Inside my Insides
Over time I started to understand how much racism and other forms of othering has impacted my body not only because of my own experiences but also generationally based on what my own elders had experienced living in society. I could see clearly how certain ways of being in body were a response to the lives they had led and the things that they tried to shield themselves, and us the kids, from. And so, the healing has begun.
The healthcare system is overdue to open up to a holistic and emotionally intelligent approach to healthcare. A paradigm shift in thinking, language and most importantly practice. In Therapist & trauma specialist Resmaa Menakem’s book My Grandmother’s Hands racialised trauma and the pathway to mending our hearts and bodies, it is said that ‘white body supremacy doesn’t live just in our thinking brains. It lives and breathes in our bodies…As a result, we will never outgrow white-body supremacy just through discussion, training, or anything else that’s mostly cognitive. Instead, we need to look to the body – and to the embodied experience of trauma.’
It is my view that without this component the migrant health sector will continue with the narrative that we people of the Global Majority (#BAMEOVER #MyMotherDidn’tGiveBirthToABAME) are fearful of Western healthcare systems – as if that would be unfounded and without reason and yet what is true is that our response is actually the only normal behaviour to being on the receiving end of abnormal, harmful behaviour from a racist society. We are in a system where the advocates of our healthcare – our GPs are the exact same people we, the patients have to lobby to get better healthcare, convince them our symptoms are real, advocate for ourselves so that they may take the time to read the medical history we come in with on paper from another time and place – often this is pushed away ‘you keep that’, they’ll say. As if your past has nothing to do with what is happening right now – isn’t it called medical history for a reason? We have to lobby for follow up investigation and are told we are aggressive when we call and call all the while managing great pain in body. A factor influencing this experience is of course that 10 minutes per appointment is just not reasonable, it takes 5 minutes for the GP just to read last visit’s notes, then a few more minutes are taken when it is your turn to explain what you’re there for, leaving only maybe 3 minutes to get the ‘help’ or for them to say come back in a few weeks. It is rare that your blood pressure is taken at an appointment and yet that is one of the key indicators that something life-threatening could be up with you. So I know what I am saying may sound radical. But necessary. We also know our counterparts in other parts of Europe like Norway have a 20-minute appointment system.
Menakem also says: ‘our deepest emotions involve the activation of a single bodily structure: our soul nerve (or vagus nerve). This nerve is connected to our lizard brain, which is concerned solely with survival and protection. Our lizard brain only has four basic commands: rest, flight, flee, or freeze…in the aftermath of a highly stressful event, our lizard brain may embed a reflexive trauma response – a wordless story of danger-in our body. This trauma can cause us to react to present events in ways that seem out of proportion or wildly inappropriate to what’s actually going on’.
If there is going to be any attempt to do the work this paradigm shift demands, a healthcare system needs to understand the impact of the racialised structure in which migrants live and equally important how that structure impacts our GPs with white bodies for there is a reason an eye roll from them happens when some of us seek out assistance. The white body is also used to responding in learned behavioural patterns based on thinking and practice in a racialised reality. This often leads to them ignoring and invalidating one’s symptoms.
A day after the interview (people in the UK sat up to watch in the wee hours) with a certain red headed royal son and his wife of the Global Majority, someone I work with started the morning by saying I can’t believe they didn’t help her with mental health support. Like that was the biggest thing. Like she developed the troubles all by herself. It never once occurred to them to think what would happen to any person’s mental health living in a consistent hostile situation? Yes, this example is about people of privilege, but you get my point that the responsibility was placed on the person experiencing the insidious violence. I specifically use this word because there is another widespread belief in the UK that speaking in a soft tone and calm manner is the only requirement for civilised behaviour in society all the while breaking you down with words and silently violent actions like ignoring or invalidating. And that is where we are with the health system – in an attempt to be down with cultural competence, migrants are rather experiencing a lens with which we are looked at when we see our healthcare workers. They are too often not using what they know about what may be prevalent in a group to give better healthcare but rather operate from a point of the racism of low expectations. They often think they have to dumb things down or assume we don’t know our own question. A few years ago, my blood sister (weird way of saying it right but hold on) had a major health situation for which she was advised to contact her sisters and have them get checked out too. My GP’s first question was, was she in fact my blood sister (because you know how close black women and their friends are – we’re all sistas). Ask yourself, would I go to my GP about an issue that affects genes in my family if it was my best friend (I am genetically unrelated to) who had the diagnosis? It seems to me that whilst the cultural competency may have flagged the you know they all call each other sista. It didn’t note that I in fact came armed