Of all the mental health burdens uniquely placed on Black women, diagnosis disparity should not be one.

Diagnosis disparity refers to the fact that Black women have a harder time receiving diagnoses for real illnesses due to both prejudice and differences in access to care. Black women require and deserve comprehensive care; however, due to diagnosis disparity, they are less likely to even receive the bare minimum care they should.

Black women are more likely to suffer from mental health issues because of generational trauma from systemic racism and enslavement. There is also a sentiment in the Black community, typically perpetuated by older individuals, that mental health issues are not real. Many believe that one simply needs to “toughen up,” which additionally furthers mental health disparity. 

There are many differences between the care Black women and women of other races require and receive. But the lack of discussion surrounding these disparities, along with the disparities themselves, often results in negative consequences–sometimes even death. 

The first step in closing the healthcare gap between Black women and women of other races is to open a discussion about diagnosis disparity, mental health, and societal inequities.

Why is diagnosis relevant to mental health in general?

While treatment of symptoms is the single most important aspect of mental health care, a diagnosis can assist both practitioners and their patients in the progress of their treatment. A diagnosis can dictate treatment plans. For example, exposure therapy is shown to be effective in those suffering from Obsessive Compulsive Disorders.

Diagnoses allow patients to relate and connect to others sharing the same or similar disorders. They help doctors to discuss a group of symptoms using a label. The alternative is to name and address individual symptoms separately, which can become complex, less effective, and difficult to keep track of.

Most importantly, diagnoses show patients that they are not alone in their struggles. A diagnosis also makes clear that others have gone through the same thing. Unfortunately, in addition to equal care and treatment, diagnosis is a mental health privilege that Black women often don’t have.

So why do so many Black women struggle to receive diagnoses?

The case of Black women in America illustrates the healthcare disparity gap for those with marginalized identities. Black women occupy a unique space within our Eurocentric patriarchal society because experience oppression from both groups we identify with. We are not treated like Black men, nor are we treated like white women. Black women often face misogynoir, which is misogyny that encompasses both racism and sexism, from doctors and practitioners as well as in everyday life.

I have experienced this disparity firsthand while attempting to obtain a diagnosis. I also often wonder what role my race and gender played in the process. Would my diagnosis still have been withheld from me if I was a white man? Or would I have been informed? Would I have received the correct medications and the right type of therapy sooner? These are questions I and many other Black women often ask ourselves.

I would also like to note that I have the privilege of health insurance, for which I feel incredibly grateful. Yet mental health professionals have still mistreated me. While health insurance greatly increases the prognosis of mental health outcomes, it still fails to address the racial issue at root regarding the diagnosis disparity. Thus this matter transcends quality of healthcare or income levels and relates mainly to race and gender.

Medical racism and diagnosis disparity

There has been a longstanding history of the mistreatment of Black people in the medical field. One of the most glaringly evident examples of medical racism in the United States? The 1932 study conducted at Tuskegee Institute, called the “Tuskegee Study of Untreated Syphilis in the Negro Male.”

Participants in the study were denied penicillin, despite its widespread availability in 1943. In 1972, an Ad Hoc Advisory Panel was appointed to review the study and concluded that it was “ethically unjustified” and that the “results [were] disproportionately meager compared to human subjects involved.”

While the Tuskegee study is an extreme case of medical racism, modern examples also exist, such as Black neighborhoods having fewer clinicians due to systematic disinvestment. Black communities are used as medical training grounds, and White doctors benefit by profiting from unjust studies and unequal healthcare.

Backwards ideas about Black pain

The incorrect notion that Black people experience less pain than other races is no longer explicitly taught in medical schools. However, it is still extremely prevalent in the mental health field and is implicitly ingrained in society due to structural racism.

This idea stems from scientific racism and eugenics, which attributed race to innately biologic and genetic qualities. A 2016 study held to assess racial attitudes yielded that about half of White medical students and residents believed there were intrinsic biological differences between Black and White people. These unfounded beliefs correlate directly with the entirely false notion that Black patients experience less severe pain than White patients.

Medical means testing

Race is inherently tied to class. While there are many positive aspects to receiving a diagnosis, they are often forms of means testing.

If you can’t acquire a diagnosis, how can you acquire accommodations for your struggle? A problem arises in collegiate or academic settings where one cannot easily use student accessibility services. Academic accommodations often depend on a doctor’s note detailing the student’s diagnosis and how it impacts their ability to complete schoolwork. This can feel like a privacy violation.

In corporate settings this struggle becomes even more difficult, as mental health days are often conflated with sick, unpaid days. Over time this can negatively impact an individual’s income, as well as their work ethic and overall enjoyability for life, due to increased job-related stress.

