The last week of May has been egregiously hellacious in America. In the midst of a very real and present pandemic, Black people and our family in justice are grieving two pandemics, at the same time. The racially-motivated loss of yet another Black life. We have cried so hard, as mothers, fathers, brothers, sisters, aunties, uncles, pastors, leaders, influencers — as humans. Our hearts are shattered as we watched what we could of the slow, strangulated, and barbaric murder of George Floyd.
In the span of three months three Black people have left this earth too soon, at the hands of police violence. After the viral video of the almost nine-minute murder of George Floyd, who was suspected of writing a bad check; the murder of Ahmaud Marbury as he was hunted down while jogging through a Georgia neighborhood; the murder of Breonna Taylor while she slept in her own apartment, and we watched a video of a White woman in Central Park who skillfully, and knowingly weaponized her privilege and entitlement against a Black man because he confronted her about her disobeying a city ordinance.
For days now, protests, riots and looting have erupted in U.S. cities, along with touching protests in Europe. Police forces are using tear gas and rubber bullets alongside military reinforcements, and curfews are in place. Agitators and instigators, many of whom are white men, have attached themselves to infiltrate and disrupt peaceful protests. They are tagging buildings with “Black Lives Matters” or “BLM” and vandalizing and destroying local businesses.
Structural, systemic, and systematic racism has always had a strong impact on the mental health of African-Americans. Racist founding documents, meant to train others were written and verbalized by creators and influential leaders in major industries such as medicine and the military. Very false and misleading ethos’s were injected around our supposed inability to learn, inferiority to lead, and other White supremacy propaganda that are still widely believed today.
Tika and Thai had a very apropos conversation with forensic psychiatrist, and Bravo’s Married to Medicine’s, Dr. Imani J. Walker. They unpacked the stigmas around why we don’t seek help, what happens when we do, why it’s so important and what the risks are if we don’t seek help. Take in the conversation and we hope you feel the fun that Dr. Imani, Tika, and Thai infused into a very transparent talk. You matter to us, so read this as often as needed.
THAI: So we’re super excited to have Dr. Imani here. I really feel like in the same way that [TIKA] told me to go see a therapist, intervention and encouragement is so necessary. There’s an article…that says, “women are at least twice as likely to experience an episode of major depression as men, and compared to our Caucasian counterparts, African-American women are only half as likely to seek help.
We’re so busy being strong, so busy being help for everyone else, we’re not asking for the help that we need. And I think it takes someone like your sister-friend to tell you it’s OK. But I think there are so many other societal things to unpack, as to why we’re still not comfortable in those spaces.
TIKA: I think it’s also culturally, it’s like, you don’t tell your business to other people. You leave everything inside the house, don’t put your business out in the street, kinda thing. And sometimes the shame that comes along with trauma or some parents are single parents who don’t have the time….
THAI: …or resources, or money…
TIKA: …or resources or money, exactly. I think there are so many outside influences of why we haven’t. But I’m glad it feels like it’s shifting and we’re able in a space like this to really talk about it in a way that we haven’t really been able to before.
DISTINGUISHING THE DIFFERENCES
TIKA: Sometimes we don’t have the vocabulary for all [of] the mental [health] disorders, so we kind of wanted to go down the line of some of them and you can kind of define them to help us be very clear on what it is. Sometimes with even anxiety and depression, we don’t recognize the difference between just being overtired, and…feeling depressed. We want to go down a list of [the disorders] and if you want to give an example of what each one might look like. That would be great.
DEPRESSION & ANXIETY
DR. IMANI: Sure. I may even use myself. I do deal with anxiety and depression, not so much anymore because I just…recently started Prozac. And I felt guilty. So guilt is a symptom of depression. Shame and guilt…I was telling my mother that I used to feel guilty because I didn’t want…her to think (I would always say that I had a happy childhood, which I did) but I always knew, even going back to my first memory, there was always like an Instagram filter, of just like melancholy, like all the time. And I could laugh. I mean, even my sense of humor in a lot of ways is (I guess) a coping mechanism, but now that I’m better [I realize], ‘Oh, I’ve been depressed my whole life,’ but that’s because it runs in my family.
So, when it comes to depression, there are a number of symptoms.
