Transcript

Russell [00:00:02] Let's get stronger.

Gates [00:00:04] Healthier.

Prickett [00:00:04] Calmer.

Russell [00:00:05] Smarter.

Gates [00:00:06] Better.

Russell [00:00:07] Living a healthier life is a journey, not a destination.

Gates [00:00:10] You can always get better.

Prickett [00:00:12] Let's get better together.

Khalilah Gates, MD [00:00:03] Eight out of every 10 Black women experience some form of trauma in their lifetime. This trauma includes sexual and domestic abuse, poverty, violence, as well as the toll of experiencing sexism, racism. I'm Dr. Khalilah Gates, we're in the first week of Women's History Month and I am so excited to be here with Dr. Inger Burnett-Zeigler. She is one of Northwestern Medicine's clinical psychologists, and author of Nobody Knows the Trouble I've Seen: The Emotional Lives of Black Women. Dr. Burnett-Zeigler is also an associate professor of Psychology and Behavioral Sciences at Northwestern Medicine Feinberg School of Medicine. Her clinical interest in mood and anxiety disorders, comorbid substance use disorders, stress management, wellness and interpersonal relationships. Her research focuses on examining the factors associated with mental health service utilization, as well as inequities in mental illness and treatment in disadvantaged communities. She is also a mindfulness instructor and a certified yoga teacher. Today, we're going to talk about her research, her book and self-care tips that we can all start practicing. Welcome, Dr. Burnett-Zeigler.

Inger Burnett-Zeigler, PhD [00:01:12] Thank you so much for having me, Dr. Gates. It's a pleasure to be here.

Khalilah Gates, MD [00:01:16] You're a fellow Chicagoan. I too have family in Roseland. Tell us about yourself. What drew you to this area of research?

Inger Burnett-Zeigler, PhD [00:01:23] I'm a South Side Chicagoan, and I grew up in Chatham. I actually went to private school in Hyde Park at the University of Chicago Lab School, and I went to church in Inglewood in Chicago. Local folks, you might know that these are some unique neighborhoods, and I think early on I saw the disparity in resources, even among those three neighborhoods that I was positioned in. While Hyde Park is a pretty diverse neighborhood, with some people to have a decent amount of affluence and education, Chatham is more a working-class neighborhood and the Inglewood neighborhood is more impoverished. And I saw even then, you know, as a high school student, how that really impacted one's access to resources. And then one's ultimate trajectories, in terms of what they were able to do with their lives, were things that they had knowledge about. So that was something that I started to explore more deeply in college. I was just interested in people. I loved my psychology courses. I loved learning about human behavior. I loved learning about how family and environment shaped one's life trajectory. And so, I think these kind of observations from childhood and high school and then becoming interested in psychology and then bringing that back as a faculty member, I really wanted to put those observations together to develop a body of work to improve the lives of the people I knew. The people that were like my mom and dad, that were people that were like my grandmother, the people that were like my other folks on my block who may not have had the same access to resources that other people had and their health was impacted as a result.

Khalilah Gates, MD [00:03:03] Talk a lot about the social determinants of health and how they impact mental health, as well as the impact of trauma and stating the obvious. We know that there is a group of people, Black women in particular, that kind of take the brunt of that pretty significantly. So how did you go from the research that you're doing to actually deciding to write Nobody Knows The Trouble I've Seen? By the way, I was reading it and I was like, she is describing me. She is talking to me about what I need to do.

Inger Burnett-Zeigler, PhD [00:03:34] Thank you for that. That is always the best compliment and affirmation I can get about the book. That was really the goal for the book of people to feel seen and feel affirmed in their experience. I think there a few things that I wanted to bring together in this work. For one, in the book, I talk a lot about my personal lived experience, my family, my own kind of earlier struggles with depression and anxiety, and I wanted to have a little bit of memoir in the book as I continue to progress in my career as a psychologist, as a practicing psychologist and as a researcher, it was very clear to me that there was a lot of misinformation that was being passed around about mental health in treatment in the general population. And I strongly believe that that misinformation really perpetuates stigma as it pertains to mental health. You know, just is another barrier to people identifying their own needs and getting access to care. And so, as a scholar, I really want it to be that bridge between science, what we know about the field and scientifically sound information and make sure that that was being disseminated to the people that needed it most. And then the third piece was just, clinically, I saw time after time, people coming into my clinical practice, Black women, high-functioning Black women, taking care of their families, dealing with stuff. Heavy stuff, trauma stuff, family stuff, racism, many of them felt ashamed and embarrassed and felt isolated in their experiences, and that isolation was really, in part, due to the fact that nobody is talking about these experiences. But I, as the therapist, I saw people coming in one after another, knew that these were shared stressors, and I wanted people to know that there was a community of folks out there that share these experiences, but also could help kind of carry the burden and lighten that load a little bit. And so, when you say you saw yourself, I truly mean that, as you know, one of the greatest compliments people can give about the work because that that was a big part of the intention.

