Discussions on Best Practices in Counselling with Black Women- Part 2

untitledIn Canada, the reported percentage by Statistics Canada (2012) of visible minority was sixteen percent. Of these, Afro- Canadian Canadians consisted of two point five percent (Canada, 2012). In a study produced in 2010, it was expected that the Afro- Canadian population in Canada would double by 2031 (Canada, 2010). No further data was found on the 2011 statistics on the percentage of Afro- Canadians[1] (Canada, 2012). For the purposes of this study, Afro- Canadians or Black Canadians refer to individuals from Caribbean and/or African nations of African descent. Some research is also limited in Canada, and thus it was necessary at times to pull information from American or British reports to substantiate information.untitled_partner

The connection between Afro- Canadians and mental health is significant and is supported by scattered wealth of research over the past ten years. Women can be impacted by mental health, and this can further impact Black women in various ways (Clarke, 2010).  Research demonstrates that while there is no difference in the rates of mental health diagnosis in Afro- Canadian women to women of varying ethnic groups, however, there is still evidence of mental health difficulties within this population (Clarke, 2010). Clinical depression is also reportedly misdiagnosed in Afro-Canadian women (Clarke, 2010), particularly due to misunderstanding and barriers which exist for women of colour. Afro-Canadian women experience structural and systematic oppression which impacts their mental health (Clarke, 2010). Referring back to the DSM-V definition, it is important to note that the writers did not include systematic oppression as an association for significant distress (Maisel Ph.D, 2013). The impact of mental health on Afro- Canadian women is not just health, but also intersected with the multiple experiences of oppression. These experiences impact women’s anxiety levels and many report they are in constant state of alarm due to these challenges (Clarke, 2010). Altogether, mental health and Afro- Canadian women are not just experienced on a personal level, but also on a cultural and structural level.girl on knee

According to Mullaly (2010), the concept of the “other” was used as a way to describe the differences between individuals on the basis of race, gender, and class. Identity is a social construct that has been maintained to keep groups of individuals in the dominant groups’ desired space within society (Mullaly, 2010). The Black woman as the other was initially manifested from slavery and continued into the postmodern era. In slavery, Black women were separated from the dominant group as a way to justify slavery and violence against women, as well as maintain the oppressive system for centuries. These images of the other developed distinctly. According to West (2008), three distinct characteristics of the Black Woman as the other were the “Mammy”, the “Jezebel” and the “Sapphire”. This will be further explained throughout the body of this report as it is addressed under cultural oppression.  The concept of the “other” reinforces white privilege. White privilege creates a pattern of assumptions which perpetuate the “othering” of Black women. These assumptions are uncomfortable and alienate Black women as well as reinforce hostility and violence (McIntosh, 1989). The assumptions create beliefs about how Black women should physically present themselves. These assumptions reinforce an older mature presence or a highly sexualized individual. The assumptions also determine oppressive cultural and social characteristics to define Black women. Mullaly (2010) describes that early writers believed that othering created a master-slave paradigm that dehumanized Black individuals as a whole.broken

Black women with mental health difficulties are subject to a range of social problems and issues related to the intersection of oppression. These difficulties include the shame and stigma associated with the diagnosis, the limited resources available to treat mental health diagnosis, the intersection between racism and mental health, and impact of mental health on their parenting skills (Clarke, 2010), (Etowa, Keddy, Egbeyemi, & Eghan, 2007).  Mental health difficulties carry a range of shame and misunderstanding by individuals within their culture and beyond which lead many women not to address or treat their symptoms. There is a stigma associated with mental health. Women also have had experiences with structures and systems which were oppressive and enhanced their feelings of shame (Clarke, 2010).  There is a correlation between depression and racism for Black women (West C. , 2008). Addressing these barriers can be difficult because they are systematic and built into the structure (Clarke, 2010). Some research has shown that depression is impacted by factors such as multiple systematic issues such as oppression, low self-esteem, stress and poverty. Women who participated in this research noted racism, racial violence and gender violence as factors that influenced their experiences of oppression (Etowa, Keddy, Egbeyemi, & Eghan, 2007). There are correlations around the experience of depression for Afro- Canadian women and with circumstances such as: concerns for their children and families, concerns around racial violence, grief and loss, the stress associated with death, racism experienced at work, menopause, and anxiety and pain (Etowa, Keddy, Egbeyemi, & Eghan, 2007).

