Rethabile Mathealira-Molapo
In societies across the world, of the various mental health conditions people experience, depression and anxiety, being the more common and more relatable conditions for the general population, somewhat dominate the mainstream mental health conversation. These two conditions are somewhat deemed more acceptable and are somewhat cloaked with some measure of respectability, provided that those affected by them remain cognitively functional and anchored in a shared sense of reality with society. Those with other conditions, such as those whose experiences feature some measure of psychosis, which involves them perceiving realities that those around them do not necessarily share, remain among the most silenced, misunderstood, and marginalised individuals.
Although modern psychiatric care has made significant strides in diagnosis and treatment, less so in prevention and rehabilitation, the foundational power dynamics within mental health institutions and broader society remain largely unchanged, more so with mental health institutions. These dynamics often deny those diagnosed with mental health conditions a meaningful voice in decisions affecting their lives.
Worse still, they are often treated as lesser beings, incapable of coherent thought or emotional perception, and are systematically denied recognition of their personhood. This denial is deeply rooted in a pervasive and largely unchallenged social prejudice against people who have been diagnosed with mental health conditions, especially those with marginalised mental health conditions, known as sanism.
It is deeply embedded in legal, medical, and cultural institutions. Like gender discrimination or other forms of discrimination, it functions to dehumanise, delegitimise, and exclude people based on their mental health status. It legitimises discrimination and exclusion, justifying the denial of rights and reinforcing the belief that people with mental health conditions are less rational, less trustworthy, and qualitatively less human.
Sanism manifests in many forms: in the legal system where people with mental health conditions can be institutionalised involuntarily; in the workplace where their capabilities are underestimated or their diagnoses weaponised against them; in the media where mental unwellness is routinely equated with violence and danger; and in everyday interpersonal interactions, where disclosure often leads to pity at best, or discomfort and unease at worst.
One of the most consistent experiences reported by people with mental health conditions is the denial of agency. In psychiatric settings, this often manifests as forced admissions which often take place through prioritising family and even non-familly members’ preferences for admission over an established need to limit the admitted person’s right to liberty, without due process of legal procedures outlined in mental health laws for minimum safeguards, or once patients are admitted, a refusal to take their concerns seriously, or to involve them in their own treatment planning, or once discharged to get their feedback on services rendered and inputs on future treatment and other possible helpful interventions, or even to get their insights on the source of their unwellness.
Reported narratives of abuse and suffering are often dismissed. Psychiatric patients frequently report that when they complain of mistreatment, whether it be over-medication, medical restraints such as sedative injections and physical restraints like forced seclusion, which is a form of solitary confinement, even as they express their anxiety and protest, their pleas tend to be ignored.
When they experience verbal abuse or even sexual assault, they are dismissed outright. Their complaints are frequently either not believed or minimised, and in many cases interpreted as symptoms of their mental health condition. Their words are treated as hallucinations or delusions, rather than credible accounts of real events.
This silencing has life-threatening consequences as deaths have in some cases arisen. When a person with mental illness reports abuse and is not believed, perpetrators are emboldened to continue without fear of consequence. The psychiatric system, intended to be a place of healing, becomes a site of trauma and re-traumatisation. People are left not only to endure abuse but to do so in a system that denies the validity of their pain and the truth of their experience.
Commonly infantilised, it is not surprising that people with mental health conditions, have experiences which mirror those of children who are violated by adults under the assumption that they cannot truly comprehend what is happening to them. Just as when a society of adults which grows up to recount experiences of childhood trauma reaches adulthood often assumes children are too young to remember or process trauma, people with mental health conditions are assumed to lack the cognitive and emotional capacity to register abuse or even recognise injustice.
In both cases, this assumption is false and sanist and makes them prime targets for violence, neglect, and control.
