Black feminist researcher Kimberlé Williams Crenshaw first proposed the concept of intersectionality in 1989 to represent the many different layers of social stratification that can combine to disadvantage people. This includes factors like race, sexual orientation, social class, age, disability, and gender. Expanding on this concept, sociologist Patricia Hill Collins described the intersectional points as the matrix of domination, influenced by oppression and privilege.
In terms of mental illness stigma, intersectionality helps to explain the diversity of our experiences as individuals living with mental illness.
Race and mental health disparities
Members of racial minorities may face additional challenges when it comes to their mental health, and they tend to have a higher burden of disability as a result of mental illness (source: American Psychiatric Association). Depression rates in Black and Hispanic people are the same as in other ethnic groups; however, their depression tends to persist longer. Indigenous populations have higher rates of PTSD and alcoholism.
The APA also notes that about 50-75% of youth offenders have a mental illness, and racial minority groups are over-represented in the criminal justice system. Compared to white youth, youth from racial minorities are more likely to be diverted to the criminal justice system rather than the mental health system.
Access to mental health care
Race can also impact access to health care. This can relate to several different factors. Some cultural groups have negative beliefs about members within the group having a mental illness and accessing mental health care. Accessing culturally appropriate mental health care can also be very challenging.
Figures from 2015 show that 48% of white adults with mental illness received mental health services. For Black and Hispanic adults, that figure was only 31%, and for Asians 22%. Barriers included lack of insurance, high levels of stigma, lack of culturally competent mental health care practitioners, and distrust of the health care system.
There is also a difference in the mental health care that’s available to people of higher vs. lower socioeconomic status. This is even more pronounced in countries where there isn’t public health care; however, even in Canada, publicly funded psychotherapy is only available to a very small set of people.
Stigma compounded
On top of the stigma that all people with mental illness face, they may experience negative attitudes towards other aspects of their identity, such as race, sexuality, gender, or social class. The prejudice and discrimination people experience related to one element of their identity can never truly be separated from other stigmatized pieces of their identity.
Those of us with mental illness will sometimes cross paths with police as a result of our illness. That’s likely to be a very different situation for me as a Canadian white woman than for an American Black man. Imagine if both myself and a Black man in Ferguson, Missouri, were to try for “suicide by cop”. Who’s more likely to “succeed”?
Discrimination in the workplace isn’t supposed to happen, but it does. It seems only reasonable to suspect that the more social strikes against you, the more likely it is that employers will discriminate. Being mentally ill is bad enough, but if you’re mentally ill, transgender, and Indigenous, that’s multiple layers of stigma.
Cumulative effects of oppression
It’s also important to recognize the cumulative effects that enduring oppression over time can have. The effects of colonialization, slavery, and segregation don’t just suddenly disappear; they can produce intergenerational trauma that affects the mental health of affected groups for many years to come.
In Canada, the findings were recently released from the National Inquiry into Murdered and Missing Indigenous Woman and Girls, calling it a genocide. The majority of society has treated this group as if they have no value, and that’s bound to have an effect on the mental health of their families as well as broader communities.
Racist, sexist, homophobic, transphobic, classist, and ableist attitudes don’t suddenly disappear either. These sorts of beliefs are socially learned, and even when our explicit beliefs change, many of us are still carrying around implicit beliefs in stereotypes that we’ve been taught in the context of our culture. We may not even recognize that we have these beliefs, but they still impact how we behave towards minority groups.
Recognizing our own privilege
It’s also important to give some thought to the ways in which we are privileged, and recognize that not everyone will share that same level of privilege and the social consequences that result.
There are many different types of social privilege, and we may have privilege related to some of our characteristics while, at the same time, facing burdens and barriers related to other characteristics.
As a white person, I have tremendous privilege. If I fail to recognize that, it limits my ability to see that people of racial minorities may face barriers that I do not. Being cis-gendered may not immediately come to mind as an area of privilege; however, if you consider the stigma faced by transgender and gender queer individuals, there’s a clear gap.
Socioeconomic status is a major source of privilege, or lack thereof. People who experience disability due to mental illness risk facing poverty and homelessness, both of which add extra layers of stigma to what is already experienced. Something like universal basic income could go a long way towards lessening those additional social burdens.
