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Microaggressions Experienced by Persons With Mental Illnesses:
An Exploratory Study
Lauren Gonzales, Kristin C. Davidoff, Kevin L. Nadal, and Philip T. Yanos
John Jay College of Criminal Justice, City University of New York
Objective: Microaggressions are subtle verbal or behavioral communications of disparaging messages to
people based upon membership in a socially marginalized group. Their negative impact has been
demonstrated for racial/ethnic groups, gender, sexual orientation, and physical disability, but currently no
research exists on microaggressions as experienced by persons with mental illnesses. Method: Qualita-
tive data were gathered from 4 focus groups with 2 samples: adult mental health consumers in an
assertive community treatment program and college students with mental illness diagnoses. Focus group
transcripts were then analyzed using an open coding approach (Strauss & Corbin, 1990) to identify
hierarchical themes and categories. Results: Five major themes were identified, including invalidation,
assumption of inferiority, fear of mental illness, shaming of mental illness, and second class citizen.
Perpetrators of microaggressions were most commonly identified as being close friends, family members,
and authority figures. Importantly, participants reported experiencing more overt discrimination experi-
ences than subtle microaggression experiences. Reported negative outcomes related to microaggression
experiences included isolation, negative emotions, and treatment nonadherence. Conclusions and Im-
plications for Practice: Reported consequences of microaggressions have important implications for
mental health treatment, especially as perpetrators were reported to include treatment providers and were
usually unaware of such negative social exchanges. Loss of social support reported by participants and
the frequent occurrence of microaggressions within close relationships implies these experiences could
contribute to internalization of stigmatizing attitudes toward mental illness. Directions for future research
include an investigation of motivation and reasoning behind perpetration of microaggressions against
persons with mental illnesses.
Keywords: mental illness and stigmatization, microaggressions, prejudice and discrimination, mental
health recovery, rejection experiences
Microaggressions have been defined as “everyday verbal, non-
verbal, and environmental slights, snubs, or insults, whether inten-
tional or unintentional, that communicate hostile, derogatory, or
negative messages to target persons based solely upon their mar-
ginalized group membership” (Sue, 2010, p. 3). Microaggressions
are distinct from more traditional and overt forms of discrimina-
tion in that otherwise well-intentioned individuals can deliver them
unconsciously, unaware of their potential harmful effects. Seminal
research on microaggressions by Sue et al. (2007) focused primar-
ily on race, identifying three major categories: microassaults,
which involve explicit attacks and are most like more traditional
forms of racism; microinsults, consisting of insensitive and de-
meaning remarks; and microinvalidations, which negate an indi-
vidual’s personal experience of their reality. Sue et al. (2007)
proposed a preliminary set of themes describing racial microag-
gressions, including “ascription of intelligence,” “criminality/as-
sumption of criminal status,” and “second class citizen.” Qualita-
tive research involving African Americans (Sue, Capodilupo, &
Holder, 2008), Asian Americans (Sue, Bucceri, Lin, Nadal, &
Torino, 2010), and Latino Americans (Rivera, Forquer, & Rangel,
2010) have supported that members of these groups experience
microaggressions in their everyday lives and that such experiences
have a negative toll on psychological well-being. It has been
argued that members of any marginalized group can become
targets of microaggressions (Sue, 2010). In fact, more recently the
concept of microaggressions has been expanded to address harm-
ful outcomes in the areas of gender (Capodilupo et al., 2010),
sexual orientation (Nadal et al., 2011;Shelton & Delgado-Romero,
2011), and ability status (Keller & Galgay, 2010).
Sue (2010) describes socially marginalized groups as “confined
to existing on the margins of our social, cultural, political, and
economic systems,” resulting in “exclusion from the mainstream
of life in our society, unequal treatment, and social injustice” (p.
5). Given this definition, people diagnosed with mental illnesses
would clearly qualify as a socially marginalized group; neverthe-
less, microaggressions toward persons with mental illnesses have
scarcely been studied or discussed. Research has documented that
many people with mental illnesses report social rejection experi-
ences that share many similarities with the concept of microag-
gressions. Yanos, Rosenfield, and Horwitz (2001) studied experi-
ences of negative social interactions and found that nearly half
This article was published Online First November 17, 2014.