hospital

Black women experience barriers in accessing treatment for mental health. Barriers such as financial constraints and physical access to clinicians for Black women. If a woman is unable to access community resources due to waitlists and lack of cultural inclusiveness, she may not have the funds to seek treatment elsewhere even though it may be beneficial for her (Clarke, 2010).  Afro- Canadian women with a mental health diagnosis or challenge are further subjected to punitive measures. In some cases, women who are misdiagnosed or do not have access to proper treatment have been imposed upon by Children’s Aid Society (CAS) who carry out the Child and Family Services Act. These sanctions further isolate the woman from accessing services, connecting with their community, and receiving proper treatment for many reasons, including feelings of shame (Clarke, 2010). There are limited resources available specifically for women of colour and evidence-based treatment to address their mental health adequately. Concerns have also been raised around health professionals’ lack of understanding of the physical and psychosocial health needs of Afro- Canadian women (Etowa, Keddy, Egbeyemi, & Eghan, 2007).

According to Mullaly (2010) oppression at the personal level is based on stereotypes consisting of, “thoughts, attitudes, and behaviors that depict negative prejudgements of subordinate groups” (pp. 68). This further separates the oppressed group as the “other” (Mullaly, 2010). In the personal level, individuals experience violence, aversion and avoidance (Mullaly, 2010). For Black women, oppression on the personal level has included experiences of racial violence, rape, standards of beauty they do not quite fit, and similar aversion to participate fully in society based upon their individual merit and achievement (West C. , 2008).  Oppression on the personal level further imposes an identity (Mullaly, 2010) on Black women which perpetuates the attitudes, stereotypes, and beliefs stated above (West C. , 2008). These attitudes and beliefs systems persisted and developed a culture where women felt silenced within their lives. “Self-silencing theory” as described by Ali and Toner (2001) refers to, “women’s self-devaluation is tied to the need to express an outer self that is in opposition to their genuine self” (pg. 174). This is maintained by belief systems in the dominant discourse that reinforces these values and keeps women from expressing their true self (Clarke, 2010). According to West, “performing strength as one’s identity, in conjunction with role strain, can contribute to depression” (2008, pp. 290). (Ali & Toner, 2001). Since their personal identity is rooted in beliefs around their strength, seeking support for mental health would be symbolic of their weakness and inability to live up to this distorted image of identity (Clarke, 2010). To add, Black women also are at risk for developing eating disorders. West argues that overeating is an escape from the impact of poverty and emotional deprivation many black women experience. This can also be missed by health professionals because of the high rates of obesity reported by Black women (West C. , 2008).

The initial stereotypes were used as a way to justify the subordination of Black woman. It was also used as a way to demonstrate that Black women were content with the roles they were forced to play. This continued to become incorporated into how Black women developed an identity that led to playing multiple strenuous roles without support, and perceptions of being strong and resilient. Another feature of slavery was the development of the hierarchy of beauty and social status used to divide the African people among each other. Individuals with lighter-skin and straighter hair were given more opportunities and privileges within the plantation. These values persisted over time. West (2008) describes this experience as colorism. Research showed that darker-skinned women have lower salaries, less education, and marry less educated men than lighter-skinned women despite the fact that darker-skinned women continued to pursue higher education and demonstrated goal oriented belief systems (West C. , 2008). To address these attitudes Black women may feel propelled to modify their hair, their skin colour, their voices, their practices so the very nature of their identity is based upon the dominant and oppressive culture (McIntosh, 1989).  Mullaly (2008) references Fanon who presented three models of defence of external identity formation termed, “pattern of compromise”, flight, and fright (p.89). Black women have been able to demonstrate these levels of identity formation. With women such as popular media icons who have embraced oppressed attitudes of sexuality (West C. , 2008) as a way, in my observation to compromise and generate power and wealth. The flight occurs when women embrace the concept of a “strong black woman” (West C. , 2008), and play complex roles in their lives. Another image as the, “mad black woman” or as West coins the Sapphire persona as the “angry sister with an attitude” (West, 2008, p.298). According to West (2008), this image influences how “anger is expressed and experienced” (p.298) by Black women. In reality, this image is a way that Black women can protect themselves from underlying mental health concerns mitigated by experiences of racism, victimization and pain. (West C. , 2008). Similarly, fright is another form of identity formation Fanon describes (Mullaly, 2010). However, by adopting oppressive attitudes on identity, one also becomes silenced as addressed earlier impacting one’s mental health as evidenced in this paper (West C. , 2008) and (hooks, 1989).

