Intersectionality: Impact of Overlapping Discrimination on Mental Health

Discrimination is not always tied to a single category; it can expand and intersect with multiple characteristics that shape how people move through the world. This leads to the term “intersectionality,” which implies experiencing different kinds of discrimination simultaneously (Webster, 2024). Since the term originates from discrimination, let’s begin by explaining what discrimination is. Discrimination can be defined as unfair treatment of someone for their identity, or for being a member of a community or group. This can be related to age, disability, ethnicity, origin, political beliefs, race, religion, sex or gender, sexual orientation, language, culture, and many other grounds. As discrimination has appeared in many contexts and forms in the past and present, it is a widely studied area to understand why it happens. Literature discussed that the act of discrimination starts with prejudice, which means it is a preconceived, often negative opinion about someone or a group based on limited or biased information. Prejudice, as the word suggests, is to make a “prejudgment.” The focus here is not on the person’s action but on the thought in their mind. Discrimination is the act of turning negative prejudice into actions. However, not every negative prejudice turns into behavior (Aronson et al., 2007).

Discrimination is a complex process and appears in different forms. When these different forms of discrimination combine, they frequently result in heightened experiences of unfair treatment known as Intersectionality. Intersectionality comes from the overlap of various kinds of discrimination. This term was coined by Kimberlé Crenshaw in 1989, primarily for marginalized individuals or groups. For example, old black women can experience racism, sexism, and ageism simultaneously. Intersectionality affects marginalized groups on the community level, but this topic is also essential for individual mental health as well. On an individual level, discrimination is a stressful and traumatic experience and causes significant mental health disorders for a prolonged time. Also, the impact on a community level is essential because it will affect how individuals access mental health treatment. In this therapy, the sketch will explore the concept of discrimination and intersectionality and how it impacts our mental health.

What is discrimination, and how does it happen?

Although discrimination often appears to be only at a behavioral level, it is the result of a broader and multi-layered process. This process usually starts with prejudice. Prejudice is a hostile attitude toward individuals solely based on their group membership. It implies that personal characteristics are irrelevant and that this negative view is linked to the group as a whole. Prejudice is discussed to have three components as follows: emotional component, which implies the type of emotion linked with the attitude, cognitive component, which implies beliefs or thoughts related to the prejudice, and behavioral component, which implies behaviors or actions taken upon the emotional and cognitive components of the prejudice (Aronson et al., 2007).

Cognitive Component: The cognitive component of prejudice is known as “stereotype”. A stereotype is basically a broad idea about a group of people, where certain traits are assumed to be true for everyone in that group, even though there’s actually a lot of diversity among its members. The reason why we are doing it is that we try to maximize our cognitive time and energy by relying on mental shortcuts we created to understand the world’s or people’s complexity. Gordon Allport described these mental shortcuts as “ the law of least effort.” Although stereotypes are meant to be adaptive and save time, they can become outdated or cause people to overlook individual differences, resulting in unfair and harmful treatment of others (Aronson et al., 2007).
Emotional Component: The question here is, if stereotypes lose their function, why do we still keep them? The answer to this question relies on the emotional component. The emotional component of prejudice relates to the feelings that automatically arise. These feelings are usually negative, involving reactions such as fear, disgust, anger, or discomfort. Gordon Allport argued that these emotions are not merely a consequence of stereotypes; instead, they lie at the heart of prejudices, making it hard to change them. The emotional element of prejudice, therefore, becomes one of the most powerful driving forces behind discriminatory behavior (Aronson et al., 2007; Allport, 1979).
Behavioral Component: The Behavioral component of prejudice is known as “discrimination”. It refers to an unfair and harmful act directed at someone solely because of their identity or group membership. While most explicit forms of discrimination are now illegal, stereotypes and prejudices can still emerge and be expressed through behavior (Aronson et al., 2007).

The reasons why prejudice occurs and leads to discrimination are complex. Some operate at the group level and others on an individual level. On an individual level, how we process information, such as attributional biases and assigning meaning to observed events, can be influential. At the group or institutional level, conformity and social categorization, such as us versus them, also play a role (Aronson et al., 2007). However, discrimination is not always based on a single identity or group membership. Individuals may be subjected to multiple forms of discrimination at the same time based on numerous characteristics. This is where ‘intersectionality’, in which numerous forms of discrimination are intertwined, comes into play. This situation has serious effects not only on the social level but also on the mental health of the individual.

Intersectionality and Mental Health

As mentioned above, individuals can come across numerous forms of discrimination. When we think of discrimination as a stressful and traumatic experience, it can lead to mental health issues. As a result, intersectionality can lead to significant emotional and social challenges, which can lead to mental health issues. Studies reveal that perceived discrimination produces heightened stress responses (Pascoe & Richman, 2009). Discrimination negatively affects an individual’s psychological state, regardless of perception or internalization (Pascoe & Richman, 2009). According to studies, discrimination is associated with depression, anxiety, and post-traumatic stress disorder symptoms. Let’s look deeper at the symptoms.

