Cultural Competency & Mental Illness

By Darrin Ryan Smith


Everyone experiences mental illness in their own way, so my experience is different. I try to remind people of that daily because when I tell my story, they often find it hard to believe that a person with a disability is also dealing with what I deal with. I reply to them in a very humane way that even people with disabilities are human. I type this with an open heart for those who are under the constant fear of having their health insurance being taken away, or who don’t have health insurance to begin with.

First off, I want to give you a short glimpse of who I am. I’m deaf, black, and gay, I struggle with depression, a mild case of Seasonal Affective Disorder (SAD), and two types of eating disorder- Anorexia and Bulimia. I take pride in who I am; a first-generation deaf individual with a rich family history. My struggles with mental illness started young, in middle school, to be exact. I grew up being a big eater, dinner was my favorite pastime – I would eat anything when I was young. It wasn’t until I moved to Cleveland and I was sent off to boarding school that my eating disorder started to take hold. I was trying to get friends, trying to make a name for myself when my anorexia started to kick in; I would become extremely picky to a point where I refused to eat anything that was provided because I was pursuing that ideal middle school persona of being Mr. Popular. My first year there, I was 125 lbs. at the beginning of the school year. By the mid-year, I was 100 lbs. I was thin, and I shrugged it off as normal because I was doing a lot of cardio. My friends noticed that I was thin to a point where they would call me Mr. Toothpick, because I could break at any moment.

By the end of the year, I was 95 lbs and I was enjoying the moment. I didn’t realize that I was harming myself because I was rejecting the necessary nutrients that my body needed. That was the start of my anorexia and it went on for 4 years; my bulimia didn’t start until my third year in middle school, along with my depression. Most of the people took notice of my frail, thin appearance around my second year, but I assured them that I was okay – I was doing new exercises and I was just trying to be healthier when in fact I was just not eating. As I look back, I must admit that I am lucky that I didn’t starve myself to death. I would eat something small, like a leaf of lettuce or a plate of tomatoes, but I was not in that mindset of eating healthy. I was in that mentality of trying to look good, because I was living at a school where I honestly stood out in numerous ways. I had to exceed academically, personality-wise, and that was a burden during my pre-adolescence.

As I mentioned, my depression and bulimia didn’t start until my third year – and that not was the biggest secret that I had to bury. In my third year, I was sexually assaulted.  I didn’t have any form of support system while I was there because my rapist was still roaming free and sharing classes with me. I had to put on a good façade, as if I was okay, but I wasn’t. I couldn’t tell my parents because I didn’t know how it would go. I couldn’t tell my friends because they were friends with him. The school didn’t believe me; they put the blame on me as if I did something to initiate the assault.  I was in a world all by myself.

In my mind, the best way to cope with the depression was by doing too much, being involved in activities that would get me out of the campus, volunteering at different events;  several ways to be able to cope with the fact that I was sexually assaulted at such a young age. Again, people at school took notice of my frail, thin appearance so they took the proper measures to be able to ensure that I would eat properly again. That worked only for an abbreviated period, because when I would eat I would excuse myself to the restroom, only to purge the food that I just ate. I didn’t want to gain weight – didn’t want to be fat. Between my depression and my eating disorder, I was lost and confused. I called this period “the internal wars”, because I was dealing with three psychological wars and I wasn’t winning any of them. I honestly was at my wits end, it wasn’t until my freshmen year where I had the opportunity to study abroad in Italy, where I found a new glimmer of hope.

People who have traveled to Italy often say that they get a breath of fresh air when they step on Italian soil -- that wasn't the case for me; I didn't feel like a breath of fresh air - I was preoccupied with finding the nearest bathroom after indulging dinner on the 14-hour flight to Rome,  so I could just binge what I ate. I stayed at various nunneries where I realized that they were accepting me for me - they didn't see me as someone who was sick - they saw me as someone who was struggling to make sense of everything that was going and using crude methods to cope from rejecting food to vomiting food. I can remember a time where I didn't want to eat. One of the nuns made me a plate and placed it in front of me. It was a salad made with vinegar and olive oil; it was good, yet I was debating internally if I wanted seconds or if I wanted to vomit it up. That was my cognizance – only of two tracks: to binge-eat or to vomit.

During my time in Italy, I met people who gave me a glimpse of hope; who taught me that my battles will be a part of a long-lasting journey and that I’m perfectly unique. Immediately upon my arrival, I sought out professional help to attain positive and healthy solutions. As years went by,  I used those tools to help keep my disorders under control.  It worked, and it continues to work.

The journey to seek help wasn’t easy, because as a deaf person, many mental health professionals leave the bulk of costs to the patients. Things like interpreters are required in order to receive any kind of mental health treatment. I had moments where I didn’t want to seek the necessary help because of the communication barriers, but I mustered up the strength and overcame my fearful reluctance.  All of my mental health providers helped to solidify the message I had first experienced while in Italy: I’m beautiful and I’m unique.

To be disabled, and to seek mental help, is so complicated. Two of the biggest hurdles that I have experienced when it comes to seeking help are the cost of access and the lack of cultural competency when it come to being deaf. The mental health field has a huge lack of interpreters, which makes recovery more difficult. Most insurance companies find the cost of providing interpreters prohibitive, versus the actual session that a client would take. The essential factor of communication is very important, especially to the deaf community and that isn’t always provided when it comes to seeking assistance for mental illness. We are often viewed as a burden. I can think of a very few times where my sessions produced as very little in regards to positive results.  I would make one recommendation to all mental health providers, it would be to take more cultural competency classes – or have an understanding of what it is like to be deaf, in order to create a level of empathy and therapeutic success for their patients.