Oppression at the cultural level consists of the manner that the dominant group seeks to perpetuate stereotypes and beliefs aimed to reinforce their privilege and power (Mullaly, 2010). Culture consists of the languages, the belief systems, the spiritual faiths, and the practices more inherent within the population and critical in the socialization of the individual and the group. Slavery, post-colonization, and modern era have continued to portray images, and stereotypes which perpetuate over time. In the 20th century, images of Black women were shown as domestic servants and caregivers. West wrote, “This belief can become institutionalized when powerful individuals create social policies and situations” (West C. , 2008, p. 292). She further argues that Black women were discouraged from achieving formalized education. Another image of Black women surfaced as oversexualized images also emerged. These images where shaped by “structural inequalities such as race, gender, and class oppression” (West, 2008, p. 293).  Taking it further, Mullaly quotes one writer who believed that the dominant group felt threatened by the subordinate group and thus perpetuated these stereotypes with violence (Mullaly, 2010). West (2008) refers to sexual terrorism as the way Black women were coerced, bribed, induced, seduced, ordered and violently raped. The “Jezebel” stereotype was a way to characterize black women as sexually promiscuous and immoral and justify their experiences of rape. These images continued in postmodern culture with the “video vixen” and sexually explicit music videos and images of Black women (West C. , 2008).  bell hooks (1989) also found that women of colour have been objectified in a manner that separated their body from their identity. Accordingly hooks states that this dehumanizing identity was perpetuated within their relationships, the culture, institutions, dominant culture and further systems of dominance and practice (hooks, 1989).

An area of exploration is the role religion and church have played upon maintaining the stereotypes of the oppressed and as buffer for the oppressed people to manage their difficulties. The discourse of religion and the modernity of witchcraft. In slavery and colonialization, the dominant group used Christianity as a way of reinforcing culture, standards and roles for Africans who were enslaved. Christianity later became adopted as a way to buffer against the impact of slavery, and provide a source of strength and messages to others seeking emancipation (Clarke, 2010). Witchcraft was practiced for centuries before and after the colonialization era was also maintained as a source of empowerment for Black individuals (Geschiere, 1997). These are complicated topics which are barely touched upon in the course of this paper, but are worth noting as an essential part of oppression at a cultural level.

According to Mulally (2010), “oppression at the structural level was defined as the means by which oppression is institutionalized in society” (p.127). It is the level in which personal and cultural oppression is maintained, and attitudes and stereotypes perpetuated on a larger scale. Oppression at the structural level creates barriers for black women that further keeps them subordinate. This further correlates with experiences of mental health as discussed earlier (Clarke, 2010).

In the research, many authors agree that mental health concerns with Afro-Canadian women need to be understood in the context of the structure and institutions which manifest processes and practices which fuel their experiences of oppression. As stated earlier, three of the main correlations between depression and Afro-Canadian women were identified as concerns for children and families due to racial violence, the impact of grief/loss and the stress of death and racism experienced at work (Etowa, Keddy, Egbeyemi, & Eghan, 2007). The intersection of ethnicity and gender with depression risk has been addressed since the 1990s (Ali & Toner, 2001), and in popular discourses by anti-racist and feminist writers (hooks, 1989). One author writes, “depression cannot be understood apart from the experiences of racism and ethno-cultural identity” (Clarke, 2010, p. 470).

