Class 2- Racism, Ableism, and Mental Health: Exploring Inequity, Stigma, and Discrimination

Racism-Williams et al (2000)

• Conceptualizes the term ‘racism’ to refer to an '"organized system that leads to the subjugation of some human population groups relative to others"

Ideology of inferiority (Racism-Williams et al 2000)

• Human population groups are categorized & rankeed relative to others 

• Those whose bodies/minds differ from these standards cast as less than or deficient

Negative Attitudes & Beliefs (Racism-Williams et al 2000)

• Development of negative attitudes & beliefs toward racial outgroups (prejudice) 

• Incorporated into social policies and institutions 

• Sometimes this is intentional, but often it escapes our consciousness

Differential Treatment (Racism-Williams et al 2000)

• Differential treatment of members of the outrageous by individuals and institutions 

• Exclusion 

• Discrediting and Erasure 

3 Primary Mechanism: Racism affects mental health (Williams et al, 2000)

• Institutional Discrimination

• Experiences of Discrimination

• Stigma of inferiority

Institutional Discrimination (3 Primary Mechanism: Racism affects mental health Williams et al, 2000)

• Restrict socioeconomic mobility 

• Resulting in racial differences (SS) & exposure to poor living conditions and limiting of opportunities and social mobility 

Experiences of Discrimination (3 Primary Mechanism: Racism affects mental health Williams et al, 2000)

• Adversely affect mental health 

• Psychological stress & distress 

Stigma of inferiority (3 Primary Mechanism: Racism affects mental health Williams et al, 2000)

• Internalized negative stereotyping & stigma

• Affects psychosocial functioning 

Anti-Black Racism Historical roots that underpin present day institutionalized racism (Williams, 2000)

• Perpetuated by ideologies that reinforced slave trade & colonation 

• Actively translated to policies that restricted access to education, employment, social mobility, and integration of african american through segregation in th eUSA through racist policies and laws 

• Negative racial stereotypes pervasive in society and culture undermines and impede equitable access to opportunity, employment, and integration 

• Resultant impact on socio-economic status and social determinants of health which are strong predictors of mental health 

• Institutionalized discrimination in the administration of Justice in courts of law

Anti-indigenous racism: historical systemic roots to the present day inequities

• Institutionalized systemic racism in policies and practices 

• Systemic cultural genocide 

• Colonization 

Ableism

• A network of beliefs, processes and practices that produces a particular kind of self and body (the bodily standard) that is projected as the perfect, species-typical and therefore essential and fully human” (Campbell,2001) 

• An organized "system of assigning value to people’s bodies and minds based on societally constructed ideas of normalcy, productivity, desirability, intelligence, excellence, and fitness” (Lewis, 2022) 

• “Ths constructed ideas are deeply rooted in eugenics, anti-blackness, misogyny, colonialism, imperialism, and capitalism. The systemic oppression that leads to people and society determining people’s value based on their culture, age, language, appearance, religion, birth or living place, “health/wellness”,  and/or their ability to satisfactorily re/produce, "excel" and “behave”. You do not have to be disabled to experience ableism" (Lewis, 2022)  

Intersectionality(how ableism shows up in the community and mental health care/society?)

• Identities and social locations as mutually shaped and entangled with each other and with systems of power 

• How social categories are mutually shaped and interrelated through forces such as colonialism, neoliberalism, racism, ableism, geopolitics, and cultural configurations to produce shifting relations of power and oppression 

• And how these relate to mental illness and mental health 

Stigma defined

a mark of shame or discredit: stain bore the stigma of cowardice

• plural usually stigmata: an identifying mark or characteristics specifically: a specific diagnostic sign of disease 

When stigma occurs: 

• When elements of labeling, stereotyping, separation, status loss, and discrimination co-occur in a power situation that allows the components of stigma to unfold.

• People distinguish and label human differences

Levels of stigma in revelation to mental health & substance use: “double stigma” 

• Social 

• Structural

• Self 

Social (Levels of stigma in relation to mental health &substance use)

Society, culture, and communities endorse negative stereotypes and act in harmful/discriminatory ways

Structural (Levels of stigma in relation to mental health &substance use)

• Widespread endorsement of stereotypes (e.g dangerousness) that influence and shape policies and institutions 

• Resulting in regressive reforms and punitive policies (Asylums, war on drugs) 

Self (Levels of stigma in relation to mental health &substance use)

• Internalized fear/sham of social stigma (crazy/weak)

• Key deterrent in seeking help and adhering to treatment 

The dangers of a single story 

• Creates stereotypes, and the problem with stereotypes is not that they are untrue, but that they are incomplete.. They make one story become the only story- Adichie (2009)

Systems of oppression- discrimination-stigma (Keyes 2002 flourishing dimensions posiitive mental health functioning)

• Psychological well-being

• Social well-being

• Environmental well-being

Psychological well-being (Systems of oppression- discrimination-stigma Keyes 2002)

• Self- acceptance

• Positive relationships

• Personal growth 

• Purpose in Life 

• Environmental mastery 

• Autonomy/self determination 

Social well-being (Systems of oppression- discrimination-stigma Keyes 2002)

• Social coherence 

• Social actualization 

• Social integration 

• Social acceptance 

• Social contribution

Environmental well-being (Systems of oppression- discrimination-stigma Keyes 2002)

• Positive feelings about life

• Satisfaction with life 

• Perceptions and valuations of positive and negative affect 

Expanding our understanding of dimensions of positive mental health

• Systems of oppression 

• Discrimination 

• Stigma 

• Intersectionality

Impacts of systems of oppression, discrimination, & stigma on mental health and substance use services

• Barriers to timely access to services 

• Poorer outcomes when accessing services 

• Poorer experiences when receiving services

•  Late entry to services (too sick or acute when first entry) 

• Entry to service through criminal justice system

Trauma and violence informed approach

• Historical trauma 

• Inter-generational trauma 

• Violence and oppression

• Trauma of racism, discrimination, and stigma 

• Loss & grief 

• Resilience and hope 

• Move from what's wrong to with the person → what has happened to the person