Black people self harm, too
Unlearning the stigma of my disabilities and their symptoms enabled me to connect with other Black folks who share similar experiences.
by Tahirah Alexander Green
The Compounded Struggle: Surviving medical racism in mental healthcare and the stigma of psychiatric disability in the Black community
This essay contains discussions of medical racism and self harm
“We’re not white, we don’t do this,” Daddy shouted as he guided me to the car to drive me to the emergency room at Georgetown University Hospital. The memory of that afternoon is pretty hazy, but the overwhelming emotion I tried to alleviate through self harm remains scarred across my arms to this day. Less visible is scarring from the trauma of my first in-patient hospitalization for a mental health crisis.
My psychiatric disabilities—anxiety, depression, and post-traumatic stress disorder—made me believe I was a worthless failure. Growing up, my family’s approach to mental health was either silence or “pray on it.” Black people fought through the pain. We were strong. That’s our culture. Any other behavior was so shameful it was best ignored.
My father, like many others in Black communities, viewed self harm as particularly alien, something white. On the surface, the statistics on self harm seem to support this idea, with rates of self injury highest among white people. With so few studies exploring self injury and race, I imagine there is actually a dearth of information on the subject and that Black people under report.
Admitting to myself that I was struggling with self-harm was a challenge. I couldn’t fathom opening up about it to someone else, let alone a researcher who was likely not to be representative of my community. As a Black person, accessing resources to heal, manage, and thrive with psychiatric disabilities can feel near impossible. My first hospitalization certainly made me believe the healthcare system wasn’t able to help me.
The earliest memory I have of the inpatient psychiatry unit, 5 West, is of sitting in a sterile room while a be-speckled, white psychiatrist interrogated me. I think this was supposed to be an intake, but his tone was more flippant and aggressive than any other provider I’d experienced at that point.
“What are the sources of your stress?” he asked. I started to describe how I graduated with substantial debt and was struggling to get a job. His response was, “So? That happens to lots of people.”
My other most vivid memory is of sitting in a larger room with this same psychiatrist, joined by a sea of white faces I presumed to be students. Donning white lab coats, they scratched away furiously at their notepads as the doctor hurled seemingly random questions at me. “What are you reading?… Why are you reading that book? What’s the book about?”
It seemed an odd place for small talk. Twelve eyes bored into me as I responded, looking down at my lap to bare the discomfort. I wanted to opt out, but the ward’s philosophy took all perceived disobedience as a sign of illness.
There was a board on the wall in the corridor listing the names of the ward’s staff, with a few fun facts about them, like their favorite movies. The cheery faces seemed out of place in what I remember as a dim hall, reeking of bleach. It seemed to me that all the staff was white. My psychiatric disabilities made me feel isolated and lonely, and now the alleged treatment was compounding this.
According to the American Psychological Association, in the United States the vast majority of individuals working in the field of psychology are white—roughly 80%. How can a white-dominant field adequately develop the standards and practices essential to ensuring Black folks are properly treated and cared for when we self harm or have other mental health struggles?
A few days into my stay, I asked to leave. Every time I watched people walk through the heavy door at the end of the hall, I felt trapped. I wanted clean clothes, my clothes. I wanted to shower. I wanted to breathe some fresh air. I wanted to use a toothbrush that didn’t disintegrate in my mouth. I longed to eat food with flavor.
I forced myself to eat all the bland mush they served, because if I didn’t it could be held against me. A refusal to eat what was provided would be perceived as a symptom of my disability, as opposed to an aversion to food that was pale and dry. Between the daily dehumanizing sessions with the medical students and the experiments with my medications, I feared staying any longer would exacerbate my symptoms to the point that I would not be able to leave.
The doctors tried to dissuade me, claiming leaving against medical advice would make it more difficult when I came back. When I came back. It seemed like a threat, as if I was destined to be institutionalized. When I had first arrived at the ER, staff advised me that if I didn’t check myself into the ward voluntarily they’d do it by force. A forced hospitalization came with a longer stay. At the time, I felt I had no choice, but the voluntarily hospitalization would be the key to my escape.
The only moment I recall healing that week was when I filled out the paperwork to leave against medical advice. Having voluntarily entered the ward, I could voluntarily leave it. There was a waiting period, but at last I knew I’d get out. It gave me a sense of hope. I admit, though, in order to leave, I swallowed the truth of my symptoms, answering doctor’s questions with what I knew they wanted to hear.
Did I have thoughts of self-harm? Of course, not, I’d say. Coping with my family’s attitude towards mental health meant I’d developed an aptitude for feigning stability. In many ways, I’ve been in training my entire life. Living as a Black person under white supremacy means I often had to camouflage myself to succeed—assimilate to white dominant norms in school and workplaces. Healthcare facilities were no different.
This is a devastating reality, given so much of healing rests on being able to name truths so you can begin to find the tools to address them. Throughout my life there have been numerous times I desperately needed help, but didn’t reach out because I feared being treated the way I was at Georgetown.
It would be three and a half years after that hospitalization before I finally found a provider who offered the care I needed. Six years after I first received my formal diagnoses. The time in between included inconsistent treatment, trials and gross errors with medication, and healthcare as traumatic as the experiences that led me to seek it out.
I was able to access appropriate care for one reason—I’d gained the financial means to do so. I now have the privilege of a job with health care benefits that enable me to see a queer woman of color therapist who approaches her practice with a keen awareness of power imbalances in healthcare.
In therapy, she pulls from expertise on the impacts of racial trauma, and even shares guidance rooted in her lived experience. She specializes in gender and sexuality, and works at a LGBTQ health clinic. I can walk into her office and say, “This white girl is taking up too much space at work and it’s stressing me out.” Instead of looking like a deer in headlights, as my previous white providers often did when I tried to broach any racial dynamic in session, she can actually empathize. She can offer me tools and resources that resonate and help.
It’s been four years since I’ve self-harmed. The thoughts still come every now and then, especially in times of acute anxiety or crisis, but I finally have a care team that alleviate, rather than exacerbate my symptoms. Unlearning the stigma of my disabilities and their symptoms enabled me to connect with other Black folks who share similar experiences.
I know Black people self-harm, too. I know I’m not alone. I get to experience how powerful it is to share resources with my fellow queer, Black nonbinary folks. We can advise each other to snap a rubberband on your wrist instead, write a message from a loved on the part of your body you want to cut, engage in an exercise that gets your heart rate up, make a list of things to do that you can reach for when the urge happens, and confide in each other online through groups like Rest for Resistance’s qtbipoc healing space.
This community is powerful, essential, but it isn’t always enough. So many Black people can’t access care. Some are isolated away from community. Many have had such horrific experiences they don’t want to risk accessing mental health care again. We’ve witnessed and grieved our loved ones caged or murdered when experiencing symptoms. Hiring practices in the field mean mental health practitioners who share our identities are seldom working at the larger hospitals and clinics that take insurance. Many of my peers don’t have insurance at all, and when they do copays can be so exorbitant the cost barrier remains. This needs to get better, we need more than piecemeal reform, we need disability justice.
Tahirah is a literary artist living in their hometown of Washington, DC. As a writer, they’re passionate about celebrating Black queer weirdos in their work. They are a firm believer in the power of art for social change– stories matter, and sharing our stories to effect change is a crucial component of movement work. Tahirah is a 2019 Lambda Literary Fellow, 2018 Sanctuaries DC Arts for Social Impact Fellow and a member of Black Youth Project 100’s MelaNation Zine team. Follow them on twitter to get updates on their work @TahirahAGreen