Health Isn’t One-Size-Fits-All

By: Delphine Gervais, LCSW

This May will mark five years since my mom was “officially” diagnosed with stage 4 breast cancer and two years since she transitioned.  There were plenty of days that I replayed the rush to the hospital, the exposure of her upper body to the doctors, the shock at what I saw. I remember the doctor questioning my mother, “When did you feel the first lump?”  I remember hearing my mother respond, “four years ago”. (hence my reference to the word “official”).  My mother was a resourceful Haitian woman, who never missed a doctor’s appointment and who never missed out on an opportunity to eat healthy.  Olive oil was a staple in our home.  Processed food was not.  She did everything she knew how to live a fit life.  In her mind, that lump negated every effort,  and it was then that her life completely changed.

For the purpose of conversation, I opt to turn my lense to black women and what their attitudes towards receiving services imply for their ultimate well being.  The stats are not favorable for communities of color.  Heart disease, cancer, hypertension, mental health–people of color lag behind in prevention and are dying at faster rates for lack of both prevention and intervention services.  In the case of breast cancer, although screenings among black women tend to be on level with those of their white counterparts, follow-ups for negative results were much lower.  Death rates among black women are 42% higher than their white counterparts.  It is one thing to schedule and conduct one’s mammogram every year.  Everyone can do that.  It’s another thing to follow up after receiving some not so favorable results.

I didn’t believe my mother loved me and my brother less because she didn’t seek the help she needed.  It couldn’t have been an easy pill to swallow to suffer in silence. Help seeking behaviors among African-American and Afro-Caribbean women have historically been a point of concern among those in the health profession.  The cultural construct surrounding help seeking behavior for physical or mental health concerns boils down to “it’s nobody’s business but mine.” If you couple that with the religious and spiritual impact on decision-making and you likely have a woman who will keep secrets from her loved ones and bear the entire emotional burden of disease.  To say that women of color reject the notion of prevention or intervention services is a fallacy.  It is best to first understand that normalizing health seeking behavior is the first order of business.

Imagine walking into a space where medical jargon is thrown at you left and right.  Machines are beeping.  People hurry about their work day, some stay long enough to inquire as to your well-being, while others just come long enough to poke and prod and leave with nary a word.  A person who speaks the king’s English would have a hard time navigating the health system.  A person who speaks limited or no English would drown in fear and embarrassment.  There is also the matter of inequitable access to services in the communities of color.  Are clinics within walking distance or near a bus stop? Do those who provide services understand the complexities of a person of color coming to their spaces in search for help?  Are they immediately placed at ease?  Are there people present in these spaces who can walk among the emotional minefields of their patient’s mind?

I remembered offering to take my mother to a cancer support group comprised of Haitian women.  The social worker in me thought it would be best for her to be among others who were grappling with similar issues.  She gave me a blank stare and a firm “No”.  I never brought it up again.  At times, we professionals believe we know what’s best for those who need help.   Imposing our norms and expectations lessens the opportunity for the person to establish personal ownership of their circumstances.  They’ve heard about the church member who became ill, went to the hospital and never came back home.  Walking into foreign spaces and experiencing a new normal is difficult for the average human being.  Being a woman of color compounds those feelings of helplessness.  When the strong black woman mystique had been challenged and the figurative “S” was off her chest, my mother didn’t want a support group.  Attendance at weekly church services was support enough.

There cannot be a one size fits all approach to healthcare.  My mother’s doctor knew well enough not to say the big “C” word in sessions.  She was delicate and respectful in her approach, she maintained deference in her tone and she left the hard discussions during one-on-ones with me.  At times she would practice her Creole on my mom.  This would make my mom smile.  The feeble attempts at seeking commonality met with ultimate respect.  For my mom that was enough to keep her committed to returning every month.  Even when the blood work started coming back with less than positive news, she kept her appointments without fail. Being seen by doctors and nurses who knew her name and smiled with their eyes made the trips that much bearable.  Half the battle is won when communities of color are provided with opportunities to maintain their personal dignity while seeking the help they so very much deserve and need.

This is not a mandate to learn a new language or join Doctors Without Borders.  It is however a call to action for professionals in the healing arts to take stock of how they approach their patients of color.  What works for Jane Doe may not work for Marie Pierre and Mary Johnson.  Cultural norms play a big part in how they each approach seeking help.  Knowing Jane’s cultural constructs and not Marie/Mary’s should cause one to pause and assess their effectiveness in providing service.  As the Haitian daughter of a Haitian woman I thought I knew all there was to making sure my mom received the services she needed.  My westernized approach to therapeutic intervention failed miserably.  I should have known that my mother cared less about support groups than ensuring she had a nurse aid to provide meals.  She cared less about the blood work coming back negative and more about when the bus would come to take her to her prayer service.  It didn’t take me long to stop hitting my head against the proverbial wall.  It was less of what I wanted and more about what she needed.  Once I made peace with that, it was smooth sailing.

