Being strong can kill you: The marriage of feminist inquiry and physiological insight to explain the risk factors of black womanhood

Background. African American women experience more chronic illness and depression than White women. It remains unclear why they are at greater risk for poor health functioning, despite reports on factors related to illness prevalence among this group. Missing from these analyses is a gender-critical approach to the ways adherence to gender scripts produces behavioral and physiological risk factors to African American women's health. Purpose. The study purpose is to deconstruct the sociohistorical context of black womanhood, including gendered expectations related to role management, coping and self-care, to delineate gender scripts that generate risk to African American women's health. Pairing behavioral and physiological risk factors with the premise of allostatic load, I introduce a model for understanding how adherence to gender scripts explains external stressors, internalized distress and vulnerability to chronic illness among African American women. Methods. Women's voices in black women's magazines and blogs were analyzed to locate expectations related to role management, coping and self-care. Linkages were drawn between adherence to these expectations and women's health experiences. Results. African American women's perceived expectations germane to role management, coping and self-care endorsed a “strength script” of self-reliance, self-silence and self-sacrifice. Adherence to this script was linked to behavioral (e.g., blocked help-seeking and self-care neglect) and physiological (e.g., chronic stressor overload) risk factors. Resultant health experiences included depression and “being on the verge of a nervous breakdown.” Conclusions. Pairing feminist inquiry with physiological insight explains a fuller spectrum of gender as a risk factor to African American women's health.