The treatment of mental health for Afro-Canadian women is one of the places to examine when understanding its effectiveness and treatment’s success (Sutherland, 2011). Sutherland (2011) argued that Western psychology can be viewed as culturally inappropriate to understand and treat Caribbean and African culture. Health professionals lack understanding of physical and psychosocial health needs of Afro-Canadian women (as discussed earlier) (Etowa, Keddy, Egbeyemi, & Eghan, 2007). The lived experiences of Afro-Caribbean women will also impact their depressive symptoms because of how they have had to deal with separations from family, displacement of culture and way of life, isolation, and violence (Etowa, Keddy, Egbeyemi, & Eghan, 2007).

In a meeting with a colleague, I presented an individual I worked with in the context of his cultural influences and attitudes as central to their identity. The colleague’s response was, “well, he has been here for 5 years so he should know how our country runs”. These attitudes, beliefs and practices are impactful for vulnerable and marginalized populations. Anti-oppressive work requires the social worker to critically assess themselves, their belief systems, and privilege. As their “baggage” will create barriers for the service user and continue to perpetuate the oppressive practices (hooks, 1989). This process of emancipation occurs as the social worker is able to analyze how language and culture are constructed in ways that are oppressive to service users and use an anti-oppressive lens to examine practice and barriers which exist for individuals within these systems and constructs (Prevatt-Hyles, 2006).

Another area is incorporating the service users own experience into clinical work. As a clinical therapist, I am seeking to use modalities and approaches which are evidence-based and matched according to the needs of the individual or family I am supporting. One author describes a model of Caribbean psychology, which incorporates fundamental areas of the individual’s culture in understanding their challenges. For example, rites of passage ceremonies where a youth receive blessing to move into a new transition stage is a critical part of their culture. Using this model as a way to enhance their emotional well-being and enhance a sense of belonging and identity is a way of incorporating social work on a personal level (Sutherland, 2011).

Social workers seek to create change in their practice within the field. Part of the change involves enhancing the capacity of individuals and communities to create change and to address barriers on a systematic level. The social worker focuses upon building efficacy and resiliency with service user (Mullaly, 2010). Narrative therapy is a powerful way for individuals to express their story, while the social worker acts as a witness able to handle their stories (Nwoye, 2006). One therapist writes, “Listening to a client’s problem story is the best way to unearth its genealogy” (Nwoye, 2006, pg. 9). In African and Caribbean culture, oral traditions, proverbs, parables, music, dance, art, and rituals are some of the approaches used to support healing, to educate and develop identity for its members (Sutherland, 2011).

When one works with a population who has been impacted by slavery and colonization, segregation and dehumanization, unequal practices and systematic discrimination it is important to understand how culture becomes impacted by these historical occurrences as described above. As a social worker, the role is around deconstructing the impact of slavery, colonization, post-colonization and modernization (Sutherland, 2011). The social worker creates space for the Afro- Canadian woman to describe, analyze, become aware, and understand how oppression creates barriers for success and to guide the woman into an awareness of how they can address these barriers with support. In my belief, creating space does more than create dialogue about oppression within culture and structural systems. Creating space validates the experiences of the “other” and acknowledges their struggle is real and needs change (West C. M., 2002).

Becoming an ally (Mullaly, 2010) is where social workers bring together the realities of the impact of personal and cultural oppression to bring research and evidence-based practices in the anti-oppressive work at the structural level. This can be as broad as supporting Black women bring formal justice on oppressive systems and practices. And further extend to developing theoretical models and evidence-based practices within medical and treatment style institutions who service Black women (Mullaly, 2010). In my opinion, being an ally also incorporates creating space to adjust oppression at a structural level by addressing it and creating policies and practices which reinforce equality and opportunity.

Overall, anti-oppressive social work for Black women dealing with mental health is a way of pulling apart the multiplicity of oppression and intersecting identities which exist between the two by understanding how the personal, cultural and structural identities have developed oppressive practices. Altogether, interventions include working with the individual, the culture and the structural levels. In summation, West (2002) further suggests interventions such as: educate professionals, conduct a comprehensive assessment, draw upon the survivor’s strengths, encourage activism, enhance support networks, acknowledge oppressive images, understand the impact of arts on identity and healing and understand the importance of spirituality. Through this work it is hoped that one can begin to work successfully in addressing these areas to fully support and help Black women heal from mental health difficulties.