Delphine is a licensed clinical social worker with experience in education, health, social welfare, community development, and individual/family/group intervention services. Her professional background emphasizes a special focus on community involvement and service; utilizing social networking for the purpose of bridging the gap between those with established needs and those with access to the resources to meet those needs. Read more on her blog.

Source:  American Cancer Society http://www.cancer.org/

 

Health Isn’t One-Size-Fits-All

Suffering In Silence: Mental Health Conversations in Communities of Color

As a person of color, the topic of mental health is avoided like the plague in our community. We all have that family member or friend who, at the mere mention of going to counseling, shouts back “I’m not crazy”; “You should pray about it”; “Tough it out”; “Therapy’s for White people”. These answers are further distractions from the real problem. I’m not saying there’s anything wrong with seeking counseling services from your religious leaders, of which is a great support system for those who believe. However, there are some things that require a different outlook. There’s just something about a fresh perspective that can bring about change. I’ll admit to being a novice in the field, but I can say that I do have some African American clients. However, amid the few, a substantial portion fails to receive continuous care (Snowden & Yamada, 2005). High levels of untrustworthiness and the stigma drenched with the word therapy/counseling may influence this lack of commitment. A part of the problem lies in the lack of public discussion and recognition of these disparities in our community and what can be done about them. Something needs to change ASAP because I, for one, am tired of hearing about the behavior of members of another race being dismissed as a result of mental health difficulties, but my own people who are struggling mentally, just as much in some areas and more in others, being publicly ridiculed, never even given the chance to defend themselves, while struggling to stay afloat in a society that was built on our backs and which is working hard to keep us that way.

The key word here is suffering because that’s exactly what we’re doing. While many people from all different backgrounds find the topic of mental health a difficult one to discuss, African Americans especially have created such a negative association with the term that discussion is actively avoided. According to the U.S. Department of Health and Human Services Office of Minority Services, African Americans are 20% more likely to report having serious psychological distress than non-Hispanic Whites. Unfortunately for us, this stress is often coupled with higher levels of poverty, with those living below the poverty line being 3 times more likely to report psychological distress, when compared to those living twice the poverty level. Yet and still, White people are receiving nearly double the amount of mental health services than African Americans. A more common practice in the African American culture is to seek help from family and friends, not from “out-group members” as therapists may be viewed (Vogul et al., 2007).

To go back to the earlier misconception of being “crazy” as a reason to seek counseling, I for one do not like to use the “c” word with anyone. EVERYBODY has struggles at one point or another in their life. Therapy helps you work through them and helps you find the most effective and productive resolution. Everyone in therapy doesn’t have a diagnosis of Bipolar or Schizophrenia. Therapy can also help you work through grief, trauma due to things such as natural disasters, relationship stress, among countless other things. Yes, you can lean on friends and family for support during these times. In fact, minority groups who value close networks have been found to use family and friends rather than counselors when seeking help (Vogul et al., 2007). African American youth tend to use a family member more often than White American youth when experiencing a problem (Vogul et al., 2007). I hear you when you wonder why someone would want to pay a person to listen to his or her problems, but I promise we have a lot more to offer than our ears. Although each client is unique and each culture has its differences, through research and experience, providers have and will gain the knowledge necessary to assist minorities if you let us.
One thing we don’t see enough of is our own people offering these services. As a member of a non-dominant population, it can be hard to relate to, or expect to be related to, a person of the dominant population, especially when some of their actions have contributed to your suffering. I remember expressing my despondency regarding my relocation to a predominantly White area. Nothing wrong with White friends, I just missed my people. Speaking with a White male, he compared it to his relocation and having to adjust to fishing for a different type of fish than he was used to. I get the analogy, but c’mon now, I’m a person not a fish. Insensitivity has a huge impact on the needs of minorities seeking services and may in fact contribute to why we tend to run the other direction. However, there are issues much bigger than this that are causing us so much pain that it’s worth the exploration to find someone who you can relate to. As much as this profession is growing and expanding, the rate of ethnically diverse providers is struggling to keep up. With this in mind, it’s important for all practitioners to be culturally sensitive to the problems brought to therapy. This is important for clients to know too that they may need to provide a more in depth explanation of their struggles, and it may take some time to find someone they’re comfortable with. Cultural sensitivity can have many interpretations, but here it’s referring to awareness of unique differences that impact treatment. For instance, some symptoms may be misinterpreted in certain cultures as something other than a mental health issue. As an example, the National Alliance on Mental Illness notes that numerous African Americans struggle to identify symptoms, underestimating the impact that it may be having on a person’s life. Take depression, it may be written off and referred to as “the blues” when in reality it is a common mental health disorder experienced among African Americans more often than White Americans.

