Classism, Stigma and Mental Health

If a white collar worker is diagnosed with a mental health disorder, the medications given are intended to make it easier for that person to function in the mainstream workplace. But if an impoverished person is diagnosed with that same mental health disorder, the same medications are given with the idea that the person will be directed toward disability culture, and never work again.

If a person is arrested for a non-serious crime in which alcohol is involved, the Courts order daily attendance at A.A. meetings, where the paradigm of the Twelve Steps is geared toward reacclimating such people into the mainstream of modern life.   These meetings, by the way, are free of charge.  But if a person with a mental health problem is arrested for the same crime, the Courts will direct that person toward a community counseling center with a “sliding scale.”  In other words, the support is at cost.  In fact, the options for cost-free mental health support groups stop at the level of a MeetUp.  Dialectical Behavior Therapy (DBT) groups, for example, are difficult to find without paying good money.  A one-to-one Cognitive Behavioral Therapy (CBT) counselor will certainly expect to be paid.  Those in poverty culture can’t possibly afford the fees for mental health support, and often wind up finding them in psychiatric facilities only, where the price they pay is complete loss of freedom.

Step Two of the Twelve Steps of Alcoholics Anonymous reads: “Came to believe that a power greater than ourselves could restore us to sanity.”  Note the use of the word “restore.”  This implies that the alcoholic was, at one time, sane, and that through the application of the Steps, they may again become sane, and thus able to reintegrate themselves into mainstream culture.    So, even though the condition of active alcoholism is regarded as “insane,” a path toward sanity is indicated.

But for a path toward sanity to be recommended for one who has a mental health diagnosis, that person must have privilege from the start.   People of poverty with such diagnoses are considered to be unemployable.  This is pure stigma against those who have mental health conditions.  People of privilege with those same kinds of conditions are routinely encouraged to keep their jobs, their families and their social lives; the idea being that the very same treatment will enhance their ability to function in mainstream society.  But impoverished people with identical diagnoses are thrust into disability culture, made to subsist on minimal income, classified as “legally incompetent,” and threatened with loss of their cost-of-living income if they even try to go out and get a job.  This clearly amounts to class discrimination, when it comes to treatment of the mentally ill.

To understand why such discrimination is directed toward those thought to be “mentally ill” but not toward those considered to be “recovering alcoholics,” I think we need to examine the grounds on which mental illness is determined.    My theory is that one is considered to be “mentally ill” as soon as one displays an inability to function healthfully within the “box” of the status quo.   Those who flourish within normal expectations based on the work ethic and success model are considered to be mentally healthy.  Those who are focused on “climbing the ladder” are considered to be “successful,” and as role models for others.   But a person who thinks outside the box is somehow seen as a threat to society, and therefore limited to confinement within the realms of those labeled “incompetent’ and “unemployable.”

I would not doubt it if well over half of those who have mental health diagnoses are actually quite eminently sane, even perhaps brilliant, perhaps luminous visionaries.  Such people often focus, not on scaling the ladder of “success,” but on actualizing their own true selves, to make the most out of their own innate design and potential.  They often develop ideas and visions that would truly benefit society if given a chance to bloom.  But how can one be in orchid in a petunia patch?  The Powers That Be will continue to uphold the status quo, despite classism and social stigma on the grandest scale.  How sad it is that those who have vision are seen as pariahs by those who do not!

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6 thoughts on “Classism, Stigma and Mental Health

  1. Lovely sharp, to the point, overview of the problem, Andy. I’m getting the sense that mainstream american culture, though like it over here to some extent, is even more entrenched with intolerance of difference and very often that difference comes with a label of mentally ill essentially meaning incompetence. But incompetence for what exactly? Fitting in? Following the unreflecting crowd who equal self worth with making money to be a so called ‘success’? Suppressing individuality and all that can offer to others? It’s scary. I haven’t been sure what you’ve meant before about classism and mental health but you have made this very clear to me now. A great piece!


    • Thanks, Lynne. It actually took me a month of Thursdays to condense and clarify my ideas on this theme. That it wound up being one of the clearer messages was the result of a huge month-long incubation and a sudden hammering out of the post, followed by a sudden moment of illumination. And of course I have never been to England or Scotland so I don’t know what it’s like there, other from the pictures I get talking with you and another person (The Paradoxical Millenial here on WordPress). But I’ve never seen so much class-based tension and stigma as I’ve seen in America today. Again, I’m thankful I moved up here and landed at very accepting community. Intolerance of class-based differences in the Big City was driving me nuts. Thanks again for your support.


  2. Intersectionality certainly plays a role, but I think it’s often more nuanced. I disagree regarding what makes someone mentally ill; while I think sometimes diagnostic labels are misapplied based on social deviance, it’s a distinct issue from people who are diagnosed because they might symptom criteria including clinically significant distress and impairment in functioning across multiple domains.

    There are certainly many issues around classism, but I don’t think it neatly overlaps with mental illness. Health professional licensing boards, including medical licensing boards, regularly ask questions about past diagnosis or past contact with mental health services that don’t follow the requirements of the Americans with Disabilities Act, so simply having high socioeconomic status isn’t a protection from discrimination.

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  3. I think it is probably more nuanced than I implied at the time (2 1/2 years ago) when I wrote this post. As I re-read it, I thought it was a bit hyperbolic. But I also recall that in those days, relatively fresh out of homelessness, I was having great difficulty organizing and conveying my thoughts. I recall that this particular post took me about a month to write. Nowadays, if I write something of this nature, it usually takes me two or three days.

    All disclaimers aside, I think the point I was trying to make was not so much in what actually *constitutes* mental illness (as in, from the perspective of a person with a legitimate diagnosis working with a trained professional), but rather what society *considers” to be mental illness. And that does seem to vary along lines of social class as well as other demographics. My experience leaving the S.F.Bay Area and moving to North Idaho was particularly refreshing, in that I found many of my “quirks” being accepted as relatively inconsequential, whereas those same personality traits would have led a previous employer in the Bay Area to suggest I needed some medication.

    To be fair, said “employer” probably had no real knowledge of mental health diagnoses, and that same employer might have only been pulling a “California-style” one-up, desiring to intimidate me enough to more readily get rid of me. Thanks again for your thoughts. Your expertise in your field continues to amaze me.

    Liked by 1 person

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