Lauren Gonzales, Kristin C. Davidoff, Kevin L. Nadal, and Philip T.
Yanos, Department of Psychology, John Jay College of Criminal Justice,
City University of New York.
Correspondence concerning this article should be addressed to Lauren
Gonzales, Department of Psychology, John Jay College of Criminal Jus-
tice, 524 W 59th Street, New York, NY 10019. E-mail: lgonzales@
jjay.cuny.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Psychiatric Rehabilitation Journal © 2014 American Psychological Association
2015, Vol. 38, No. 3, 234–241 1095-158X/15/$12.00 http://dx.doi.org/10.1037/prj0000096
234
(48%) of study participants reported having experienced negative
social interactions, including being “treated like something is
wrong with you,” within a variety of contexts, including friends,
family, and mental health program staff. Lundberg, Hansson,
Wentz, and Björkman (2009) measured recovery-related outcomes
associated with experiences of social rejection in a sample of
mental health service recipients. The most commonly endorsed
rejection experiences included being treated differently by friends
after having been in a mental hospital, belief of being avoided by
others, and being treated as less competent by others upon learning
about contact with mental health services. Social rejection expe-
riences were negatively associated with self-esteem, empower-
ment, and sense of coherence.
It is important to examine microaggressions in relation to mental
illness because they can potentially have an impact upon function-
ing and well-being. Additionally, experiences of discrimination
and stigmatization can have important effects on the identity of
people with mental illnesses. Perceived stigmatization can poten-
tially increase the likelihood of the internalization of stigma, which
can in turn impact psychiatric symptom severity and important
outcomes such as hope, self-esteem, and empowerment (Livings-
ton & Boyd, 2010).
Hypothesized Categories of Microaggressions Related
to Mental Illness
In light of previous research focusing on experiences of people
diagnosed with mental illnesses, as well as the literature examining
microaggressions toward other groups, we determined a priori
hypothesized categories microaggressions that would be likely to
apply to persons with mental illnesses:
1. Microaggressions in which the experiential reality of
persons with mental illnesses is invalidated, such as when
others act as though the person is simply exaggerating
obstacles that everyone experiences;
2. Microaggressions in which individuals with mental ill-
nesses are regarded as having lower intelligence, lower
paying jobs, or lower scholastic or professional success;
3. Microaggressions communicating that individuals with
mental illnesses are helpless or should be treated like
children. This is consistent with findings of microaggres-
sions toward persons with physical disabilities (Keller &
Galgay, 2010);
4. Microaggressions communicating the idea that persons
with mental illnesses are dangerous. There is substantial
evidence that many members of the general public asso-
ciate mental illness with dangerousness (Corrigan et al.,
2002;Silton, Flannelly, Milstein, & Vaaler, 2011).
However, microaggressions toward individuals diagnosed with
mental illnesses may differ from those reported in other margin-
alized groups due to several factors. First, mental illness has been
considered to be a concealable identity (Quinn, Kahng, & Crocker,
2004), given that a diagnosis may not be apparent to others unless
it has been previously disclosed. The concealable nature of a
mental health diagnosis affords a choice for disclosure, but to
whom and in what situations one chooses to disclose a diagnosis
could have implications for who perpetrates microaggressions and
in what setting.
The current study used a qualitative approach to investigate the
experience of microaggressions among people with mental ill-
nesses from their own perspective and with their own words,
consistent with previous research exploring microaggressions in
new populations (Nadal, 2011). By illuminating the different cat-
egories of microaggressions experienced in everyday life, we hope
to offer implications for public education to prevent the incidence
of such experiences.
Method
Participants
Participants were recruited from two sites in New York City: the
“Resource Center” for an agency that provides housing and treat-
ment services to formerly homeless adults with severe mental
illness, and the Office of Accessibility Services and Counseling
Center for a public college. The Office of Accessibility Services
and Counseling Center offer support services to undergraduate
students with adjustment issues and a variety of disabilities, in-
cluding psychiatric disorders. These two sites were chosen to
maximize sample diversity in regards to types of interpersonal
interactions experienced. Inclusion criteria for eligibility were: (a)
self-reported diagnosis of a mental disorder as determined with
criteria from the DSM–IV–TR, (b) at least 18 years old, (c) able to
provide informed consent, and (d) fluent in English.
