I’m Shantel, a final-year MSc Occupational Therapy student currently on placement with JB Occupational Therapy. My work focuses on the intersection of chronic illness, medical injustice, and occupational loss, especially for marginalised communities. Through this blog and our podcast This Is My “Normal,” I aim to reflect lived experience through an occupational therapy lens.
Chronic pain is rarely just physical. For many Black women in the U.K., it’s an ongoing negotiation between body, identity, and a system that often refuses to listen. It is a daily disruption, an invisible weight, and a form of occupational injustice that extends far beyond biology.
This blog explores the lived realities of chronic illness from a Black British lens, drawing from my own experiences and my current occupational therapy placement, where themes of identity, loss, and systemic bias are central. Grounded in the principles of OT, I aim to reflect on how chronic pain affects not only the body, but the ability to live a meaningful, self-directed life.
Unequal Pain: The Evidence Behind the Experience
Chronic pain is not experienced equally. Studies consistently show racial disparities in pain recognition, diagnosis, and treatment particularly among Black women.
- Black women are around 50% less likely to be diagnosed with endometriosis compared to white women, despite reporting equally severe or more persistent symptoms (Perro, Weckesser, & Griffith, 2023).
- In areas such as South London, Black women live with disproportionately high rates of long-term conditions yet are less likely to be offered early interventions or culturally appropriate support (King’s College London, 2023).
- Pain in Black patients is more likely to be minimised or dismissed by healthcare professionals, a bias rooted in harmful myths about pain tolerance and emotional resilience
This is not just a clinical oversight, it is a systemic failure that has serious occupational consequences. Many women disengage from healthcare services altogether due to experiences of invalidation, mistrust, and medical gaslighting. The result is not just untreated pain, but unacknowledged suffering.
When Pain Erodes Daily Life: Occupational Loss in Action
In occupational therapy, we define health not by the absence of illness but by the ability to participate in meaningful activities or occupations. Chronic pain fundamentally disrupts this.
From personal experience, living with PCOS and IBS has meant grappling with fluctuating pain, fatigue, and unpredictability. Flare-ups affect everything from basic ADLs like cooking and cleaning, to more complex roles like engaging with my OT placement or maintaining social connections. On low-energy days, even holding a conversation feels emotionally taxing. This is not laziness it’s occupational loss.
Using the Canadian Model of Occupational Performance and Engagement (CMOP-E), I can see how the interaction between the person (my physical and emotional self), the environment (placement expectations, healthcare settings, public spaces), and the occupation (study, self-care, socialising) becomes disrupted (Townsend, & Polatajko, 2007).
Over time, these disruptions compound. You begin to cancel plans before symptoms even start, out of fear. You overexert to “prove” you’re okay, then pay for it with a week in bed. Your identity, as a student, a friend, a daughter starts to slip.
What Occupational Therapy Can Actually Offer
What drew me to occupational therapy is its recognition that healing isn’t just about pain management, it’s about participation. It’s about helping people find ways to engage in life despite limitations, using strategies that empower rather than restrict.
For Black women living with chronic conditions, OT can offer practical and affirming support:
- Pacing and energy conservation — helping clients learn to manage their energy, set boundaries, and work with their body rather than against it.
- Task adaptation — simplifying, sequencing, or modifying daily tasks to maintain independence and reduce flare risk.
- Validation — listening without minimising. Supporting emotional processing around the grief, loss, and identity shifts that come with long-term conditions.
- Advocacy — supporting clients in navigating complex systems, challenging medical dismissal, and promoting access to culturally safe care.
During my placement, I’ve seen this in action through remote client sessions and masterclasses. For example, in a pacing and heatwave masterclass, we helped clients understand how temperature dysregulation, fatigue, and activity thresholds impact daily functioning and offered ways to modify their environments and routines. This wasn’t just theory. It was practical intervention rooted in real lives, often ignored by traditional services.
Medical Gaslighting and Its Occupational Toll
Gaslighting doesn’t always come with malice sometimes it’s delivered with a clipboard and a smile. But the effects are real: delayed diagnoses, internalised self-doubt, and the slow erosion of trust in your own body.
In podcast discussions and client reflections, we’ve heard stories of women who were told their pain was “just stress,” or who were offered antidepressants instead of referrals. This repeated dismissal doesn’t just affect physical health it interferes with your ability to engage with healthcare at all. Many women stop going to appointments. They minimise symptoms or overcompensate to avoid being seen as dramatic.
This emotional fatigue has serious occupational impacts: missed work, disrupted routines, reduced self-care, strained relationships. It is an invisible burden carried in silence.
Representation, Culture, and the Strong Black Woman Script
Within many Black communities, especially among women, the expectation to “push through” pain is deeply ingrained. Rest can feel like weakness. Asking for help can feel like failure. This cultural narrative often referred to as the “Strong Black Woman” script reinforces resilience but also fuels silence.
As one study of Black women with osteoarthritis in the American South found, many of the women described themselves as always having to “carry everything”, never allowed to fall apart, never prioritising their own need (Cousin, Johnson-Mallard, & Booker, 2022). Though this was a U.S. study, the themes hit close to home. I’ve seen these patterns in myself, my family, and my peers. The emotional cost is high.
Occupational therapy has a duty to hold space for these dynamics to question what roles women feel forced into and to support them in reshaping what strength looks like.
Occupational Therapy as Advocacy and Reclamation
OT is not just about adaptations; it is about liberation and empowerment. OT represents restoring agency. And recognising that medical trauma, systemic racism, and chronic illness intersect in ways that restrict participation then doing something about it.
This placement has helped me see that advocacy is not an optional add-on in practice it is essential. Whether it’s supporting a Blue Badge application, co-developing inclusive resources like blogs and podcasts, or simply listening without judgment, our role is to promote occupational justice.
Final Thoughts
Black women are more than the pain we carry but we deserve to be seen for what we carry. Being tired isn’t a character flaw. Flare-ups aren’t excuses. Advocacy isn’t optional. We are worthy of rest, care, and being believed.
Want to hear more?
Check out our podcast, This Is My “Normal.”
We share honest conversations about chronic illness, occupational loss, medical racism, and what it means to live a full life while managing pain.
References
King’s College London. (2025, June 6). Black women face the worst health inequalities in South London. King’s College London.
Nicholas, M. K., Molloy, A. R., Tonkin, L. E., & Beeston, L. (2011). Manage Your Pain: Practical and Positive Ways of Adapting to Chronic Pain (2nd ed.). ABC Books.
Townsend, E., & Polatajko, H. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, and Justice through Occupation. CAOT Publications.
Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113
Wanogho, A. (2025, June 5). Addressing healthcare disparities with a focus on the Black population. British Journal of Nursing, 33(18), 858–860. https://doi.org/10.12968/bjon.2024.0348
