mental illnesses. Social Work Education,

36(4), 414-429. Retrieved from http://dx.doi.org/10.1080/02615479.2017.1297393

Disabato, D. J., Kashdan, T. B., Short, J. L., Jarden, A. (2016). What predicts positive life events

that influence the course of depression? A longitudinal examination of gratitude and meaning in life. Cogn Ther Res, 41:444-458. Springer Science + Business Media New York. DOI: 10.1007/s10608-016-9785-x

Grohol, J. M. (2009). NAMI: Nearly 75 percent of donations from pharma. PsychCentral.

Retrieved from https://psychcentral.com/blog/nami-nearly-75-percent-of-funding-from-pharma/

Holley, L. C., Stromwall, L. K., & Tavassoli, K. Y. (2013). Teaching note—Oppression of

people with mental illnesses: Incorporating content into multiple-issue diversity courses. Journal of Social Work Education, 51: 398-406. Retrieved from http://dx.doi.org/10.1080/10437797.2015.1012940

James, D. & Glaze, L. (2006). Mental health problems of prison and jail inmates. Bureau of

Justice Statistics: Special Report. U.S. Department of Justice. Retrieved from https://www.bjs.gov/content/pub/pdf/mhppji.pdf

“Mental Health” Oppression and Liberation. (2016). Re-evaluation Counseling. Retrieved from

https://www.rc.org/publication/theory/liberationpolicy/mental_health_jf

National Alliance on Mental Illness (NAMI). (2018). Retrieved from https://www.nami.org

National Alliance on Mental Illness (NAMI). (n.d.). Frequently asked questions: What does

NAMI stand for and what is its mission? Retrieved from https://www.nami.org/FAQ/General-Information-FAQ/What-does-NAMI-stand-for-and-what-is-its-mission

National Alliance on Mental Illness (NAMI). (n.d.). About NAMI. Retrieved from

https://www.nami.org/About-NAMI

National Alliance on Mental Illness (NAMI). (n.d.). About NAMI: Policy platform: Identity and

mission. Retrieved from https://www.nami.org/About-NAMI/Policy-Platform/1-Identity-and-Mission

National Alliance on Mental Illness (NAMI). (n.d.). Research. Retrieved from

https://www.nami.org/Learn-More/Research

National Alliance on Mental Illness (NAMI). (n.d.). Mental health by the numbers. Retrieved

from https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2015). Behavioral

health trends in the United States: Results from the 2014 national survey on drug use and health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm#idtextanchor073

Scheyett, A. (2006). Silence and surveillance: Mental illness, evidence-based practice, and a

Foucaulitian lens. Journal of Progressive Human Services, 17:1, 71-

92. Retrieved from https://doi.org/10.1300/J059v17n01_05  

Vertilo, V., & Gibson, J. (2014). Influence of character strengths on mental health stigma. The

Journal of Positive Psychology, 9:3, 266-275. Retrieved from https://doi.org/10.1080/17439760.2014.891245