Typical guidelines for the optimal number of participants in
focus groups range from 4 –12 (Krueger, 1988;Seal, Bogart, &
Ehrhardt, 1998). Two focus groups were estimated to be an ap-
propriate number from each site to reach theme saturation. The
final sample consisted of four focus groups with 21 participants:
four from the college sample and 17 from the mental health
agency. Recruitment of the college sample took place over a
6-month period and proved a challenge; this could be due to a
number of factors, including scheduling constraints, availability,
and willingness of college students to disclose mental health status.
Additionally, several participants signed up for focus groups but
did not attend. However, the college groups reported similar
themes as the other two focus groups and provided evidence of
data saturation. Additionally, although the college focus groups
only consisted of two participants each they were conducted using
the same guidelines as all other focus groups to garner discussion
rather than question-answer format.
Procedure
Institutional Review Board approval was obtained for all study
recruitment and informed consent items, including fliers and
e-mail announcements. Recruitment procedures included posting
and distributing flyers in the college Counseling Center and Office
of Accessibility Services, and at the Resource Center of a mental
health agency. In addition, announcements were made in the
waiting room of the mental health agency clinical site, as well as
in common areas of the Resource Center. Participants from the
Resource Center communicated interest to researchers in person
and were screened for inclusion criteria in the same day; college
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235
MICROAGGRESSIONS MENTAL ILLNESS
participants contacted the research team to communicate interest
and schedule a screening. Participants completed written informed
consent prior to being scheduled for the focus groups. Focus
groups were scheduled at the Resource Center the same day of
recruitment; college focus groups were scheduled after enough
participants were screened and consented. Participants were of-
fered a $20 incentive for attending the focus group.
Each focus group lasted roughly 90 min and was led by a
moderator and comoderator. The moderator and comoderator were
a doctoral student with clinical experience working with severe
mental illness and a licensed psychologist. The role of the mod-
erator was to lead focus groups by asking targeted questions, and
the role of the comoderator was to facilitate additional discussion.
Focus groups were audio-recorded and transcribed verbatim.
Groups took place in a private enclosed room either at the college
or at the mental health agency’s Resource Center. Participants
again provided verbal consent to participate in the study, and also
agreed to maintain confidentiality of the discussion before the
focus group began.
Participants from the mental health agency ranged in age from
36 to 58 years (M⫽48.4, SD ⫽6.7), and participants from the
college sample ranged from 18 to 30 (M⫽23.7, SD ⫽5.3). The
majority of participants identified as male (62.0%), and the ma-
jority of participants reported their race as Black (33.3%) or
Hispanic (33.3%). Participants from the mental health agency
reported being diagnosed with schizophrenia spectrum disorders
(41.2%), bipolar disorder (23.5%), and major depression (23.5%).
Participants in the college sample reported diagnoses of bipolar
disorder (two of four participants), depression (one participant),
and attention-deficit hyperactive disorder (one participant). The
majority of participants (90.5%) reported being hospitalized at
least one time for psychiatric reasons.
Measures
Prior to the focus groups, participants were administered a brief
demographic questionnaire to provide information on race/ethnic-
ity, gender, age, self-reported diagnosis, and education. A guide
was also used for each focus group that included general prompts
and topics for discussion. Prompts included items such as: “De-
scribe a time when someone who did not have a mental illness
diagnosis has made you feel uncomfortable because of your mental
illness,” and “Think about a time when you may have been subtly
discriminated against because of your mental illness diagnosis.
Describe the scenario as best as you can.” Prompts were followed
by questions of how participants reacted to the situation, what
messages they perceived were being conveyed to them, and how
they felt after the event occurred.
Analyses
Focus group transcripts were analyzed using hierarchical open-
coding approach (Strauss & Corbin, 1990). First, general catego-
ries or themes of response topics were derived from reading each
transcript (e.g., invalidating experiences). Specific text examples
were then chosen to represent these categories, reread, and reor-
ganized into additional subcategories (e.g., experiences in which it
was assumed all experiences of mental illness are the same).