Anybody out there familiar with the TV series A Different World? I recently began binge watching it again on Netflix, and there was an episode where Whitley attended one therapy session when her feelings for Dwayne and Julian were conflictual. Her one take away was “relax, relate, release”, and I’ve noticed in future episodes that she repeats that same phrase in times of stress. Though comically expressed through Jasmine Guy’s overly dramatic character, it was a great example of one of the many benefits therapy has to offer: the things you learn can be applied to different areas of your life and used over and over again. This is especially true due to the fact that the likelihood of African Americans currently receiving services decreases if there was past service (Broman, 2012). I was pleasantly surprised at even the slightest mention of the subject of therapy in the late 80’s/early 90’s. Psychological distress doesn’t necessarily mean a diagnosable disorder; it simply refers to your mind feeling overloaded with what life has thrown at you.

There has also been a lot of discussion around medication that is offered in conjunction to therapy. True, it can be helpful, but it’s also costly in the long run of continuously having to refill prescriptions. Therapy is about activating tools that you already have within yourself to work through troubling situations. Let me tell you something, the old me was against this ‘hoopla’, as it’s often referred to, at one point too. I’ve experienced things in my life where therapy crossed my mind, and just as swiftly I kicked it out. I won’t sugar coat it, it’s a very vulnerable process; sharing your personal story with a stranger, anticipating judgment and backlash for what you have to say, expecting to be misheard and misunderstood. But for your own good, sometimes you have to take that chance. Speaking from personal experience, it’s a necessity. Just like your doctors and dentists appointments, hair appointments, even the popular need for retail therapy and other personal care appointments, this mental health check-up is just as, if not more, important.

Cost is something that can also contribute to this suffering. Many people think that all these services are offered at an unreasonable price, and that just isn’t true. There are numerous community health clinics that offer these services to individuals with or without insurance and on a sliding scale fee. Sometimes these places also have interns, who are training in the field under the supervision of a licensed professional, and offer these services free of charge. This can also be found on college campus’ that again, offer services on a sliding scale fee and sometimes free of charge. All this requires is a little research, whether it’s through the Internet, word of mouth, or asking other health care providers for referrals.

With all of the discrimination and injustice present in society, because unfortunately it doesn’t seem to be going anywhere, why not strengthen your mind so that we can continue to fight back. When will the media talk about the possibility of a black mans actions being attributed to mental health issues? When we find the motivation in ourselves to take control of our lives and stop being afraid to acknowledge that we need help. Suffering in silence is more detrimental than allowing someone who is qualified to return you to your most empowered state.

Alysha Thomas is a native of Newton, MA and a current resident of Hattiesburg, MS. In the fall she is relocating to California to obtain a Doctorate degree in Marriage and Family Therapy and is looking forward to serving in an urban community to increase the level of ethnic participation in mental health care. Alysha enjoys cooking, being outdoors, and almost everything social.

Sources:

Broman, C. L. 2012. Race differences in the receipt of mental health services among young adults. Psychological Services, 9(1), 38-48.

Snowden, L. R. & Yamada, A. 2005. Cultural differences in access to care. Annual Review of Clinical Psychology, 1, 143-166.

Vogul, D. L., Wester, S. R., & Larson, L. M. 2007. Avoiding counseling: Psychological factors that inhibit seeking help. Journal of Counseling & Development, 85, 410-422.

http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61

https://www.nami.org/Find-Support/Diverse-Communities/African-Americans

Suffering In Silence: Mental Health Conversations in Communities of Color

Sometimes It Is Just Black & White | The Color Wheel

Let’s talk straight no chaser! When it comes to being a black woman in America a mental illness is the last thing that you would also like to have associated with your name. Take myself for instance, I have dealt with Depression for most of my life and it wasn’t until I was 27 years old that I realized how much I needed help. I never thought about telling anyone in my family about my struggles or even my experiences. So when I decided to create a mental health blog showcasing my life, I knew it was going to be seen as an attention seeking affair. Little did I know how much therapy this blog was going to be not only for me, but for other people who looked like me.