- Guilt and shame
- A decrease in interest that you used to have
Very recently I was [starting to dip] into depression. And I began to notice now when I look back, I was always in my robe, I was always in bed…I would go to work…but I wasn’t really motivated. I would do what I had to do [but then it would be like], OK, I’m out. All I wanted to do was slide back in bed. That’s all I wanted to do. I wasn’t doing the things I like to do. So now I’m…out of the house and I’m like, ‘Oh my gosh, there’s other people out here! Who knew, right?’ That’s crazy!
Other symptoms include:
- Naturally depressed mood, which is also called dysthymia, in psychology and psychiatry
THAI: Question for you, because you just said, you just started losing interest, did something happen? I feel like everyone has this idea of depression, that there has to be some triggering event or something has to make you feel [inaudible]…
DR. IMANI: No. When I first see patients, I will ask them, usually/all the time, if they’re complaining of depression, ‘Did something happen recently?’ ‘Cause sometimes it does. For me, there wasn’t anything that happened. It just happens. I guess the best way to describe it is diabetics need insulin, and I need serotonin, and that’s it. It is just a chemical. I just need it. I need more of it.
Another symptom of depression is:
- Decreased energy
TIKA: Oh my god, I’m like, ‘Am I depressed?’ (Laughter)
DR. IMANI: Which I had. Which in moms is hard to kind of discern.
THAI: Right, because I don’t remember the last time that I had energy. (Laughter)
DR. IMANI: Right! It’s hard to discern because it’s like, ‘Am I tired because this child wakes me up at 5 AM to watch these TV shows I don’t wanna watch?’ (Laughter) Ya know? Or, if I see Caillou one more time, I swear to god…(Laughter).
TIKA: It’s [about] a little bad boy.
DR. IMANI: I mean he’s always whinin’ about somethin’ (Laughter). Anyway! Am I tired because I’m just physiologically tired, because I’m not getting enough sleep? Or am I tired because it’s depression? And sometimes it’s really hard to tease it out…I was having low energy which also came with sleeping too much. So a change in sleep habits, some people don’t sleep enough, and that’s insomnia. I was sleeping too much and that’s hypersomnia.
Also the worst of the worst with depression is when you start having thoughts of wanting to harm yourself, or even coming up with a plan to try to harm yourself. And when that happens, that’s when you really do have to contact 911, contact a hospital, your doctor, whoever you need to contact. That’s when things…can get very, very dangerous very quickly.
Kate Spade, the designer, she committed suicide. People were like, ‘Why did she commit suicide? She’s got everything. She has all this money.’ It has nothing to do with that. It’s literally a chemical imbalance. Your serotonin is just low. You can have all the money in the world, it doesn’t matter. And was she successful? Yes! Because there’s Kate Spade bags, and shoes, and tote bags…all over the place. But she was depressed. And she unfortunately succumbed to that depression.
THAI: And the sad part is, I think, in addition to the number of folks who are at risk for suicide or self-harm, there’s also…a huge category of people, and I think Black women and Black moms in particular who developed or who have been trained to have such a high threshold for pain…and you can suffer for so long. And you may never think of harming yourself. You may just be denying yourself so much joy and relief, right?
DR. IMANI: Right. Exactly. I’ll explain a little bit more about myself to you guys. I have something called Irritable Bowel Syndrome [(IBS)]. So what a lot of people don’t know is that serotonin is the chemical or the neurotransmitter in your brain that keeps your mood where it needs to be. But most of the serotonin in your body is actually in your gut. And that’s what propels your food along, which is called peristalsis. I have [IBS], so my insides were a mess for decades. And I started taking this medicine, this antidepressant and then I was like, ‘How come my stomach doesn’t hurt no more? How come I don’t have these intermittent periods of…constipation, diarrhea anymore?’ Because now my body has more serotonin, and my gut has more serotonin.
And also, I have fibromyalgia with chronic fatigue. But guess who hasn’t been in pain over the last three weeks? Me!