Responses within each of these subcategories were then reviewed
for exemplary quotes that reflected the various response themes.
After the theme hierarchy was developed, the transcript was then
reviewed for reports of overt discrimination experiences, as well as
reports of reactions to microaggressions and discrimination expe-
riences. A researcher who moderated each focus group first com-
pleted the hierarchical analysis. Then, an additional researcher
who had not moderated focus groups reviewed transcripts and
independently developed categories that were then compared with
the first analysis. The two reviewers compared and evaluated
identified categories and made revisions following discussion and
negotiation of coding differences.
Results
Five major themes of microaggressions were derived from the
combined focus group transcripts: invalidation, assumption of
inferiority, fear of mental illness, shaming of mental illness, and
second class citizen. Although the focus of the study was types of
microaggressions that people with mental illness experience, two
additional themes emerged: overt discrimination and negative out-
comes.
Theme 1: Invalidation
One of the most commonly reported microaggression themes
included those that communicated invalidation of mental illness
experiences. Invalidation was reported by a total of 13 focus group
participants and included three subthemes: minimization, sympto-
mizing, and patronization.
Minimization. Participants reported a number of experiences
in which they felt their experiences living with mental illness were
minimized in importance and intensity. These microaggressions
were perpetrated by a wide range of relations, including friends
and acquaintances, family members, and even health care profes-
sionals. A college student remarked:
I’ve heard people say “You can’t be depressed, you’re smiling.” That
really annoys me. “You can’t be bipolar because you seem really
calm.”
Another participant described a minimizing experience within a
mental health treatment setting:
Sometimes professionals actually act that way, like a psychiatrist or a
therapist. I’ve had that happen where somebody has said to me “I had
another client who did this when they were depressed. So you’re not
actually that depressed.”
These microaggressions communicate a lack of knowledge
about different presentations and symptoms of mental illness, and
are experienced as an invalidation and rejection of the victim’s
personal experience living with mental illness.
Symptomizing. Participants described a number of experi-
ences in which emotions and behaviors considered “normal” for
people without mental illnesses are assumed to be a symptom of
their mental illness. This is an invalidating experience as it com-
municates the assumption that the “mentally ill” person is unable
to express any range of emotion without it being attributed to their
mental health diagnosis. A college participant expressed frustra-
tion with family members:
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236 GONZALES, DAVIDOFF, NADAL, AND YANOS
People in my family, if I actually start being happy they’re like “Are
you sure you’re okay? You look happy today.” It’s like I’m allowed
to be happy sometimes. Or if I do a lot of activities or if I stay up late
I’ll have people call me up and say “Maybe you’re manic, you stayed
up really late. You’ve done a lot more things than you usually do.”
Symptomizing microaggressions produced confusion because
the remarks were reportedly perceived to be a product of genuine
concern, but still left the victim experiencing negative feelings.
Patronization. Participants also reported experiencing micro-
aggressions that communicated condescension or a false sense of
support. One participant reported experiencing microaggressions
communicating patronization as a response to winning an award
connected to her diagnosis:
They were trying to be nice but they weren’t, pretty much. Saying
like, “Wow, that’s really brave of you. You got a really unique
award.” They meant it in the best way possible, the way they were
supposed to react but it’s like, “Okay...whatever you’re saying
doesn’t feel complimentary and I don’t know why.”
This participant described her experience of distress as being a
result of the nature of microaggressions; because they are subtle
communications of negative attitudes, she was unsure about
whether the microaggression was purposefully perpetrated or an
attempt at genuine congratulations. The remarks therefore led to
feelings of confusion and unease.
Theme 2: Assumption of Inferiority
Another of the most commonly reported microaggression expe-
riences included the assumption that persons with mental illnesses
are inferior to those without mental illnesses. A total of 13 partic-
ipants reported having experienced microaggressions communicat-
ing inferiority. Three identified subcategories included assump-
tions of lower intelligence, assumptions of incompetence, and
denial of individual agency.