Khalilah Gates, MD [00:05:49] Absolutely. And I want to thank you for that, because it really does. When you're seeing yourself and someone's calling into question, is that OK? It really makes you have to pause and reevaluate some of the things that you're doing. So thank you for being brave enough to put that book out there. You talk about trauma and trauma is a very strong word, and I think that people don't really realize what trauma is. We think of it in very narrow terms. So can you just elaborate a little bit on why you say that trauma could even be experiencing sexism, racism?

Inger Burnett-Zeigler, PhD [00:06:26] Sure. You know, I think that's a really important question because, of course, as a clinician, as a clinical psychologist, we do indeed have a pretty narrow definition of trauma, although in my work, I do broaden that definition. Clinically speaking, when we think about trauma or trauma exposure, we're thinking about people who have directly experienced or have been exposed to a life-threatening event. And so those types of life-threatening events include things like childhood abuse, intimate partner violence, chronic illness, community violence like gun violence, war or terrorism, natural disaster. These are some of the things that's on that kind of standard list of traumatic experiences. While most people in the general population have experienced a trauma at some point in their lifetime. I, for example, have been in a car accident, that's kind of a common experience. Only a fraction of those individuals go on to experience traumatic stress or PTSD. And as you mentioned in the opening remarks, more Black women than in the general population, not only have had that traumatic exposure, its eight out of 10, as compared to seven out of 10. And more Black women go on to develop PTSD; about 12% to 14% as compared to 7% in the general population. But coming to that kind of broadening the definition, I think that there are a lot of things that are not a part of that clinical definition that are important to consider. For example, there's a large literature on race-based trauma or the impact of racism and discrimination, vicarious trauma that's second-hand trauma through conversation, through witnessing, through exposures, through intergenerational trauma, which there's a lot of conversation, particularly of the impact in the Black community of intergenerational trauma, whereby trauma is passed down, not only genetically, but behaviorally and psychologically in families. Contextual trauma. Right. So that's trauma that's felt that perhaps there's not a direct experience that you've had, but it's that weight that your community or your culture carries that still impacts the ways that you move day to day. Bringing in the science. We know that these things have a real impact, not only on mental health and physical health. Dr. Sierra Carter has done some really important work looking at the impact of racism and discrimination on cellular aging and how that contributes to a rapid aging process. And there's a lot of work kind of building up in that area to show that these aren't just kind of like buzz words about trauma, and they have a fuzzy effect. They have actually very real outcomes. And so, particularly when working within my work Black adults, I think looking at it through that wider lens, in terms of how we understand trauma, is incredibly important.

Khalilah Gates, MD [00:09:35] So you just alluded to the science that links trauma to some physicality. And in your book, you talk about how trauma and mental health are linked to physical health as well. Can you elaborate on that a little bit more?

Inger Burnett-Zeigler, PhD [00:09:49] I do think it was really important in the book to link mental health and physical health. We know that people often prioritize their physical health over their mental health, more likely to go see a physical health provider over a mental health provider, more likely to take their physical health medications over their psychiatric medications, but we also know that stress has a really clear and direct impact on physical health outcomes. And so, what I talk about quite a lot in the book and in my research is that disproportionate burden of stress, the trauma, the provider and caregiver burden, that weight of, you know, having fewer resources and having to stretch it further. The impact that that has and how that's associated with physical health conditions that we know are disproportionately prevalent among Black women. So maternal health outcomes, for example, low birth weight, preterm birth, miscarriage, fibroids, cancer progression, cardiovascular disease, hypertension, all of these conditions that are related to stress or stress can impact and are also disproportionately prevalent among Black women. And that's for stress in general. And we think about traumatic stress. There's a literature around traumatic stress and fibroid development, for example. There is a literature around traumatic stress and obesity, for example. We know that trauma exposure can have a real intangible impact on the physical body.

Khalilah Gates, MD [00:11:20] You talk about the impact of mental illness and stress on Black women, and in your book, you deal with this idea or identity of a strong Black woman. So just last night, someone was like, yeah, you're a strong Black woman. And I used to wear that label as a badge of honor. And a lot of different things and experiences, including reading your book, I'm starting to question that. Can you elaborate on this notion, or who this strong Black woman traditionally is and why, perhaps, we need to challenge this identity and be willing to not embrace her?