Depression: Depression is a mood disorder that negatively impacts functioning and is characterized by a depressed mood, low energy, loss of interest, and feelings of worthlessness. Depression stems from multiple causes, such as biological changes, personality traits, adverse life experiences, and cultural and environmental factors. Adverse life experiences, such as discrimination, can trigger depressive symptoms. Additionally, poor living conditions, economic disparities, and negative social interactions with others can contribute to these difficulties (Lewinsohn, 1974). In particular, studies indicate that people who experience more perceived discrimination have more depressive symptoms (Pascoe & Richman, 2009).

Anxiety: Anxiety is an emotion characterized by worry about the future. The person experiencing anxiety thinks about possible adverse outcomes and the problems these outcomes may cause. Anxiety is a normal emotion we have; however, sometimes anxiety can become dysfunctional and can turn into a disorder. Both genetic and environmental factors influence anxiety disorders. As an environmental factor, being under extreme stress is a significant risk factor for anxiety disorders. In particular, a factor such as discrimination, which can put a person under much stress, can create a basis for stressful living conditions. According to the reports, systemic discrimination, such as racism, puts individuals at higher risk for anxiety disorders (MacIntyre et al., 2023). Experiencing multiple forms of discrimination at once can really contribute to feelings of anxiety and further anxiety disorders.

PTSD: In Post-traumatic stress disorder (PTSD), individuals experience intense fear and helplessness following a traumatic event. They may involuntarily recall the experience or feel triggered by reminders, making it feel like they are re-experiencing the traumatic situation. These individuals often avoid stimuli associated with the trauma and experience distressing emotions such as fear, anxiety, anger, shame, and guilt. Although not every stressful life event is characterized as a trauma, several cultural, familial, psychological, biological, and social factors affect the likelihood of PTSD. According to a case study conducted by Williams et al., a case of a 22-year-old First Nation woman was studied in terms of racial trauma. She has faced prejudice at work and experienced violent attacks in the neighborhood. After suffering several injustices, she started to feel anxious, doubted her capabilities at work, and became increasingly isolated from others. Additionally, she felt restless and irritable and experienced intrusive thoughts that blamed herself for the discrimination she encountered. In the study, researchers reconceptualized the intersection of racial trauma and PTSD in regard to how these experiences build up, and people may show signs of PTSD for a prolonged duration. This is primarily a study focused on racial discrimination, but the ideas presented can also be relevant to other forms of discrimination where individuals may perceive a threat to their safety, leading to intense emotional reactions (Williams et al., 2023).

Research shows that discrimination can really have adverse effects on mental health, especially when we consider the intersecting identities people have. The stress from challenging these different aspects of discrimination may lead to heightened feelings of anxiety and depression. This may seem a bit abstract; let’s make it concrete with a short example.

For instance, we can consider the case of a refugee woman. A refugee woman in their midlife might come across several challenges after the immigration process; these can include a lack of social support networks, language proficiency, cultural differences, getting health services, getting employment or education if it is needed, shelter and housing problems, and much more. Coping with these challenges in daily life will become more complex as discrimination is encountered. For instance, finding employment can be challenging initially due to being a refugee; however, being a woman or middle-aged (or both) in this situation may further extend the duration of the job search. Additionally, even when an individual’s education or qualifications from their home country align with job requirements and their legal documentation is in order, the combined challenges of being a refugee, a woman, or a middle-aged person might result in lost job opportunities, leading to negative feelings. These feelings can be sadness and hopelessness, leading to thoughts of worthlessness or failure. Suppose these feelings and thoughts persist for over 2 weeks. In that case, the person may experience anhedonia and problems such as difficulty engaging in physical activity, sleep disturbances, and a change in eating routine. Given that this person lacks emotional or social support, professional support might be necessary.

How does Intersectionality affect seeking care for mental health?

Inequalities affect how people think about and seek help for their mental health problems. For example, racial minorities who also have low incomes often find it hard to access affordable mental health services. This is usually due to discrimination or a lack of care to understand their culture. Additionally, the stigma around mental health in their communities can make them hesitant to ask for help. (Oexle & Corrigan, 2018). Freiman and Cunningham (1997) found that minoritized groups were less likely to seek mental health care in clinical settings.

Cooper-Patrick et al. (1999) conducted a community-based study showing promising developments in reducing disparities because individuals and communities gain awareness, and targeted intervention programs are developed over time. Nevertheless, national data present a negative view, revealing that these inequalities continue despite local improvements. Wells et al. (2001) highlighted that structural barriers, such as insufficient insurance coverage and high care costs, cause mental health utilization to be lower still. Similarly, Cook et al. (2014) pointed out that marginalized groups still face lower rates of mental health service utilization, even in more recent years.

How can culturally competent care help?

Intersectionality shows how important it is to understand culture in mental health care. This idea helps therapists see their clients as whole people. Each person has a mix of backgrounds, histories, and experiences. These differences shape who they are and what challenges they face, such as struggles with anxiety, self-esteem, relationships with others, and academic or job performance. As mentioned above, research has shown that experiences of discrimination and systemic inequalities can significantly increase the risk of conditions like PTSD, anxiety, and depression, especially for marginalized communities (Lowe et al., 2021).