Assumptions of lower intelligence. Focus group participants
reported experiences communicating the assumption that they pos-
sessed lower intelligence than those without a mental illness. One
participant described an experience while on the psychiatric unit of
a metropolitan hospital:
Now, one of the rules while you’re in the psych ward: you cannot
wear [shirt] sleeves like this, right...sothey’ll say something to you
like, “Listen, you cannot wear your sleeves [outside].” Right...I
understand you couldn’t take off your sleeves but we’re getting ready
to go outside, that’s why I took them off, you understand what I’m
saying? Now, [on the nonpsychiatric unit] they wouldn’t say that to
them. They think they can understand better.
This participant believed that hospital staff communicated with
patients with mental illnesses differently and inappropriately com-
pared with patients without a mental illness. This particular mi-
croaggression communicated the assumption that people with
mental illnesses are unable to understand directions as completely
as people without mental illnesses, and the statement made by staff
also conveyed a sense of irritation and impatience that the partic-
ipant did not perceive to be appropriate for the situation.
Assumptions of Incompetence. An additional subtheme of
microaggressions communicating assumptions of inferiority in-
cluded those in which perpetrators perceived persons with mental
illnesses as less competent than those without a mental illness.
Many of these experiences were reported as taking place within
public assistance and mental health treatment settings. One partic-
ipant expressed frustration and anger with his experience gaining
employment within the mental health setting:
They won’t give you a job that you tell people what to clean...they
won’t give you that type of job...butthey’ll give you a cleaning job
. . . because you’re mentally ill, they think that all you can do is just
scrub floors.
Although this participant did not report experiencing overt dis-
crimination during the job application process, he felt the types of
duties required of him upon acquiring the job were more menial
than those that would be required from someone without a mental
health diagnosis. Because his job would be within a setting in
which his mental health diagnosis was already disclosed, this
assumption of incompetence would have a negative impact upon
his job description.
Denial of individual agency. Participants also reported mi-
croaggressions that communicated the idea that persons with men-
tal are not individuals and do not possess the agency or willpower
necessary to function within the larger society. Such experiences
were described by two participants in the college sample. Micro-
aggressions within this subtheme were described as being systemic
within societal structures including the education system, hospi-
tals, and various media outlets. One participant described their
experience after being exposed to a particular news story:
[Someone said] “Oh, well if you have a mental illness you’re not able
to really control yourself” and “This guy told him to do it and so he
didn’t know what he was doing was wrong.” People think that you are
automatically more susceptible to...other people’s wills. You’ll do
things because someone tells you to...that you’re weak. Not
necessarily weak strength-wise, but power—willpower.
Participants reported feeling a loss of individuality as a result of
such communications, experiencing emotions such as frustration
and anger.
Theme 3: Fear of Mental Illness
A third theme of microaggression experiences included those
communicating a sense of fear regarding persons with mental
illnesses. A total of 12 participants reported experiencing micro-
aggressions communicating fear. Two main subthemes identified
include: assumptions of dangerousness/unpredictability and fear of
contamination.
Assumptions of dangerousness/unpredictability. Some par-
ticipants reported experiences in which they felt like others as-
sumed or acted as though they were unpredictable or dangerous
because of their mental health diagnosis. One participant described
an experience with the criminal justice system after he was ar-
rested for a crime he did not commit:
. . . what’s really bothering me is the fact that I was arrested, I spent
8 months of my life in a cage for something I did not do, but they
thought maybe he did it because—well, he does have a mental illness,
he does take medications, he tends to be violent, so they based all that
on that.
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237
MICROAGGRESSIONS MENTAL ILLNESS
This participant’s diagnosis was automatically considered a
dangerous and even criminal trait, which led to severe and unwar-
ranted consequences. Another participant reported experiencing
such microaggressions in the school setting:
[In class] we were talking about mental illness and relating to
crime—if mentally ill people—people with mental illness are more
likely to commit crime. And I piped up. I said, “Well, I have a mental
illness. I’m bipolar. And I don’t feel the need to commit a crime.” So
that was my first time disclosing.
