Empowering Women of Color with Invisible Disability Through the Framework of Feminist Therapy
Author: Mia-Megan Foo, Applied Clinical Psychology masters program Class of 2024
Many articles that revolve around the topic of disability have related to a more physical perspective such as physical and intellectual disabilities. Disabilities can range beyond the scope of visible disabilities that include invisible disabilities such as autoimmune diseases (Rheumatoid Arthritis, Systemic Lupus Erythematosus and Multiple Sclerosis). Invisible disabilities are mental, physical and neurological conditions that can affect a person’s daily activity. Women diagnosed with invisible disabilities often go unnoticed as others are unaware of the conditions that can challenge or limit them, and they are left to silently suffer (Castillo, 2020; Chrisler, 2008). Furthermore, societal pressures may make it easy for individuals to minimize invisible disabilities and difficult for them to remain open to the positive aspects inherent in them (Williams & Upadhyay, 2008).
Besides that, women of color (WOC) are greatly affected due to the apparent health discrepancies between minority and White populations in the United States (Feldman & Tegart, 2008). Mental health issues such as depression and anxiety are more prevalent in WOC (Chrisler, 2008; Feldman & Tegart, 2008). These issues are easily manifested from two areas: symptoms and stressors stemming from invisible disability and from societal constructivism pressures of having a minority and disability status. However, many articles have suggested ways to assist WOC in coping with their diagnosis as well as the societal pressure that comes with. This encyclopedia article aims to explore disabilities that are invisible disabilities that affect women of color and how to empower them amid their adversities through the framework of feminist therapy.
History
The medical model and social model that stem from the worldview of the United States, have very different perspectives on disability and illnesses. The medical model has been criticized for disregarding the social and cultural dimensions of disability and illnesses of individuals (Feldman & Tegart, 2008). The social model has also been criticized for marginalizing minorities with disabilities and causing disputes between people with disabilities and their non-disabled communities (Feldman & Tegart, 2008). However, both medical and social model have clear demarcations between the individual and their environment as both models have a more individualistic worldview as compared to a more collectivistic perspective that is held by many US minorities including African American women (Feldman & Tegart, 2008).
Invisible disabilities that come from diseases such as autoimmune disorders result when the immune system is unable to distinguish between its own cells and foreign cells. This encyclopedia entry focuses on women of color with hidden disabilities as women are more likely to be impacted by various autoimmune disorders in comparison to men (Chrisler, 2008). The female-to-male ratio of patients with systemic lupus erythematosus (SLE), Sjogren’s syndrome, and Hashimoto’s thyroiditis is 9:1. The ratio for Grave’s disease is 6:1, for rheumatoid arthritis (RA), chronic active hepatitis, scleroderma and myasthenia gravis is 3:1 and for multiple sclerosis (MS) and pernicious anemia is 1.5:1 (Chrisler, 2008).
It is important to note that the prevalence of autoimmune disorders varies by geographic region and ethnicity. In an article written by Feldman and Tegart (2003) stated that the constructions of chronic illness and disability of African American women are often neglected. Various research has shown that SLE is more common among women of Chinese and African decent as it is three times more likely to occur in African American than in European American women (Chrisler, 2008). On the other hand, RA is less likely to surface among rural African Americans but instead is more common among some Native American groups (Chrisler, 2008). MS is five times more likely to occur in women who are tropical climates and Grave’s disease is more common in developed countries (Chrisler, 2008). Interestingly, Scleroderma has been found in women living in areas near airports which led to the suggestion of the toxicity of being exposed to airport fuel. Furthermore, other suspected toxins that trigger autoimmunity are hair dyes, vinyl chloride and silicone breast implants (Chrisler, 2008). Using the intersectionality approach, that studies the impact of social determinants of health, we will be able to better address health care needs and inequities for individuals experiencing invisible disabilities and provide a more effective therapeutic treatment (Caiola et al., 2014).
