Nafsiyat Senior Psychotherapist, Baffour Ababio, has written an article (included below) for the programme of a new play Barber Shop Chronicles, which is showing at the National Theatre until July 8th. The article looks at why men in black communities avoid speaking out about mental health.
STRONG BLACK MALE
Fear predominates in conversations about mental health issues. It is used in connection to people’s perception and knowledge about the range of treatment options available. It is linked to the spectre of being sectioned under the Mental Health Act, of the police being involved, of the effects of antipsychotic medication, of stories of individuals with mental health problems inexplicably dying in police cells.
Amongst London’s ethnic minority groups, this fear mutates when it intersects with ideas about mental illness from their various countries of origin. In Ghana’s capital, Accra, for example, the perception of mental health problems conflates sometimes with the mysterious happenings behind the walls of the Accra psychiatric hospital; a perception reinforced by the sight of mentally ill people wandering the streets begging, wearing rags, sometimes naked.
Most languages use derogatory terms to talk about their mentally ill. In Lagos, Nigeria the Yoruba term were (meaning insane) is linked to the Yaba hospital, while the Shona word Benzi (meaning stupidity) is used to talk about the SASCAM hospital in Harare, Zimbabwe, adding further stigma to these much-feared – and usually urban – psychiatric hospitals. The attitudes towards mental illness in these developing countries vary between the urban and rural areas. In the rural areas communities seem more settled with the dynamic existence of familiar, caring relationships with the mentally ill person.
Recently, I have been struck by memories of the stereotypes I held growing up in Accra and of using the Ga term S?k?yelor (meaning mad person). I recall visits to Banjul in The Gambia in the 1980s where in Wolof, they say denga mankeh – similar to ‘one missing a screw’.
When I arrived in the UK I experienced disorientation followed by a period of profound sadness, and this was partly instrumental in my decision to train to become a psychotherapist. But I also made the choice because of the prevailing fear, stigma and shame within the black community, which places a lid on psychological problems, stemming their expression and thwarting access to timely treatment. There seems to be a notion that once an individual is touched by mental illness, they can never return to the way things were; that they are marred for life.
When I started training, there were very few professional spaces to engage black people in talking therapy, and the mental health treatments offered were geared largely towards medication and hospitalisation, often seen as necessary restraints in the context of the stereotype of the ‘black, dangerous male’. As one of the few black male psychotherapists, I felt I could play an important role in helping other men talk about their problems.
Until the 1980s it was difficult for members of the black and ethnic minority groups in the UK to access psychotherapy or counselling. Places like Nafsiyat Intercultural Therapy centre set up stalls during that period to work with them. They (black people) were excluded from traditional psychotherapy because of the notion that they were not psychologically minded. My training came about through a collaboration between Nafsiyat and UCL and it challenged me to confront the racism implicit in much medical and psychotherapeutic theory. Intercultural psychotherapy acknowledges the reality of mental illness but argues that the course, recovery, outcome and symptoms are shaped by the cultural and social context.
There is an urgent need for early intervention in issues of mental health, particularly as the black community in the UK, operates under the pressure of striving to be seen as capable of survival and of becoming financially successful. The link between this pressured environment impacting underlying vulnerabilities and widening psychological fissures is a strong one. The stress of racism, migration, vestiges of the colonial experience, the fragmentation of communities and the processes black men experience in the mental health system, stoke up the fear of addressing the early signs of mental health problems, contributing to increased rates of mental illness.
Racism, has its overt expressions but is also experienced as micro-aggressions. A black, male client who consulted me for psychotherapy, talked about his internalisation of the stereotype of the ‘dangerous black male’. He described daily running the gauntlet to work: observing the empty seat next to him not being readily taken, the frustrations of disempowerment at work, walking home late and hurrying to overtake the white woman in front – to reassure her. He would arrive home and snap at his wife and children, unwinding with a drink. He realised his anger was displaced. He went to the dentist; a white female dentist put a temporary fix on his molar and cautioned him to not chew any bones. He left the dental surgery angry but confused – was he being too sensitive? Why did she refer to ‘bones’ and not ‘any hard foods’?
The notion of the strong, black man – interpreted to mean an aversion to talking about emotional problems – results in the accumulation of stress. And the stereotype of the strong black male inevitably seep into spaces where male interaction often occurs, such as sport (participating or watching), the barber shop and the gym. This could mask or inhibit vulnerability and further discourage men from opening up, due to the fear that it might be deemed an indication of homosexuality or bisexuality. This silence also indicates the community’s position not to air its ‘dirty linen’ in public.
The Barber Shop Chronicles play describes the setting within which the barbering occurs. The client sitting in the chair, a cloth wrapped around him, induces regression and introduces a degree of intimacy and vulnerability in the interaction. It resonates with my work as a psychotherapist and made me consider the possibilities of collaborations between barbers and therapists.
I remember visiting my barber the day before my wedding on the pretext of getting a good haircut for the big day. I now see my barber as the ‘best man’ no one knew about, and our talk that day prepared me for my rite of passage. For my clients, too, the barber shop can provide a place of refuge. ‘John’, who saw me for psychotherapy, had left his country of origin in Africa – a country where he was exposed to the brutalities of civil war. He arrived in the UK and found a job in transport, met a black British woman, got married and had children. His in-laws did not approve of him and thought his spoken English was not up to par. Eventually John embarked on an affair and took to drink, becoming alcohol-dependent.
During this time, John developed a rapport with his barber and would travel to north London to see him. He enjoyed sitting in the chair – akin to the counselling chair, perhaps – as his barber stood behind him, cut his hair and conversed with him. Despite this interaction, John’s drinking spiralled out of control, into domestic violence, arrest and a breakdown. His marriage ended and so did his relationship with his children.
With proper support, the trust and routine of this weekly session with the barber could have enabled John to seek help sooner from his GP, who could have facilitated a referral to an appropriate psychological, medical and cultural intervention to complement the barber’s time with him.
When I saw John for psychotherapy, it was clear that the cause of his breakdown was multifactorial and intersectional. Amongst other things, he had unaddressed issues from his encounter with the civil war in his country of origin. His sense and experience of community had already been fragmented before he arrived in the UK and he attempted to recreate a family around him. His marriage was in part undermined by the internalised colonial issues of fluency in English and the stress of getting a middleclass job to placate his in-laws. John also struggled to strike the balance of being vulnerable with his wife whilst remaining the ‘strong man’ he felt he had to be.
In my work with John, he disclosed his fear of breakdown and of being diagnosed with schizophrenia. This fear is real in so far as it is based on actual reported cases within the black population where patients are two to three times more likely to be involuntarily hospitalised under the Mental Health Act.
In relation to their numbers within the general population, black people are over represented in psychiatric hospitals; particularly in locked wards, probation services and prisons. Black men are over-represented in the diagnosis of serious mental illnesses such as schizophrenia, resulting in labelling, reinforcing mistrust and suspicion of mental health professionals. These experiences enable negative perceptions of mental illness to be directed towards places like The Paterson Centre for mental health in west London.
It is a fear which deters people from seeking help. To change this, we need to find ways to raise awareness of local mental health resources, particularly culturally appropriate services in black communities – and this could mean collaborating with barbers. What if we could work to embed a working knowledge of signs, symptoms and treatment of mental illness within these communities? It’s not entirely about focusing on deficits, it is also about acknowledging existing strengths within these communities, its people, its resilience, its contributions, its coping mechanisms and facilitating and celebrating them.