Recently, former first lady Michelle Obama spoke about experiencing ”low-grade depression” caused by the double pandemic of covid-19 and racial strife. It was a striking admission from a woman regarded as a strong role model. But as Black female psychiatrists, we know that even the healer needs healing sometimes.
We and our colleagues are well versed in diagnosing depression and anxiety. Some of us suffer from it ourselves. But what all Black women are facing today is something different, something additional. Black women sit squarely at the confluence of multiple systems of oppression, and are experiencing a disproportionate loss of life and livelihood in the era of covid-19.
Lately we have seen an unusual number of Black women exhibit symptoms that would normally be attributed to depression, including fatigue, sleep disturbances and hopelessness. According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), our profession’s handbook of mental disorders, consideration of any diagnosis of major depressive disorder must take into account any “underlying cause.” If one exists, it must be treated first.
In the case of Black women, the symptoms are the inevitable result of the pandemic’s impact on human psyches that are already systematically oppressed and battered. Our current mental health systems over-pathologize Black women’s experience of pain and trauma without first affirming the source of the stress: ongoing delayed justice for our community.
The pressures are easily seen: According to a report by the nonprofit organization Lean In, Black women are nearly twice as likely as White men to say that they’ve been laid off, furloughed, or had their hours and/or pay reduced because of the pandemic. Black women are more likely than White workers to work outside the home as essential workers.
Black women are also taking on more responsibility as caregivers, the study shows. Almost half of Black households with children are headed by single women, and so must face issues of child care and virtual schooling on their own. Black women report spending three times as many hours per week caring for elderly or sick relatives as do White women.
In June, a Washington Post-Ipsos poll found that 31 percent of Black adults personally knew someone who had died of covid-19, compared to 9 percent of Whites. An online survey of more than 1,000 Black women by Essence magazine had similar findings, and also noted that 63 percent of respondents felt their mental health was being affected by the pandemic.
As Black female psychiatrists, we recognize the feeling of being overwhelmed. There aren’t many of us: Roughly 2 percent of practicing physicians in the United States identify as Black women. Of those, only a small number choose psychiatry as their specialty.
Like our male counterparts, many of us choose to practice in Black communities because we know firsthand how the mental health profession overlooks Black people. We think often of the fact that only one in three African Americans who need mental health care receive it. We know that compared with the general population, African Americans who seek mental health care are less likely to be offered either evidence-based medications or talk therapy.
Even if we all saw patients 24/7, we Black female psychiatrists could never meet the mental health needs of Black women. On the rare occasion that we meet, we speak freely about the anguish we feel. We tell each other how we cried when our own therapists asked how we were holding up. We let our shoulders slump from the weight of it. We admit that we have no answers, and at times feel hopeless.
And then we get up again, and we do our jobs.
Without doubt, all Americans are at an elevated risk of mental health problems because of the stress of the pandemic. However, the tremendous social, psychological and economic load placed on Black women in particular warrants dedicated attention.
As psychiatrists, and as Black women, we believe it is imperative that our mental health is a national priority. Black women uphold households and serve the country as essential workers. We are strong. We are resilient. We persevere. But what we really need to maintain mental health is societal change, at all levels.