This participant reported experiencing the class discussion as a
microaggression experience because of the assumed link between
mental illness and criminal behavior. However, she felt empow-
ered to disclose her mental illness in order to disprove assumptions
of criminality.
Fear of contamination. Participants reported microaggres-
sions communicating that others are afraid to get “too close” to
those who they know or suspect may have a mental illness:
When I get around people outside in public, I feel like I’m being
out-numbered like hell, they look at me...andthen they take a
second look and start moving away from me, and sit somewhere else,
and they see me sitting down, they want to move somewhere else...
and everybody will move far away and sit in a different seat and sit in
another seat and then I’m just sitting by myself.
This microaggression experience resulted in feelings of isolation
and alienation. Participants reported feeling like they were auto-
matically labeled as “crazy” upon first sight, and considered not to
be a part of “normal” society and therefore someone to be feared
and avoided.
Theme 4: Shaming of Mental Illness
In addition to microaggression experiences communicating fear
of mental illness, seven participants also reported experiences that
portrayed mental illness as a shameful characteristic that should
only be disclosed in very specific circumstances. Participants
reported experiencing these microaggressions most often after
disclosure, which communicated that the diagnosis should be kept
personal and private. One college participant described an experi-
ence after disclosing her status to a close friend:
I just said “I have bipolar disorder.” And his response was “Oh, okay.”
And then he said...“That’s okay that you’re telling me but that’s not
appropriate to say in an interview.” I thought that was really like,
wow, like what does this have to do with how I— basically I disclosed
something to him and he’s saying, “Maybe that’s appropriate for me
but it wouldn’t be appropriate for other situations.”
Although this communication was meant by the perpetrator to
be helpful, the victim was left feeling confused and insecure about
her diagnosis and the decision of whether or not to disclose.
Theme 5: Second Class Citizen
Microaggression experiences communicating the perception of
persons with mental illnesses as being of a lower class or status
than persons without mental illnesses were reported by a total of
seven focus group participants. These experiences included micro-
aggressions communicating that the opinions and experiences of
persons with mental illnesses are without merit and should not be
addressed or considered important. Microaggressions with this
theme were reported as occurring most commonly within hospitals
and psychiatric treatment settings. One participant described an
experience related to his own mental health treatment:
All the hospitals...right away you become some subservient human
being...I’mvery well trained, all that medical model and person’s
model, that goes out the window, they want to prescribe medication to
you, and it has an adverse effect, they keep you on it for a week or 2
or 3 weeks into your body: “Give it time, it will adjust.” Well, a month
and a half later, it ain’t adjusted. I’m still going through problematic
situations with it, can you be amenable to lower the dosage, or just
listening to what I’m saying?
Participants expressed frustration and feeling a lack of control
over their own treatment and recovery because of such microag-
gressions encountered when interacting with mental health treat-
ment providers. Although providers are assumed to have the pa-
tient’s best interests in mind, participants reported feeling
dismissed and left “in the dark” after these experiences.
Theme 6: Experiences of Overt Discrimination
Although the goal of focus groups was to identify and discuss
subtle microaggression experiences, participants also reported a
significant amount of overt experiences of rejection and discrim-
ination due to their mental health diagnosis. In total, 15 partici-
pants reported personal experiences of overt discrimination. Envi-
ronments in which discrimination occurred ranged from school
and workplace settings to participants’ homes. One participant
described a particularly salient instance of discrimination upon his
return to the community after a hospitalization:
Well, I had discrimination when I was hospitalized and I went back to
work and the super didn’t want me to work no more because I was in
a psych ward. So he didn’t like it or he couldn’t understand it why I
was in a psych ward because of my depression and I lost my job
behind that...they called him. They called him to let him know that
I was in the psych hospital because of my depression.
Although disclosure of his hospitalization is considered illegal
under the Americans with Disabilities Act of 1990 (ADA, 1990),
this participant experienced the loss of his job due to his mental
health status.