with information that it was genetic hence visiting my own GP – it's why I call it racism of low expectations. I think a more conscientious question from the GP could have been has anyone else in the family had a similar diagnosis – there’s a viable alternative for you. Had this been a one off experience, the garden variety being talked down to I deal with daily as a migrant I would have let it be because not every hill is one to die on. But in this GP surgery, I have been explained to about how my period works all because they couldn’t diagnose what was actually wrong with me. Never mind that I have been handling my own blood since I was 13. I was blamed for being sick due to not eating vegetables although I have two good servings a day – this line of questioning was simply indicative of another assumption about my shape and how my ‘type’ eat. They kept putting me through a series of the same test and often forgetting to add the one test and I’d have to go back again and again. Meanwhile, I was getting sicker and sicker. As a performer, the work is active and physical and there are no sick days for freelancers. It was the reason I had gone to see them, physically working was getting hard. Eventually, I learned, they suspected what it could be but never had that conversation with me and when my body was finally at its wits end and I returned to them, I was prescribed something that would take 1 month to see some changes and yet had I been helped earlier, my working life would be easier with some pain relief. To my mind, your Doctor is the last line of defence where all masks must come down, you are truly vulnerable, because you are not well and sometimes have to be partially clothed for an exam. So, it matters how they behave when you are in that state. It matters that they have to know context to really help you or begin to solve what is many times a puzzle, we know there are things even the greatest medical minds don’t know, even more reason to trust and speak to the person who spends more time with this body, those 5-8 minutes can’t give you a full picture – in other words listen. But what one often experiences only leads you to be on alert, armour on and on guard.
We continue to be subjects of research without prior informed consent being even considered, there’s a long dark history of this with people of the Global Majority so we have every right to question any sign of it today. And yet the widespread narrative is that we are innately suspicious. Emotional intelligence demands that a people who have experienced a history of maltreatment in medicine will be keen to question things and if nothing else I hope gone are the days where Doctors were Gods and we obeyed without question. We are in a time like no other where a quest for agency reigns supreme so of course that should trickledown to those little rooms where we’re half naked talking about the stuff we probably can’t to anyone else.
In my long body story here in the UK, I have gone from specialist to specialist and on one occasion entered an office to find the Doctor, Nurse and a researcher. Prior informed consent would have given me an opportunity to reflect on whether or not I want to be part of whatever that researcher’s thesis topic was. English is my first language, so I understood easily that although they were all seated down when I entered giving the impression they all had the right and necessity to be there, I knew I didn’t have to consent to the presence of a researcher in my private medical consultation. What about patients who speak 3 other languages and know English only to a conversational standard but may miss this nuance?
For me if cultural competence is something healthcare is serious about, it is important to know this. A lot of our cultures have care and respect ingrained in them. That sounds standard you may think but what’s missing in the healthcare system’s understanding is that culture is an embodied experience . It’s how you address people older than you. It is embodied in how you hold your physical posture and use your voice – something unconscious because you’ve observed it and been doing it since you were born. Every culture has their version of course. In the UK this embodiment learned from my upbringing has been marked as negative, feeding yet another widespread narrative when it comes to healthcare that we are docile or need to be infantilised (whilst at the same time we are also ‘aggressive’ when it comes to our rights – as if you should demand equality nicely, either way both are narratives that trap us in a harmful social construct). But what happens when you take those unconscious ways of being to a new context? Author Mohsin Hamid once said in an interview ‘every migrant deals with the sorrow of two losses, not belonging in the new place but also no longer being of home.’
It seems so simple now but the hardest thing was understanding that I had to redefine my boundaries. Who was I in this new place? To even begin to contemplate the journey of being whole here, I had to learn to code switch better.
Something as simple as when someone says how are you? In my cultural context, you actually answer that question and the person asking is around to hear it. I still forget sometimes that someone saying you alright could be said and they will be off their own way before you answer. Sometimes I remember it’s okay not to answer. It’s small and comical to me now as I still catch myself perhaps too often giving an answer. At first it seemed unusual because one has a different way of dealing with the world. When switching into a cultural context new to you, especially at the beginning you have to read the situation, then your brain has to decide how to translate how you’d normally respond in your own context and assess if it suits this one. This can make you slow to speak at times in regular conversations and an impatient listener will be speaking for you or over you or assuming that you’re a little lamb that needs training.
