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July is <\/em><\/em>Bebe Moore Campbell National Minority Mental Health Awareness Month<\/em><\/em>. <\/em><\/a><\/p>\n At 36, Chajuana Mayes had reached her limit. <\/p>\n She had relocated to a new state with her daughters and new husband, and was struggling to balance the expectations of being a mother and wife while holding down two jobs and taking care of the house. She also grappled with guilt \u2014 she\u2019d moved her daughters away from their fathers and worried about how they were coping. <\/p>\n Mayes said she began overeating and drinking to manage stress, leading to excessive weight gain, other physical health issues and exhaustion.<\/p>\n \u201cEvery day I got up, I looked in the mirror, cried and told myself, \u201cThis can’t be my life. This can’t be just it,\u2019\u201d she said. \u201cI was creating so much unnecessary suffering because I believed that I had to be everything to everybody once I became a wife and a mom.\u201d<\/p>\n While Mayes\u2019 story is common for many women in midlife or approaching that stage, her physical and emotional exhaustion had an additional layer. From the examples set by the women in her family and cultural representations of Black women in media, there was an unspoken understanding that her efforts were expected of a strong Black woman in America. <\/p>\n Cheryl L. Woods Giscomb\u00e9, Ph.D., RN,<\/a>, a professor at the University of North Carolina at Chapel Hill, developed the often-used framework for the Strong Black Woman (SBW) schema<\/a>, noting the Black women she studied characterized the \u201csuperwoman\u201d role<\/a> into five main ideas: the obligation to manifest strength, the obligation to help others, the obligation to suppress emotions, the pressure to show resistance to being vulnerable or dependent, and the need to demonstrate a determination to succeed despite limited resources. <\/p>\n There\u2019s often a paradox within the SBW schema. In some cases, it can encourage a sense of positive self-worth and pride. A study<\/a> in the Annals of the New York Academy of Sciences found that even when Black women felt they had to project strength and resilience in adverse conditions, the schema offered a protective impact from negative health effects of chronic racial discrimination. <\/em>However, the more detrimental aspects of the SBW schema can compromise Black women\u2019s physical<\/a> and mental health and well-being.<\/p>\n Taisha Caldwell-Harvey, <\/strong>Ph.D.<\/a>, <\/strong>a licensed psychologist and founder of therapy practice The Black Girl Doctor<\/a>, regularly works with women managing the duality of the SBW schema. <\/p>\n \u201c<\/strong>In practice, that looks like a woman who is the emotional, financial and spiritual backbone for everyone around her but has no socially acceptable space to be soft, tired, sick or in need herself,\u201d Caldwell-Harvey said. \u201cAt the same time, it\u2019s important to say: For many of us, this isn\u2019t just a behavior pattern, it\u2019s an identity. In my work with Black women, I name it as both cultural pride and survival strategy. I also invite us to look honestly at what it costs.\u201d<\/p>\n In conversations with patients, Caldwell-Harvey said she sees three manifestations of the negative side of the SBW schema, all of which impact Black women\u2019s physical and mental health. <\/p>\n Hyper\u2011independence and overwork can lead to \u201cBlack women feeling compelled to carry everything alone, to work \u2018twice as hard\u2019 at home and at work and still never feel \u2018enough,\u2019\u201d she said. <\/p>\n There\u2019s emotional suppression, which involves \u201ca difficulty naming sadness, fear or trauma because \u2018I\u2019m supposed to be strong,\u2019 which delays help\u2011seeking until crisis.\u201d Then there are physical and maternal health risks<\/a> of \u201cpushing through pain, minimizing symptoms and being dismissed by healthcare providers who assume Black women can tolerate more, contributing to dangerous gaps in treatment and Black maternal morbidity and mortality.\u201d <\/p>\n Data from the 2023 KFF Survey on Racism, Discrimination and Health: Experiences and Impacts Across Racial and Ethnic Groups<\/a> illustrates some of those potential connections. <\/p>\n Among Black adults, women were more likely to say they were treated unfairly by a healthcare provider because of their racial or ethnic background (21% to 13%). Black adults said they were more likely to have difficulty finding a provider who could understand their background and experiences than white adults (46% to 38%), and 24% of Black adults reported negative experiences with providers that included assuming something about their lives without asking, blaming them for a health issue, refusing to prescribe pain medications or ignoring direct requests and questions. <\/p>\n Vanessa Anyanso, Ph.D.<\/a>, who got her doctorate in counseling psychology at the University of Minnesota, studied the positive and negative mental health outcomes for Black women related to the SBW schema for her dissertation. As a descendant of Nigerian immigrants, Anyanso also wanted to look at the experiences of Black women with more recent immigration family histories and found they had a similar concept of the SBW schema within contexts familiar to their cultures.<\/p>\n \u201cEveryone had such a complex relationship with the SBW schema,\u201d Anyanso said about the women in her study. \u201cThey talked of being high achieving as a positive, and something that motivated them to be successful. A lot of women took pride in being able to care for their family and broader community, and being a leader. They saw being resilient as a positive thing, as an understanding they could overcome and do whatever they needed to do.\u201d<\/p>\n At the same time, the respondents talked about the mental and physical toll of living up to expectations inherent in the SBW trope.<\/p>\n\n The duality of the Strong Black Woman schema<\/strong> <\/h3>\n