by Guilaine Kinouani Follow @KGuilaine

I felt privileged to read Chimamanda Ngozi Adichie’s powerful words on depression. The piece, reportedly published in error, has now been removed. The courage and honesty it took for her to come forward and describe her experience with such intimate detail was truly moving. To a large degree, I was not surprised by her account. Indeed, many 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 these experiences to come with the territory of having to navigate through injustice and oppression. We call that life. The bio-chemical theories which may account for what seems to only become manifest in structures of domination and subjugation don’t necessarily matter much to us. In spite of the controversy surrounding the article’s publication and subsequent removal from The Guardian’s website, it at least seems to have encouraged a conversation on the emotional needs and experiences of Black and African women.

Sadly, these conversations have occurred almost exclusively within a medical/psychiatric model and many websites are now urging Black women to seek support for this ‘illness’. Whilst attempts at encouraging people to seek support for emotional or psychological problems must be applauded, the imprisonment of Black women’s experiences within a medical discourse needs to be questioned. Indeed, it does not speak to all of us. Personally, it was only during the course of my psychology studies that I realized that this recurring feeling of imminent passing 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-traumatized.

Is depression a useful word for Black women?

These categories erased the daily onslaughts on my existence whilst positing that I was diseased. I did not feel shame. I did not feel stigma. I felt insulted in my intelligence and in my experience. Many of my friends and relatives would rather drink a bleach cocktail than head for mental health services. Unlike Chimamanda however, most of the Black women I know would not dream of calling what they experience ‘depression’ (or ‘anxiety’ or any other term for mental ‘illnesses’). Although we are all too often conditioned to think so, for many Black women, this approach makes no sense. And why should it? Why should Black women be expected to locate their distress within mainstream psychiatric frameworks—frameworks that have historically been used to pathologize and interiorize us—without resistance?

Do not be fooled into thinking for one second that Black women are oblivious to the normalization of the racism and sexism imbedded within psychiatric standards of normality. Some of us 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, we have learnt the life-limiting impact of being in a world that is pre-emptive 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 preconceptions. And it is highly disturbing that we would be pathologised 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.

 

The case for a ‘paradigm shift’

Black women’s distress, even within mental health services, is often not seen. Perhaps this is unsurprising if we are forced to adhere to a worldview and use a language that can invalidate our very pain, distress and experience of the world. Yet, it is a language that millions of people accept without question. A language now embraced even by people whose interests may not be served by it. A language which seems to have become a pre-condition for our psychological needs to be seen. A language that, to me, perpetuates centuries of oppression by erasing our experiences and histories as Black women, and which replicates the invisibility of our wounds. It is perfectly within anyone’s rights to choose the name given to any lived experience, without being devalued.

If the medical model does help women like Chimamanda make sense of their experience and care for themselves, then this must be respected. However, it is important not to lose sight of the fact that the evidence upon which illness/disease theories (such as chemical imbalance in the brain) are based remains contestable. In its attempt to shift current conceptualisations of emotional distress, the British Psychological Society’s Division of Clinical Psychology (DCP) issued a position statement on psychiatric diagnoses. The statement makes clear that current psychiatric classification systems and diagnoses have significant limitations—both conceptually and empirically.

Further, in making the case for what it calls a ‘paradigm shift’, the DCP highlights the impact of psychiatric diagnoses on the lives of those in distress. These impacts include the marginalisation of lived experience, the decontextualisation of distress and stigmatisation. Encouragingly, the statement also recognises the ‘ethnocentric bias’ inherent within such conceptualisations given that they come out of a Western worldview and, that can translate into discriminatory practices.

On one hand, we have come a long way in terms of increasing the relevance and appropriateness of mental health services for racialised groups. Indeed, specialist services have burgeoned in the past decades and various collectives now exist to try and ensure that psychological needs are met in ways that are more congruent to peoples’ values, worldviews, histories and social realities. For example, the Nasfiyat Intercultural Therapy Centre specialises in providing psychotherapy for clients from diverse backgrounds. The Black and Asian Therapist Network (BAATN), a network of well over 800 therapists, counsellors and supporters, seeks to better address the psychological needs of Black and Asian people in the UK. The Afiya Trust and Black Mental Health UK, were set up to help reduce the inequalities in the mental health care for people from BAME groups and African and African-Caribbean communities respectively and, to support these communities increase their strategic influence in the commissioning and developing mental health services.

On the other hand, whilst our voices might have got louder, race-based inequalities within the mental health system remain starker than ever, and the training curriculum of most mental health professional is still uncontestably White. As shown in the Care Quality Commission’s Equal Measures report it remains the case that I, as a Black woman, I am more likely to be prescribed psychotropic medication than to be offered therapy; that my chances of being coerced into psychiatric ‘care’ if I am in distress are still much higher than average; and that I am less likely to want to engage with mental health services.

A better approach

Rather than giving further support to the dominant discourse, the way to encourage Black women to seek support for emotional problems is to make space for other conceptualisations of distress, to allow us to name our experiences and use whichever framework rings true for us. This means accepting with humility that psychiatric diagnoses are just lenses and, as such, they are not the only frameworks that exist to make sense of the world. Though there are relatively few studies looking at the experience of women of colour who have used mental health services, when their voices have been listened to (see, for example, the Mental Health Foundation’s Recovery and resilience report), it has been clear that they have felt restricted or oppressed by mental health services’ dominant view of mental distress as ‘illness’, that they felt their distress was decontextualized, and that alternative views of distress were problematized.

Various frameworks do exist to understand and situate our experiences as Black women, including: socio-political, religio-spiritual, inter-generational/ancestral, intersectional approaches, and combinations of any of these or many others. The problem with the current conceptualisations of emotional distress is that they silence other narratives and worldviews and thus further marginalise other epistemologies and ontologies. This restricts our ways of thinking or knowing, and, put simply, perpetuates invisibility and disengagement. Not only is this wounding; it may well prevent the most distressed amongst us to come forward, seek help or speak out.

My sincere hope is that powerful women like Chimamanda will champion marginalised and silenced narratives and give credence to explanatory models that are more consistent with Afro-centric worldviews. Doing so may help position our experiences of distress within the struggle for liberation and recognition.

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Guilaine is a French woman of African descent, an amateur writer, an independent trainer and a race, culture & equality consultant currently working toward a Doctorate in Clinical Psychology and accreditation as an integrative psychotherapist. Before this, she completed a degree in Cultural Studies and studied Counseling Psychology after obtaining a Masters in Transcultural Mental Health. She blogs at racereflections on the interface of psychology, mental health, social justice, inequalities and difference. Tweet her @KGuilaine

This article was edited by Sunili Govinnage

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