By Madhuri Jha, LCSW, MPH | April 26, 2023
Vice President of Science, Equity, and Integration, ETR
As a leader in health equity and a person of color, I often feel the tension of reconciling my family upbringing experience with what science and public health teaches me. In between work trips this spring, I was able to squeeze in a getaway vacation over a long weekend.
My rideshare driver to the airport was a young Black woman with a magnetic personality. We struck up a conversation, and I told her it was going to be my first vacation prior to the pandemic. She related that she was about to take a getaway to Disney World with her infant son, also her first break in quite some time.
I found myself welling up with emotion sharing with her that I had worked the healthcare frontlines through the peak of the pandemic and had spent the last three years tirelessly working on health and social justice. She echoed a welling of emotions, disclosing that she was pregnant for the second time in three years, and she was driving cars to make ends meet as a single parent.
We connected on having a family culture of feeling guilty for taking a break and scheduling intentional time away from work. While we were two women of color with completely different backstories, it dawned on me that we were both never taught that it was okay to rest.
Research has generated an interesting paradigm regarding the impact of stress tolerance on BIPOC folx. On one hand, evidence tells us that stress tolerance is influenced by trauma associated with factors like racism, immigration, colonialism, xenophobia, and discrimination. But evidence also tells us that the medical system itself has not only perpetrated trauma but generated dangerous myths that people of color need to rest less than white counterparts.
A study conducted in 2016 exposed that many doctors and doctors-to-be exhibit racially biased falsehoods that the manifestation of pain tolerance is biologically different between Black patients and white patients. More simply articulated, that Black people have “thicker skin” and need less rest than white people do.
The foundations of these beliefs are steeped in the documented actions of many pro-slavery physicians, like Samuel A Cartwright, the notorious proponent of the psychiatric diagnosis “drapetomania” wherein the pursuit of “getting away” by a Black person was to be treated as a disease. I can’t help but think about my ancestors affected by colonial oppression in India, or my rideshare driver’s ancestral connection to slavery, and how our ancestral experiences perhaps influenced our own present-day difficulty with accepting rest.
The mere thought of rest, or a “get-away” for the generations before us would have been met with institutionalization, criminalization, or life-threatening violence. For those who came before us, to not rest, was survival. And yet the long-term impacts of not being able to rest have resulted in generations of poor health outcomes in people of color.
We must continually make efforts to acknowledge the historical injustices of our public health system and uplift the stories of previous generations to give light to their experiences – like the victims of J. Marion Sims, notorious for gynecological experimentation on enslaved women. We know the names of three of his victims that emerged from his records: Anarcha, Lucy, and Betsey. These three women not only repeatedly healed each other, but took turns giving each other space for rest while developing many of the concepts widely used in gynecological and surgical nursing today.
We must also reimagine our assumptions and expectations about rest and recovery to make them more responsive to experiences of marginalized people, and how these assumptions can extend negative feedback loops for younger generations.
For years, I was a clinical mental health provider at an outpatient Medicaid clinic in Washington Heights, Manhattan. Our clients experienced various combinations of racial discrimination, language access barriers, low socioeconomic status, and disparate challenges associated with health and educational attainment. A common symptom of depression and PTSD observed was insomnia or poor sleep, which correlates to poor health and economic success.
My clients were confronting very real challenges to achieving rest, including lack of housing, childcare, chronic illness, and economic strife. We were ever-aware that these inequities were rooted in complicated social and political determinants of rest and recovery, and we had to reframe what progress toward success might mean for our clients. I remember working with a 13-year-old kiddo who had been forced to share a bed with his entire family due to financial and apartment constraints.
He was feeling the age-inappropriateness of this sleeping arrangement and was getting in trouble in school for falling asleep in class. The clinic identified funds to get him a small mattress to sleep on the floor of the room, which for this adolescent, was his first-ever experience of autonomous and independent rest. It was wondrous to see what solid sleep did for his mood elevation, cognitive function, and overall healing recovery.
I was recently introduced to the emerging brilliance of Trisha Hersey who focuses on rest as resistance for people of color – that our productivity does not define our worth and that our humanity alone, is enough for survival. According to the Bureau of Labor Statistics, on average, people who identify as white, make up the largest percentage of the US labor force.
It is worth highlighting, however, that 33% of the emergency room, psychiatric, and substance use hospital workforce is Black. About a third of the food service and accommodation industry workforce is Hispanic/Latinx/Latine, and about a quarter of the data processing and internet industry workforce identifies as Asian.
We also know that all three racial identity groups (with the exception of Asian people who identify as male) still make significantly less on the US dollar, compared to their white counterparts. This wage gap again promotes the generational negative feedback loop that not resting, indeed does mean economic survival.
Now consider and imagine what might happen if these workforces of color decided to collectively take rest on the same day. We would experience a crisis of unparalleled economic resource constraints – a strong case for the worth and value of normalizing regular rest for BIPOC people. To rewrite false and biased narratives, our work must make visible the experiences of previous generations of color who resisted through rest, in whatever capacity they could, like Anarcha, Lucy, and Betsey.
Rest has not only been something we, as people of color, have always needed, but it is something we have always deserved. Breaking the negative feedback loop means we must allow ourselves to rest, to honor those before us who could not.
Madhuri Jha, LCSW, MPH (she/her/hers) is the Vice President of Science, Equity, and Integration at ETR. In her role she is charged with embedding and integrating equity into organizational practices, while sustaining the scientific integrity of ETR's long history as a leader in the health and education space. She is a practicing psychotherapist, specializing in trauma and resiliency, and also a nationally recognized thought leader on health equity, mental health, and health systems strengthening. She can be reached at firstname.lastname@example.org