Reality is complicated
On top of all of those layers come individual differences. While, in general, Black non-heterosexual women are likely to face more systemic discrimination than white straight men, that doesn’t mean that a specific white straight male is always going to have a more positive experience than a Black lesbian woman.
We live in a complicated society, and that’s what intersectionality is all about. There are many layers of significance and many things that have the potential to be used for or against us. Perhaps what matters most is recognizing that complexity, and being open to the fact that others may have very different experiences than we do. Certainly within the mental illness community, we face enough stigma already without inadvertently pulling each other down.
Somehow, far too many people have not gotten the message that we are all created equal. There is no health with mental health, and there is no justice without justice and equitable treatment for all.
What are some of the factors that contribute to your level of privilege or lack thereof, and what role has intersectionality played?
The Social Justice & Equality page has info and resources on a wide variety of social issues.
I am privileged as a white heterosexual “normal” looking woman. But I also now, approaching age 60, have limited finances. So, even with my good insurance, there isn’t much I can do besides keeping on and working two jobs, living in an area I don’t really like, and never being able to really take a chunk of time off (like at least a month) to just chill the eff out away from everything, which I feel would be very beneficial for me. Oh well, could be worse…
Yeah, but doesn’t make it easy.
When I was released from the hospital in 2015, and had to go into a shelter, I was treated like an animal by the staff that ran the shelter.
It wasn’t bad enough my dignity was stripped, but everything about me was affected by that horendous experience.
The constant belittling and cursing, was just a tip of the iceberg in that horrible place.
I kept to myself a majority of the time and just kept striving to better myself and situation by going to the mental health facility. It was a long 2 & 1/2 years, but it’s done and over with. Thank God!
It’s atrocious that the people in our society who are most in need also get treated the worst.
It is a true shame. I’m so frightened that it would happen again in my lifetime. I have nightmares of that place regularly. I don’t wish that on anyone.
Yeah, no one deserves that.
I’m privileged my mom can afford the medical attention I’m receiving for my mental illness. I’m black and besides the lack of privilege in the black community to proper mental health care, lack of knowledge contributes much. They believe when you have a mental illness you don’t get better. They usually mentally write you off.
There’s definitely a long way to go in educating people, especially in certain communities.
II’m a transgender woman with an intersecitonality score about as low as it gets., along with being on the autism spectrum. Getting help has been very difficult, as has fitting in and making friends. I live in fear of harassment and discrimination in all walks of life. I can’t work and can’t even find a job as it’s unlikely that anyone will hire me, despite anti-discrimination laws. When I have sought help, I’ve often found that mental health and medical professionals will blame my transition for a lot of my ‘issues’, but that isn’t the case.
That’s really shitty. Yeah, anti-discrimination laws may sound all well and good, but in practice they don’t protect the people that need them the most.
They’re still necessary,, but they really don’t mean a whole lot in practical terms, because discrimination is often very difficult to prove.
I agree
I’m about as privileged as privileged comes, being white and male and having many friends and family who are supportive when I have struggled with intrusive thoughts. I consistently need to remind myself that not everyone has the sort of privilege I do.
If only more people would make that effort.
Agreed.
Is it okay if I share this post on my blog at some point?
Sure!
Thanks!
As a white female, I have had privilege in the help I got. My parents used to take me to the county mental health center for help and meds when I was younger. I have access to therapists if I need it. I feel lucky with the health care I have access to through my job.
I’m glad that you’ve had that.
This is SUCH a great article, and an important reminder for me to check my privilege. I must constantly remind myself that, as a white cis-gendered woman with health insurance and financial stability, I do have many privileges (and access to resources) that marginalized people don’t.
I think it’s really important that we do that, especially since so many people seem totally oblivious and take it for granted
Absolutely agree.
Public psychotherapy tends to be gated behind long waiting lists, as well as being of significantly poorer quality than private, in my experience.
Also I’m LGBTQ and… heavy sigh… the mental health advocates in my country really don’t care about us.
That seems rather hypocritical for people to be mental health advocates without believing in mental health support for all who need it.
Unfortunately they don’t see it that way, and I’m just an angry militant LGBTQ anti Christian you know? 😛
Universal basic income….yessss. And be willing to pay more in taxes.
It could make such a huge difference.