Inger Burnett-Zeigler, PhD [00:11:56] The strong Black woman is getting a lot of attention of late, and it's really a cultural prototype to describe this kind of pinnacle Black woman who is strong in all circumstances, despite whatever challenges might confront her. Who's resilient, who's able to provide and caretake for her family despite limited resources, who's able to just continue to make it. You know, as they say, day by day, just putting their head down or head up with pride and getting the job done and doing so despite any internal suffering that they might be experiencing, and a lot of that strength and a lot of that resilience that's displayed by this strong Black woman is usually grounded in their spirituality and faith. To be clear, I think there is a lot to be proud of in terms of carrying that identity. That strength is something that has helped Black women to push through racism, sexism, and discrimination, through challenging, intimate relationships, through challenging family relationships. But one thing that I wanted to demonstrate in the book is that only to highlight and celebrate the strong Black woman and what she demonstrates to the outside world, but to also give a peek behind what I call the other side of the strong Black woman, the pain, the suffering, the vulnerability that's often not acknowledged, the desire for help that's not asked for, the exhaustion that I know so many Black women experience all the time, but especially now over the past couple of years in the context of COVID and racial injustice. So, to peek behind that and to give Black women an invitation to name that, to name that suffering, to name that discomfort. Like I said, the pain and be kind of liberated in doing so because I think so often there's this pressure and expectation to put forward that perfect face, that put-together face that's always showing up in a lot of shame and embarrassment for the things that might be on the other side of that, but it's both sides that are our humanity. I was at a conference not too long ago, and one of the other panelists said, I don't want to be magic. I don't. I just want to be regular. Like, I don't want to be strong. I don't want to be, you know, have this expectation of being able to do all things all the time. Like, I want to be able to say I can't do it anymore. And I think that that was one of the goals of the book as well is that there's space for it all. And all of it is human and all of it is just and it doesn't take away from our goodness and value as Black women and just as people in general.

Khalilah Gates, MD [00:14:53] So it feels sometimes almost like a failure if you're just a regular, right?

Inger Burnett-Zeigler, PhD [00:14:59] Yeah, yeah, it can't. And I think that that's the messaging that has been given to us, that's how we were taught to be strong Black when we were taught to act a certain way, we were taught to work harder in order to get the same benefit, and it is a lot of pressure and in my clinical practice I see that all the time in really high-achieving Black women who are anxious because of the stress that comes from trying to meet this unrealistic bar and the bar is always moving. The judgmental voice, a family, or society, or the workplace is always there, and there's this pervasive sense of not feeling good enough. And so, one thing I'd like to offer to people is, what if you were just to release that expectation, which is a difficult concept, even for me, as I say it out loud. Like, what if I were to let go of this expectation of what people think I should do, how people think I should dress or talk or wear my hair, or how achieving people think I should be, all these things that just add to the pressure and I'll just invite Black women to choose their own course, which I think is really a new concept for a lot of people that can be brought into so many things; not only career, but choosing your own course in terms of what family looks like. Choosing your own course in terms of, you know, how you might like to spend your free time. But I think that that can be really liberating for a lot of people.

Khalilah Gates, MD [00:16:36] The women who are listening, who are diverse in many ways, race, ethnicity, et cetera, who are probably like, I share those same concerns. And so, if you would just enlighten us a little bit more about why it's important to focus on everyone, but particularly on Black women, because it seems to be a different lived experience.

Inger Burnett-Zeigler, PhD [00:16:58] It is true that many of the phenomena that I discuss in our conversation today and in the book are our shared experiences, not only among women, but just among people in general. Everybody can relate to stress. Many people can relate to the burden that comes from managing work and family and trying to also take care of yourself at the same time. But the point that I want to get across in the book and highlight is that these burdens are heavier among Black women, and there's data to support that. There's data to support that Black women report more stress. Right? So, there's the stress everybody feels. And then add a, you know, about five things on top of that. And that's the stress that Black women feel. And those are the things we name. Racism, discrimination, trauma, et cetera, right? A lot of people experience trauma. More Black women will experience trauma. A lot of people experience financial strain. More Black women live in poverty. More Black women are unemployed. More Black women are also solely caring for their children and the breadwinners of their families. So that has a different kind of grain to it for Black women who are carrying that and feeling it in a different way. That's why I wanted to kind of highlight the unique experience of Black women. But to be sure, they are stressors that are applicable to a wide variety of people.