References

Ali, A., & Toner, B. (2001). Symptoms of depression among Caribbean women and Caribbean-Canadian women. Psychology of Women Quarterly, 25(2), pps.175-180.

Canada, S. (2010, March 9). Study: Projections of the diversity of the Canadian population. Retrieved March 9, 2015, from Statistics Canada: http://www.statcan.gc.ca/daily-quotidien/100309/dq100309a-eng.htm

Canada, S. (2012, October 24). Census Profile. Retrieved March 9, 2015, from Statistics Canaada Catalogue no. 98-316-XWE: http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/prof/index.cfm?Lang=E

Clarke, J. N. (2010). The portrayal of depression in the three most popular English-language Black-American magazines in the USA: Ebony, Essence, and Jet. Ethnicity and Health, 15(5), 459-473. doi:10.1080/13557858.2010.488.261

Etowa, J., Keddy, B., Egbeyemi, J., & Eghan, F. (2007). Depression: The ‘invisible grey fog’ influencing the midlife health of African Canadian women. International Journal of Mental Health Nursing, 16, 203-213. doi:10.1111/j.1447-0349.2007.00469.x

Geschiere, P. (1997). The Modernity of Witchcraft: Politics and the Occult in Postcolonial Africa. Virginia: University of Virginia.

hooks, b. (1989). Talking Back: Thinking feminist and Thunking black. Toronto: Between the Lines Press.

Maisel Ph.D, E. R. (2013, July 23). The new definition of a mental disorder. Retrieved March 9, 2015, from Psychology Today: https://www.psychologytoday.com/blog/rethinking-psychology/201307/the-new-definition-mental-disorder

McIntosh, P. (1989). White privilege: Unpacking the invisible backpack. Retrieved March 9, 2015, from Institute for Social Research: University of Michigan: https://www.isr.umich.edu/home/diversity/resources/white-privilege.pdf

Mullaly, B. (2010). Challenging Oppession and Confronting Privilege (2nd ed.). Toronto: Oxford University Press.

Prevatt-Hyles, (2006) “LPI’s Life Source Mapping: 7 E’s of Liberation” and Spirituality. Hyles, Dianne (2006) Life Source Mapping, Disk One to Four, Toronto: Liberation Practice International

Statistics Canada. 2012. Canada (Code 01) and Canada (Code 01) (table). Census Profile. 2011 Census. Statistics Canada Catalogue no. 98-316-XWE. Ottawa. Released October 24, 2012.http://www12.statcan.gc.ca/census-recensement/2011/dp-pd/prof/index.cfm?Lang=E. Accessed on March 9, 2015.

Sutherland, M. (2011). Toward a Caribbean psychology: An African-centered approach. Journal of Black Studies, 42(8), 1175-1194. doi:10.11770021934711410547

United States Department of Housing and Urban Development. (2008).Indiana income limits [Data file]. Retrieved from http://www.huduser.org/Datasets/IL/IL08/in_fy2008.pdf

West, C. (2008). Mammy, Jezebel, Sapphire and their homegirls: Developing an “oppositional gaze” towards the images of black women. In J. Chrisler, & P. Rozee, Lectures on the psychology of women (4th ed. ed., pp. 286-299). New York: McGraw Hill. Retrieved from Dr. Carolyn West: http://www.drcarolynwest.com/media/sites/162/files/article_mammy-jezebel-sapphire-homegirls.pdf

West, C. M. (2002). I find myself at therapy’s doorstep: Summary and suggested readings on violence in the lives of Black women. Women and Therapy, 25(3/4), 193-201. Retrieved from http://www.drcarolynwest.com/media/sites/162/files/article_therapy-doorstep.pdf

[1] A thorough search and examination of the website: Statistics Canada did not result any information for 2011 visible minority population data.

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