Article Analysis – “Breaking it down: Mental health and the African community”

Liz Spikol linked to this article back in December and as a Black American with West Indian heritage (and by default, African and French), I couldn’t resist commenting.

Author Morenike Fasuyi blasts the United Kingdom’s mental health system as being less than inadequate for Africans. I don’t doubt it.

I do wonder about Fasuyi’s seemingly sheer hatred for anyone of European descent (in America, we’d refer to them as “white” or “Caucasian”). The article seethes with anger.

“The general consensus suggests that African people have to work twice as hard as their european counterparts in every aspect of our social, cultural and economical existence in order to make ends meet.”

This also is the case for Black Americans.

Fasuyi explains how she’s been diagnosed with bipolar disorder but says her disorder is mainly triggered by things related to Africa: “slavery, politics, oppression.” Her turning point was on May 1, 2004 when “it was as if [her] ancestors called” upon her and “removed the scales from her eyes.” She refers to Karl Marx when speaking about “groups” – Africans – who are oppressed and eventually rise up and lead a revolution. In addition, she believes the numbers 7 and 9 relate to the African people and that 2007 could be the year when “division within the African community” would be “homogenized[d]… to effect change.”

As a Black American, I know that African people truly value their ancestors and even practice ancestry worship. This is where I believe she is coming from. To any other nationality, Fasuyi is crazy (no pun intended). It wouldn’t surprise me if her mental health status file read, “bipolar disorder with psychosis.” Not knowing about African ancestry worship can make any doctor of non-African nationality misdiagnose Fasuyi. To be able to accurately help her, she must be accurately understood.

She asked for an African psychiatrist who might have a cultural understanding of where she was coming from. She mentions this was a slow process since “there [were] hardly any.” She also asked for an African social worker but was given “an insensitive male european (sic) social worker who adversely affected my health with his actions, racist remarks and incompetence.”

She takes a nice jab at Big Pharma and pharma reps, too:

“Maintaining you within the system keeps consultants in their jobs and increases the profit of the pharmaceutical industry, which has a turnover of billions.”

Zyprexa; Cymbalta, anyone?

“Another tactic used to undermine you is intellectual intimidation.
Consultants and doctors discuss very complicated clinical issues with
patients who are incapable of understanding what is actually being

Doctors rarely explain things in layman’s terms to a patient – using
clinical jargon to imply that the doctor knows best. Very few patients
challenge their physicians on their diagnoses and care. On the other
hand, many patients don’t make an attempt to understand and research
what their physicians have said and simply take them at their word.
It’s sad but true:

“This method of complicated jargon is also
used when they talk to relatives, leaving everybody somewhat confused
and resigned to the fact that the system knows best.”

The system doesn’t know best. Relatives figure, “Well, the doctor went to medical
school, s/he should know what s/he’s talking about.” People often
forget that doctors are fallible; they make mistakes too and aren’t
always correct. In the age of libraries, encyclopedias, dictionaries,
and the Internet, every patient should know precisely what his/her
doctor is speaking of in reference to his/her care. After speaking with a physician, it is a patient’s responsibility to educate
him/herself. Not to do so is ignorance.

"People often forget that doctors are fallible."

Fasuyi attempted to introduce the concept of Post-Traumatic Slave Syndrome (PTSS), developed by American doctor Joy
(incorrectly named in the article), during her weekly
assessment with a panel of doctors, consultants, and therapists (among
others). She says that the symptoms in the book precisely describe her
condition. The
introduction of what she believed to be an accurate diagnosis was
quickly dismissed because “the mental health system in the UK is so
rigid and based on discriminative European ideology that they will
never accept [PTSS] as a clinical condition.” It is not so much
discriminative European ideology as much as doctors needing to be able
to put a square peg into a round hole. In other words, PTSS ain’t in
the DSM-IV TR, sista
. If a proposed psychiatric diagnosis isn’t in the
fourth edition of the Diagnostic and Statistical Manual of Mental
Disorders (text revision), it isn’t considered a valid diagnosis. Not
necessarily that the medical system is right about this, but that’s the
way the medical field works. Fasuyi adds that PTSS has been recognized
in America, but I’ve never heard of a single case of it. Never until I
read this article.

PTSS, according to Dr. DeGruy-Leary, is based on the concept of
Post-Traumatic Stress Disorder
(PTSD). Fasuyi lists the following
symptoms of PTSS:

  • Difficulty falling or staying asleep
  • Irritability or outbursts of anger
  • Intense psychological distress at exposure to internal or external
    cues that symbolize or resemble a traumatic event, i.e. slave trade
  • Feeling a detachment or estranged from others

Fasuyi cites a statistic from an NIMH in England study, “Inside
Outside: Improving Mental Health Services for Black and Minority Ethnic
Communities in England”
: “An overwhelming 66 percent of African people
complained of discrimination within the mental health services.” I
scanned a PDF version of the study and did not find that statistic
cited. (Please feel free to correct me if I’m wrong.) However, I stumbled upon a fact sheet from, which essentially said that
Africans and Blacks are discriminated in the UK overall and especially
in the mental health system.

Fasuyi said something that jumped out at me (which may or may not be true):

“Another aspect of their practices which concerned me was that if you
refuse your medication, you are forced to have an injection. If you
were agitated or questioned their motives in a passionate way, you are
seen as aggressive and given an injection.”