In the healthcare system any hesitation in speaking may come across as if you’re lacking intelligence, not having command of the language (that is not a crime) so they inevitably speak louder and use hand gestures (for example a staff member touching her breasts to ask if you’ve come for a mammogram). Sometimes all my brain is doing is remembering to adjust my way of speaking. Say what you will but adjusting how one speaks provides a cloak of access to many parts of British society. Though it is natural to adapt how you say certain words the longer you live in a place, however, in my sector it has been categorically said that access to certain jobs would be impossible if I still had an ‘accent’ (nevermind that English is my first language so comprehension is not an issue) - so I make no apologies for what I have to do to work.
What has this to do with migrant health?
Remembering where you are - by that I mean it takes a kind of armouring up to go out in the world as an immigrant. Yes, we all armour up for work mode or sorting out official paperwork. But in my experience as an immigrant, it is that the threat of physical violence can be experienced on even a simple Sunday walk by the river, so remembering where I am and having my wits about me can literally save my life. And because naturally like with all humans, the body behaves differently on different days, remembering can depend on so many things like, what kind of day you have had, are you feeling well? If there is a big event happening back in your homeland that pang of longing will create a bodily response. All these factors can dictate how I will respond to external circumstances. It is one of the things I love about theatre-making (in those good spaces) where we arrive as we are and support each other in making the work from the reality of what one’s experiencing, maybe someone comes to rehearsal having fought with a partner or a pet is ill, or your train was delayed because there was a suicide on the tracks which gets you thinking about how really lonely it can be. So, your body may be tense and your voice low and what I know for sure is, in those cases you’re not going to necessarily have a good sense of what you need or best practice on how to respond to those encounters of racism of low expectations and silent acts of violence because your body is processing something else. It takes practice to say I am not okay, to recognise when it is in fact safe to release the armour that shields your wellbeing and embrace a space where you can truly trust the people you are saying it to. It takes practice to start really listening to your body for it has an inbuilt early warning system. Like with the basic needs, it knows when you are thirsty, hungry, tired or lustful – it gives clear signals. It also knows when you are about to get really angry, when you are yearning to be held and when you are taking in violence that should not be metabolised. It takes practice to feel those signals because sometimes the armour we have to wear in society prevents us from tuning into that frequency. I remain devastated at the fact that the one place in public life where it should be okay to say I am not okay or I think something is wrong is a minefield.
So, when I entered that specialists’ office that day and three people were there I sat and listened to the introductions. And thankfully I was in a place where I knew that it was not in any way beneficial to my health and quest to be well to have a researcher in the room for a private medical consult so I could say no, that day. But from an ethical viewpoint, I should never have been put in a position to make an on the spot decision about a researcher listening in. The researcher was visibly angry in their response to my questioning and ultimate refusal to consent to their presence in the room as they stormed out of it. It didn’t end there; I was asked how many people lived in my home because that could be the cause of my sickness. Of course, they were dumbstruck when I said two people, so that theory of overcrowded migrant homes was out the door. Then, they tried to sell me hard on taking an experimental drug which a prior specialist told me not to ever take except under specific health circumstances. I explained this information. And as those were not the circumstances I was in, there was no need to force the issue. Though the GP in the room told me that they can actually force me to take this medication if it came to it - the already shaky trust with my healthcare worker, who was there to help me, was lost in that moment. And we wonder why the issue of trust in the healthcare system from the Global Majority persists.
I am fortunate that the work I do has been a pathway to my own journey to self-healing and helped me get much clearer on the impact of how my Black African woman migrant body is affected by society’s demands on it to not take up space whilst simultaneously being a good immigrant.
As a migrant your body goes through many shifts in embodiment, because your job when you step outside of your own safe space (and many do not have that) is to calculate and assess how you can access whatever space you are needing to enter. And sometimes it will be for physical safety.
Society is asking us to perform our own identity because there is a test to pass but you can never pass it because the goalpost for that test shifts as it is different for each situation. And if anything you do goes ‘wrong’, society can fall back on the label assigned you - ‘different’ ‘difficult’ ‘dumb’ as proof that it’s you that created your own suffering.
British society’s demand on even how we speak allows or denies us access to parts of society. You sometimes have to hide parts of who you are not by choice but for access and safety, that act of hiding by force always unsettles the body. Certainly, in the sector in which I work, we play with different ways of speaking for dramatic purpose but what is interesting is that when the migrant enters the room, you best not be an audible migrant - months ago, I came across this phraseology in a Knowledge Cafe – on Things I Am Not, the webinar hosted by Migrant Dramaturgies Network. I have lived in several countries, so I have a hybrid way of speaking already. I notice without fail how my experience is different in spaces where I use an adapted version of my speech.
