Listen to this article

This issue discusses mental health and may bring up topics that can cause mental distress. If you or anyone you know needs assistance, please call Lifeline on 131114, Beyond Blue on 1300 22 4636, or 000 for immediate help.

 

I run a fairly popular therapy and coaching service for Black people and people of colour in Australia.  My work as a psychotherapist is informed by the academic research work that I do on Afro-diasporic scholarship on the intersecting topics of racial trauma, belonging, blackness, and migranthood.  This work is underpinned by research evidence from various studies that report on the impacts of the stress of racial minoritisation and marginalisation on the body and on the psyche. 

Black migrants and minority stress

All migrants experience some form of stress when they upend their lives and re-settle in a new country. Having a minority racial/cultural background often means additional challenges and barriers to the migrant experience. In particular, migrants who lived in spaces where they were part of the majority previously may experience more complex challenges in their settlement experience in Australia as they may not have much resilience in coping with being a minority. 

Migrants from racially and culturally minoritised groups also struggle with contradicting experiences of becoming hyper visible, where their bodies are marked as different while at the same time, being highly invisible when it comes to employment, promotions, etc. My clients often reflect that they are forced to adopt identities that were never pivotal or important for them in their home countries. For the first time, they might start describing themselves as “African” or “Black,” even though those identities may not have held any strong political and social relevance pre-migration.

Minority stress is a framework that explains the relationship between structural stressors (e.g. racial discrimination at work), the coping factors (e.g. substance abuse, hypervigilance), and health outcomes (e.g. anxiety, depression or cardiovascular diseases, high blood pressure etc.). According to a study by Pittman and colleagues , minority stress is: 

 

(a) unique – an addition to the everyday stressors experienced by all people; 

(b) chronic – constant and ongoing practices that reproduce experiences of “outsiderness;” and 

(c) socially based – experienced within social spaces, institutions, and structures beyond the individual 

‘Colour-blind’ mental health approaches

The weathering framework, developed by public health researcher, Professor Arline Geronimus, is one useful approach that may help us understand how minority stress can be applied to racial and cultural minorities in Australia.  Akin to a rock being eroded by constant exposure to the harsh elements, weathering wears down your bodily systems so that in effect, a person becomes chronologically older than their biological age. In a recent NPR interview Prof Geronimus stated that, “it’s not that every Black person has more weathering damage than every white person [but rather] it’s about how much stress [one experiences] versus social support you get in your everyday life.”

One would assume correctly that if racial stress was such a big predictor in people’s overall health and mental health specifically, that more attention to race and racism would be accorded in mental health training.  Maybe this has changed, but in my training as a psychotherapist there was no mention of racial trauma, race, or racism in our entire curriculum. It was never mentioned, addressed, or even considered. This was just a little over a decade ago.

To put it bluntly, my training never prepared me to work with people who weren’t white. The psychology approaches we were taught were generally based on experiences of people in WEIRD societies – that is, Western and/or WHITE, Educated, Industrialised, Rich, and Democratic. WEIRD studies that have for centuries significantly influenced psychology – including how mental health diagnoses are made – assume [incorrectly] that there is very little variation across WEIRD experiences and other populations, thus cementing Anglo-centric approaches in mental health practice.  The expertise I have developed over the years on anti-racism in psychotherapeutic practices has been intentionally sought due to the gaps I observed in mental health services in Australia.

The psychology approaches we were taught were generally based on experiences of people in WEIRD societies - that is, Western and/or WHITE, Educated, Industrialised, Rich, and Democratic.

Dr Kathomi Gatwiri Tweet

Seeing race and seeing its impact in mental health practice with migrants

So, how does knowledge about how weathering and minority stress inform the work I do as a psychotherapist now? The first issue I noticed amongst my clients was the over-focus on individualized approaches that led to clinical diagnosis of depression and anxiety. However, as we worked through the issues, I noticed many of my Blac/k clients were describing symptoms of racial battle fatigue and in some cases, weathering.  Coined by American professor William Smith, racial battle fatigue is the cumulative impact of living in a space with high racial stressors.

There are social, psychological, physical, spiritual, and emotional implications of racial stress. Socially, clients talk about disconnecting from their relationships, likening their withdrawal to feeling lethargic, flat, blue and unmotivated. Psychological symptomatology may include feeling anxious and hypervigilant, feeling hypercritical of one’s self and focusing on perfectionism. Thoughts of worthlessness, feeling like an imposter and as though they’re not good enough are rife, especially in the workplace.

Physiologically, my clients have reported issues with their digestive systems, diarrhoea, constipation, and bloating. They also oversleep or under sleep and report constant somatic aches in the body that are not solved by painkillers or “rest.” Emotionally, they talk about a heightened sense of chaos, vigilance, irritability, resentment, and anger. Spiritually, clients reflect on a sense of powerlessness and hopelessness over their lives in general, feeling defeated and ‘not seeing a way forward’. For Blac/k patients, it is very important that these symptoms, which present similarly to other mental illnesses, are viewed holistically through a trauma-informed and an anti-racist perspective.

What can we do?

  1. Talk through your symptoms with a psychologist or psychotherapist who understands how race and racism affects the everyday experiences of feeling human.   There might be people who have been given a significant mental health diagnosis when they are mostly presenting with the fatigue of weathering everyday structural stress caused by inequality and minoritisation in a race-conscious society. 

2. It might be useful too, to re-evaluate your own internalised stigma about mental health. For some of us, especially from Brown and Black communities, we may have grown up in cultural contexts where mental health is only ever seen through the extreme. Think of how stereotypes around mental illness may have disconnected you from navigating your own infrastructure of mental health safely and kindly. 

3. I suggest that we take active steps in decolonising our healing processes. As I mentioned earlier, there are several psychological approaches that have been developed without people of colour in mind. Approaches that focus on eliminating the flaws within an individual rather than eliminating the structural injustice and inequality affecting the individual may feel ineffective or ‘blamey’ for people who have been impacted most by systemic inequality. 

4. A combination of the personal and the political should be a part of working with people whose personal lives are affected daily by structures and systems surrounding them. It’s important however to recognise that a one size fits all model does not work.

5. Be mindful of mental health approaches that are colour-blind as they do cause harm and are ineffective in addressing the chronic impacts of racial stress or racial trauma.

In summary, experiencing daily racial stigma and prejudice (both in overt and covert ways), including the expectations of racial prejudice and discrimination, cause people to internalise societal stigma and can lead to racial trauma. Living in a race-conscious society may lead to minority stress and experiences of hypervigilance.

If reading this article has raised any issues for you, I recommend the following psychology, counselling and psychotherapy services that operate from a culturally safe framework. 

 

Other services:

 

MEET THE AUTHOR

Dr Kathomi Gatwiri

Dr Kathomi Gatwiri is an Associate Professor in the Faculty of Health at Southern Cross University, an ARC DECRA Fellow at the Centre for Children & Young People (CCYP), President of the peak body Australian Women & Gender Studies Association (AWGSA) and a practising psychotherapist. Kathomi is one of Australia’s leading Afro-diasporic scholars whose award-winning interdisciplinary research investigates the intersecting topics of racial trauma, belonging, blackness, and migranthood. Dr Gatwiri has received numerous awards for excellence in research and community service, including a Vice-Chancellor’s Award in Research Excellence and Outstanding Community Impact. She is the Founder and Director of Healing Together, a service that provides accessible, culturally sensitive therapeutic support for people impacted by racial trauma.