On a humid July morning that was to hit 95°F, Tiffany Hathorn found herself frozen in her front yard. The 35-year-old copywriter from Searcy, AR, wanted to do the right thing, but she hesitated. Lying in the street in front of her house was a ripped-open cardboard box addressed to a house a few blocks away. It contained nothing but the paper packaging and a receipt for Bath and Body Works items that were long gone. Someone had likely stolen the contents and dumped the box outside Tiffany’s house. “I felt like I should return it,” she says. “But then I got nervous.”
Anyone might have wondered if the box had traces of coronavirus and thought twice before touching it. And, like any single woman venturing to a strange house, Tiffany considered whom she might tell where she was going. But her biggest worry was the one that strikes Black women and other people of color in particular: What if the person at the house prejudged her? What if they thought she had stolen the box? What if she ended up like Renisha McBride, a young Black woman who was shot through a screen door by a white man in Dearborn Heights, MI, in 2013? (It’s believed that the 19-year-old had a car accident and knocked on his door for help.)
Tiffany took a breath and decided to return the box to its owner, but first she snapped a photo of the address and texted it to a friend. “Just in case something happened to me. Like me being arrested. Or going missing. Or being shot. Or being killed. You know, the usual stuff you worry about when returning an empty box,” says Tiffany, who’d had Confederate flags waved at her while at a peaceful Black Lives Matters protest the month before. In the end, Tiffany and the white woman who answered the door chatted about the package, their children, and hobbies they shared before she headed home.
But Tiffany was exhausted. “It turned out well, but look at all the worrying and fear I had to push through,” says Tiffany, who has struggled with anxiety since she was a child yet wasn’t officially diagnosed with clinical anxiety until she broke down crying in her son’s doctor’s office 10 years ago. “But I guarantee you that even a Black person without clinical anxiety would have had at least some of the same situational anxiety I experienced.”
She’s right. While I don’t have an anxiety disorder, I am a Black woman, and I found myself nodding “yes” as she described each and every apprehension that ran through her mind.
If the COVID-19 pandemic didn’t send you into a spiral, the second shock wave of 2020 probably did. The Black Lives Matter movement has turned a nearly blinding spotlight on the ugly racial injustice that permeates a country where Black women like Breonna Taylor (who was sleeping in her bed in Louisville, KY) and Atatiana Jefferson (who was playing video games with her nephew in Fort Worth, TX) have been mistakenly shot by the police in their own homes. It has also added to the already burdensome emotional load Black women already carry with very few resources for coping.
As if the societal stigma surrounding mental illness and the difficulty of finding the right treatment weren’t enough of a barrier, Black women face additional challenges to getting support, says Angela Neal-Barnett, Ph.D., a professor of psychological sciences and the director of the Program for Research on Anxiety Disorders Among African Americans at Kent State University. There are many, but they include issues like a dearth of appropriate providers, financial concerns, and unique stresses Black women face that are poorly understood in treatment circles. Black adults in general (and Black women in particular) are more likely than white ones to report feeling sad and hopeless some of the time, according to the Substance Abuse and Mental Health Services Administration. But only 30% of Black adults who needed mental health care in 2017 received it. (The same survey found that 48% of white adults got the care they needed—not a great number, but better.)
Another big problem is lack of research into Black people’s mental health concerns: An oft-quoted study from 2000 shows that African Americans seeking treatment are less likely to be offered evidence-based medication, therapy, or psychotherapy. This also highlights another issue: a lack of research. There is a dearth of information not only on what’s happening in the African-American community, but also on what works for the African- American community. Sirry Alang, Ph.D., chair of the Health Justice Collaborative at Lehigh University and the author of a recent study on mental health care among Black people, points out that most of what we know about “evidence-based” treatments has been developed by research and experiments on white people, and so it isn’t necessarily applicable to African Americans. Here, Prevention takes a look at some of the obstacles and how they can be addressed.
Once you’ve decided to seek out a therapist, finding one you click with can be harder than getting your insurance company to rectify a mistake on a claim. Now imagine how much more difficult that might be if you needed one who deeply understood your background.
