Resisting the label: Black women, invisibility and mental health.

Most Black women I know are no strangers to what most mental health professionals would see as depressive and/or anxiety ‘disorders’. The majority of us consider this to come with the territory of having to navigate through injustice and oppression. We call that life.  The bio-chemical theories that may account for what seems to only become manifest in structures of domination and subjugation, don’t matter much to us. For me, it was only during the course of my psychology studies that I came to understand that this recurring feeling of imminent black out had a medical term: anxiety or panic ‘attacks’.  Calling this anxiety did not provide comfort or reassurance.  I did not think: ‘great, now I know what’s wrong with me’. I felt angry.  Angry and invisible.  Angry and re-traumatised. These categories erased the daily onslaughts on my existence whilst trying to put to me that there was something wrong with me, that I was diseased. I did not feel shame. I did not feel stigma. I felt insulted in my intelligence and in my experience.

Black women are absent from most ‘talking therapy’ rooms.  Many of my friends and relatives would rather drink a bleach cocktail than head for mental health services. So what is going on here?  Probably several things, nonetheless, one of these things is that many Black women do not call what they experience, depression or anxiety or mental ‘illnesses’. Although we are all too often conditioned to think so, for most of us, it is not our explanatory model.  And, why should it be? Why would you expect Black women to locate their distress within psychiatric frameworks, frameworks that have historically been used to inferiorize them, without resistance?

Do not be fooled into thinking for one second that Black women are oblivious to the normalization of the racism and sexism which is imbedded within psychiatric standards of normality. Many of us are not.  We may not have the language to articulate this but, given that there is no single aspect of our being that has not been imprisoned by labels, most of us have learnt the life limiting impact of being in a world that is preemptive of our existence. To me it seems perfectly adaptive and pragmatic for many of us to refuse yet another label and its associated prejudices and pre-conceptions. Refusing further pre-definition is indeed perfectly understandable as far as I am concerned.  And, it is highly disturbing that we would be pathologized for, essentially, resisting further oppression.

Putting a medical label onto an experience does not make the experience any more or less real or painful. Nor does it validate it; all it does is just this: it gives it a medical label.  It is perfectly within anyone’s rights to choose the name given to any lived experience, without being devalued. Black women do present to a range of services but, often, their distress is not seen. Perhaps this is unsurprising if we are forced to adhere to a worldview and language that invalidate our very pain and distress. Evidence of our distress and vulnerabilities is around for everyone to see if one chooses to pay closer attention and look at us without wearing stereotype tainted goggles.

The most rewarding work I do takes place at the heart of communities.  When I find and meet people where they feel at their safest.  I have recently facilitated a mental health resilience training session within a Black church.  Although a few women openly disclosed their use of mental health services, my attention was drawn to those who were less verbal. I knew there were many more women with untold stories of emotional distress and, they also disclosed something of their stories albeit, in different ways. They disclosed in the intensity of the gazes they gave me or in their teary eyes.  They disclosed in the loud silences they sought safety in when others spoke of the challenges they had faced as Black women. Some disclosed in the power of the hugs they gave to me when I had finished and/or in the proximity they sought with me at the end of the session.

Most never uttered a word. When we, as mental health professionals, expect Black women in distress to disclose in ways that make us feel at ease or that are less demanding cognitively or emotionally, we expect them to do the work.  We expect Black women to meet the needs of mental health systems. We force them to adhere to specific worldviews, to seek help in  particular ways and to use the language or modes of communication we value as conditions for us attending to them or seeing their emotional needs. We perpetuate centuries of oppression by charging Black women with caring for the more privileged or for those who subjugate or other us, erasing our experiences and histories and replicating the invisibility of our wounds.

