The UK's Mental Health Systems Aren't Designed For Women Of Colour Like Me. That Has To Change

I don't fit the ‘traditional’ profile of someone with bipolar disorder. My pain, and need for help, went unattended because of my identity as a Muslim woman of colour, writes Noha Magd
Getty Creative
Getty Creative

Mental health is complicated. Bipolar disorder is complicated. And life is complicated too. But navigating the world with a chronic mental health condition as a Muslim woman of colour is even more complicated.

I should know.

Earlier this year, I was diagnosed with bipolar disorder. This followed several years of living with depression, a panic disorder, and prescribed medication that, while helpful at first, slowly began to chip away at everything that was holding me together.

It would probably help to tell you how I got here. I first experienced anxiety and depression during my final undergraduate year, but the severity of my depressive episodes and debilitating anxiety began interfering with my life, to the point I struggled with basic tasks like getting out of bed, eating breakfast, or even leaving the house. Each episode would see me struggle with panic attacks and insomnia.

I had graduated with a first, I was doing a PhD programme that I really enjoyed, everything was going well. So why was I feeling like this? I didn’t know, and I felt confusion and guilt but mostly frustration with the unpredictability and lack of control over my own mental state.

As I found it harder to function, I decided to seek help. Inside, it felt like I was being pushed against my will to seek help, like my body was moving while my mind remained in denial and in fear of what I was opening myself up to. After describing my symptoms, a doctor prescribed SSRIs, which offered enough stability to keep me going.

“I had too many responsibilities and a career to think about – I didn’t have the time to experiment with different medications and diagnoses”

And that’s what I did. I kept on going, despite knowing deep down something wasn’t right. I had too many responsibilities and a career to think about – I didn’t have the time to experiment with different medications and diagnoses. The prevailing stigma within academia on mental health, and lack of understanding, held me back too. Studying for my PhD, my mental health deteriorated at an alarming rate – which isn’t surprising considering the state of mental health in academia. In fact, 51% of PhD students reportedly experience mental health issues whilst in academia.

My family would tell me to pray on it, tell me they couldn’t believe I could be so functional yet so depressed. That was both toxic and invalidating to hear, and created a wall between me and my family – then a wall between myself and my culture and religious upbringing. The spiritual element of suicide made it harder to discuss. Islam regards suicide as a major sin, and I didn’t want to be sinful. As most Muslim women are, I was socialised and conditioned to hide my pain, to tolerate it silently.

My friends would tell me I was fine, that this too would pass. Some of them finally recognised the severity of the situation and encouraged me to get professional help. I wanted to be seen by a psychiatrist. My self-help techniques, research and coping mechanisms and prayers had reached their limit.

I will never forget the day I reached my breaking point. Several weeks of suicidal tendencies had built up in my mind, and I was ready to end my life quietly and without fuss. A friend sensed the urgency of the situation and instructed me to go see a psychiatrist. I explained, all calm and collected, how I was ready to commit suicide if I didn’t get help. I stressed the urgency, I told my doctor I needed help now or I worried that I would end my own life.

I had begun to suspect I was experiencing symptoms of the bipolar spectrum. But as I sat in my appointment with my GP, I felt further and further from the ‘normal’ bipolar patient with each question. My doctor asked if I drank too often sometimes, if I’d experimented with drugs, if I’d been having problems with addiction to substances, if I’d had heightened sexual activity in the past few months, if I’d made plans to kill myself. To all of these I answered no. In no way did these questions consider my religious or cultural identity.

“My pain, my need for help, went unattended because of my identity as a Muslim woman of colour.”

Bipolar disorder is often characterised by episodes of mania – but as manic episodes go, mine were harder to recognise. I don’t drink for religious reasons, I don’t have access to hard drugs, and I have cultivated a high degree of discipline over myself. All these indicators of bipolar disorder presented to me just didn’t exist in my context due to the life I led as a Muslim woman. My pain, my need for help, went unattended because of my identity as a Muslim woman of colour.

However, my experience was just a symptom of the whiteness and institutional racism in the health care system; a system where people of colour are less likely to be believed and get help, even if they ask for it. Not fitting into the ‘standard’ diagnosis prevented others from spotting the signs that would encourage intervention. Not fitting into the bipolar ‘box’ made me invisible.

Hypomanic episodes – periods of elevated moods and energies that are easier to control – were much harder to disguise, and for a long time I thought I was just a high-functioning depressed person. But my hypomania would last weeks – I would be restless and energised, thoughts racing and mood elevated. I finished my writing my PhD thesis over the course of three or four hypomanic episodes, only interrupted by physical and mental breakdowns during depressive episodes.

Then came the night I visited the hospital confident my mental health meant I wouldn’t make it to morning. Sat in the A&E waiting room, it became clear the only way I would be seen was to refuse to leave and describe in explicit detail why I wanted to end my life – and how I would do it. I had to do so to five different strangers. I can safely say I would not have made it if it were not for my friends who held my hand through it all. They saved my life, but I was forced to save my own.

“I am one of the lucky ones to have been able to navigate a toxic and complicated, institutionally flawed system not designed to serve women like me”

Now, I have a new diagnosis and new medication, I’m finally on the mend. I have learned the invaluable lesson of being my own best advocate, asking and demanding adequate care. For years I was terrified of everything about myself, and now for the first time I can say I’m no longer afraid.

My story, though, is just one of millions. I am one of the lucky ones to have been able to navigate a toxic and complicated, institutionally flawed system not designed to serve women like me. We rarely discuss the spiritual and religious stigma towards mental health. Religion and culture are complex and are more difficult to discern than the material world of mental health issues as valued by productivity.

It was important for me to write this, because more needs to be done for women of colour, and particularly Black and Muslim women in the healthcare system. There is help out there and resources available specifically aiming towards culturally-competent and inclusive care such as BAATN, and Nafsiyat in the UK. But we need better research for evidence-based policy making, more awareness of unconscious bias and racism in mental health services, and we need to train and hire more BAME mental health practitioners. This requires a revolutionary approach, one that is dynamic and resilient but which does not place the burden on people of colour alone. It is a crisis we all have to take part in stopping if we want to better, even save, thousands of lives.

I wrote these words in the hope someone who needs to read them finds them. I wouldn’t have had the strength or capacity to advocate for myself if it weren’t for the people, resources and community that I found. And to anyone who is reading this who feels the same, know there is help out there – even though it may be hard to find and difficult to access. It’s there, and it’s worth fighting for. Because you are worth fighting for.

Dr Noha Magd is a writer, activist and PhD student at the University of Bristol. Follow her on Twitter at @get2noha

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