For a moment in time, we have stopped talking about COVID-19, and focused on humanity, and the current discourse is about how none of us should be silent about racism. There is a call for us all to be anti-racist. As people of colour, if you do not speak up, you are agreeing with racism. As white people, you are colluding with racists by not speaking up.
I am a believer in justice and standing up for the disenfranchised, because I know what it is like to not have your voice heard. Without systemic justice, though, nothing will be fixed. Within a system that is just, individuals all have access to all opportunities. And no one is discriminated against for individual characteristics such as race or gender or socioeconomic status. Or, mental health.
Historically, mental health has been developed by white males, and still today, the majority of the field is still white, so where does that leave the unique challenges of suffering with a mental illness as a person of colour. A lot of research has gone into the diagnosis of mental illness and the development of the diagnostic tools. And these are reviewed to ensure that our definitions are relevant to the context within which we live. However, we are still using diagnostic tools, which are predominantly developed with a Euro-centric, Western understanding of human behaviour.
As an example, there is still an underdiagnosis of girls with ADHD because the symptoms were initially based on boys, and hyperactivity may look different for a girl, which is why many women are only diagnosed with ADHD in mid to late adulthood. The same goes for Autism. And because women are socialized differently in society, women on the Autism spectrum, are able to hide their symptoms, because there is a societal expectation to fit in, and behave in a certain way to be regarded as a woman in this society.
There is also an underrepresentation of men with mental illness, because there is still the stigma of mental illness being an indication of weakness. Men are not readily willing to admit that they are suffering, and also willing to seek help, for fear of not “manning up”, or appearing weak. Boys are taught that they are not to ask for help, or cry.
What about the cultural meaning of “hearing voices”, such as when the ancestors are speaking? Or when you are called to be a sangoma? There are a number of beliefs within the African, South American or Asian cultures, which can be explained away as a symptom of a mental illness. So how do we differentiate between cultural understanding and mental illness symptoms?
Aside from the stigma of mental illness, there is the stigma of seeking help for mental illness, and seeing a psychologist for a “white” disease. As a person of colour your family might not understand or agree with you struggling with a mental illness, and you might be judged, or ostracized for seeking help for a mental illness. And being that many causes of mental illness relate to family dynamics and triggers as a result of lack of family support, this presents quite the predicament.
And finally, access to mental health practitioners. The majority of psychologists are white, and the majority of therapy is conducted in English, and Afrikaans. When searching for a psychologist, you may want to see someone who fits the same demographic as you do, or speaks the same language as you. How difficult must it be to undergo therapy to uncover deep-seated emotional and identity issues in a second, or third, language?
Also, the socioeconomic barrier for people of colour in having access to the mental healthcare professionals that they may need. A number of studies have been conducted on the inequality of healthcare systems, and mental health care is a privileged form of care, which further creates a barrier between the races and socioeconomic classes. Healthcare systems in South Africa have been shown to be unequally distributed within the country.
It’s also important to consider the fact that certain behaviours are prevalent amongst the impoverished, and when impacted by mental illness, they are not subtyped as being afflicted by mental illness, but are viewed as criminals or deviants. Because of unconscious bias in regards to race, there are certain characteristics attributed to certain races, like violence, which have the potential to result in misdiagnoses, or underdiagnosis. As an example, being lazy is attributed to being black, but one of the key symptoms in ADHD or depression is reduced productivity. This will be missed as a diagnosis, if it is assumed that the person is inherently lazy.
When considering mental wellness within the context of race (or gender, or sexuality), we need to acknowledge further layers of challenge, and stigma associated as a result. And ultimately the fact that anyone with mental illness, regardless of demographic wants to be heard and cared for, and understood.
Counselling Psychology in South Africa by Jason Bantjies, Ashraf Kagee, and Charles Young
HPSCA Report of the Working Group on Promulgation of Regulations
Synergi Collaborative Centre briefing paper on priorities to address ethnic inequalities in severe mental illness