Who are you Calling Crazy? Illness, Identity and Intersectionality

We often hear that mental illness can affect anyone, that it knows no boundaries of race, age, gender or class. Whilst it is of course true that no group is immune, and that the suffering and limitations caused by the illness are equally distressing whoever you are, there are nevertheless discernible patterns in incidence and experience of mental illness.  Indeed, I often think that as well as being an important issue in its own right, mental illness – who is affected, how we interpret behaviours and emotions, and how we understand and treat those affected – offers a stark insight into the dynamics of social oppression and privilege.

       Statistics suggest that socially marginalised groups are particularly prone to mental health problems that have a strong social or reactive component. Depression and anxiety disorders are very common amongst women, who are indeed twice as likely as men to suffer from unipolar depression, whilst people of black, Bangladeshi, Indian and Pakistani backgrounds are much more likely to suffer from common mental health disorders, particularly anxiety and panic disorders. Queer people, who are more likely found across all sections society, thus controlling for other socio-economic factors, are up to three times more likely to attempt suicide, lesbian and bisexual woman up to four times as like to develop alcohol dependence, and gay and bisexual men are more prone to eating disorders and body images issues than heterosexual men. The fact that marginalised groups are much more vulnerable to the mental health disorders of this kind highlights the differentials in power and control that these groups have over the various socio-economic determinants of mental health; their social position, status in and treatment by society, and their vulnerability and exposure to certain mental health risks. They reveal the long term damage created by the accumulation of subtle micro-aggressions as well as more overt discrimination and hostility.

       Discrepancies in incidences of mental health problems are then further exaggerated, as the myths created to justify the continued marginalisation of oppressed groups – that their emotions are weaker and their behaviour less rational – mean that they are expected to suffer. This is reflected in patterns of diagnosis. Women’s mental and physical processes have long since been pathologised and presented as a problem, betraying a deep fear of female emotions, sexuality and reproductive capacities, from Plato’s theories of the ‘wandering womb’ to the belief that sexual deprivation led to female ‘hysteria’. Whilst we may have moved on slightly from this, the idea that women are more irrational and emotionally unstable – thus biologically inferior and naturally less suited to public life – stubbornly persists. Most women will be familiar with being told to ‘calm down’, that they ‘overreacting’, ‘oversensitive’, ‘hysterical’, having their emotional responses dismissed as it must just be their ‘time of the month’, or hearing young men speak mockingly of their ‘crazy’ ex. As well as working to undermine women in their day to day lives, this expectation of mental instability can indeed be dangerous, for example by having physical illnesses misdiagnosed as psychological and even being wrongly committed to psychiatric institutions, and being made to doubt their own mind can make women more vulnerable to the emotional abuse of gaslighting.

       This tendency to pathologise the behaviours and emotions of marginalised groups is also revealed in the difference in incidences of even the rarer, more severe conditions that are not as easily attributable to external factors. People of African Caribbean descent are greatly over-represented on psychiatric wards, are diagnosed with schizophrenia and psychosis at up to eight times the rate of the white population and are far more likely to be detained under the Mental Health Act. These statistical discrepancies are likely to reflect differences in how behaviours are interpreted and diagnosed. People from black ethnic backgrounds are much more frequently referred to mental health services by police or strangers, and staff in mental health hospitals and psychiatrists report that they are more likely to consider black patients to be dangerous, despite the fact that they are no more likely than white people to have displayed aggressive behaviour prior to admission. Meanwhile, queer identities and behaviours are still burdened by the legacy of being categorised as mental illnesses in themselves; it was only in 1973 that homosexuality was finally removed from Diagnostic and Statistical Manual of Mental Disorders, and Community Mental Health Teams remain the gatekeepers of access to services for trans* people.

       As well as the differences in interpretations, there may also be genuine variations across genders, socio-economic classes, cultures and ethnicities in the ways in which emotions are expressed and symptoms are displayed.  Yet it is the culturally dominant groups that get to define what the healthy, appropriate ways to conduct oneself are, and do so in accordance with their own norms and practices. Thus people with less social privilege must not only contend with higher levels of mental distress arising from their social marginalisation, but are considered weaker or less stable generally, and their behaviour is interpreted as such.

