On the cusp of July’s BIPOC Mental Health Month, the U.S. Supreme Court (SCOTUS) deemed affirmative action for college and university admission no longer necessary.1Affirmative action: US Supreme Court overturns race-based college admissions. BBC News. https://www.bbc.com/news/world-us-canada-65886212. Published June 29, 2023. Accessed July 4, 2023. Although Biden’s groundbreaking Justice40 aims to name and reduce the health, environmental, and social justice inequities faced by racialized and Indigenous people2Justice40 Initiative | Environmental Justice. The White House. Accessed July 4, 2023. https://www.whitehouse.gov/environmentaljustice/justice40/, SCOTUS’ decision reminds us why a whole-of-society approach is needed to address mental health concerns in BIPOC populations.
What do environmental justice policies and school admission criteria have to do with the mental health of racialized and Indigenous people? They signal how our society values BIPOC populations and which actions to take to support us. As Joy-Ann Reid notes3I got into Harvard because of affirmative action. Some of my classmates got in for their wealth. Accessed July 4, 2023. https://www.msnbc.com/the-reidout/reidout-blog/joy-reid-affirmative-action-harvard-supreme-court-rcna92190, affirmative action was her only route to getting into Harvard – as it was for Justice Ketanji Brown Jackson. “Some of the people I went to school with were far less smart than me or the other Black folks there. They got in because their daddy and their grandaddy went there,” Reid notes. “I went to school with someone whose name was on one of the buildings, people who are third- and fourth-generation legacies, whose parents pumped money into Harvard to get them in.”
It’s important to recognize that there are many interconnected layers of oppression, all of which can impact BIPOC mental health. John Bell’s Four I’s of Oppression4(PDF) Expression of the Oppressed: Using Critical Pedagogy in Arts Education to Disrupt Systems of Oppression. Accessed July 4, 2023. https://www.researchgate.net/publication/343826097_Expression_of_the_Oppressed_Using_Critical_Pedagogy_in_Arts_Education_to_Disrupt_Systems_of_Oppression sheds light on why oppression isn’t just a matter of prejudice – it’s a complex web of different historical factors, cultural beliefs, and more.
The basis of any oppressive system is ideological: the idea that one group is better than another and thus has the right to control that group. In our white-dominant culture, non-white people are deemed inferior: less intelligent, capable, stronger, deserving, etc. This cultural belief then gets played out in our institutions (Black and Indigenous people are highly overrepresented in prison), on the interpersonal level (where members of the dominant group tell racist ‘jokes’ and engage in other microaggressions), and also becomes internalized (where oppressed groups eventually start to believe the negative perceptions about themselves).
Racialized and Indigenous people are constantly fighting to make our way in a world that isn’t made for us and may even actively oppose us. Frequent microaggressions at work and in our daily lives can contribute significantly to mental health concerns. But we cannot forget that it is our cultural histories and beliefs that make these aggressions possible.
Naturopathic doctors understand that addressing what we call ‘mental health’ means taking a comprehensive approach that includes genetics, trauma, nutrition, our physical environment, and more.
Dr. Gaynel Nave is a Black naturopathic doctor from Jamaica who combines knowledge from her own culture with naturopathic medicine and trauma-informed training to facilitate healing. “Trauma is a safety mechanism that our nervous systems employ to keep us safe,” Nave explains. “It engages when we feel overwhelmed, or when an experience is perceived as too overwhelming.” When working with patients on intergenerational trauma, she differentiates between ‘large T’ trauma (when our lives feel threatened, as in genocide, slavery, and institutional racism) and ‘small T’ trauma (more minor stresses, such as someone trying to touch your hair, saying “You’re pretty for a black girl,” or policing the food that you eat). Noting that ‘small T’ trauma can accumulate to become ‘large T’ trauma, she observes, “Intergenerational trauma can change your DNA5Youssef N, Lockwood L, Su S, Hao G, Rutten B. The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Brain Sciences. 2018;8(5):83. doi:10.3390/brainsci8050083 and result in conditions like heart disease, hormonal disturbances, and feeling really stressed.”
Describing herself as a “certified guide to freeing the queen within,” Nave considers the ‘queen’ our true selves. “It’s a decolonized way of approaching healthcare which recognizes that the mind, heart, and spirit are aspects of who you are,” Nave explains. “I see working with the inner queen as a reintegration of that wisdom that we have, a re-valuing of the tools that we already possess so that we can move forward.”
Dr. Aminah Keats is a Black naturopathic doctor, a faculty member at the Maryland University of Integrative Health, and the current Vice President of the Oncology Association of Naturopathic Physicians. Keats notes that for everyone, chronic stress can lead to inflammation and other metabolic impacts that may raise the risk of cancer and other chronic health conditions. But for African Americans, ‘stress’ includes the chronic inequalities that this population has dealt with in the past and continues to deal with today.
Indeed, researchers have noted that the very culture of the mental health industry limits access to equity-deserving communities due to a lack of practitioner empathy and inclusive practices that recognize the impact of intergenerational trauma. The authors observe that discussions of white supremacy as a factor that creates divisiveness and ‘othering’ is necessary to understand mental healthcare for marginalized communities.6Feliz VA, Hobbs SD, Borunda R. Strengthen and Respect Each Thread. Int J Environ Res Public Health. 2022;19(21):14117. doi:10.3390/ijerph192114117
But even when healthcare providers such as naturopathic doctors include the impact of social and cultural traumas on mental health, other factors may make racialized and Indigenous people less likely to seek support. “There is mistrust in the African American community when it comes to health care because of the medical abuse that has occurred over the centuries,” says Keats.