I don’t doubt that this practice exists, but can only assume this is the minority rather than the majority.

“Mental illness doesn’t discriminate by race; diagnoses do.”

Fasuyi cites the following stats without support, which makes me a little nervous:

  • More than 80 percent of patients in psych wards are African.
  • African people are more likely than Europeans to be given a clinical
    diagnosis that warrants medication, intervention, and detention under
    the Mental Health Act of 1983.

From cursory research, I haven’t discovered the statistics cited, but
did stumble upon an interesting fact about the UK mental health system:
Blacks are six times more likely than whites to be diagnosed with
schizophrenia and black men are ten times more likely than white men to
be diagnosed with schizophrenia. This is a troubling fact, indeed, but
Fasuyi’s assertion that the mental state of whites “always seemed to be
more severe than those of African patients” is also out of whack. It’s possible Fasuyi saw mental health staff treat black patients as
more severe cases; it’s not necessarily that blacks suffered more
severely than their white counterparts. Blacks and whites can suffer from similar mental health conditions and
whites aren’t necessarily more severe than blacks and vice versa.
Mental illness doesn’t discriminate by race; diagnoses do.

“The british Mental Health System has no real interest in understanding
the core root of African mental health issues which are predominately
caused by issues relating to socio-economics, cultural identity,
employment, racism, oppression and learning the historical facts of
African Evolution.

The system is not interested in how brothers and sisters became the way
they were or what the triggers are. They are more concerned with
medication and sedation. … There was no implementation of an
efficient equality action plan or a commitment to addressing our
“cultural needs.”

If this is an issue that is bothering a
patient, then the doctor should deem it as something that should be
addressed. Asking about family history or other things the patient
deems irrelevant do nothing to help the patient’s mental state. Doctors
need to be more aware and understanding to patients who have various
issues (whether it be slavery, sexual abuse, or financial problems) and
listen to what they are experiencing NOW before gaining a background on
what happened in the past. If Fasuyi needs to discuss issues related to
African evolution to make progress in her mental illness, she needs a
doctor who will accommodate her. This isn’t just pandering to a patient;
this is common sense. Doctors need to stop looking for diagnoses and
asking questions that fit “within” a diagnosis and begin to listen to
their patients.

I only had an issue with Fasuyi’s complaint that mental health hospitals should provide the proper tools for Africans (Blacks) to take care of
themselves. I hate to be nitpicky about this because she still has a
good point, but it’s not a hospital’s job to provide the best tools of
hygiene care for each ethnic group. Fine-toothed combs, unsuitable body
lotion, no hair grease, and cheap shampoo are some of her complaints.
The fine-toothed comb argument is somewhat legitimate but it is what it
is – those in the mental health ward need to make do with what they
are given. The unsuitable body lotion falls flat on its face; mental
health hospitals (even in the U.S.) are not required to provide
“suitable” body lotion based a person’s ethnic background. The absence
of hair grease and the provision of “cheap shampoo” are so terrible
that I don’t even consider them valid arguments. Having been in the
U.S. mental health system, I can tell you that hair grease for Blacks
is really a luxury and that having “cheap shampoo” is better than
having no shampoo at all. She argues that these same hospitals
don’t provide deodorant, which I agree they should; It’s unfair
to have mental health workers subject to ill body odors from people who
could take care of themselves.

Much of Fasuyi’s arguments are littered with racism this and racism
that. Racism’s existence is real; I’ve
encountered it myself a few times. (You can’t be Black and not
encounter racism at some point in your life.) But I reject the argument
that all whites are racist and that the white man is evil and out to
get the black man. One of my biggest pet peeves are black people who go
around blaming everything on racism – almost exclusively by whites.
“She’s racist; she won’t give me a promotion” or “He’s racist; she
wouldn’t approve my home loan application.”
Before running to the race
card, Blacks of all countries need to take a good look at themselves
before pointing outward to oppression. Why was the Black lady denied a
promotion? Is it because her white boss is racist or did the boss
notice that the Black lady has been consistently tardy and therefore
denied her promotion? Why was the Black man’s home loan application
denied? Is it really that the banker (or bank) is racist or that the
Black man’s credit isn’t good enough to have a home loan application
approved? I’m not saying this is always the case, but Blacks are quick
to point the finger at “the white man” without looking at themselves to
see if they erred in any way.

“The only way to effect change – not just in a mental health system – in a country is to work with everyone no matter what race.”

Fasuyi’s arguments are generally supported: UK stats point to a
significant discrepancy between whites and blacks in the mental health
system. However, Fasuyi’s solution is to “establish a grassroots
African mental health body that has the capacity to consult, advise and
make recommendations on any issue that concerns African people and the
mental health system.” I disagree; the only way to “fix this mess” is
to work with the dreaded “european” (in her words) to effect change in
a system that seems to be racially imbalanced. Black Americans forget
that the Emancipation Proclamation and the Civil Rights Act of 1965
were both pushed through Congress and enacted by white men. British
Blacks need to recognize that part of American history and learn from
it. The only way to effect change – not just in a mental health system
– in a country is to work with everyone no matter what race.

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