I have agonised greatly about how much of my own story to tell because I didn’t want to fall into the one person story trap. I feared that it would be marked off as a terrible experience for one person. But I don’t control that and frankly if you are reading this and thinking it’s just one person then you’re making my point for me. I have shared them because I know we all have a body and we all know what it’s like to sit in that gown with the back open. My hope with the audio piece itself is that there is an awareness that for me as a migrant I am trying to do the work of re-membering myself and settling my body from society’s brutality. I am not unwell because I am a migrant – there’s a narrative that we arrive on these shores with our mental health and other health issues and yet the simple truth is that being stripped of your identity and constantly being asked to define everything in terms of fitting into society’s assessment of what is a good immigrant takes a physical toll.
But it would be a great shame if that was all that was communicated.
My state is that I am a healing body, reconciling the past and ongoing, often silent violence of British society and preparing to walk with all the multiplicity that is me.
Multiplicity is a positive thing – there is a narrative that keeps trying to make us think you are broken from having multiple heritages and languages and customs.
Mine is not a struggle of fitting in but of convincing people you can love and be multiple things. There are things I love about living here and I am making it home because I am here. The journey is allowing my body to take shape as my spirit takes space. I am most proud of my migratory heritage, my own migratory journey because it has made me the kind of artist I am. I am a global shapeshifter and I seek to be seen as I am, met where I am and I offer the same. The othering has also brought a deeper path of connection to my own heritage – that can never be a bad thing. In the audio piece I have spoken in another language and chosen not to translate because I believe that hearts know each other and you’ll understand. And equally important, it is about opening up to what aspect of self expression must remain silent when one migrates, the incalculable loss of migration is often not having anyone else to speak your home language with, use those sounds specific to it. I also think there is something deeply nourishing about speaking to a loved one in a language in which they dream and think and feel.
People often say find your people – that is true. I have found tiny spaces where all of my multiplicity is welcome and encouraged. But this whole truth telling isn’t just about a quest to healing. For me and my body it is of course. I have done this in the hope that the people responsible for the wellbeing of society by taking care of the individuals make a permanent paradigm shift to looking at the person as a whole. Shift the focus to healing and not just treating illness. Many cultures have had remedies for healing embedded in them in which the somatics are rooted, let us begin to entertain the idea, for example, that it is not all talk therapy. Ultimately, because I can write what I dream, I hope to see a society in which there is an end to violence being inflicted on people when they seek medical care. I hope to live in a time where there is no intentional trauma and abuse inflicted on us by and within institutions of care. Such an investment in wellbeing would be worth it long term when balancing the books too.
In a collection of writing titled Diverse bodies, diverse practices – towards an inclusive somatics Edited by Don Hanlon Johnson, Muriel Jamille Vinson in her essay titled Sankofa: a journey of embodied re-membering has adopted the term embodied suicide adapted from that of her colleague Diego Basdeo (intellectual suicide). ‘Embodied suicide is the practice of actively preventing the full expression of one’s embodiment/expression of self/truth in order to preserve a feeling of safety and/or connection…so we learn to make adjustments of mind and body. To survive.’
Due to centuries of racialised trauma, the Black body continues to be looked at through harmful lenses, to be demanded of and ignored as it is widely believed that we feel less pain. Likewise the migrant body is expected to withstand it all for the we are strong narrative that persists. So,
we adapt and partake in embodied suicide daily.
What I love about the somatics approach is the belief that we are inherently resilient and not in a fetishize my trauma kind of way but on a body level. Yes the body may remember the trauma, but you can re-member body to be settled in self again. My soul seeks to thrive and fly. As an artist I belong everywhere and nowhere all at once. Migration is intrinsically human. To move is to be human.
I end with a quote attributed to a beloved shapeshifter Maya Angelou: ‘you only are free when you realise you belong no place – you belong every place – no place at all. The price is high. The reward is great.’
A word on process
I knew it was the right program to be part of when I first spoke to our workshop facilitator Imogen. Her generosity and openness has given this closet optimist an opportunity to be met as I am. What a gift. Likewise, I was greatly enriched by the sharing of conversation with my colleagues in the workshop. I was fascinated with what stage of our migrancy we were at depending on when and how we arrived and how that shaped our view on things. It is true that we are meant to shapeshift. Ultimately, it struck me that collectively we were there to do what the job of an artist has always been – that is to question how society functions. I assigned further meaning to our lived experiences, in that what we have been given in this life, as artists we must use. The relationship with any new place can be an instant love or instant repulsion and most times it is a journey of learning, as with life, to shapeshift as we incorporate experiences into ourselves.