Why Are Black Women More Likely To Be Diagnosed As Bipolar In Britain?

Government statistics show that black women are more likely to be diagnosed with bipolar than any other demographic in the UK. Yet black women suffering with a mental illness report feeling isolated and misunderstood.

It’s a topic that is very close to my heart, having grown up with my mum, Maria, who has bipolar, and witnessing firsthand the unique set of challenges that an illness like this brings.

For women like her, the intersection of race and mental health presents a double burden. From growing up in a deeply religious community in Virginia in the United States, to migrating to the UK and struggling to get a diagnosis, Mum has a wealth of experience on this topic.

I know how her mental illness impacted me as a child but I wanted to find out what it was like for her as a young woman with four children. She was 27 when she had my twin sisters; four years later, when she was 31, I was born. For four years she was a single parent with three kids.

The beauty of growing up and becoming a woman in your own right is that you start to see your mum differently. You realise how many complex layers there are to their experiences, you learn that they do not exist only in relation to you, and you develop a deep respect for them that you could never have known as a child.

So I phoned my lovely mama to chat about living as a black woman with bipolar. I’m very grateful to be able to share our conversation and so is she. As she said during our chat: "I hope it will help move individuals and communities past coping and towards thriving."

Georgia: Firstly, how would you describe your bipolar?

Mum: I think there are a lot of misconceptions about being bipolar. It isn’t that you have multiple personalities or many people living inside of you but it’s...

Georgia: ...It’s like two sides of the coin, isn’t it?

Mum: Yes, and one is enhanced you and the other side is less functional. So obviously enhanced you is going to feel a lot better. I have hypomania, which is a short period of mania lasting for a few days or so. I don’t experience psychosis, which is a loss of touch with reality, though.

Georgia: Like the stereotypical image of someone running down the street naked?

Mum: Yes! That stereotype of mania is actually what put me off getting my diagnosis for years, because my depressions were severe and they were the hardest symptom for me to deal with. They presented the most obvious, whereas the hypomania was a lot more discreet. Hypomania can just be 'life and soul of the party' or it can come across as 'bitch', because part of mania can manifest itself as anger. A lot of hypomania traits are praised, such as the rapid ideas, creativity and the ability to work without sleep.

Georgia: When exactly was it that you got officially diagnosed with bipolar?

Mum: I can’t remember exactly the date of diagnosis, I think I was 45. 2013 maybe? It was after I took that bottle of pills. Leading up to that, the problem was I couldn't get diagnosed. I didn’t have the best junior psychiatrist diagnosing me and they misdiagnosed me initially with depression. I felt really dismissed.

Georgia: So how did you feel once you got the diagnosis?

Mum: I felt relieved, it validated a lot of my experiences. In a way it gave me a new set of tools to cope with how I was feeling. It gave me information, symptoms and treatments. I knew that I was unwell and I no longer felt like I was just 'a bad person'.

Georgia: Interesting, because research shows that black women are more likely to be diagnosed than other demographics in the UK. What do you think of this?

Mum: Wooooow I didn't know that! That's an interesting statistic because I felt isolated in that aspect. Even within my own (large) family there is only one person who is depressed to the point where she has therapy and takes medication.

Georgia: My thought was that perhaps there's a socioeconomic element? I looked into it and found some research that seems to confirm this. It says that the trauma of domestic violence and discrimination might play a part. And there’s more research that suggests that black women who present with symptoms aren’t treated adequately. Perhaps black women, particularly those from low income backgrounds, need more support?

Mum: I agree, that’s my own story. It was my social worker who spotted it. You’re probably right.

Georgia: I initially assumed it would be the other way round, because I thought the stereotypes of black female characteristics – loud, angry, strong – would cause medical professionals to overlook the bipolar diagnosis and pass it off as 'that's just who you are'.

Mum: Exactly, as my current psychiatrist said: "We had to rule out that you didn't just have an 'exuberant personality'."

Georgia: That's what I mean, I feel like it is an extra struggle – in so many parts of our lives – as a black woman to be taken seriously. Do you agree? I think there is a trope that women, especially black women with children, are meant to be seen as matriarchal, strong and therefore they can kind of handle anything. You can cope. No matter what.

Mum: You can cope, you’re seen as coping. You are a multitasker, you're strong, you just get on with it, you’re an independent woman. Also if you’re trying to put food on the table or whatever, you haven't got time to have a mental health problem. You haven't got the space to step back and think about your life, you got shit to be doing. Especially with black women there's a sense of dignity, you fix up. No matter how hard things are going, you put your clothes on, you do your hair. Within our community, that’s a thing: you fix up and you get on. So sometimes being seen as capable has been to the detriment of my own health.

Georgia: Black women aren't necessarily given the space to be unwell, we are not seen as vulnerable. Therefore, I can imagine if you’re experiencing certain characteristics that you thought might allude to a mental health issue you would personally be put off getting help.