Unfortunately, the number of African Americans in the mental health profession is low. Only about 4% of psychologists, for example, are Black. “With the dual pandemics of racism and COVID-19 upon us, Black women are overwhelmed,” says Neal-Barnett. “We don’t have time to explain to a therapist what it means to be Black and female in this country. We don’t have the energy to educate our therapists about who we are as Black women.”
“That’s one of the reasons I started my practice,” says cognitive behavioral therapist Tamika Lewis, LCSW, founder of Women of Color Therapy, Inc., which serves the greater Los Angeles area. She notes that she’s one of just a few Black therapists for one of the largest health insurance providers in the region.
Ask pointed questions
While licensed therapists in most states are required to demonstrate some level of cultural competency—meaning they know what various communities are facing and can navigate cultural differences between themselves and a client—it can be hard to judge someone’s level of expertise off the bat. Rheeda Walker, Ph.D., author of The Unapologetic Guide to Black Mental Health, suggests asking your potential therapist tough questions.
“You want to know what percentage of their current or previous clients were Black or African American,” she advises. “You should also come up with a list of three potential therapists you’d consider working with. That way, if the first person you find doesn’t work out, your response won’t be to give up, especially if you’re already feeling tired, depressed, or anxious.” And a good therapist will continue to be open to learning, says Neal-Barnett. “Cultural competence is a lifetime pursuit—and data tells us we need more of it.”
One thing that keeps many Black women from reaching out for help is the belief that we should be able to handle anything on our own. “It’s been bred into Black women that we have to be strong all the time—but it’s a trap,” says Monnica Williams, Ph.D., ABPP, a psychologist and Canada Research Chair of Mental Health Disparities at the University of Ottawa.
“It’s been bred into Black women that we have to be strong all the time—but it’s a trap.”
The idea of putting an “S” on your chest and declaring yourself a superheroine has its upside: Recent research shows that there’s power in Strong Black Woman Syndrome that helps Black women deal with the racial discrimination we face. But there is a negative impact on our health and well-being as we push ourselves too hard and put others’ needs before our own. “If you have a machine running all the time and it never turns off, it burns out,” explains Williams. “Strong Black Woman Syndrome makes us terrible at self-care.”
Strong Black Woman Syndrome often arises because Black women who need support are not offered any. Williams recalls going on a zip-lining trip last April and being the only Black person there. The guides had helped everyone except her secure their harnesses and were preparing to leave—but Williams pointed out that she hadn’t been assisted. “The attendants weren’t trying not to see me,” she says. “They seemed just as baffled as I was that they’d overlooked me. But Black women are often invisible in society. They’re considered the least important and are the least protected. How do you get your health care needs met when nobody sees or hears you?”
Revisit what strength means
Asking for help is wisdom, not weakness. “There are so many things in society we don’t have control over, but whether or not we can lean on others and be vulnerable isn’t one of them,” says Walker. Black women actually have the power to leave Strong Black Woman Syndrome behind them, she says. “We need to remember that if we can overcome the fear of what people will say if we do ask for help, that actually makes us stronger,” she says.
Fortunately, mainstream media and celebrities are working to destigmatize the discussion of our problems and to encourage Black women to ask for help. Jada Pinkett Smith’s Red Table Talk on Facebook Watch has more than 9 million followers. The show stars Pinkett Smith, her mother, and her daughter as they hash out topics like mental illness, divorce, and racism. The show’s recently announced spin-off will star Cuban-American pop star Gloria Estefan and her family tackling similar topics. Therapist Joy Harden Bradford’s wildly popular Therapy for Black Girls podcast demystifies what happens in therapy and offers practical advice for strengthening mental health. Still, far more outreach needs to take place.
Being underinsured is a huge problem for many people, and while 86% of Black women in America had access to health care last year, levels of coverage vary, particularly among women of reproductive age. Tiffany Hathorn laments that while her plan covers medication for her anxiety, it doesn’t cover therapy. “I wish I had more options,” she says.
