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Daughters’ Keeper – The Care and Treatment of Black Girls in America

I avoided writing about my baby girl for almost 4 years, partly because I didn’t want to process my experience with her in real time. Everything is constantly changing, like the expressions running across his face and disappearing when my camera is ready. I am continually learning to be his father. But after engaging with many girls of a similar color who carry pains and burdens beyond their age, I know that each of them is someone’s little girl too. Their future can be filled with opportunities for discovery, growth, and unencumbered learning, if they are allowed to be themselves. I write now to acknowledge their curiosity, their freedom to be children, and their maturing experiences, hoping that the same recognition will be extended to my daughter.

Being a black dad raising a black daughter is exciting. Being a black pediatric and adolescent psychiatrist and addiction medicine specialist caring for black girls and women in various care systems troubles me. Black girls in America are getting mixed messages about who they’re supposed to be: superheroes (#BlackGirlMagic) or, more commonly, supervillains (#AngryBlackWoman).

Although media, advocacy and academic efforts have drawn attention to the intolerable abuse of black boys,1 we often fail to acknowledge the experiences of their female counterparts. Perhaps we’re too ashamed to examine an age-old reality: Black girls are hurt by the intersection of racism and sexism. These “isms” manifest in prejudices, stereotypes and practices that leave black girls vulnerable to abuse, dehumanization and death. Our silence about black girls has clinical consequences throughout their lives.

When I interview black girls and their parents, I hear common themes – experiences in which normal emotions are caricatured, classic symptoms overlooked, and their voices ignored.

Elementary school version: The parents of three black girls have requested a consultation regarding a possible mood disorder in their second 8-year-old daughter. In a pre-assessment meeting, school officials told me they had “succeeded” in suspending her every day for weeks, for infractions ranging from breaking school rules. shouting instructions at a classmate sitting in her place. Three times she was pulled out of school, taken to the emergency department of a large children’s teaching hospital, and sent home.

When I spoke with her parents, they described her as more rigid and sensitive than her sisters – characterizations consistent with her diagnosis of Autism Spectrum Disorder (ASD) Level 1, with no intellectual disability. Nonetheless, she was affable when not teased or annoyed by her siblings. I interviewed the family for over an hour. Asked about the school, the father replied, “It’s not well understood,” and he wondered if the school environment was doing more harm than good. The mother asked about bipolar spectrum disorder or seasonal affective disorder, noting the cyclical deterioration in the daughter’s mood in the fall. The girl was pleasant and eager to talk to my stuffed animal, asking, “What’s your name?” She said she loved to learn; after seeing his report cards and the results of his academic tests, I accepted.

Assessment: An 8-year-old black girl with ASD, showing signs of ASD at school.

Plan: Recognize the serious disparities within our mental health care system; many families have no way to fill the void when a patient does not meet the clinical criteria for psychiatric hospitalization or when no inpatient bed can be found. Validate the father’s observation that his daughter is misunderstood at school. Share the evidence that a disproportionate number of girls of color are disciplined in elementary school.2 Inform the mother that the assessment revealed no symptoms of pediatric bipolar disorder or disruptive mood regulation disorder. Note that their daughter is affable and pleasant when not teasing her sisters. Encourage positive parenting strategies such as praising positive behaviors. Coordinate a clinician-educator-parent team meeting to discuss developing the equivalent of a 504 plan (Section 504 of the Rehabilitation Act of 1973 prohibits discrimination against people with disabilities , but private schools without federal funding are exempt).

For black girls, I’m willing to think in hyperbole, but you have to recognize that these girls are actually just girls. No child is one-dimensional “good” or “bad”.

Teenagers: While covering the inpatient adolescent psychiatric unit, I received an early morning report that an “angry” 16-year-old black girl admitted for suicidal ideation with a plan and intent was causing trouble for the crew. When I met her, this kid-faced teenager with tight, frizzy curls around her temples quickly said to me, “You have 3 minutes. I recognized signs of emotional trauma, bilateral abrasions on the medial and lateral prominences of his arms – non-suicidal self-harm injuries, too numerous to count. Anxious to respect his preferences, I asked, “Do you want to listen to music?” She obliged; I chose “Bigger” by Beyoncé: “If you feel insignificant you better think again…Life is your birthright, they hid it in the fine print/pick up the pen and rewrite it…Step into your essence and know you are excellent… You are part of something bigger… Bigger than the image they presented to us.

Assessment: A well-guarded 14-year-old black female with a history of unspecified trauma-related and self-injurious stressors.

Outline: Remind staff that she is 14, not 16. Black girls are routinely adulterated due to historical biases that rob these girls of childhood freedoms and dangerously mix femininity and femininity.3 Find out more about the girl’s suicidal thoughts. Suicide rates among black teens have risen dramatically for more than a decade, with the biggest increase occurring among black girls.4 Promote the use of psychosocial interventions by and for the patient; suggest that they listen to music or write a few sentences when their emotions rise (technique taken from cognitive-behavioral therapy). For those who cut, to have a layer of skin less than the others is to feel all that our world offers, beautiful and abject. This missing layer can be replaced with language and therapy if done thoughtfully. The next day, the nurse in charge said to me: “Your friend wants to be the first to meet you.

Our culture teaches us to assume that black girls can “handle it.” However, we often confuse their resilience with freedom from harm and miss opportunities to validate their experiences. Additionally, one can be resilient and still have post-traumatic stress disorder (PTSD).

Emerging adult: “I’m tired of hospitals. Even over email, I sensed the patient’s exasperation. A 23-year-old black woman with PTSD, attention deficit hyperactivity disorder (ADHD), and a history of cannabis and certain opioid use presented to an emergency department reporting abdominal pain. Sent home, she felt rejected. The pain did not subside and returned hours later. This time, he was reportedly told, “We won’t give you painkillers. I saw your chart. Embarrassed, she cried. Finally, an abdominal ultrasound revealed the source of his pain: hepatosplenomegaly. Urgent splenectomy, admission granted. Despite the success of the procedure and the relief of physical pain, when I visited the patient, she focused on the exchange of the previous days. “I have a successful job, a partner, kids and a home…and all they see is a drug addict…I guess nothing I do matters for all of you.” Emotional healing will not be quick.

Assessment: A young black woman with a history of trauma, ADHD, and long-distance substance use who is trying to defend herself and navigate a health care system that is not kind to people who have used drugs. substances.

Plan: Coordinate a team meeting between inpatient and outpatient providers. Emphasize that the patient’s opioid use never met the criteria for an opioid use disorder and occurred more than 5 years ago. Recognize that the medical system has historically undertreated the pain of black patients. Address the inappropriateness of language in their chart (eg, “difficult patient”) that is often used to describe marginalized groups.5

The real and perceived experiences of Black girls and women involve navigating spaces where their needs are often not considered; meanwhile, we tend to overlook just how well they do through thick and thin.

Addressing the conditions that black girls and young women face and protecting their freedom to be themselves requires fundamentally changing relationships with patriarchal institutions – from education to health care to the justice system – that reinforce their negative experiences. While equality justice movements and diversity, equity and inclusion plans aim to protect our children from discrimination, they cannot completely eradicate inequalities based on race and gender. One practice, however, can help us enhance its effects, and even I need to be aware of this when engaging my little black girl – that practice being empathy.


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