       Yet this is not to say that the relationship between mental illness and social privilege is straight forward one. As with the unequal system of social relations that it reflects and exemplifies, people’s experiences of mental health can be affected in varied and complicated ways, and even being in a position of social privilege does not always leave you directly and uncomplicatedly better off. Whilst women are seen as weak and therefore expected  to suffer from ill health, the flip-side is of course that men, as the ‘stronger’ sex, are not considered to suffer from mental distress at all – they are rational and resilient, their emotional responses legitimate and appropriate. Yet this is a cruel double-edged sword, as when they do experience mental health problems, they are discouraged from seeking help, and are less likely to be taken seriously when they do. Most people with depression will have experienced the frustration of being told to ‘lighten up’ or ‘get a grip’, but this can take on a gendered dynamic, with men being told to ‘man up’, suggesting to male sufferers that in having their condition they have failed as men. In the western world, women are more likely to attempt suicide, but men are far more likely to actually die from it; indeed it is second most common cause of death for men between the ages of 18 and 35. The social stigma of this ‘weakness’ would cause such a loss in status and respect that there can simply be no coming back from it. Whilst a women’s sanity is always under suspicion, men cannot access help even when they need it.

       A cruel catch 22 therefore exists across the privilege gradient; whether you are considered weak or strong, inferior or superior, your social status can work against you when it comes to mental health. However, most people cannot simply be categorized as either wholly oppressed or privileged, and have a mixture different identities and circumstances. Yet this too can create a fertile ground for mental health problems to develop, perhaps because a certain level of privilege can subject you to high levels of social pressures and expectations, yet other, less privileged aspects of a person’s identity can render these particularly difficult to fulfill, creating a toxic cocktail. For example, whilst women are still far more susceptible to eating disorders and body images issues, it tends to be a relatively privileged group amongst these – white, middle class, young, often from loving, supportive homes – that are affected. Similarly, in Britain, people of Indian descent tend to be above average in terms of socio-economic status and educational attainment, and overall have lower rates of depression, anxiety and other common mental health problems, yet rates of self-harm and suicide amongst young Indian women are up to three times higher than in the general population. If separated from other white backgrounds, the ethnic group that consistently shows the highest rates across all of the common mental health disorders and have the highest suicide rate are people from Irish backgrounds.

       Quite which forces, oppressions and pressures are at work in these particular cases is beyond the scope of this article, but one thing is for sure: when suffering mental distress under the kyriarchy, everybody loses. If you are seen as socially inferior, your behaviour and emotions are pathologised and delegitimised, and low expectations can lead you to devalue yourself. If you are seen as socially superior, you must always be strong and stable, you are not allowed to ask for help, and the pressures of fulfilling the roles that are expected of you can prove too much. As this is a symptom of broader social oppression, only ending this, and the prescriptive social roles and judgements that come with it, would create a more healthy and nuanced attitude towards mental health. However, it may be helpful to stop considering mental health in such absolute terms, where stringent sets of behaviours and means of expressing oneself are deemed inherently and objectively inappropriate or wrong,  and to end the stigma whereby a mental health diagnosis is often seen as a moral judgement or character failing. Rather, it should simply mean that your thoughts, emotions and behaviours are affecting your own ability to live your life as you wish, thus you owe it to yourself to get the support you deserve.

2 Responses to “Who are you Calling Crazy? Illness, Identity and Intersectionality”
  1. steven1111 says:

    Excellent analysis and comments. I think privilege and power help keep a lot of people out of the system who might benefit from some help. And likewise many people who need help are stigmatized for needing it because of who they are. Speaking as a gay man and someone with bipolar disorder I can say that I’ve not been subjected to much personal oppression but I do feel it in the way society makes us feel about ourselves and how weak we must be to have these illnesses and be how we are. It’s all conjoined and interconnected for me and I feel what others do too easily for comfort. I know that if I had money and power I’d just be considered “eccentric” and not mentally ill. It’s all societal perspective. Thank you for posting this. I like the political sensibility you exhibit.

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  1. […] social, personal and biological. The connection between mental illness, traumatic experiences and marginalised identities is well known, and even conditions that are not seen as having such a strong reactive component, […]

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