Mentalism, Micro-Aggression and the Peer Practitioner
by patricia.deegan on Monday, December 13, 2004 - 8:20pm

I was visiting with a group of peer practitioners who were working as advocates and mentors with people in a state psychiatric hospital. They were the first group of former consumer/survivors to work openly in that particular state hospital. The group had asked me to come and meet with them because they felt a growing tension between themselves and "traditional staff" on the units. When they walked onto the psychiatric ward in the morning, the staff walked by them as if they were not even there. When there was a staff birthday or special event, the peer practitioners were not invited. Traditional staff did not socialize after work or during breaks with peer practitioners. Traditional staff frequently forgot to invite peer practitioners to important meetings. What was going on?

I wrote this short piece in order to begin to sketch out some ideas regarding mentalism, micro-aggression and the peer practitioner who is working in traditional mental health settings. Your reflections on this topic are welcome!

Mentalism refers to the oppression of people who have been diagnosed with psychiatric disorders. It has similarities with other "isms" such as racism (the oppression of racial minorities), sexism (the oppression of women), heterosexism (the oppression of gay men and lesbians), class-based oppression (the oppression of people based on the socio-economic class they were born into), and able-ism (the oppression of people with disabilities). Like all forms of oppression, mentalism occurs at cultural, systemic, interpersonal, and personal levels.

At a cultural level mentalism in America is characterized by fear of emotionality and the primacy of rationality. An example of mentalism at the cultural level is the creation and perpetuation of stereotypes through media and films, about people diagnosed with psychiatric disorders as dangerous, unpredictable, criminal and predatory.

At the systemic level, mentalism refers to the ways that people with psychiatric diagnoses are discriminated against and are kept in a position of poverty, second class citizenship and are segregated from the community. Examples of mentalism at systemic levels include being forced to live below the poverty level on SSI; work disincentives that prevent us from re-entering the workforce; marriage disincentives that lower our SSI checks if we marry; being placed in segregated settings from which it is difficult to escape such as nursing homes, adult homes, board and care homes, and day treatment programs; inadequate healthcare (Medicaid, Medicare) which lead to premature death for many; loss of custody of our children instead of supports to be effective parents; rules that say we can't use the same bathrooms that staff use; the freedom the media feels in portraying us as murderers; etc.

At an interpersonal level mentalism shows itself as prejudice and bigotry directed at those of us with psychiatric diagnoses. Examples include being denied a job if our psychiatric history is revealed; having a romantic partner break off the relationship when they find out we have a psychiatric history; a neighborhood protesting the establishment of a group home in a town; a supervisor at work leaving an advertisement for a new anti-depressant on your desk at work because you have been a bit down lately; being told that your passionate objection to putting a client in restraints is simply you being unprofessional; etc.

Finally, at the personal level, the oppression we experience can be internalized as a form of self-hatred, internalized stigma, lowered self-esteem and a tendency to talk about ourselves and our experience in the language of psychiatry. Examples of internalized oppression include the desire to pass in public as normal; to hide, lie about or closet our psychiatric history; the desire to distance ourselves from other people with psychiatric diagnoses; referring to ourselves as diagnoses; distrusting our perceptions, emotions and experiences; and using clinical jargon to insult other people with psychiatric diagnoses i.e., "She is so low functioning. He is so borderliney."

Peer practitioners may encounter mentalism in all its forms when on the job. In its most obvious form, mentalism is a macro-aggression. A macro-aggression is obvious and easily identified by all who witness it as unfair, biased and/or discriminatory. An example of a mentalist macro-aggression is an emergency room automatically placing people with psychiatric diagnoses in restraints while waiting to be seen by a physician or having only clients (not staff) go through a metal detector at a local mental health center.

Another form that mentalism can take is called micro-aggression. Micro-aggressions are more subtle, not as obvious and therefore are harder to point out or confront. Mentalist micro-aggressions occur frequently and have a tendency to wear us down over time. Micro-aggressions tend to be "invisible" and we often experience the cumulative effect of them as tension between ourselves. Here are some examples of mentalist micro-aggressions experienced by peer practitioners on the job:

  • I had been a patient in a mental hospital. Some time later I returned as a worker to the same hospital. My paid, full time job was to work with patients as a peer educator. I overheard staff grumbling that my very presence on the unit was a violation of professional boundaries.
  • I had been a patient in a mental hospital. Some time later I returned as a worker to the same hospital. My paid, full time job was to work with patients doing advocacy and peer support. Some staff expressed concern about which bathroom I could use. They questioned if I should use the staff bathroom or the patient bathroom.
  • Once I went to escort a patient to a peer group meeting off the hospital unit and a staff person said, "Only staff can do that." I felt like saying, "I am staff!"
  • When I walk into the building the traditional staff don't even say hello to me. They look down and pass by like I'm not even there."
  • I couldn't believe it. They said that to apply for the job I had to have a letter from my psychiatrist saying that I had chronic and persistent mental illness (SPMI). I felt like wearing a sign that said I was "SPAMI" as in SPAM.
  • I was working at a clubhouse and they had a holiday party. There was a keg of beer but they said only staff could have the beer. I figured that meant me so I went and served myself and they said I couldn't have any.
  • I spoke up passionately during a treatment team meeting because I felt that the client was being treated unfairly. My supervisor told me I was being unprofessional for speaking up like that. He said I had to stop "personalizing the issue."