Evidence-based and trauma-informed interventions can be found in various therapy modalities such as cognitive behavioral therapy, prolonged exposure, and cognitive processing therapies. Even though these modalities have not been developed through the lens of intersectionality, utilizing significant techniques is beneficial for people who experience different forms of discrimination simultaneously. For example, in a study conducted on race-based stress and trauma interventions for veterans of color, cognitive behavioral therapy, dialectical behavioral therapy, and acceptance and commitment therapy methods were utilized for building a safe space and resilience and addressing the emotional impact of discrimination. The findings indicated that participants felt empowered by the intervention for the future and confronted the traumatic experience they encountered due to discrimination more authentically (Williams et al., 2021).

Of course, culturally competent care considers not only race and cultural differences but also factors like gender, socioeconomic status, and culture, which affect a person’s overall well-being by affecting their mood and cognitions. By understanding these factors, mental health providers can create better ways to help. For example, knowing how racism affects someone’s mood or how it is affecting their anxiety or depression allows therapists to offer the proper support and teach clients how to deal with these problems.

To sum up, considering the effects of intersectionality in therapy and culturally competent care helps people from different backgrounds. It creates a safe space for everyone to work on their mental health, assisting clients to feel understood and improving therapists’ work. If you are experiencing any mental health issues due to discrimination or intersectionality, culturally competent therapy might help you cope with the challenges you are facing.

Take-aways

Discrimination isn’t always linked to one category; it can involve multiple overlapping characteristics affecting how people navigate the world. This is called “intersectionality,” meaning experiencing various types of discrimination at once.
Discrimination starts with prejudice, which means it is a preconceived, often negative opinion about someone or a group based on limited or biased information.
Prejudice has three components: emotional (linked to feelings), cognitive (beliefs or thoughts), and behavioral (actions based on feelings and thoughts).
Discrimination isn’t always based on a single identity; individuals often face multiple overlapping forms, known as ‘intersectionality’, leading to serious social and mental health effects.
Experiencing discrimination and intersectionality negatively affects an individual’s well-being and leads to depression, anxiety, and post-traumatic stress disorder symptoms.
Experiencing discrimination and intersectionality also influences the accessibility of mental health services and how people think about and seek help for their mental health problems.
Considering the effects of intersectionality in therapy and culturally competent care helps people from different backgrounds.

References

Intersectionality. (2024). In Merriam-Webster Dictionary. https://www.merriam-webster.com/dictionary/intersectionality
Aronson, E., Wilson, T. D., & Akert, R. M. (2007). Social psychology (6th ed.). Pearson Education.
Allport, G. W. (1979). The nature of prejudice (25th anniversary ed.). Basic Books.
Oexle, N., & Corrigan, P. (2018). Understanding Mental Illness Stigma Toward Persons With Multiple Stigmatized Conditions: Implications of Intersectionality Theory. Psychiatric services, 69 5, 587-589 . https://doi.org/10.1176/appi.ps.201700312.
Pascoe, E. A., & Smart Richman, L. (2009). Perceived discrimination and health: a meta-analytic review. Psychological bulletin, 135(4), 531.
Lewinsohn, P. M. (1974). A behavioral approach to depression. In R. M.Friedman & M. M. Katz (Eds.), The psychology of depression: Contemporary theory and research (pp. 157–185). New York: Wiley
MacIntyre, M. M., Zare, M., & Williams, M. T. (2023). Anxiety-Related Disorders in the Context of Racism. Current Psychiatry Reports, 25(2), 31–43. https://doi.org/10.1007/s11920-022-01408-2
Williams, M.T., Osman, M., Gran-Ruaz, S. et al. Intersection of Racism and PTSD: Assessment and Treatment of Racial Stress and Trauma. Curr Treat Options Psych 8, 167–185 (2021). https://doi.org/10.1007/s40501-021-00250-2
Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., & Ford, D. E. (1999). Race, gender, and partnership in the patient-physician relationship. JAMA, 282(6), 583–589. https://doi.org/10.1001/jama.282.6.583
Cook, B. L., Trinh, N. H., Li, Z., Hou, S. S., & Progovac, A. M. (2014). Trends in racial-ethnic disparities in access to mental health care, 2004–2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453
Freiman, M. P., & Cunningham, P. J. (1997). Use of ambulatory medical care by African Americans and whites: Effects of health care system affiliation and other factors. Medical Care Research and Review, 54(2), 136–160. https://doi.org/10.1177/107755879705400203
Oexle, N., & Corrigan, P. W. (2018). Understanding mental illness stigma toward persons with mental illness: A systematic review of measures. International Journal of Mental Health, 47(2), 169–184. https://doi.org/10.1080/00207411.2018.1453243
Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158(12), 2027–2032. https://doi.org/10.1176/appi.ajp.158.12.2027

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