The Framework of Feminist Therapy
An effective feminist therapist understands dominant societal and cultural circumstances that may affect an individual. They consider different systems of inequity: sexism, racism, classism, ageism and patriarchy and advocates for equality (Enns et al., 2018; Kottler & Montgomery, 2019). Feminist therapists also engage in empathetic listening, helping clients and the teaching of active coping techniques can be very helpful, getting to know them as a person first (Chrisler, 2008; Fischer, 2008; Williams & Upadhyay, 2008). Moreover, having a client who identifies as a WOC, it is necessary to engage in cultural humility by understanding the different factors that may have contributed the client’s diagnosis. It is important to provide a safe environment for vulnerability during the initial stage of the diagnosis (Fischer, 2008). Intentional listening and empathy towards the patient’s struggles are also very crucial during sessions (Fischer, 2008). Feminist therapy is for everyone and not only confined to individuals who identify as females. Intervention of this framework can be done in an individual as well as group setting (Kottler & Montgomery, 2019).
Mental Health Outcomes
WOC with autoimmune disorders such as MS and SLE are more likely to experience fear and anxiety that are future-oriented due to the disabling and life-threatening effects caused by their disabilities. Anxiety and depression are common problems experienced when dealing with symptoms and treatments (Chrisler, 2008). As mentioned, there are health disparities found between White native Americans and minority populations and with autoimmune disorders which are often difficult to treat due to the unpredictability of the disorders, adds on to the stress of an individual. Furthermore, more stress may be provoked onto this vulnerable population due to societal oppression towards their minority and disability status. Stress is shown to compromise immune functioning and is a potential triggering factor in autoimmune disorders which leads to symptom flare-ups (Chrisler, 2008). Signs of depression can be detected as the decrease in mobility increases which pushes one’s sense of isolation from society (Chrisler, 2008). With that, WOC with autoimmune disorders can benefit from psychotherapy as they learn to adjust to their diagnosis and learn to cope with their symptoms through empowerment (Chrisler, 2008).
Clinical Implications
Therapists who are dealing with WOC with invisible disabilities should assist women through crisis management such as techniques for anxiety, anger, stress and pain management (Chrisler, 2008; Enns, 2018; Twohey, 2001). It is important to acknowledge and validate the client amid their adversities and help them adjust to their life-changing diagnosis. As Chrisler (2008) mentions in her article that it is common for people to fall into the familiar “sick role” that is similarly played when one experiences the flu, a bad cold or chickenpox. She goes on emphasizing that it would be better to adopt an “impaired role” where the individual strives to maintain normal responsibilities and behavior within the limits of the health condition instead so being motivated to recover as autoimmune diseases are not curable (Chrisler, 2008).
In an article by Twohey (2001) who identifies as a feminist therapist wrote from a dual perspective: of a psychotherapist and a cancer patient stated that “A good therapist can help their client grieve”. The client could be experiencing actual grief, that is the loss of independence such as not being able to drive or potential losses which are future-oriented such as the loss of future career options and sexuality. She mentions just as significant, to also be able to help clients grieve the loss of possibilities through anticipating new potential losses that could occur and helping clients to prepare how to deal with them (Twohey, 2001). Moreover, to make the client aware of societal oppressions that may have affected them and to find ways to help them empower through structural pressures.
It is also necessary to integrate assertiveness training and coping to deal with times of uncertainty and fear of death, disability and sexuality (Chrisler, 2008; Twohey, 2001). Another key principle is to incorporate the illness into the self-concept without letting the illness define the individual. This can be achieved through helping the client gain insight that they are now unable to do everything as they used to and emphasize that they do not need to do it all (Chrisler, 2008; Fischer, 2008). By assisting the client in self-advocacy and practicing scenarios ways to self-advocate (such as advocating for managing their work life or disability accommodation in an educational setting) and providing encouragement such as keeping a journal or using art therapy which can be helpful ways for women to come to terms with their situations (Castillo, 2020; Chrisler, 2008; Enns et al., 2018; Fischer, 2008).
Lastly, it is imperative for therapists working with WOC with autoimmune disorders should do some general reading about women’s health and behavioral medicine as therapists should be aware of the different disease foundations (Lupus Foundation of America and Multiple Sclerosis Association of America), blogs, and social support groups in the area that are available for clients (Chrisler, 2008; Lerner & Reid-Cunningham, 2008). Foundations and blogs are beneficial resources as they provide education on the disease and helpful tips for daily pain and stress management as well as spaces to connect with support groups in local areas. Support groups can provide a sense of social support and engagement that decreases stigmatization and isolation. There are many helpful ways and resources summarized in this entry and hopefully will help therapists bridge the gap between the silent suffering women of color with invisible disabilities face.
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