My Sisters' Keeper-Part One.

As I was preparing to leave work one evening I looked at my schedule for the day. Seven of the ten patients that came in for appointments that day were women of color (five Black and two Latina). Although each woman presented with a different issue,  they all had one thing in common: each one told a story about trying to be strong and hoping the bad feelings would pass. This saddened me and made me think about the experience of being a woman,  the extra "fun" that comes with being a woman of color, and how being a woman impacts mental health. I split this into 2 parts because it was all over the place trying to cover everything. Today I'm focusing on my experience of working with black women. 

Oh what a wonderful thing to be a woman! We come with extra body parts that do amazing things such as create life and make food. We are hardwired to be nurturing, caring, and loving. Sounds awesome doesn't it? It is, until you factor in the extent to which being a woman is a set up to be discriminated against, and victimized in many ways. Consider the single mother who works long hours, and is sexually harassed by coworkers. She doesn't feel like she can report it for fear that she will be fired and have no way to care for her children. What about the women who have been stuck in abusive marriages, yet lack financial resources to leave or have families that tell them that divorce is wrong?  Or how about the fact that our bodies sometimes betray us, and don't function as they should? This can leave a woman feeling that something is "wrong" with her. Now factor in being diagnosed with a psychiatric condition. Then amplify the situation by being a black woman: the person born with two strikes against her.

There are many studies about patients' preferences for providers of the same ethnicity (racial/ethnic concordance), but not much exists about the provider perspective. When I worked in a clinic with a more diverse staff and population I didn't think about it as much. Now that I am the only black person in my role I'm more aware: black girl magic happens in my office sometimes. Before I jump all the way into this, I just want to make it clear that I treat ALL of my patients with the same dedication and respect; no one receives preferential treatment. Taking care of a black woman is just a different experience sometimes. It really hit home for me on the day that I mentioned above. As the last patient was leaving she mentioned how comforting it was to meet with someone who looked like her, understood her style of speaking, and didn't overreact to her sounding loud and angry. Her statement basically summarized everything for me. My blackness can be therapeutic to the woman who has a mistrust of the medical establishment. I have the ability to translate the unspoken words communicated by certain facial expressions and the multiple meanings of the word "girl" depending on the tone of voice or way that it's pronounced. Although our lifestyles and upbringing may be different, I still know what it's like to walk through this world in a black woman's body being exposed to all sorts of stereotypes and discrimination. I understand the culture of being taught to be strong, not show any signs of weakness, and being told to pray about it. Sometimes we laugh and joke while crying inside. Unfortunately I know what it's like to hit a brick wall and need help to breathe again, and I didn't want to take prescriptions medications either.  I'm often reminded of one reason I decided to work in psychiatry. During my undergraduate nursing program my psychiatry rotation was at John George Psychiatric Pavilion in San Leandro. There were patients my age who had multiple hospitalizations, or ignored symptoms for years and ended up hospitalized. I wanted to help people stay healthy and out of the hospital.

So what happens in my office? It begins with her smiling most times when I call her name in the waiting area. My goal: make them realize that having a mental health issue doesn't make you crazy or weak (despite what your family or friends say), and make them believe that they can be better. My office is a safe place for them to talk about anything that's plaguing them.  They can laugh, cry, or not say much at all. It's 30-60 minutes to focus on her, not the grown kids on her nerves or the husband that won't help around the house. Sometimes we talk about race, politics, the new generation's lack of home training, and community violence. We have a lot of conversations about not being responsible for childhood trauma and having the power to work through it. Yes, sometimes I encourage them to set boundaries (cut people off without feeling bad about it). When it's necessary I encourage them to take their medications. Ultimately, my hope is to decrease the stigma of mental illness in the black community one person at a time; sometimes people encourage their friends and family to get treatment after they feel better.

** Insert my obligatory rant about political and economic issues (it's hard to write without one because of all the foolishness we're currently subjected to). The proposed health care finance bill is a bunch of rubbish (it's not a healthcare bill, it's all about money). They want to reduce funding for mental health and substance abuse treatment. How is that helpful to American people who are traumatized by the reality that they can be killed because of their skin color, and or having a history of mental illness? The recent murder of Charleena Lyles in Seattle was a harsh reality check: she could've easily been one of my patients (a black woman with children, and mental health issues).