Most peer practitioners will encounter micro-aggressions on the job. How should staff handle these types of experiences and still remain within the role of the peer practitioner? The answer is that first peer practitioners must be able to identify micro-aggression when it happens. This requires consciousness raising and a supportive group of peer practitioners who can help us name mentalism when it is happening. Secondly, peer practitioners must support and validate for each other, the reality of mentalist micro-aggression when it is reported by a co-worker. Third, peer practitioners must learn to strategically respond to those people or policies that are oppressive, whether it was intentional or not.


‘Your article on Mentalism, Micro-Aggression and the Peer Practitioner’ is very interesting and I enjoyed reading it. My thoughts about the subject are what about policies and procedures being amended to address this need in different sittings?

I have an “ism” definition I worked on this afternoon to share. It is a little tongue in cheek with some attitude, and something that needs talked more about.

1. Professionalism: The belief that degrees accounts for differences in human character or ability and that particular institutions learning formats are superior methods of learning.
2. Professionalism: Discrimination or prejudice based on method and/or level of education documented by institutions. Some think the idea is propitiated so aforementioned institutions can make increasing amounts of money, and others to create “out group hate” for solidity based on secret Greek organizations principals.
Then there is the whole idea of Professionalism – as being positive. I think it is divisive that people with college degrees or experience in a line of work are “Professionals.” At consumer conferences “professional consumers” often place themselves as being higher in “system” because they have a degree(s), openly, unashamedly, and un-repetitively.

Mentalism is alive and well in the present “Recovery Movement,” also. In meetings held to address over-hauling the system to become “consumer-directed” most of the people, with a few exceptions, have degrees. Having a degree has a bit of magical thinking related to it, and “professionals” are thought to be better suited for the task of re-building the system, it seems. I think one of the biggest problems with the MHS is that historically and continually, administers and supporting staff (professionals) think it best to limit “non-professionals” be they consumers, or family members, and their input.

I do not have a degree, and yet I often observe my behaviors and thinking, at times as “I am high functioning,” or the like, which is a form of Mentalism, and proof that “non-professionals” have this kind of disease, also. It is a form of human dysfunctional weakness, and we need to talk about it and bring it into “the light of day.”

Maybe labels have a tendency to obscure the fact of - being human and learning from experience is who we all are, and that navigating through life, with others, in helpful, meaningful, and respectful ways – is the road we are on?

Please, excuse my poor writing, or is it right my poor thinking? I have mental behaviors and thoughts said to be “outside the norms.” These characteristics have helped me grow strong in many ways. Yet, I still have much to learn and growth is areas that I have yet to discover.

This is a great article, its great to have a name for this kind of experience.
I have my own internalised stigma and have encountered mentalism and micro aggression in paid roles as an advocate.
It is encouraging to have names and frameworks for identifying and then (she says optimistically) eliminating them.
Thanks and best wishes
Sarah Porter
Wellington New Zealand

Thank you so much for defining and explaining this experience. I recently went to Case Manger Training, so I could learn how to train or assist in training case managers.
The meeting was 2 days and was to teach strengths perspective and recovery. I was dismayed at the degree Mentalism was displayed. We all participated in an activity where we told 2 truths and 1 lie. My lie was that I was a case manager. When it was our turn we had to explain the lie and make it a truth. I said I was not a case manager but a CPS. You should have heard the mur murs'. And then no one talked with me. Thanks goodness we were in the last part of the 2nd day. But it did amaze me that one cm approached me and said, "This meeting is suppose to be confidential, what are you doing here?" My statement in return was, "I am training to teach CM's how to respond in a way that is recovery oriented. So If my training exceeds your expectations of what a trained and certified consumer should be doing, maybe that's something you need to look at." The honesty really opened a door for a great conversation, but this is an emotionally hard spot to be in.

I work part time for a community support group. I am 68 years old and am a long time client in this same community. My relations with all staff are excellent and I am happy with my job.

Because this is not uncommon at all, and because consumers did not build a broken system that we are hired to start transforming, I would like to see EEO complaint forms and process covered as part of Peer Support training.
Since we didn't create and further break the public mental health care system, I feel that the first, second and third waves to have to face this stigmatization, mentalisms, and other insults to our personhood, the money we make should be 4-5 times what it is now.
Thanks for this opportunity!

I worked as a volunteer for the last 2 years because there are no paid peer support positions in the mental health organization where I received care. (Not working with any of my own care providers.) The organization paid for my Recovery Support certification training in exchange for a set number of volunteer hours. I see many instances of mentalism at both the macro- and micro-aggression levels, (towards consumers and/or me) and frequently point them out. I'm usually dismissed with the comment that my "self-stigma is coloring my perception of the incident." This is followed by a session of "supervision" (aka therapy) to help me examine my self-stigma and it's role in my misinterpretation of the situation. I recently resigned to take a paid position elsewhere. A co-supervisor told me that my desire to get a paid job is part of my self-stigma -- that I have an irrational need to prove to myself that I CAN get a paying job. "By volunteering you've already proven that you CAN work, so there's no need for you to get a paid job." All I could think to say was, "Would you please role model that for me? I'd like to see how volunteering instead of getting paid for YOUR job is better for you. After all, you've already proven that you CAN, so there's really no need for you to keep working." She didn't see how that was the same at all.

