How do we take the misogyny out of mental health?

I started therapy in 2017. At the time, I was raising my young kids alone, attempting to keep up with a never-ending to-do list, spending all of my spare time running from one errand to the next. A full night’s sleep was a rare luxury. The only thing keeping me somewhat balanced was my new job at a popular parenting publication where I was given the freedom to crank out rage-infused articles capturing the anger of the moment, and write about my life as an overwhelmed mother in a country that won’t mandate federal paid parental leave or an affordable child care system.

Basically, I got paid to vent. But if writing is catharsis, it wasn’t enough. My exhaustion-induced rage felt beyond me and the raw, ravaged words I banged out on the keyboard.

When I described the layers of my fury, my therapist suggested I keep a diary of how I spent my time every day for one week. At this, I clenched my jaw, drove home listening to heavy metal at high volume, and drank a bottle of wine after picking up my kids from school.

Still, I completed the assignment dutifully, knowing damn well I didn’t have a time management problem; I had a society problem, as I lived in one that banked on my relentless, resigned unpaid labor. The intersection of my ethnicity (Italian-American) and my husband’s (Iranian-American) only amplified the situation, as both cultures glorify women who make tomato sauce from scratch, clean windows, and are mindless care machines to kids and elders. When learning about how both our cultures relegated women to support roles, my therapist said: It seems like you try to make things harder on yourself. Again, the problem was me, the broken, defective individual.

While cognitive behavioral therapy (CBT) or talk therapy, asserted itself early on as the universal solution to mental health problems, it wasn’t designed for everyone. The origins of psychology emerged in the late 1800s by white, European men, Sigmund Freud being the most notable among them, and later, American white men. Regardless of how much the field has evolved and how many variations of therapy there are now, the original framework of individual responsibility and symptom-searching has trickled down to modern practice.

“Psychology, psychiatry, and medicine decided it would center itself in the dialogue and make itself the only source of knowledge, and all other forms of knowledge were inferior,” Cyndi Darnell, a sex therapist based in New York City, tells Mic. “That wiped out all of the Indigenous knowledge, all the women’s knowledge, all of the stuff that healers had been doing since homo sapiens were on the planet, all gone because a couple of white dudes were like, ‘I wrote a paper about it.’”

To be clear, Darnell is not anti-science, nor is she saying we need to tear down the only mental health system we have. She does point out, however, that we should consider its limitations, including whom the treatment is geared toward and whom it comes from.

According to a 2017 American Psychological Association report, women now outnumber men in the psychology workforce overall, yet are underrepresented in academia, top honors, and journals. Also, not shockingly, they’re paid less. The effect is women being shut out from the larger psychotherapy dialogue which dictates who and what gets studied, the course curricula for rising psychotherapists, and the framework in which therapists operate and interact with their patients. This lack of representation at the top results in an ineffective and isolating experience for women and other historically oppressed and underrepresented people seeking therapy services. And even if women are treating women, many are using that older, very male, very white framework to do so — some, without really realizing it.

Many people who’ve done talk therapy will tell you it is a transformational experience. Therapy can help process thoughts and feelings, provide powerful insights, and is bolstered by the indulgent 1:1 model. It’s also built on the premise that the individual is somehow flawed, disordered, and defective, rather than the systems, cultures, and societies into which they were born, and so they need to be drug-dependent and keep coming back and “doing the work” in order to get better. For women, who already feel inherently flawed and defective in every single way society tells them, this presents the possibility of real harm.

Like many women I know, I’ve been diagnosed with generalized anxiety. And because a therapist with a bunch of degrees and certification acronyms after her name diagnosed me, it undeniably stuck somewhere in my psyche. A whopping 264 million people worldwide have anxiety disorder, and women are twice as likely as men to be diagnosed with it in their lifetime, according to the Anxiety and Depression Association of America. But given how widespread anxiety supposedly is, are women suffering from a real condition, or are many of them simply responding to the trauma of living in a misogynistic society? Personally, I don’t know if anxiety as a diagnosis suits me.

I’ll journal with you for a moment to figure it out:

Do I have anxiety or am I nervous existing in a society that inflicts gender-based violence on women?