It was very difficult even for me as a doctor to take a step outside of myself objectively and be like, ‘OK, Bitch listen, you need serotonin and it’s gonna attack all these things.’ ‘Cause I was like, ‘Well maybe I just need something for anxiety, maybe I just need something for depression, maybe I just need something for my stomach.’ That’s not what it was. I hate to make it sound like it was a miracle drug, but for me it was. …So the fact that I’m even sitting here talking to you guys and not…falling asleep…
But to your point, yes, Black women we have trained ourselves to have a high pain tolerance but, when you look at the studies (and actually my best friend from medical school is an anesthesiologist told me this), she was a part of a study that shows that Black people, honestly, we have a lower pain threshold.
So in medicine right, because of racism and slave masters and the way that they were thinking at the time, believed and still doctors were polled last year, STILL believe that Black people have a higher pain threshold. We actually do not. But why do they believe that? Here’s an example. The father of gynecology was a White man. He owned slaves. He did experiments, let’s call them experiments, on slave women. So when you go to the doctor today, when you go to the gynecologist, a lot of those tools are virtually unchanged because they were based upon…the tools that he used back then. So why did those White people, those doctors, those people in power believe that we had a higher pain threshold? Because they didn’t give us any pain medication. So of course you’re gonna believe we have a higher pain threshold…
TIKA: And we kept going. We continued to go back to work because we had to.
DR. IMANI: Exactly. Let’s take the opioid epidemic. Largely, not Black folks, largely White people, because White doctors gave these medications to their White patients. When a Black person goes and complains of the same pain, they weren’t getting those medications. …Kind of bit them in the ass a little bit, unfortunately, but…this is really where…all of this stems from. [It’s] not like, ‘Oh we just have a high pain threshold.’ No we don’t…but for example, I have chronic fatigue and fibromyalgia, I’m used to dealing with pain. So when I had my son I was like, ‘I mean yeah, like labor that’s kind of whack but it’s like a really bad cramp.’ Which to me that’s what I was able to do, but that’s because I had been dealing with pain, in some form, my whole life.
It’s not that we genetically, ‘Oh Black people have big butts, so we can run far.’ (Laughter) Genetically, that’s not how it is. It’s that we just have conditioned ourselves to be able to withstand pain. But really,…Black people, our pain threshold is lower.
TIKA: What’s the difference between bipolar and depression?
DR. IMANI: OK. So when I see a patient for the first time and they’re like, ‘Oh I have depression…I’m sad. I have these symptoms.’ I’m like, ‘OK, so let’s take a break. Do you ever feel the opposite of that? Do you ever feel like your mood is very elevated? Do you ever feel like you don’t have to sleep? Do you ever feel like, ‘Oh, I only slept for four hours,’ and the next day you’re not tired, and you don’t take a nap, and the next day you just go, go, go? Do people ever tell you you’re talking way too fast? Do the thoughts in your head ever move too fast? Do you ever do things that can be considered to be very, very impulsive?
Like, I had a patient once who spent $1,000 on socks.
TIKA: Wow. That’s a lot of socks.
DR. IMANI: Right. So I’ll say, ‘If you’ve ever done anything impulsive, have you ever regretted that decision and had to go take all that stuff back, or that car back?’ So Bipolar Disorder refers to what’s called mood instability. Your mood goes up and down.
THAI: I hear Schizophrenia mentioned alongside Bipolar Disorder a lot. What are the differences and then what’s the correlations between the two?
DR. IMANI: Depression and Bipolar Disorder are known as mood disorders…if I’m like, ‘Oh hey! How are you doing?’
TIKA: I’m good.
DR. IMANI: OK, great, that’s your mood. Your affect is what I see. So if you were like I’m good (with a more melancholy inflection), I would say your affect, what I see, is not matching your mood. So your mood is what you report. Your affect is what I see. So depression and Bipolar Disorder are mood disorders, like, ‘Hey how you doin’, how you feelin’ today?’
Schizophrenia is a psychotic disorder. So now we move into a different category, right…Schizophrenia is categorized by a few different things.
So, what is a delusion? A delusion is a fixed, false, firm belief.
So I have patients, they’re like, ‘Yo, for real, I know for sure that somebody’s stealing my stuff out of my locker. Now, there have been cases where…(I work in a facility where patients live and I go see them. We’ll go review the tape. But also we know because of their history, they have a history of paranoia.) I know no one was in their stuff, but they believe that. It’s fixed, this is what happened.