Mum: It’s a constant fight. Being told by medical professionals that you don’t know what you’re suffering. There’s a disregard for your experience and you’re assumed to have no knowledge of the situation. I have never seen myself represented in the medical community. So it's difficult to identify, you go in to appointments with your back already up.

Georgia: It can feel like there is quite a patronising and biased attitude from the medical community, can’t it? That’s my experience, too.

Mum: Part of the difficulty with being an ethnic minority when it comes to asking for help is that psychiatrists are not immune to the social prejudices that other people have. They’re human, too.

I think if you normalise psychiatry as a study or career choice, these levels [of academia] become available for black participation. I think the more you can bring that into the community, the better the chances are of people coming forward and normalising the whole spectrum of mental illness. That I think would be a good thing.

Georgia: How do you feel the stigma of not only being bipolar but then layering on top of that being a black woman? Does it feel like an extra burden?

Mum: I think so, yes. Take anything related to mental illness or disability that anyone experiences and then consider being black as the icing on top of it.

The stigma of bipolar is real, especially when you know how your own community is going to treat you. Part of it, within the black community especially, is that there are other real life threats going on. You might get shot or you might get blamed for a crime, and when there are actual physical threats it can be seen as some kind of luxury to have a mental illness. It’s like, why are you sad? You didn't get fired, you didn't get passed up for a promotion, you didn’t get stopped by the police.

Georgia: I can understand where that line of thought comes from. I guess if you already have external issues or threats then once something internal or individualised, like mental health, springs up it could be quite tricky to accommodate.

Mum: Yes and you challenge their world view, and the issue becomes othered. Religion often comes into it too, in our community.

I remember once, when I was 14 or 15, I was experiencing symptoms of bipolar and I was pretty sure this was different to the usual teenage hormonal stuff. So I told my Christian mum I'd like to see a psychiatrist and without missing a beat, she said: "Psychiatrist?! You can’t go to a psychiatrist, the neighbours will think you’re crazy."

Georgia: Moving on to parenting! How did you find being bipolar and having four children? One of whom has a disability [Georgia's youngest brother, Gabriel, has autism].

Mum: Post-diagnosis there was a lot of guilt, you start looking back and looking at things you did which you didn’t realise. Or you just start wondering, How did I fuck them – the kids – up? This all happens naturally with parenting but now I'm realising certain things didn’t have to happen and wouldn’t have if I'd been diagnosed and had medication.

Georgia: I can imagine it was tricky though, as life doesn't stop for mental illness. Especially if you have children.

Mum: In a way, thank god I did have you guys because it meant I had to do something. The positive is the social regulation which is a good thing, having a routine. Having to have you bathed, having to have your dinner ready or having to have your wings for some obscure Christmas show. There are constant adjustments to appear sane or appear okay. You spend a lot of time trying to be normal. But it's positive because it means I cannot lie around, not without getting the attention of social services.

Georgia: As a mother you’ve got people to answer to.

Mum: Yes, there are a lot of people to answer to when you’ve got four kids!

Georgia: Do you feel like having your diagnosis and being a black woman affected your relationship with us or style of parenting?

Mum: I feel like culturally I was a little bit more strict perhaps than some of the other parents. But also I think there's a split between my mental illness and my character. It was never going to be in my character that the sun was going to shine out of your arse; I was never going to spoil you guys as part of the tradition in which I was raised.

I think that’s a black tradition, I’m in charge. I’m also expected to be held to a higher standard of parenting in terms of discipline, having my children be polite and well dressed. Even if you don’t have all the money in the world, black people show up and show out.

But my mental illness and my personality/culture do overlap. I was once accused of being distant with you guys. Now, being emotionally distant is a symptom of being depressed. A lot of the hypomanic traits are not, in terms of parenting, great things.

When I'm manic I’ll take you everywhere, I’ll sign you up to everything, then suddenly I’ve signed you up for basketball, football, gymnastics, ballet and now I've got to deal with getting you there.

Georgia: I feel like I noticed it when I was younger. Sometimes you had days where you were more tired but I think I saw from a young age that everyone’s parents were different. I think I had such a diverse mixture of people growing up with different family situations.

You didn't really ever hide much. Some days I'd come home and you’d be sleeping and I’d be like, Oh she’s having a bad day. You weren't trying to put on a face, which I thought was really helpful.

Mum: I think I tried to explain all this as much as I could to you in an age-appropriate way. As you got older, I told you more, which I think is to you guys' benefit. We can have conversations around mental health, we have open discussions. If the fact that we do that can inspire or help anyone else, then even better.

My mum has now been stable with her bipolar for a while, which she credits to therapy, seeing a psychologist and finding a dose of medication that works for her. I know that the NHS waiting lists for therapy are too long, and I hope that can change. Too many people are forced to struggle on without the help and resources they need. What it will take for our politicians to realise that, I do not know. But this I do know: My mum is my hero and I'm beyond proud of her.