Identifying and Overcoming Mentalism

1. Identifying and Overcoming Mentalism Coni Kalinowski Pat Risser

2. Why use the term Mentalism? • It connotes the systematic mistreatment of labeled people. • Analogous to racism, sexism • The defining factor is a power difference between the provider and the consumer • Power differences must be actively maintained using offensive mechanisms

3. Systematicdiscrimination • inequalities are institutionalized within the social structure • imbalance in economic, political, and social power • pervades social system and all aspects of people's lives • generates and sustains misinformation and ignorance that are translated into attitudes, assumptions, feelings, and beliefs • it provides justification for itself • it affects everyone

4. Offensive Mechanisms (Chester Pierce, MD) • Their function is to maintain the power differential between individuals or groups of people. • They are implemented largely through the aggregate effect of micro-aggressions. • They are usually unconsciously employed. • They become institutionalized by incorporation into policy and procedure.

5. Macroaggressions and Microaggressions

6. Macroaggressions • Blatant and concrete • Physical assault during restraint • Deprivation • The brutality of the action is hard to deny • The hostility is blatant • The impact of the action is hard to deny • The harm is obvious (e.g., physical injury)

7. Microaggressions • ·They are small, often interpersonal, attacks on the person’s power, worth, and wellbeing that are not in themselves an overt threat to the person’s safety, health, or status. • ·They are usually unconsciously employed by the offender. • ·The person encounters them hundreds or thousands of times each day and in all settings. • ·The aggregate impact is as devastating as a macro-aggression, such as physical violence. • ·To address power differences, the dominant (“power-up”) group must assume responsibility for the eradication of micro-aggressions.

8. The dynamic process of offensive mechanisms They provide justification for the dominant group to remain in power over the offended group: • the dominant group is more skilled, experienced, capable. • the offended group is deficient, inexperienced, controversial. • They assert the good intentions of the dominant group towards the offended group, and gratify the dominant group's need to feel charitable, open-minded, and kind. • They chastise, punish, discredit, or blame members of the offended group who are dissatisfied with the situation, especially in ways that make them appear unreasonable or absurd. • The offended group is held responsible for ameliorating the conditions that permit the offense, while the shortcomings and deficiencies of the dominant group are tolerated and protected.

9. Examples of Microaggressions • Language and clinical terminology • The physical environment • Atomization • Pseudo-empathy • Prognostication • Risk assessment

10. The impact of offensive mechanisms on people in the “power-down” position • They are exhausting. • They reduce opportunity. • They are internalized in unique ways, and can be destructive to self-esteem, wellbeing, and self-determination. • They cause people to feel that they are out of touch with reality. • They can cause mounting anger and/or grief. • They cause learned helplessness and depression.

11. The impact of offensive mechanisms on people in the “power-up” group • Loss of valuable human resources and diversity. • Loss of personal integrity and compromise of values. • Fear and isolation. • Loss of support from “power-down” group. • Loss of effectiveness. • Feelings of depression, anger, bitterness, despair.

12. Integration of power issues into community mental health services • Acknowledge the presence of prejudice and discrimination as it impacts people's lives. • Apply the “would I accept this” rule • Assist people to identify and defend against micro-aggressions and offensive power dynamics. • Confront and avoid offensive mechanisms such as atomization, tokenism, false compromise, offensive language, and procrastination. • Evaluate “ethical” issues as power issues – often the term ethics is used to describe abuse of power (e.g., sexual exploitation) or it can be used as an excuse for an offensive mechanism (e.g., consumers prohibited from visiting inpatient unit because it is “not ethical.”)

13. Integration of power issues into community mental health services • Evaluate mental health concerns within the context of oppression. Avoid pathologizing a person's attempts to cope with an impossible situation. • Provide services that support consumer choice and empowerment. • Provide constant reminders to staff that the purpose of the organization is to provide services, and the organization is accountable to the recipient of those services. • Learn to accept and affirm the anger and indignation that people may feel as a result of oppression. • Openly confront negative stereotypes and assumptions – be intolerant of intolerance.

14. Organizational suggestions: • Engaging in social change takes time, energy, and resources. It is also very emotionally draining. Make sure you allocate adequate resources so that change agents don’t burn out. • Take time at the outset to define your group values and goals. Talk about these often, so the group stays focused and grounded. • Summarize your core values and goals in a few “bullets,” then use these to evaluate group decisions (e.g., “Does having a membership fee fit with our core value of inclusion?”). • Affirm personal accountability rather than power over others. Stay task-oriented rather than position-oriented.

15. Organizational suggestions: • Establish a routine for meetings, communications, procedures – then rotate the leadership/facilitator role among members. • Establish group achievement as a value, rather than individual achievement. • Affirm and recognize all contributions by group members, without judging, comparing, ranking, or competing. This supports a group dynamic that is inclusive of people of all abilities and means. • Expect that individual members will contribute in different ways, and that the group as a whole should reflect the attributes of all members and not just those of the highest achievers. • Find ways to constructively debrief experiences of discrimination and hostility that help the group to find strategies to cope with prejudice and oppression. • Find ways to have fun together.

16. Organizational suggestions: • Move to Positive Assumptions: • a.Communicate respect, dignity, and worth. • b.The person receiving the service and the provider collaborate to define goals, obstacles, and solutions. (“If we can work together to come to a better understanding of the problem, we can devise an effective solution.”) • c.Move from “knowing” to seeking. • d.Move from “doing for” to facilitating. • e.Move from judging to understanding.