The best thing I can say to everybody out there, don’t try to dissuade them. It’s like if you were like, ‘The sky is purple.’ First of all, no it’s not, everybody calm down. You need to have a seat, that’s not true. But that’s a firm belief right? So delusions can be really, really difficult for people to deal with because it’s like, ‘How are you gonna tell me? I know this is happening. Somebody’s poisoning my food…
You know sometimes we have to deal with you know, ‘My uncle touched my child.’ Investigations have to take place with child protective services, it can get really funky sometimes but we have to do that work. So that’s a delusion.
A lot of times I will see people who have…paranoid delusions. Sometimes people are so paranoid they won’t eat, they won’t drink water, and that’s when they gotta go to the hospital. And they have to be treated [inaudible]…but delusions can be of any kind.
Then there are hallucinations, of which there are various ones. The most common one is auditory hallucinations, which is when the person is hearing sounds or most commonly voices. Sometimes the voices, they’ll be like, ‘Oh it’s the devil, or it’s god, or it’s my dead grandmother, or it’s my sister,’ whoever it is. And sometimes they hear…10 voices at a time. Sometimes [the voices] are inside their head, sometimes they’re outside their head.
Some other common delusions are visual hallucinations, where they’re seeing things like shadows, or objects, or figures they may feel. So that’s tactile hallucinations or smell, that’s olfactory hallucinations. But the most common one is auditory, so like, ‘I’m hearing voices.’
There’s another sign of Schizophrenia, which isn’t always present. And that is what is called a negative symptom. Which means that the person is very, very withdrawn. They just kind of look like bumps on a log. It’s kind of hard to describe but here’s a perfect example, if you go outside, we’re not far from Hollywood and Vine [streets in Los Angeles] there are a lot of homeless people, and you can sometimes see them talking to themselves. [They’re]…sitting, hunched over, withdrawn, those are negative symptoms.
TIKA: What can we do to help that? Is there a medication that balances? What is it? Is it not enough serotonin?
DR. IMANI: So with Schizophrenia, it’s a different neurotransmitter or a different chemical, and that’s dopamine…Dopamine is found in a different part of your brain, but when dopamine levels get low, that’s when that occurs. Let’s take cocaine for example. If you do too much cocaine, you deplete your dopamine and your dopamine drops and you can start to hallucinate or become paranoid. So…you’ve seen in movies and they’re like, ‘The police are at the door!’, it’s like well no, but you have been doing cocaine for the past 72 hours…
TIKA: Your dopamine is low.
DR. IMANI: Your dopamine’s very low. And you probably need what’s called an antipsychotic medication. Schizophrenia is a psychotic disorder. Antipsychotic medication helps to raise levels of dopamine, so the person doesn’t experience those symptoms anymore. But to answer your question from before, there is a connection between, not necessarily Schizophrenia and Bipolar Disorder, but psychosis and Bipolar Disorder. With depression, Bipolar Disorder and obviously Schizophrenia…sometimes when people get super depressed, they can become psychotic. Sometimes when people get very, very manic or depressed when they’re bipolar, they can also become psychotic. So they might hear voices, they might get paranoid. It can be very confusing to someone who isn’t used to it, but for somebody like me who’s a psychiatrist I can be like…, ‘OK boom, I know what’s happening…’ I’m gonna ask you ‘cause I’m not gonna put words in your mouth. But then when I figure out what’s going on, that’s when we can talk about medication.
TIKA: OK. I wanna delve into an article that we have [from] the National Institute of Mental Health, it says that anorexia is the most fatal [disease] of mental illness, with an estimated mortality rate of around 10%, because of death by starvation, or metabolic collapse. But suicide is a common factor, so can we talk about some eating disorders…that affect mental health?
DR. IMANI: I used to actually work at an eating disorders hospital. So these were people that were so sick, that they had to…come into a hospital. They had to have their food regulated, they had to be weighed everyday. And with those types of patients you can’t show them their weight. And these were people, who some of them were like 80 pounds. It’s a mental illness.
So anorexia tends to run in families, there is a genetic component. When I would meet these patients’ families, if the patient’s anorexic, sometimes the mom would be anorexic, sometimes the mom wouldn’t. Maybe the mom would be bulimic and was [secretly] throwing up. A lot of patients that I’ve seen with anorexia, have a history of trauma. And a lot of it is sexual trauma.