Theme 7: Negative Outcomes
Identification and description of microaggression experiences
were often accompanied by participant reports of negative out-
comes and personal reactions related to these experiences. These
responses often communicated feelings of frustration, loss of self-
esteem, and alienation as a result of microaggressions. One par-
ticipant described his experience after his first hospitalization:
I was like shunned, looked down upon and not included because of
that. So it was...uneasy coping, you know once that stigma was
attached to me...Ilost self-esteem at one point. It really caused me
to feel like damn, you know, I’m out of the ordinary now. I’m not a
normal person anymore, so that—taking that in mind is what caused
me to stop taking my medications on numerous attempts throughout
the years, and by doing so end up decompensating and being hospi-
talized all over again.
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238 GONZALES, DAVIDOFF, NADAL, AND YANOS
As a result of these negative mental and emotional reactions in
an attempt to be considered “normal” after having internalized
negative stigmatizing attitudes toward mental illness, this partici-
pant decided to discontinue medication compliance. The resulting
decompensation and additional hospitalization acted as a vicious
cycle for increased feelings of isolation, low self-esteem, and
self-stigmatization.
Evidence for Data Saturation
Although we originally estimated four focus groups to achieve
data saturation, enough participants were obtained for only three
focus groups in the first round of recruitment. We first analyzed
transcripts for these three focus groups and found evidence for data
saturation in that participants reported similar themes across
groups. However, we decided to recruit for a fourth focus group to
have the same amount of groups for each participant sample and
maintain consistency with our original estimation. The fourth
focus group included college participants and described the same
themes as in the other three groups, with the addition of one
additional subtheme, “denial of personal agency.” We found two
pieces of evidence to determine data saturation: first, the finding
that the fourth focus group described the same themes as the other
groups; and second, that the one additional category described fell
under a preexisting theme as a subtheme. This is consistent with
established guidelines for achieving data saturation in qualitative
analysis in that the data should be “rich, full, and complete”
(Morse, 1995, p. 149).
Discussion
As hypothesized, participants with mental illness diagnoses
reported experiencing a range of microaggressions across various
settings including those hypothesized categories communicating
invalidation, lower intelligence, helplessness (denial of personal
agency), and dangerousness. Some categories identified were con-
sistent with expectations based upon the existing literature regard-
ing negative interpersonal experiences of persons with mental
illnesses, including microinvalidations, assumptions of inferiority,
and assumptions of dangerousness. These categories seem to be
consistent with commonly endorsed rejection experiences found
by Lundberg et al. (2009), including the belief of being avoided by
others and being treated as less competent by others, in addition to
findings of Yanos et al. (2001) that persons with severe mental
illness experienced people “acting like something is wrong with
you.” Contextual factors related to microaggressions were consis-
tent with the literature in that perpetrators were not limited to
strangers and acquaintances but also included friends, family
members, and authority figures. The additional finding of data
saturation across the two samples in our study also suggests that
mental health consumers’ experiences of microaggressions appear
to be quite consistent across different settings.
Similarly, our study aligns with previous research on microag-
gressions toward other marginalized groups. For instance, partic-
ipants in our study experienced being invalidated, being assumed
to be inferior, and being treated as a second-class citizen, which
matches studies with people of color (Rivera et al., 2010;Sue et
al., 2010), women (Capodilupo et al., 2010), lesbian, gay, bisexual,
and transgender (LGBT) people (Nadal et al., 2011;Nadal et al.,
2012), and people with disabilities (Keller & Galgay, 2010). Sim-
ilar to studies on African Americans and Latino Americans (Rivera
et al., 2010), participants reported that others were afraid of them,
often assuming that they would be criminal or violent.
One theme that appeared to slightly differ from other groups
was “shaming of mental illness.” Participants in our study reported
feeling like they were chastised for their mental illness and many
were explicitly told (often by well-intentioned people) that they
should keep their illness a secret. Nondisclosure could act as a
barrier to receiving much needed support and treatment, and is
reinforced by such microaggressions that communicate having a
mental illness is something to be ashamed of and should be kept
private in most, if not all, situations. Although people with mental
illnesses are typically considered a group of people with a health
condition, rather than an oppressed minority, it is noteworthy that
the experiences of persons in our study parallel those of groups
typically considered to be oppressed minorities. This suggests that
the field needs to take a broader view of the impact of social
conditions on people diagnosed with mental illnesses (Yanos,
Knight, & Roe, 2007).