More othering or labelling often follows: we call Black women ‘hard to reach’, ‘difficult’ or ‘difficult to engage’ and ‘resistant’ as though marginalisation was ever the solution to…marginalisation. Making mental health services more relevant to Black women is an ambitious task. However, it seems to me that some simple steps may go some way in reducing the gap that exists between Black women and mental health services: meeting them where they feel safe geographically, linguistically and psychologically. Allowing Black women to name their experience, this means accepting with humility, that psychiatric diagnoses are just lenses and as such, they are not the only framework to make sense of the world. And, recognising that much of the trauma Black women have to endure, is part of a shared history. A history that can get easily replicated within mental health services when the trauma attached to it, is rendered invisible.

Thank you for reading.

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  1. Guilaine: Your advocacy is fiercely intelligent and powerfully empathic. Thank you for sharing your writing and for the work you do in the world in understanding, advocating, and giving voice to Black women and others who are marginalized.
    The pain of being “patholigized” – having legitimate social and interpersonal experiences viewed as illness – is a topic near and dear to my heart. I feel I have an ally, as a Jewish brother, breaking through the censors of authentic experience. Much much respect, David

    1. Hi David, Thanks so much for taking the time to write such a supportive comment. It is truly appreciated. I don’t set out to be an advocate. I just write what I think and feel (when I can figure this out). Mainly it is for my own processing and, as a stance against silencing forces. If I can help illuminate the experiences of those who are marginalised whilst doing so, then that’s really rewarding and worth the hours I spend trying to articulate sometimes what seems unintelligible. I’m glad my writing speaks to you and look forward to reading more of yours, who knows maybe we’ll write a piece together one of these days. Thank you.

      1. Ah, I hadn’t seen your reply. My apologies. The idea of writing a piece together some day brings a smile to my face. Perhaps it can even be in dialogue form- that is what I see in front of my eyes at the moment.

  2. Guilaine, this is such a thoughtful and elegantly argued critique of a system that pathologizes individuals rather than the structural inequalities that make their lives more challenging. It reminds me of many situations I’ve encountered in my work. Here’s a link to one of the essays I wrote about a similar challenge for Native Americans in case you’re interested:

  3. Dear Guilaine,

    Thank you so much for this article, it came at a perfect time! I found your site via the (also) brilliant article you wrote: The language of distress: Black women’s mental health and invisibility which spoke to me deeply and i nodded passionately in my echoed feelings.

    I´ve just got home after completing a Trauma Sensitive yoga training as part of my ongoing studies and have been utterly frustrated with the methodology we have been asked to apply. The focus is entirely based on people “within” institutionalised health services and not concerned with those who aren´t seen by this model…Very frustrating to try to articulate that repeatedly but i just want to thank you so much for having this conversation.

    I´m now motivated to seek out “others” (excuse the pun) working in the field of mental health and beyond to learn a more sympathetic approach in how to reach people in the community (i´m mostly UK based). It would be lovely to learn more from you and continue the conversation.

    Much warmth, Dionne

  4. This is amazing, Guilaine. You so eloquently articulate my feelings a 19 year old Black British girl. Thank you so very much. It’s so warming to hear this especially when other people of colour don’t see this.

    I was wondering is there actually a chemical imbalance that is exacerbated by external factors such as racism or socio-economic status? Or is it largely not biologically but an emotional response to the pressures of living in a Western world? Please forgive me if I have misread your article in any way.

    1. Hiya, thank you for your warm comment. It is much appreciated. I think, to try and address your question, the answer will depend largely on who you ask. I would tell you this: there is absolutely no evidence that mental health problems are CAUSED by ‘chemical imbalances’ in the brain. Our brain interact with our environment in complex ways and any change in brain structures which can be found may well be there because of the experiences people go through or as a response of their becoming psychologically distressed. In other words, not everyone with mental health problems will have anything ‘different’ cerebrally. Of those who do, we can never be certain that any difference(s) observed is the cause rather than the effect of their mental health problems. And, if a causal relationship was ever established, of course it is the environment which provides the conditions for mental health distress to manifest. In my opinion (as you probably gather), the narratives of illness/cerebral abnormalities and/or other biologically based explanation of mental distress are fundamentally flawed, unhelpful and for many, oppressive.
      My 2 cents. Hope this helps a little 🙂

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