Looking at psychiatric spaces: The design of many psychiatric facilities reinforces this dynamic. Locked wards, institutional clothing, forced medication, and restrictions on movement all create an environment that diminishes personhood. Patients are often stripped not just of their rights, but of their identities, reduced to diagnoses, symptoms, and behaviours. And their personhood erased by the psychiatric lens.
This dehumanisation extends to the way psychiatric treatment is delivered. Various measures, restraints, and forced drugging, often without informed consent, are routine practices. These interventions are justified by a paternalistic logic that views them as incapable of making decisions in their own best interests, and therefore as needing control rather than care.
The concept of “lack of insight,” a clinical term frequently used to describe individuals who reject their psychiatric diagnosis or treatment, is another tool that reinforces the hierarchy of the sane versus the insane. Rather than being seen as a legitimate difference of opinion or a reflection of a person’s lived experience, such rejection is interpreted as further evidence of illness, creating a circular logic in which disagreement is itself pathology. In this system, to speak against one’s treatment is to prove one’s unfitness to speak at all.
Discrimination and sanism also manifest differently in different groups or categories of patients. Locally, criminally charged persons in psychiatric care receive better treatment than those who are committed for ordinary mental health care purposes, receiving charitable visitors and enjoying recreational activities, as they are perceived as being less mentally ill, while those under civil admissions often spend their days idling like prisoners in the fenced off backyard, aimlessly counting down days until their discharge.
Patients with depression and/or with suicidal ideation, especially those with favourable socioeconomic circumstances, tend to receive special care and enjoy private rooms, which those with psychosis are not deemed worthy of, even when it has been directed by the medical practitioner in charge. Women are particularly vulnerable to sexual violence, while geriatric patients tend to receive much gentler care and experience no isolation for disruptive behaviour. These experiences are not isolated incidents or the result of a few bad practitioners; they are systemic and rooted in sanism and its interaction with other factors of privilege and oppression.
One of the most insidious effects of sanism is internalised oppression or internalised sanism. Many individuals who have experienced psychiatric labelling come to believe the negative stereotypes about themselves: that they are broken, incapable, or unworthy of love and belonging, that the abuse levelled against them for various reasons related and unrelated to their condition is justified. This internalised sanism can deepen despair and make healing even more difficult, especially when combined with the trauma of institutional and domestic abuse.
To challenge sanism is to insist on the full humanity of people with mental health conditions. It is to recognise that they, like everyone else, possess a deep inner world, capable of insight, reflection, and growth. It is to affirm that they are not simply the sum of their symptoms or the labels imposed upon them.
This recognition demands systemic change. Mental health systems must shift from paternalistic models to rights-based, trauma-informed approaches that prioritise consent, dignity, and collaboration. Peer-led advocacy and survivor movements must be centered, as they offer a powerful counter-narrative to mainstream psychiatry, one rooted in lived experience, mutual support, and collective liberation.
Legal systems must also evolve to safeguard the rights of people with mental health conditions, ensuring that their testimony is taken seriously, their autonomy is respected, and their protection from abuse is guaranteed. Education and public awareness campaigns are needed to dismantle the myths and fears that sustain sanism and to cultivate compassion, understanding, and solidarity.
Most importantly, we must listen to the voices of those who have been silenced, especially within the walls of psychiatric institutions. Their stories are not incoherent noise. They are not the ravings of madness. They are truths, often painful, often complex, that demand to be heard.
To be a person with a mental health condition in today’s world should not be equal to holding a precarious position, vulnerable not only to internal struggle but to systemic violence and silencing. People with mental health conditions should not be denied a voice in matters affecting them, treated as lesser beings, and subjected to abuse with impunity, all under the shadow of sanism.
As long as we continue to view them as incapable of thought, unworthy of trust, and impervious to pain, we perpetuate a cycle of dehumanisation and harm. It is way past time to hear, honour, and uphold the voices of those whom the world has long ignored and abused. Only then can we begin to build a society in which all minds, regardless of how they are labelled, are treated with the dignity and equality they deserve.
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