 Khalilah Gates, MD [00:18:30] Thank you for elaborating on that, because I want people listening to understand that it's not an either/or, it's an/and, and we have to deal with that as we move forward. So, I think we have set a very good stage and very convincing conversation to date of the importance of acknowledging and dealing with mental health. As clinicians, it's not just enough to identify the problem. How do we actually start to deal with, treat and change the problem? I walk out of my office today, what can I do to make things better for me from a mental health standpoint, from my sister and my aunt?

Inger Burnett-Zeigler, PhD [00:19:11] I go back with the basic principle of mindfulness, of just becoming aware. Increasing awareness. And I think so many people are not really aware of the deep impact stress and traumatic stress is having on their lives, on their relationships, on their mental health, on their physical health, on their productivity, and so just slowing down long enough to take stock of that, to examine those headaches, those sleepless nights, the tightness in tension in the neck, the twisting and turning of your stomach, being aware of that, being aware of the potential triggers of that, because I think that awareness is really the starting point for being able to take behavioral steps for change. As therapists, we identify the patterns, we identify the things that are currently contributing to the maintenance of the suffering, so that might be the thoughts, that might be bad relationships, it might be your environment. And once we figured out that pattern, we figured out what's contributing. Then we can develop a plan for change. In terms of that plan for change, at the top of my list is boundaries, boundaries, boundaries. We know that this is something that a lot of Black women struggle with; saying no, taking on too much, wanting to do everything for everybody and so just, re-shifting that in a way that more aggressively prioritizes the self. And in doing so, makes room for the things that you want to do. And now, you know, I'm hearing a lot in conversations like it's not enough to just get your nails done. It's not enough to just have a bubble bath. And I agree with that. I think those are good things, and I agree. And so, one of my number one strategies to use in terms of creating, what do you do when you create those boundaries? What about just rest? What about just be still?

Khalilah Gates, MD [00:21:05] Something we don't know how to do right in this society.

Inger Burnett-Zeigler, PhD [00:21:09] That's right. That's right. And then when I work with people on that, in my practice, there's a narrative about feeling useless or, I should be doing something else with my time, or I'm wasting my time. In a mindfulness world, we talk about just being versus doing all the time and soaking up the goodness of just being with a loved one, feeling the laugh or feeling their warm voice, or whatever that might be. So, paying attention, set boundaries and then implement, sure, your practice, whatever that might be. I'll add to that, thinking about how you talk to yourself, the narratives, chatter that we play in our minds all the time. We talked a little bit about it in terms of that pressure and expectation that contributes to some of these unhealthy patterns. But when people more closely examine it, they'll see how harsh and critical we often can be to ourselves; telling ourselves we're not good at not, telling ourselves we're not doing enough, telling ourselves we are not far enough in our careers or productive enough. And so, again, coming back to awareness, paying attention to that, and then changing that narrative such that it's one that you're speaking to yourself in the way that you speak to a friend or a loved one, speaking to yourself with love, with love and compassion. Right? With grace and compassion. And I think that that's so important for Black women, in particular, because a lot of us are cultured to be kind of, like, we're hard on ourselves, right? We can be hard; hard on each other, hard on ourselves. And I think that, you know, there's a culture around that. Often, I'll speak for myself, my grandmother and my mother pushed me really hard because they knew the society was hard. Like, the world is hard. So, this is how we prepare our girls. It cannot feel good when it's internalized in an unhealthy way. So just noticing that and practicing some self-compassion. The other thing I'll add before we move on is the rest and then joy. Like, what if people paid more attention to those little moments of joy that present day-to-day, even in the midst of the suffering? They're still there, and then acknowledge that, embrace it and practice gratitude around those things?

Khalilah Gates, MD [00:23:28] Are there any last things you want our listeners to hear or know?

Inger Burnett-Zeigler, PhD [00:23:34] You're not alone, you're in community with so many other Black women, women, people who have shared difficult experiences, and relief from suffering is possible. I think so often, we become kind of numb to discomfort, no matter what the source of your discomfort might be. But there is relief possible. And I just encourage people to accept the hand reaching out to them that they might be reluctant to accept.

Khalilah Gates, MD [00:24:02] Thank you. This has been phenomenal. I want to thank you for being in conversation with me today. I feel seen in a world where we're often not seen, so thank you, like this is going to carry me through the weekend and into next week, though. Thank you, Dr. Burnett-Zeigler.