THAI: And have you seen Black women represented in this group as well?
DR. IMANI: Personally I have not. When I’ve seen Black women, they fall more on the binge eating disorder side. Or the bulimia side of things,…which is not to say that Black women and Black girls don’t suffer from anorexia, ‘cause I’ve definitely read of cases. What is interesting is when I talk to women who had anorexia is that they were traumatized, they were sexually victimized. And I began to realize that their desire to control their food was tied to the fact that they wanted to stay the age they were when they were victimized. They didn’t want to become a woman. Because then they felt like, I’m making this up, ‘If I was traumatized when I was 12, if I start to grow breasts and hips then I’m really going to be…
TIKA: I’m really going to be traumatized again. Wow.
DR. IMANI: Yeah. And also there’s so much anxiety. And as someone who’s dealt with anxiety, you just feel so chaotic inside. And you just wanna control anything, and food, it’s one of the…easiest things to control. It’s really sad and hard for them because they view food as a drug. So when people binge, it’s not, ‘Oh I’m just hungry, aaahhhhh!’ They binge because, when they binge their serotonin shoots up.
THAI: So they’re medicating.
DR. IMANI: They’re medicating with food.
THAI: Can you talk…about what anxiety looks like? Because I think a lot of folks have this picture that it’s (and it could be, right?) like a full-on panic attack, like I can’t breathe. I think it’s like a heart attack. But what can it look like? Because I know in my family, especially my mom to my aunts they would say things like, ‘Oh, I just have bad nerves,’ and then they’d end up on some sort of anti-anxiety medicine (Laughter). But what does it look like, how does it manifest?
DR. IMANI: …I’ll use myself as an example right, for me (and for other people), anxiety, I’ll just kind of describe it generally. So anxiety describes what people call nerves or nervousness. But it describes a sense of internalized chaos…You start to feel restless, like you can’t stop moving, some people feel like the walls are closing in, you’re having a hard time thinking…your way through. Which is why, (I’ll just backtrack a little bit) people with Bipolar Disorder who are manic and elevated, they describe anxiety…So even though I don’t have Bipolar Disorder, that racing thought thing, when I get anxious that’s what happens to me. [It’s] like, ‘Oh my god, what’s happening, I can’t breathe…
TIKA: Your heart just…
DR. IMANI: Yeah, it’s like, ‘Oh my god, I need to get outta here.’ Anxiety from what I’ve been told by other patients and also I can verify this, anxiety is essentially your brain’s way of telling you, you didn’t deal with something.
[LONG PAUSE and SIGHS]
Now it doesn’t mean that it isn’t genetic. (Laughter) It doesn’t mean that I failed a test and I didn’t properly digest that. There are so many things in my life that just because, I mean, nobody…
TIKA: Yeah, it just feels like a bad party in your head, you just can’t control. There is some kind of depression in my family in certain family members. …I remember hanging out with Thai and Blaire and coming in…I’m used to holding things tight too, and not dealing, and then all of a sudden I’m just…,‘I think I have anxiety.’ And I start crying, and I was just like, I can’t control anything in my head, I start feeling overwhelmed. I didn’t understand. I felt so out of control…and I’m a person who likes to be in control (like this is how it should be, etc.) I need to control everything also because of trauma in my past. Also feeling like I don’t know how to deal with this. And I don’t even know what it is! And they just listened to me and I was like, it calmed me down…I thought anxiety was like you have to have depression, etc.
DR. IMANI: Well you know the funny part about that, is that when I talk to patients I say to them… Here’s the thing, anxiety and depression are completely different to you. To your brain they look very similar. Anxiety and depression often go together and when I’ve talked to patients I say…’When you have anxiety do you feel bad afterward?’ …When you have anxiety it’s because you’re holding stuff in. And people are like, ‘You should talk about it.’ So…with your example, you talked about it and you felt better, and afterwards you were like, ‘Damn, I shouldn’t even have said all that. Now they know all my business, and now I look stupid…’ You know what I mean? That’s really what people think! And I think the same way. And I don’t know why that is but that’s just what anxiety does to you.