I know I'll encounter more examples of this at the new job, but I'm a pioneer. My real job is to open doors and pave a basic path that others behind me will widen into a road. My mission is to thrive in this climate, to improve my wellness, and to serve other people with SMI's to find their way forward as well. Educating staff and administrators is my hobby.

Yeah -- two supervisors -- guess my "self-stigma" is so challenging a team approach was needed. ;-)

I appreciate and identify with your article. I feel that I should contribute to this discussion pertaining to the positive strides that have been made and to also speak to our own personal responsibilitie as a Peer Support Specialist in the workplace. I have evolved over the last 5 years in my position here to use these situations of mentalism and micro agression as an opportunity to educate others as to the humanism and value in us all. I have been involved in many work conversations and situations where I have experienced these times when some staff were unaware that I was a Peer Specialist. I take these opportunities to speak up, to use my own personal reference as to who I am and to use these times as an opportunity of growth for all. That is my responsibility. Spreading awareness at all levels and throughout the community is my responsibility. I do not use anger and frustration as tools to accomplish this. Having open conversations has proven to open up minds and change beliefs and opinions. The county agency where I work is moving forward in the belief that mental illness is not just for those that have been diagnosed or hospitalized, we are moving toward the belief that we areall human, mental, physical and spiritual together. It is a belief in the bringing together as a whole person.

Thank you for addressing such a deep rooted concern for all of us working for system change. I am fortunate in that, while I have experienced macro and micro aggression among my family, in the community, and in personal relationships, I do not experience it in my job. I have been working in a paid position at a CRR program for over 6 years with a very recovery oriented organization. They have paid for both my CPS and WRAP facilitation certificates. My co-workers routinely utilize my "insider knowledge" to help them connect to and better understand the POV of our residents, and they attend my bi-monthly WRAP groups in an effort to learn more about recovery. They see my presence on our team as a valuable asset, helping to blur the line between "staff" and "consumer" and providing a richer experience for everyone. I know I am very lucky to have carved out such a niche. My hope is that all organizations can learn to see how valuable "professional peers" are in the recovery process and begin to really utilize the unprecedented resources we can provide.

I deeply hope that this is not still the case as most of the comments were not recent. The Peer Practitioners we use are if significant value to our program. Their insight and understanding is fantastic and cannot in any way be undermined.
Mentalism, the oppression of people who have been diagnosed with psychiatric disorders, is still in existence. Working with individuals trying to get back into the work force, we encounter this regularly. Education, education, education. How important this is to helping to destroy some of the barriers individuals with disabilities face. We are working on marketing materials that can assist with getting the education of potential employers out there. It is a slow process that cannot be overlooked or discontinued.
Simultaneously, individuals can become part of the work force and "tend to be "invisible" and we often experience the cumulative effect of them as tension between ourselves". This is a very difficult situation to identify and then address as many times the individuals involved do not report or discuss the concerns that are happening. Encouragement and regular visits to the individuals in these situations are of great value to them and the employers that are unaware that this is happening.

I find it troubling that among persons in recovery, with lived experience, or how ever you chose to identify continuously look down on individuals who decide to pursue higher education and become "professionals" as a bad thing. Some of us have worked hard for those degrees as part of our personal recovery and healing, and find it insulting to be discredited as flawed to peer work because of it. If we want to avoid isms as a whole, than all need to be at the table and accepted, not judged. Not everyone needs to identify as a psychiatric survivor to have survived. My experience does not invalidate yours, and yours does not invalidate mine. Its a part of my personal narrative, and my own, and not one that anyone else is justified in putting a value judgement upon.

Hi. I have a PhD in clinical psychology but self-identify as a person with the lived experience of recovery. I agree that no one should judge us and that our story, is our story to tell as we see fit.

This was a fantastic article. It was spot-on in many ways.

There is one major error, though. Near the beginning of the article, the term "sexism" was defined as "oppression against women." It should have been defined as "oppression based on gender." Men and boys can be victims of discrimination also. One informative book on this subject is "The Second Sexism" by David Benatar.

Hello Pat Deegan. I was going to thank you for responding, but I noticed that your comment got deleted for some reason.

Thanks for the clarification around the term "sexism". Much appreciated.

Micro-aggression are prevalent in work settings

I agree.

The lies of the pseudoscience drug racket known as "psychiatry", are the single biggest driver of "mentalism". ALL of the bogus "diagnoses" in the DSM serve to prop up the abuse and discrimination inherent in a system designed to be dis-empowering. You will all continue to be slaves and prisoners, as long as you continue to support the incompetent, crooked, and corrupt system, and it's stigma-perpetuating LABELS. All DSM "diagnoses" serve simply as excuses to sell drugs for PhRMA....

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