Suffering in silence: an essay on why Black people struggle to voice their pain
Black people are taught to muscle through the pain. We’re told from a young age that taking time to cry doesn’t do us any good. It’s hard for me to feel valuable if I’m not helping others or I can’t rise above the anxiety, depression and trauma I experience. I have to keep moving.
No wonder we’re hesitant about therapy.
“Why would I want to go ask for help when all my life I’ve been told, ‘if I ask for help, I’m less than?’” says Black Columbia therapist Tasca Tolson.
My breaking point was the pandemic. After years of staying busy to avoid the pain, the lockdown forced me to stand still. Self-deprecating thoughts and untreated trauma ran wild in the sudden quiet of my mind.
My decision to restart therapy, after brief attempts during elementary and high school, was one I made in hiding. I didn’t want to deal with outside opinions on whether I “needed” it. But it took months of quiet struggling to make that decision.
That self-imposed silence is common among Black families, and it doesn’t help. It belittles our feelings, even if that’s not what our loved ones mean to do. We stay silent about the hurt and the trauma.
Black adults in the U.S. are more likely than white adults to report persistent symptoms of emotional distress, according to the U.S. Department of Health and Human Services. However, only one in three Black adults who need mental health care receive it.
This internal fear is just one of many barriers Black people face when seeking therapy. Between the stigma, lack of competent care and socioeconomic barriers, therapy is a difficult yet crucial resource for Black mental health.
Dismantling external and internal stigma
I’ve heard all the adages. “What happens in the house stays in the house.” “Do as I say, not as I do.”
“For a very long period of time, we’ve been taught not to talk about your business,” Tolson says.
The stigma against therapy is a powerful force. Issues that can’t be physically identified are treated as nonexistent. “We take care of business, and we deal with it and just move on,” says Dedrae Kelly, a Black Columbia therapist. “If there isn’t something sticking out of your neck, like a bone, you don’t need a doctor; you’ll be fine.”
Racism is one of the things we have to face every day. It’s a trauma that we are constantly re-exposed to, in everything from microaggressions to videos of police brutality. Black people are always in that high-stress space. Our great-grandparents were during slavery. Our grandparents and parents were during the Civil Rights movement. We are now. According to the U.S. Surgeon General, this collective racial trauma makes Black people highly vulnerable to developing mental health disorders. This pain is in our DNA.m
This is even worse for Black women. We’re trained to take on everybody else’s problems. By the time we recognize our own pain, we’re already carrying double, triple, quadruple the weight. I’ve been doing this for as long as I can remember. I take that nurturing instinct to an unhealthy level. I’m constantly burning myself out, trying to convince myself I’m stronger for doing so. I only allow everything to hit me when no one can see its impact.
“We’re being conditioned to think that strength and power is questioned when we are actually crying or we have sensitivity and we have a heart,” Kelly says. “So Black women in particular are asked to carry the world, raise it, and never shed a tear when we disappear, and nobody gives a shit.”
Putting on a front
Verna Laboy, a Black community leader, created the award-winning program Live Well by Faith, which brought disease prevention straight to Black Columbians.
“A lot of people think of me as somebody that doesn’t need any help, doesn’t need anything because Miss Verna got it all together,” Laboy says. “Well, when I lost my mom, it seemed like the bottom fell out of my life. I needed some grounding.”
Laboy’s mother died on Oct. 5, 2021. After 10 years of taking care of her mother, the aftermath of her death took a major toll. She needed someone to talk to.
“It’s scary, to be honest, to say things out loud that you’ve just had dancing in your head,” Laboy says of starting therapy. “To put language to it, verbalize it and say it out loud for not only somebody else to hear, but you hear it too.”
The fear of the unknown keeps many Black people from seeking therapy, says Dr. Christine Woods, a Black Columbia licensed clinical social worker. We’re scared of a response, scared of being judged and don’t know what the session is going to look like.
Lack of culturally competent care
For centuries, Black people have been mistreated or untreated by the mental health care system. Black men are more likely to be misdiagnosed with schizophrenia when expressing symptoms related to mood disorders or PTSD, according to a 2018 study in Psychiatric Services Journal. A track record of discrimination in health care has led to a distrust of non-Black providers.