You’ll have an anxiety attack, let’s say, let’s call it that. And then people are like, ‘What’s wrong?’ and it’s like, ‘Oh my god, everything is wrong!’ And then you feel bad and then you can slip into a depression after that. Because again,…guilt, you’re holding it in, and then your serotonin levels drop, then it starts to fulminate into depression. They’re very tightly linked even though they feel different. They feel different, which is why you can oftentimes treat anxiety and depression with an antidepressant.
TIKA: Wow. Sigh. Well, seriously I’m really so happy that you’re here…I’m literally just staring at you because there’s just so many things I feel like I’ve learned.
HELP FOR ALL INCOME LEVELS
With that, which is why I think this space is necessary in many different forms of just talking about mental health, and all the way it looks, in every aspect. So how would somebody who doesn’t have the financial means to actually go and pay a therapist, how would they go about getting some kind of help? Can you talk about that?
DR. IMANI: Sure. I’m not gonna sit here and say there’s a lot of resources but the resources are out there. There are definitely places with sliding scales… If anybody out there, you type in “sliding scale therapist near me” things will pop up.
And unfortunately, I’m speaking to those people who live in major cities. …[For those who live in the middle of the country, or in rural areas] …You [may] have to travel, but with the advent of telemedicine and telepsychiatry, you can actually get those services to your phone. There’s apps for that. There are apps that have therapy with sliding scale. If you are someone who really can’t even afford [a] sliding scale, the best thing to do is to contact whatever the general information number is in your area. In LA it’s called The Department of Mental Health or DMH. But based upon whatever city you’re in, there is a county-funded mental health service. And you go to one of their offices, they will do what’s called an in-take, and they will determine, ‘Does this person need a therapist? Does this person need a therapist and a psychiatrist?’
The help is out there. It may take a while but I guarantee you that the work you put in to getting yourself better and the tracks that you make now are going to not just help you. In a way I’m happy that I finally decided to get help because it’s almost like, I feel like I’m repairing the trauma and issues that my family has had in the past. I feel like I want this to end with me. ‘Cause I have a son! Is he anxious and depressed? No, he’s not! I put in measures in his upbringing to make sure. I’m gonna tell you I love you all the time, I’m gonna big you up all the time like, ‘Yo! You are awesome!’ like all the time. And it’s not that I didn’t have all of those things. I needed to make sure when I had a child that…these things that were going on with me ended with me.
Find the help (not just for yourself)…but find the help to heal yourself but also to heal your family line.
[Here’s an article link to help you to think outside of the box on your worthy quest to find affordable therapy, utilizing a sliding scale practice, university, college and community resources.]
THAI: And even if you’re not in acute pain or if you’re not in distress…you don’t have to have a cyst to go to the dermatologist, we just want to take care of our skin. You go get your teeth cleaned. I think it’s OK just to go talk to someone. Just to have an outlet, if that’s available to you. Because I think with the stigma of it all, so many of us are worried about what happens if we’re labeled bipolar? What happens…
DR. IMANI: What happens if you’re labeled? Then you get the help you need. That’s what happens.
THAI: And that’s what we need to tell our community because I think for so long it’s been, ‘OK well what is that gonna preclude me from? How are people gonna view me?
DR. IMANI: Yeah. I tell people. You don’t have to tell the whole world your personal business.
TIKA: It is such a joy to have you here. You are everything I ever wanted you to be, when I see you on TV and more, way more. I want to add the disclaimer that Dr. Imani is the only doctor here and if it gets to the point where you’re feeling some type of way and you’re exhibiting any of the symptoms, talk to someone and get professional help.
We love you here.
DR. IMANI: I had such a good time just talking to you guys. I like to come on to things like this because psychiatry is not sad and dower…actually psychiatrists have really…weird senses of humor. We all have something. And it doesn’t have to be sad and scary. I like to find the fun in the pain I guess. I like to make my patients laugh and I hope that anybody who’s listening…if you’re having issues please find help. But once you do find the help, please don’t tell the whole world, share your experiences with somebody who you trust, who you think might need some help too.
You can follow Dr. Imani on Instagram; keep up with her on Bravo’s Married to Medicine; and this summer be ready to discuss all things mental health, mental illness and pop culture on her new podcast, Imani State of Mind on Stitcher.