Researchers have noted that BIPOC communities have extensive histories of abuse in white mental healthcare. At one time, enslaved Africans were accepted as payment. The field of eugenics promoted the idea of biologically based racial inferiority. Today, Black people are commonly overdiagnosed with serious mental health conditions while receiving substandard healthcare. And what happens when Black people demand better treatment? They are pathologized rather than recognizing their response as appropriate reactions to trauma and oppression.7Waller BY, Giusto A, Tepper M, et al. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J. Published online May 3, 2023:1-5. doi:10.1007/s10597-023-01124-y
Dr. Baljit Khamba is a naturopathic doctor of South Asian descent who has had her own experiences as a cancer patient. She found that her South Asian doctors better understood her cultural context, such as acknowledging the importance of family support. “When I was going to appointments or getting care, my family was around. That’s just how it goes from a cultural standpoint; we’re very collectivist,” Khamba explains. She also found that non-South Asian doctors made many assumptions. She recalls once such doctor who immediately advised her to “cut out all those spicy Indian foods” without asking her about her diet. These experiences point to the fact that racialized and Indigenous people can experience negative mental health impacts simply by interacting with the healthcare system, even when seeking care for a non-mental health condition.
Researchers have noted how the underrepresentation of BIPOC mental health professionals adversely affects BIPOC people seeking mental health support. Yet, BIPOC healthcare professionals also face inequalities in schools and healthcare institutions.8Waller BY, Giusto A, Tepper M, et al. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J. Published online May 3, 2023:1-5. doi:10.1007/s10597-023-01124-y According to a 2020 study, although White people make up 54% of psychiatry residents in the U.S., they only account for 29% of the applicant pool.9Wyse R, Hwang WT, Ahmed AA, Richards E, Deville C. Diversity by Race, Ethnicity, and Sex within the US Psychiatry Physician Workforce. Acad Psychiatry. 2020;44(5):523-530. https://doi.org/doi:10.1007/s40596-020-01276-z
Nave recalls that the concept of a clinical partnership was a key aspect that drew her to naturopathic medicine. “I’m the expert in naturopathic medicine. You’re the expert in you. Without your expertise, mine is meaningless and would result in a cookie-cutter, perpetuating-harm way of doing medical care,” Nave explains. “This dynamic relationship creates a safe space for clients to realize that although trauma happens to you, healing happens with you. You already have tools for healing and the solution. You just need the space to explore that and figure out what next steps would work best for you.” As the Psychiatric Association of Naturopathic Doctors’ tagline notes, “There is no health without mental health.” If you are a racialized or Indigenous person looking for a healthcare practitioner who is well-versed in providing culturally sensitive care, understands the impact of historical and ongoing traumas, and knows how to combine the best of naturopathic and conventional medicine to support whole person healing, consider adding a naturopathic doctor to your healthcare team.
Footnotes
- 1Affirmative action: US Supreme Court overturns race-based college admissions. BBC News. https://www.bbc.com/news/world-us-canada-65886212. Published June 29, 2023. Accessed July 4, 2023.
- 2Justice40 Initiative | Environmental Justice. The White House. Accessed July 4, 2023. https://www.whitehouse.gov/environmentaljustice/justice40/
- 3I got into Harvard because of affirmative action. Some of my classmates got in for their wealth. Accessed July 4, 2023. https://www.msnbc.com/the-reidout/reidout-blog/joy-reid-affirmative-action-harvard-supreme-court-rcna92190
- 4(PDF) Expression of the Oppressed: Using Critical Pedagogy in Arts Education to Disrupt Systems of Oppression. Accessed July 4, 2023. https://www.researchgate.net/publication/343826097_Expression_of_the_Oppressed_Using_Critical_Pedagogy_in_Arts_Education_to_Disrupt_Systems_of_Oppression
- 5Youssef N, Lockwood L, Su S, Hao G, Rutten B. The Effects of Trauma, with or without PTSD, on the Transgenerational DNA Methylation Alterations in Human Offsprings. Brain Sciences. 2018;8(5):83. doi:10.3390/brainsci8050083
- 6Feliz VA, Hobbs SD, Borunda R. Strengthen and Respect Each Thread. Int J Environ Res Public Health. 2022;19(21):14117. doi:10.3390/ijerph192114117
- 7Waller BY, Giusto A, Tepper M, et al. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J. Published online May 3, 2023:1-5. doi:10.1007/s10597-023-01124-y
- 8Waller BY, Giusto A, Tepper M, et al. Should We Trust You? Strategies to Improve Access to Mental Healthcare to BIPOC Communities During the COVID-19 Pandemic. Community Ment Health J. Published online May 3, 2023:1-5. doi:10.1007/s10597-023-01124-y
- 9Wyse R, Hwang WT, Ahmed AA, Richards E, Deville C. Diversity by Race, Ethnicity, and Sex within the US Psychiatry Physician Workforce. Acad Psychiatry. 2020;44(5):523-530. https://doi.org/doi:10.1007/s40596-020-01276-z
