Mental health is undeniably important. Any type of mental illness, until recent years, was heavily stigmatized. In fact, it wasn’t until the 1970s that mental illnesses were seen as a chemical imbalance in the brain as opposed to mystical causes or moral failings. Even now, there are mental illnesses that face intense stigma such as schizophrenia and antisocial personality disorder. Any of these illnesses can be isolating and debilitating to the point of disability. It’s fantastic that discussions surrounding mental health are so prominent, and that people are finding community with each other. Lessening that stigma is a wonderful thing.
However, I’ve always found it unusual that discussions about mental health are so open among younger generations, but I’ve seen little discussion about the privilege that comes with being an advocate.
Now, let me clarify before I get further into this. I’m not saying anyone is privileged for having a mental illness. Rather, there is a privilege in being open about having mental illness, in saying to people that you are struggling as opposed to struggling in silence. This privilege isn’t fair, nor is it right. I wish everyone were able to be as open as they want with their mental health. However, that simply isn’t feasible for many.
Mental Health and Medical Bias
People, particularly women and gender non-conforming people, and especially those who are chronically ill/physically disabled, often times have to hide their mental illnesses in order to receive quality care for their physical illnesses. While, people with mental illness report being dehumanized and dismissed by their healthcare providers, this is doubly true for anybody with both mental illness and physical illness. There are numerous accounts of serious medical conditions being dismissed as “all in your head” or “just anxiety.” It happens every day. Take the woman with a stroke was misdiagnosed as having an anxiety attack. Or just look at reddit forums that discuss the various illnesses that were brushed off as anxiety. Science already shows that Women are more likely to die from heart attacks because their symptoms are brushed off as anxiety. This also is true for other diseases. Women are more likely to be misdiagnosed, with a 17.5% rate of misdiagnoses for strokes and a 22.5% rate of misdiagnoses for lung cancer. These serious illnesses are often misdiagnosed as stress or anxiety. So would it come as any surprise that women with existing mental illnesses would hide or downplay their diagnoses in order to get physical illness?
We don’t even have great studies that show the rates of misdiagnoses in gender non-conforming people. Anecdotally, one trans patient has reported: “[My doctors] treat me as if I had no rights. As if I weren’t human. Many times my doctors have refused to treat my asthma and diabetes. They allege my problems are mental, they dismiss the symptoms I describe to them and mock me because I am trans.”
Studies show that nearly half of trans people have been mistreated by healthcare professionals and 28% of trans people have postponed or not received care out of fear of discrimination. Another 28% of trans people of color have been refused care by a professional. Read that again. Over a quarter of the trans population have been flat out refused care because of anti-trans bias. In fact, politics have tried to instate policies that in order to receive gender-affirming care, someone must not be autistic or have any “psychiatric symptoms.” So, it should come as no surprise that many gender non-conforming people try to hide their mental illnesses in order to receive some physical healthcare.
Equally devastating is the fact that despite 81.7% of respondents to the U.S Transgender Survey reporting they had suicidal ideation, there are barriers to mental healthcare as well that ensure many trans people cannot access therapy. Without a safe space to discuss mental health, and the physical health risk involved of talking about any diagnoses to medical providers, trans people are often forced to struggle in silence.
I’ve personally experienced medical bias
I personally have learned to hide my mental illnesses from every doctor I’ve had (until recently). This is because for five years I was told my numerous chronic conditions were all from mental illnesses. During a hospital stint where I went nearly two weeks without food because of continuous vomiting, I was refused any treatment options outside of talking to a counselor. They said I had an eating disorder. My mom and I spent hundreds of dollars and a week of traveling in order to go to the Mayo Clinic because of unexplained symptoms (which I now know was EDS and periodic paralysis). They did an incredibly in-depth intake, and numerous doctors were intrigued by my case. They were ready to do all sorts of physical testing, until I had mentioned that I had been sexually assaulted years prior. Those tests then turned into appointments with their psychiatrists and a class on somatic breathing exercises.
I’ve been told my queerness is the cause of my symptoms, and that “women create their own problems for attention.” My identities were used as extra fodder for biased professionals to dismiss me. To add salt into the wound, doctors were eager to add depression and anxiety to my chart without once consulting me or a mental health professional. All of this mistreatment ultimately caused me to develop medical PTSD. It’s only now that I have diagnoses for my conditions and a trusted, unbiased care team that I feel safe to seek treatment for my mental health. Because, unfortunately, as much as I needed treatment years ago, I feel hiding my mental illnesses saved my physical health.
The BIPOC community deserves to talk about mental health too…But they often can’t.
However, medical bias isn’t the only reason that people are unable to be open with their mental health. BIPOC people experience mental illness at similar rates to white people, however they tend to have less access to treatment. Lack of insurance and culturally competent providers are just a few barriers to getting treatment, as well as the stigma around mental health and cultural expectations.
In a Blue Cross Blue Shield survey, 54% of Black respondents and 47% of Hispanic respondents reported that people with mental illness were “looked down upon.” Part of this stigma can be traced back to slavery, where it was thought Black people weren’t able to develop mental illness. So the Black community described mental illnesses as being “stressed” or “tired,” which tied mental illness into a personal failing. Add that into a cultural mistrust of the medical system, and you’ve got a recipe for mental illness going quietly untreated for generations. Within Hispanic/Latine populations, this stigma can be attributed to mental illness being seen as a moral failing as well. Religion plays a part in that stigma, as someone with mental illness can be accused as being possessed or having mental illnesses as a result of engaging in sinful behavior.
The Indigenous community also faces struggles when it comes to mental health. While they experience serious psychological distress 2.5 times more than the general population, they face high economic barriers and a lack of culturally competent treatment programs when seeking care. Within the AAPI community, it was found that they’re the racial minority group who is least likely to seek help. This is because mental health is seen as taboo despite extensive generational trauma, and there are cultural values that are expected to be upheld. There’s also language barriers and a lack of awarness of resources.
To be the one to break that silence on mental health, to seek treatment, is to risk familial shame and disappointment all while knowing that you may not even receive adequate care. It’s not an easy feat. It’s no surprise that people within the BIPOC community are less likely to speak out about their mental health, and are often suffering in silence. Add in intersecting identities like gender, class, sexuality, etc. and the stronger the silence becomes.
So what now?
You may be asking what this was written for. Do I want you to stop talking about mental health? No, definitely not. Ironically, I wrote this with the intention of continuing discussions around mental health.
So, when people are having those all-important discussions about mental health, I would urge them to check in. Ask if there are people being excluded from the conversation and what ways we can bring them to the table-but only if they’re ready to share. Don’t shame people whether share about their mental health or not. I also hope people begin to realize that the roots of the issues I discussed above are so much deeper than what’s written here. In order to break down these barriers, we have to integrate decolonization and anti-biased practices into mental health advocacy.
If you’re a practitioner, ensure your therapeutic practices are culturally competent and inclusive to those who may be hesitant to open up or be “labelled.” Begin to realize the privilege that it is to be open about mental health, and advocate for those who are still struggling to speak openly.
What are your thoughts on this? How can we improve mental health advocacy?