Depending on the illness, a diagnosis is complex, time consuming, and above all expensive. Many people cannot afford to maintain their mental health due to care costs and rapidly increasing prescription drug prices.

Examples of how medical racism impacts Black women

Medical racism infiltrates every aspect of healthcare. An example of this is in maternal care. Many of the causes of pregnancy-related death are preventable, yet Black women are three to four times more likely to die during childbirth than white women.

One particularly notable detail is that increases in income levels do not mitigate these disparities, nor do increases in education levels. Serena Williams, one of the world’s most accomplished tennis players, experienced mistreatment throughout her pregnancy and childbirth; Williams’ doctors even disregarded her concerns of blood clots.

Other examples of medical racism are the prescription of emergency department analgesics and recommendations for cardiac catheterization. A study analyzing patients of multiple races in the 1997-1999 National Hospital Ambulatory Medical Care Survey concluded that physicians were less likely to prescribe opioids to Black patients than white patients. In 1999, a study investigating the effect of race and sex on physicians’ recommendations for cardiac catherization yielded that Black women were significantly less likely to be referred for catheterization than white men.

How does racial diagnosis disparity impact mental health?

This is a cruel Catch-22, as the racial diagnosis disparity surrounding mental health in turn detrimentally affects the mental health of the individuals facing said disparity. For instance, research has shown that the stress of racism already yields physical and cellular implications amongst black women. 

Provider representation

One major way in which these disparities negatively impact individuals is the racial and ethnic makeups of mental health professionals. According to Dr. Erica Richards, M.D., PhD., women of colour make up less than 5 percent of psychiatrists, psychologists, and social workers. 

It is incredibly difficult to seek adequate treatment when the practitioners do not look like you. It is culturally and contextually different being a Black woman than a woman of other races; certain aspects of life can only be understood and empathized by other Black women. 

Willingness to seek care

Dr. Richards notes that willingness to seek care is a larger factor than mental health stigma. Another way racial diagnosis disparities hinders recovery is willingness to seek care. A semblance of distrust and fear of doctors arises because the medical system so often wrongfully treats Black women. Individuals are far less likely to seek care the longer they are mistreated by those who are supposed to help them, thus worsening their mental health.

Self-diagnosis

Lastly, the racial diagnosis disparity typically results in self-diagnosis. If individuals lack the resources to properly attain a diagnosis, they tend to seek out information from the internet. While self-diagnoses do often assist in the process of an official diagnosis, they can cloud the pursuit of proper care. The fault in self diagnosis does not lie with the people who turn to it, but within the faulty medical system where there is a need for self-diagnosis in the first place.

What next?

Black women’s mental health is incredibly important. While the disparities perpetuated by a deeply systematically racist and patriarchal society cannot be resolved in or addressed by one article, we can take smaller steps to close the gap. 

In order to safeguard one’s mental health, Dr. Richards recommends good sleep hygiene, exercise, proper nutrition, socialization, mediation, and boundary setting. She also notes the importance of “culturally sensitive care,” which takes the individual’s racial and ethnic composition into consideration while receiving treatment. A higher volume of Black mental health practitioners is necessary, as is the deconstruction of the idea of Black pain in medical schools.

On a much smaller scale, the creation of a website with a collection of resources for Black women could be helpful. One website that comes to mind is Zencare. While it is not specifically for Black women, it allows the individual to search for a therapist, psychiatrist, or another mental health practitioner using certain filters such as race, insurance company, gender, or sexuality. Some resources more specifically aimed towards Black women include the Black Emotional and Mental Health Collective, the Black Mental Health Alliance, and Hued. 

In conclusion…

We cannot prioritize Black womens’ mental health without considering the intersectionality of our identities. There is a shortage of care from mental health professionals who look like us and share our experiences, which makes this difficult, but my wish to non-Black practitioners is to listen and to notice the “Black pain” false bias when practicing.

To other Black women struggling with their mental health: we shouldn’t be treated by the medical system like this. We deserve proper care from doctors who listen to us–and if they don’t listen, we have a right to either assert ourselves or find more competent care.

We are often taught by society as women, especially as Black women, that our perspectives and experiences don’t matter but they do. If a medication or a type of treatment isn’t working, it’s okay to speak up and voice your concerns, even if they are overlooked. We have a right to mental health care and prioritizing Black womens’ mental health allows us to further progress as a society.  

We as a society cannot say that mental health care exists for either Black people or women as a whole until Black womens’ mental health is prioritized.

This article is part of Supportiv’s Amplify article collection.