Have I internalized the stories of dead girls from my hometown, disappeared women, and #metoo (which doesn’t even include my own experiences with gender-based violence and trauma)?

And is a prescription for daily Xanax and perpetual therapy sessions where the insight I receive continuously has me talking about my childhood in loops, and is focused around my diagnosis, actually helping me get better? Or is it making me feel worse? Stuck?

The goal of CBT is to arm you with awareness, emotional intelligence, and coping mechanisms. It’s used to help you with your current problems, which one could reasonably assume have solutions. Darnell says the current model is designed to keep clients coming back, week after week, year after year. For some people with severe diagnoses, it’s necessary. But for most, the model is falling short in equipping people with the actual practical skills they need to self-soothe and heal. Worse, it can make people feel they have a lifelong struggle with mental illness, rather than a momentary difficulty that can be overcome.

“People hire therapists to help them learn the skills they need to manage themselves, not make them dependent on a system that they have to keep paying for,” she says. “If I’m doing my job properly I will make myself obsolete, which is in opposition to capitalism.” This, I must note, is also in opposition to patriarchy because patriarchy structurally formed capitalism. Darnell believes in a more robust approach to mental health, one which includes traditional psychotherapy and psychiatry, and also encompasses a team of healers: medical doctors and therapists, yes, but also coaches and bodyworkers, among other Indigenous healing modalities.

When I re-entered therapy this year after five years to cope with the pandemic, I didn’t want someone who was going to make me feel like something was wrong with me or create rigid rules around how I did therapy. This meant I intentionally shopped for a therapist who had the highest likelihood of rejecting the status quo and lowest chance of putting labels on me and my experiences. I hired a woman of color. She was the first therapist who I felt truly saw and heard me. And because her approach was through a lens of oppression, we were able to work through some of the hardest stuff I’ve dealt with in my life, in a much shorter time frame, sans diagnostics and personal blame.

My therapist said, “It seems like you try to make things harder on yourself.” Again, the problem was me, the broken, defective individual.

Marvin Toliver is a social worker at the Radical Therapy Center in Philadelphia and co-founder of Melanated Social Work. He recently posted a meme on Instagram that read: “The mental health diagnosis is white supremacy’s way of gaslighting us. White supremacy, capitalism, patriarchy are sick and need treatment plans.” To be clear, Toliver is not anti-diagnosis or medication, but he thinks overdiagnosis for women, Black and brown people, and transgender individuals is happening at an unnecessarily high rate and causing real harm. Because therapy is still largely dominated by white men and the framework they created, therapists may not realize the trauma that white supremacy and patriarchy causes and how working with folks affected by it could look different than working with cisgendered white men.

Toliver agrees that therapy overall could benefit from the care team approach, but it could also be done differently when interacting with clients. “When therapists and counselors call the people they’re working with ‘patients,’ I cringe. They’re not sick, they’re dealing with life,” Toliver tells Mic. Beyond some simple language changes, he recommends integrating the experiences of women and other historically oppressed groups in every single college psychology education course, rather than offering just one. “To say that you’re culturally competent after one course, that’s bullshit.”

Additionally, Toliver sees it as his responsibility to uplift women, especially Black, brown, transgender, and disabled women. “If I’m calling myself a feminist, if I’m saying I believe men, women, non-binary, and trans folks should all be seen as equal, I can’t just sit by and let Black women’s bodies be policed by whiteness,” he says. “Men need to start speaking up about women’s issues.”

Through therapy and alternative healing methods, I was eventually able to assert my boundaries so that my husband-society problem became just a society problem. When I felt my husband wasn’t doing his fair share around the house or with our children, I didn’t trudge through it and get angry. I stopped and cried. Taking it a step further, I explained that I couldn’t be the best partner, mother, and worker if old gender norms existed and boundaries around my time, mental health, and rest were not respected. And, if he wasn’t going to change, I wouldn’t be able to participate in our life anymore.

So he decided to heal too. He stands up fiercely for me and my daughters. We both express our emotions openly. We also cry on a regular basis — when we’re stressed, when we’re sorry, and during all Marvel movies — so our kids can see it. My husband is my kids’ superhero.

Imagine if all our heroes who are men modeled emotional dexterity and skill to those who look up to them. Maybe, then, we could be saved.