In the mental health community there are very few African Americans. From support groups, rallies, speaking engagements and even research centers we are lacking representation. From my experience alone I have always been the only black person and black woman in many support groups, I have never encountered a black mental health professional and I have never met someone who was open and as honest as I am about their illness. Until recently, I thought that it didn’t even matter.

When I began talking to young, black girls about their daily lives, I was shocked to hear that they were open and honest about their emotions, but felt like no one wanted to listen to them. How is that? How can it be that way when you are born to a mother and father? Shouldn’t they want to listen? Aren’t they asking fact finding questions? How are we not showing compassion to our own children?

Let’s get to the facts…

“Post-traumatic stress disorder (PTSD) is a real illness. You can get PTSD after experiencing a traumatic event, such as a war, hurricane, sexual assault, physical abuse, or a bad accident. Although you are no longer in danger, PTSD makes you feel stressed and afraid. It affects you and the people around you.

Consumers with PTSD can experience a range of emotions such as flashbacks, hallucinations, “going blank”, detachment from events and others, trouble sleeping, nervousness, or being over aware. PTSD can also be accompanied by other mental illnesses such as depression, anxiety, bipolar and schizophrenia.

PTSD does not only effect one age group or race; however, it is proven to be more prevalent in “urban communities”, veterans and patients with other mental disorders. Anyone who has faced a traumatic event like sexual assault, combat, life threatening events  or witnessed others, survivors of natural disasters, unexpected loss of someone or illness that caused severe pain or procedures can develop PTSD”(1).

With adequate treatment including psychotherapy, medications and support from family and friends, PTSD can be managed successfully. However, if left untreated, PTSD can last for months and even years depending on the severity.

In the summer of 2005, I was diagnosed with three different mental illnesses (yes it’s possible). The one I had always heard of was PTSD. Growing up I heard the term being used for survivors of rape, bank robberies and really bad car accidents. The term ” I put it in the back of my mind” was always used to describe what PTSD was and how it can come back to haunt you in the future.

I didn’t even feel like I had been involved in something traumatic enough to be considered a mental illness. So when I got the results from my evaluation, I was shocked. I never told the doctors that I was molested, I used to get bullied and threatened at school or I was in an abusive relationship in high school. So how could they have known about the things I locked away?

As I began thinking about it, I had never been asked how I was feeling or what I was feeling when I was at home. It wasn’t a topic of discussion at the dinner table. It wasn’t even a concern anywhere in my home. And I am sure in any black home we have all heard the ” Shut up. I don’t want to hear anything you have to say. Why are you crying?” Those negative statements which some of us have heard, mold us and begin to create other issues.

If a child has gone through something traumatic like maybe being bullied or threatened at school and has not had an outlet to voice their feelings and experience PTSD can begin to develop. So if you can’t feel safe and supported at home, then where else can you feel comfortable when there is no one that looks like you and shares your experiences in your Insurance Coverage Network?

We don’t see black health advocates on television, we don’t even see black people in medication ads or television shows (other than Andre on Empire). It’s as if black people are Immune to mental illness. The characters are superhuman and forever fearless. They don’t have any duality or vulnerability. When I think about segregation and slavery I always think about the long term psychological effects that it had and is still having on black people. With the current racial situations on the rise, PTSD still has a presence in our community.

I don’t think television is the key to representation or the hear all see all as well. If we don’t have prominent medical professionals, qualified programs and black advocates in our communities, we will continue to sweep mental illness under the rug. Yes it is a black or white thing because let’s be real we all choose what’s comfortable for us. And if you feel as though someone will understand your experience, then you would think they will understand what kind of treatment you need.

My question is who will step up?

Lindsay Anderson is the Editor-In-Chief and Founder of ConsciouslyCoping.org, a Mental Wellness social media site that primarily focuses on educating minorities, underprivileged and lower income based families on healthy approaches of managing Mental Illnesses.

(1) https://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html

Sometimes It Is Just Black & White | The Color Wheel

We Can Protect Others by Protecting Ourselves!

Delicately purposed for the nation’s Black women; brown girls, black girls; light-skinned, brown-skinned, and dark-skinned:

To young Black women and girls, who fall in the age bracket for rates of new HIV infections, whether you have tested positive or negative, or don’t yet know your status, we all have a purpose in life which is to live life more abundantly.

March 10th was National Women and Girls HIV/AIDS Awareness Day (NWGHAAD), an annual observance that sheds light on the impact of HIV and AIDS on women and girls. The theme this year was “The Best Defense Is a Good Offense.” HIV prevention is key in fighting the infectious disease that disproportionately impacts Black women and girls.

