The Triple-Plus Bind: An Intersectional Examination of Race, Gender, and Mental Health Stigma in the Lives of Black Women Living with Serious Mental Illness

Background: For Black women, experiences of stigma based on mental illness, gender, and race are often inordinately challenging and alter life quality, despite personal resiliency. One in seventeen adults lives with Serious Mental Illness; and while SMIs are becoming more visible and socially accepted, many people still experience considerable discrimination where they work, live, in families, social institutions, and legislation. Furthermore, gender- and race-related stigma intersect with stigma around mental illness, compounding and magnifying problems individuals living with SMI face.

Methods: Data are drawn from narratives collected in a life history study of Black women living with SMI, who also perform multiple roles, such as caregiver, worker, and friend/family member. Narrative, phenomenological techniques are used to analyze nine case studies of women aged 20 to 60, from a range of cultural and demographic backgrounds, all of whom have Axis I diagnoses. Study objectives are to: 1) uncover types and nature of stigma the respondents encounter, including cross-cutting themes and unique cases; 2) understand the impact of stigma and describe the complexity of multiple, intersecting stigmas that shape the women’s everyday experiences; and 3) identify effective, strengths-based interventions that build on the resiliency and resourcefulness of Black women who experience adverse events, unfair treatment, and inequitable outcomes because of stigma and discrimination.

Results: show that stigma tends to be experienced multiply but reported singularly; that is, when asked directly about experiences where stigma was present or played a role in a particular outcome, most respondents identify one specific type, or category, of stigma at a time (e.g., “I know it was because of my race,…”; “It’s because I’m a woman…”; or, “They just think I’m crazy.”), indicating that context matters when it comes to determining which identity is most salient and when; in some cases, there appears to be a hierarchy of stigmatized identities.

However, the complexity of intersectionally-experienced stigma emerges when the women are asked simply to “tell a story about [X] experience.” In these wider-ranging narrative journeys, respondents describe feelings and intuition related to knowing that while they are already disadvantaged in many spheres by gender and race, the addition of publicly-known mental illness could be a tipping point. As one respondent said, she had to “act normal, not herself," because while she couldn’t hide her gender and race, if she were seen as a “crazy, Black woman,” she wouldn’t have a chance.

Conclusions/Implications: Obstacles faced by respondents in this study reflect previous research about SMI-related stigma and gender- and race-based oppression. Yet these finding provide an alternative view, highlighting ways in which the women are keenly attuned to how they are perceived and treated, the inspired solutions that emerge when they draw on strengths related to their experiences as women, community and solidarity in facing racial discrimination, and creative ways they deal with the stigma associated with lifelong SMI. These findings suggest the importance of examining stigma intersectionally to advance practical, recovery-oriented interventions, research, and policy that build on the strengths and resilience of people living with intersectional stigma and challenges.