With a Black provider, Black patients spend less time explaining cultural differences and language used. Tolson says that women of color might struggle with colorism, especially those with darker skin tones who face heightened discrimination. Speaking about this with a Black provider means focusing more on unpacking the self-esteem impact rather than explaining what colorism is.
“Black providers can bring that empathy in, and they themselves do the work and study to become competent in addressing what is happening within the brain,” Kelly says.
In towns with a majority white population like Columbia, Black providers are a rarity, Tolson says. Many providers who arrive in town are either young professionals without much attachment to the community or already have another job that keeps them busy. In an environment not conducive to retention, Tolson sees a lot of turnover. Because the network is small, Black providers lack resources to support one another, Kelly says.
It’s possible for a non-Black provider to be a good therapist for Black clients. My own therapist is white, and my trust in her is founded in her open mindset, something all providers need to have. “Even if I’m not a therapist of color, am I so stuck in my ways that I’m not going to be willing to learn and hear what my clients are saying?” Tolson says.
By the numbers
Compared with the general population, African Americans are less likely to be offered either evidence-based medication therapy or psychotherapy. Here are a few other statistics:
• Physicians engaged in 33% less patient-centered communication with African American patients than with white patients.
• 63% of Black people believe that depression is a sign of personal weakness.
• About 11% of African Americans are not covered by health insurance, compared with about 7% for non-Hispanic whites.
Poverty also has an adverse effect on mental health status, according to the U.S. Department of Health and Human Services. Black people who live below the poverty line are twice as likely to report serious psychological distress.
Because of the discrepancies in wages and unemployment, Black Americans can lag behind other racial and ethnic groups, despite having the same level of education or working in the same industry, says Dr. Jordan Booker, a Black MU African-American psychology professor. Black Americans tend to have fewer funds up front, resulting in relatively less purchasing power. According to the Census Bureau, “about 27% of African Americans live below the poverty level, compared to about 10.8% of non-Hispanic white people.”
This isn’t conducive to seeking therapy in the first place. If basic needs such as food, shelter, clothing and housing aren’t met, how can you start to think about mental health care costs? We’re in survival mode, and we can’t leave it long enough to think about our mental well-being. Therapy is rarely a one-time visit.
“You’ve also historically had fewer families having some of the insurance coverage that would allow for, pretty smoothly, getting to see practitioners as often as they like,” Booker says.
Hope for the future
Therapy is a tool; it’s not a hindrance. It can help us get to a better place.
I still remember my 2018 therapy session when I told my therapist I had no thoughts of harming myself and realized, for once, I was telling the truth.
“Therapeutic interventions change the way the limbic brain is taking in information and giving information,” Kelly says. “We’re really working to get to the core of where it comes from, change and switch that narrative and empower women.”
Yes, I’ve made progress in my mental health because of therapy. However, I still have the internalization that being vulnerable about my issues will make others see me as weak. Writing this essay was especially difficult because of that. For myself and many others, therapy isn’t a linear journey. Through sessions over the years, I’ve been able to work through intrusive thoughts, giving myself more permission to be imperfect.
We need to normalize seeking therapy in the Black community. We need that tiredness we feel every day to be identified and validated. There is power in discernment, and talking to a therapist can bring that.
“It’s a sign of strength to get the help that you need and so rightly deserve,” Laboy says.
Naming our trauma can make us stronger, and no one benefits when we fight ourselves to try to suppress it. Suffering every day shouldn’t be our norm. We owe ourselves that much.
Where to find help
Local providers are working on ways to overcome these internal and external blocks. Kelly runs a support group for women of color on Friday nights, giving them space to explore problems they face in a group therapy setting, often a more comfortable introduction to therapy.
To combat socioeconomic barriers, Woods is partnering with The Family Access Center of Excellence of Boone County. FACE will pay providers for 10 sessions on behalf of the client, allowing a short-term therapy option for folks with lower socioeconomic status. Woods is also a social work professor at MU, and educates students on how to work with people of color.