I navigated America’s mental health system for years. While I am a trauma survivor, I had something else going on. For the first 40 years of my life I had an undiagnosed learning disability: auditory processing disorder. Auditory processing disorder or APD can have profound effects on a person’s mental health because of the obstacles to healthy interpersonal communication it presents. When you cannot properly process and respond to verbal cues, people perceive you as stupid at the worst, or very odd at the most benign. A healthy social life becomes almost impossible. To complicate things, at around age 32 I started to experience PMDD or premenstrual dysphoric disorder, which resulted in profound depression every month until I had a hysterectomy at age 39.
So, saddled with these undiagnosed disorders I made my way through the offices of countless therapists, psychologists, and psychiatrists. I presented with complaints that were sometimes labeled depression. Sometimes they were labeled anxiety. The anxiety was sometimes modified by words like generalized or social. I even got a seasonal affective disorder diagnosis thrown in for good measure. PTSD finally showed up on my diagnosis list after I was shut down and ignored for years when I tried to talk about my trauma history. But the most interesting diagnosis I was given was that of borderline personality disorder.
Prior to the onset of the PMDD, I presented to provider after provider with the same complaints. Complaints about difficulties interacting with co-workers. Complaints about my inability to speak in meetings and classrooms. Complaints about apprehension in social settings. Complaints about problems with focus and concentration. Complaints of sadness due to the existence of the other complaints. What accounted for the different diagnoses?
When I looked through my mountains of medical records, I saw that the providers who listed my race as black applied diagnoses like major depressive disorder and PTSD. The providers who saw me as white preferred diagnoses of panic disorder and borderline personality disorder.
Never did a provider ask me what my ethnic background was. They all felt comfortable guessing and reporting their guesses in my medical records.
My experiences lead me to think these providers thought that a black woman might have a reason to be upset, whereas a white woman is simply crazy.
I think many people will agree that it is hard to be a black woman in the United States. But is it so much easier to be a white woman? Apparently I’ve been both so I’ll go ahead and answer that.
The answer is: It depends. Most of my professional and academic dealings have been with white people, so I’ll talk about them. The fact that my interactions are primarily with white people is largely due to the homogenous racial makeup of Kansas. Here’s an example of how color shades my interactions, so to speak. When white people see me as white they assume I have opinions and experiences like they do. When white people see me as black it is usually because they are trying to pick a fight with me over something they saw on Fox News.
White Twilah gets, “What did you think about these current events?”
Black Twilah gets, “Why do you all always have to riot?”
White Twilah gets congratulations on her academic achievement. Black Twilah gets accusations that affirmative action gave her unearned advantages. White Twilah gets complimented on her curly hair. Black Twilah gets asked why she doesn’t straighten her locks.
White Twilah gets asked for an opinion, praised for her hard work and complimented on her appearance. Black Twilah gets asked to defend her civility, accomplishments, and personal presentation based on racial affiliation with strangers who are stereotyped on the television. As black Twilah, I’m not asked for my thoughts, I’m asked to defend my integrity. So yes, being a black woman is a bit more stressful in that regard.
Psychiatry does not exist in a vacuum impervious to the dynamics of a racist society. The dynamics I have outlined above have affected my diagnoses. Just because I have an extra layer of bullshit to deal with when I’m perceived as black doesn’t mean I don’t have enough bullshit to deal with when I’m perceived as white. I am not aware of any woman who has not dealt with gender-based harassment which ranges from inappropriate remarks, to catcalls, to threats and all the way up to rape and other physical abuse. White women are certainly not immune to the pervasive societal ills that are sexism and gender-based violence.
Let’s add another dynamic to this race and diagnosis discussion. The providers who initially dismissed me from therapy and denied I could have experienced trauma were all middle-aged white women. They had PhDs in Psychology or Masters of Social Work degrees. Their diagnoses were major depressive disorder and they refused to treat me for more than a few sessions. They all saw me as white.
I didn’t get a diagnosis of PTSD until I saw a brown-skinned psychiatrist of an ethnicity and culture unknown to me who went to medical school in Pakistan. He labeled me as African-American in my medical records. I then saw a few more providers who were originally from Middle Eastern and South Asian countries. Some of them looked a lot like me. All of the ones who labeled me African-American took my trauma seriously. Only one Middle Eastern doctor, a man from Syria who labeled me as white, diagnosed borderline personality disorder instead of PTSD or depression or both. I can’t help but wonder if their experiences as brown people in the Unites States helped them understand some of the stressors I have experienced and their effects.
Not a single practitioner of any extraction or cultural persuasion took my complaints of PMDD seriously until I found a reproductive endocrinologist on my own, with whom I started treatment. Not a single practitioner considered whether an auditory disorder that affects communication could have a role in my mood experiences. For that omission I blame them less because my APD is usually not evident in one-on-one conversations with no background noise, which is the context in which I saw all of the clinicians.
Of course, my experiences are just anecdotal. But if racial bias due to subjective experiences of practitioners can play such a large role in mental health diagnostics, how is this even considered a scientific discipline? If I had such an enormous variance of diagnoses among cardiologists that correlated with my perceived race and ethnicity, cardiology would be called into question. But in psychiatry this kind of bias is the norm, and it is accepted as such.