Although the main purpose of focus group discussion was to
identify instances of subtle discrimination experienced by persons
with mental illnesses, it is important to note that participants
reported far more instances of overt discrimination than subtler
microaggression experiences. This is of particular interest because
it suggests that rejection of and discrimination against persons with
mental illnesses is still considered to be socially acceptable, in
contrast with the political incorrectness of being overtly discrim-
inatory toward other socially marginalized groups. Additionally,
some participant responses suggested that mental illness isn’t
always a concealable identity that can be hidden from others.
Previous research has suggested that stigmatization and rejec-
tion experiences related to mental illness can be experienced in
such intimate environments as the home setting, and perpetrated by
close contacts (Wright et al., 2000;Yanos, Rosenfield, & Horwitz,
2001). This was also demonstrated in the present study, as partic-
ipants reported that much of the distress related to microaggres-
sions was because they were being perpetrated within intimate
contexts such as the home and by trusted individuals including
friends, family members, and professional treatment providers. As
a result, a number of participants reported deciding to discontinue
medication adherence and participation in mental health treatment
services. These findings mirror existing literature regarding nega-
tive consequences of stigmatization and rejection experiences for
quality of life (Yanos et al., 2001), global functioning (Lundberg
et al., 2007), self-esteem and empowerment (Lundberg et al.,
2009), sense of mastery and control (Wright et al., 2000), and
overall perceived health (Jormfeldt, Arvidsson, Svensson, & Hans-
son, 2008).
Reported consequences of microaggressions thus have impor-
tant implications for mental health treatment, especially given that
perpetrators are sometimes unaware of their comments or behav-
iors and the subsequent effects. Microaggressions could have
negative effects upon therapeutic alliance and effectiveness and act
as an important barrier to recovery. Additionally, the loss of social
support that participants reported as a result of microaggressions
communicating rejection and invalidation could also present a
barrier to recovery. Finally, because microaggressions were com-
monly reported as occurring within close relationships, these ex-
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239
MICROAGGRESSIONS MENTAL ILLNESS
periences could contribute to internalization of stigmatizing atti-
tudes toward mental illness. Some support of internalization of
stigma can be seen in participants’ rationalizations of their re-
sponses toward microaggressions as being a way to “become
normal again” and avoid the stigmatizing status of having a mental
illness diagnosis.
The current study has several limitations. The sample size was
small, and thus the microaggression experiences reported cannot
be considered to be fully representative of those experienced by all
persons with mental illnesses. In particular, the college focus
group sample consisted of four participants who were all female,
which places limits on generalizability of experiences to the gen-
eral population of college students with severe mental illness.
However, it is important to note that although fewer participants
attended focus groups than hoped, they reported the same themes
with the addition of one additional, “denial of personal agency.”
Additionally, participants were predominantly male, African
American, and with diagnoses considered to be severe mental
illness. There may be some categories of microaggressions expe-
rienced that were not identified within this sample. Future research
should continue to explore whether these experiences differ as a
function of background demographic characteristics or type of
mental illness diagnosis.
Future research should endeavor to examine the frequency of
such microaggressions as experienced across a wider sample and
relate these to outcome factors related to quality of life and
recovery. Gaining additional understanding of the effects of mi-
croaggressions on persons with mental illnesses can help to inform
preventative interventions against the internalization of stigmatiz-
ing attitudes, and to more fully understand their contributions to
negative physical and mental health outcomes. Future research
could also address the impact of microaggressions against people
with mental illnesses in the context of the therapy relationship and
implications for alliance and treatment retention and outcomes.
Further research on intersectional identities may also be useful in
understanding the effects of microaggressions; perhaps people of
other marginalized groups who also are diagnosed with a mental
illness may experience multiple types of microaggressions in their
lives. Directions for future research should also include an inves-
tigation of motivation and reasoning behind the perpetration of
these microaggressions; development of a scale would be benefi-
cial to examine the frequency with which the use of microaggres-
sions are endorsed among members of the general public. By
understanding the experience of the perpetrator, we may also gain
insight into effective intervention approaches for decreasing men-
tal health stigma.
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Accepted August 12, 2014 䡲
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