Effective steps to help prevent HIV infection for you and your partner:

Check out What every woman needs to know about HIV and What every girl needs to know about HIV

 We must continue to protect ourselves, our physical and emotional health and encourage others to do the same. Whoever your partner may be, make your personal health and well-being pillars of the relationship. Go get tested together, talk honestly with each other, educate one another, and most of all encourage each other to protect and respect your bodies, make decisions and take actions—do what is needed to be safe.

In honor of National Women and Girls HIV/AIDS Awareness Day, I challenge all women, especially Black women, at every age to lend your strength and your voice to HIV/AIDS awareness. We can protect others by protecting ourselves!

Share on all of your social media platforms using the hashtag #NWGHAAD and #BestDefense.

Signed,

EnviableZsanai

Office on Women’s Health, U.S. Department of Health and Human Services. (n.d.). About National Women and Girls HIV/AIDS Awareness Day | womenshealth.gov. Retrieved from http://www.womenshealth.gov/nwghaad/about/

https://www.bwhi.org/blog/2015/03/10/home/taking-control-of-my-health/

 

We Can Protect Others by Protecting Ourselves!

Spinach & Sundried Tomato Stuffed Shells

Spinach & Sundried Tomato Stuffed Shells

This recipe makes 5 servings of 3 shells each.

INGREDIENTS:

10 oz fresh spinach

8 oz fresh mozzarella

32 oz part skim ricotta cheese

8 oz sundried tomatoes in olive oil, julienne cut or sliced

1/2 tsp sea salt

1/2 tsp black pepper

1/2 tsp italian seasoning blend

12 oz (1 box) jumbo shells pasta

DIRECTIONS:

1. Prepare jumbo shells according to package instructions. Once the pasta is fully cooked, drain, rinse with cold water, and set aside to cool.

2. Add 1/4 cup water to a skillet, then add the spinach, cover, and cook until completely wilted (about 2 minutes).

3. Add the sundried tomatoes, ricotta cheese, mozzarella and seasonings to the skillet and mix thoroughly. Once the mozzarella cheese has melted, remove the cheese mixture from heat and let cool for 5-10 minutes.

4.Spread 1/3 of spaghetti sauce in the bottom of a 9 x 13 inch pan (or whatever dish your heart desires). Stuff shells with a tablespoon-full of the filling and place open side up, and close together in the pan.

5. Bake at 350 degrees for 20-25 minutes, or until cheese is bubbling. Serve with a side of your favorite green vegetable or a light garlic bread. Enjoy!

 

Spinach & Sundried Tomato Stuffed Shells

Spinach & Strawberry Salad w|Feta Cheese

Spinach & Strawberry Salad w|Feta Cheese

This recipe makes 6-8 servings.

INGREDIENTS:

1 15 oz bag of spinach

1 pint strawberries, sliced

1 15 oz can of chickpeas, drained and rinsed

6 oz feta cheese, crumbled

1 tsp sea salt

1 tsp black pepper

1/2 cup honey

2 lemons

1/2 cup olive oil + 2 tsp

DIRECTIONS:

1. Preheat oven to 400 degrees.

2. Drain and rinse chickpeas, then toss with olive oil and spread evenly onto a baking sheet.

3. Bake 15-20 minutes, until crisp.

4. Remove the chickpeas from the oven and let cool, then mix with spinach, strawberries, and feta cheese. Toss with the honey-lemon dressing immediately before serving.

For the Dressing:

1. Mix ½ cup extra virgin olive oil with ½ cup of raw honey and the fresh juice of 2 lemons.

2. Season with 1 teaspoon of sea salt and 1 teaspoon of black pepper. Mix vigorously. Store in the refrigerator for no more than one week.

Spinach & Strawberry Salad w|Feta Cheese

Chicken Apple Breakfast Sausage

IMG_4372

Chicken Apple Breakfast Sausage

This recipe makes 10 sausages; one sausage is one serving.

INGREDIENTS:

1 lb ground chicken

1 gala apple, diced

1/2 yellow onion, diced

1 tsp ground sage

1 tsp sea salt

1 tsp black pepper

1 tbsp honey

2 tsp olive oil

DIRECTIONS:

1. Heat 1 tsp olive oil in a small pan over medium high heat. Toss in the diced onions and coat in the oil, then spread into a single layer and cook for 2-3 minutes, then add the apples and saute again for 2-3 more minutes. Once they are done, remove from heat and set aside in a small bowl to cool.

2. In a medium bowl, mix together all of the ingredients thoroughly and form 10 patties.

3. Heat the other tsp of olive oil, then saute the burgers for 9-12 minutes, flipping once during the cooking time.

4. Serve warm with a side of honey or maple syrup.

 

Chicken Apple Breakfast Sausage