Others don’t have insurance at all: Coronavirus has left many people unemployed and without employer- provided coverage and has forced cash-strapped parents to choose between buying insurance for their child and buying it for themselves. Even people lucky enough to have benefits may be asked to pay more as higher charges are passed along to them by their companies.
If you want therapy but cannot afford it, experts suggest turning to a university in your area that trains graduate students to be counselors or psychologists. “If they have a clinic, it often is free or offers a sliding scale,” explains Neal-Barnett, who is also the author of Soothe Your Nerves: The Black Woman’s Guide to Understanding and Overcoming Anxiety, Panic, and Fear. “In most cases you’ll get state-of-the-art, high-quality care from someone who is being supervised by someone like me.” You can also ask any therapist if they are willing to negotiate a fee you can afford. If you are employed, ask your HR department whether your Employee Assistance Program offers culturally competent options.
The impact of discrimination and living in fear on Black women’s mental health cannot be overstated and is a huge source of anxiety and stress. Black women see a constant barrage of news and videos of people who look like them and those they love being killed driving while Black, jogging while Black, or sleeping while Black. We feel for our friends and family who are experiencing racial trauma, even if we are not directly affected. “I have a client who lost her father to police brutality. With everything that has happened with George Floyd, she’s dealing with PTSD in a unique way,” says Lewis.
Williams says the data backs up what therapists are seeing in their offices. “Research shows that the mental health of Black people suffers when events like the killing of unarmed Black men happen. Every Black woman I know is so emotionally exhausted seeing what’s been going on in America right now,” she says. Adding to their stress is well-meaning outreach from white friends who often then center the conversation around their guilt, says Lewis: “They’re putting Black women in a position to educate them and calm their nerves when Black women are already unhinged.”
Put yourself first
You don’t have the power to singlehandedly stop racism, of course, but you can blunt its impact, says Walker. A spiritual practice (like listening to empowering scriptures or repeating strengthening mantras) can help you manage tough moments and situations. “People who are more spiritual are also psychologically healthier,” says Walker. “If something negative happens at 9 a.m. at work, you have two choices: Path A is to be angry, ruminate about it, and get psychologically worked up. Path B is to focus on a grounding phrase that will get you from this moment to the next, like ‘The Lord will fight my battles.’”
Another thing you can do is become an expert in basic self-care, whether that’s keeping up a running practice, sleeping under a weighted blanket, taking regular trips to a nail salon, or seeing a therapist. Reframing any potentially negative situation you find yourself in, says Neal-Barnett, is extremely powerful. Tiffany sees her anxiety as “a blessing and a curse”—the blessing being that it makes her consider all angles of a situation. “You just have to work at not letting your worries and sense of caution get so out of control that you end up not doing the things you want or need to do,” she says. Such things could include a major step like accepting an exciting but scary new job or relationship, but also “something small, like returning an empty package to a stranger’s house,” she says. Tiffany says she’s glad she did it.
5 DIY Ways to Improve Your Mental Health Any woman can bolster her strength to get through trying times.
2. Form a sister circle.
Whether we’re doing one another’s hair, playing cards, or listening to music in a living room, Black women have always come together to share their worries. “The power of Black women gathering to support and uplift one another is an indigenous form of healing,” says Neal-Barnett. Also, figure out who’s adding drama to your life or draining your energy, suggests Lewis. Then set boundaries to limit the interaction (if any) you have with any such person.
3. Take note of your emotional triggers.
Notice what actions, phrases, or situations can put you in a terrible mood or lift you up on a cloud of joy. “They’re equally important to recognize,” says Lewis.
4. Do a quarterly relationship check-in.
Is there something you’re not getting from your partner (attention, assistance, affection)? What would it look like if you were getting it? “Taking time to think about this starts a conversation, a practice of vulnerability, and a habit of asserting your needs,” says Lewis.
5. Get enough rest.
“Sleep is directly linked to mental health,” says Neal- Barnett. Be sure you’re getting at least seven to eight hours a night.
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