Everybody loves to prescribe harder workouts to bodies that are already under siege. That is part of the problem. Too many stressed women are being told to punish themselves back into health while their nervous systems are running on fumes. This essay explores Pilates as something deeper than exercise: a practice of breath, control, awareness, and regulation. Because sometimes the problem is not that the body needs more discipline. The problem is that the body has not felt safe for a very long time.

There is a particular kind of cruelty in the way wellness culture talks to stressed bodies. If you are exhausted, anxious, inflamed, foggy, or running on empty, the answer is almost always the same: push harder. Sweat more. Stay disciplined. Be more consistent. But a body living under chronic stress does not always need more intensity. Sometimes it needs regulation. Sometimes it needs safety.

That is part of what makes Pilates matter. Pilates is not just exercise. It is a mind-body practice built on breath, concentration, control, alignment, and awareness. Research has linked Pilates to improvements in anxiety, depressive symptoms, fatigue, and energy, which is exactly why it deserves to be discussed as more than a fitness trend (Fleming & Herring, 2018). It offers something many stressed bodies are not getting enough of: structured movement that does not demand panic to count as progress.

Breath is one of the clearest reasons why. Stress often pulls people into shallow, upper-chest breathing, the kind of breathing that keeps the body hovering near alert. Pilates asks for something more intentional. It asks people to slow down, organize their breath, and connect movement to control. Research on diaphragmatic breathing has linked these kinds of practices to lower stress, improved emotional state, and healthier autonomic regulation (Ma et al., 2017; Hamasaki, 2020). In plain language, when breathing changes, the nervous system can change too.

That matters because chronic stress does not just live in the mind. It shows up in the jaw, the shoulders, the spine, the gut, the sleep cycle, and the breath. It changes posture. It changes concentration. It changes how easily a person moves through the day without feeling overwhelmed. A body under stress often begins bracing without permission. Pilates interrupts that pattern by asking the body to pay attention to itself rather than merely pushing through.

It also improves body awareness, and that matters psychologically. Interoceptive awareness, or the ability to notice internal bodily sensations, has been linked to better emotion regulation (Price & Hooven, 2018). That means learning to notice tension, breath-holding, agitation, fatigue, or collapse sooner is not some soft extra. It is part of how people become less disconnected from themselves. Pilates teaches that kind of noticing. It asks people to feel where they are gripping, where they are rushing, and where they are holding more than they need to.

That may sound small, but it is not. A person who can tell when their body is clenching has a better chance of softening before stress becomes overwhelming. A person who can feel when they are holding their breath has a better chance of regulating before panic takes over. A person who can tell the difference between challenge and threat is already moving differently through the world. Pilates can help build that distinction.

There is also evidence that Pilates can support sleep, mood, and resilience over time. In one randomized controlled trial, a 12-week Pilates program improved sleep quality, anxiety, depression, and fatigue in postmenopausal women (Aibar-Almazán et al., 2019). Other review-level research has found that Pilates can improve sleep quality overall (Chen et al., 2020). So no, one class is not going to heal a life built under pressure. But consistent practice may help a stressed body stop acting like rest is unsafe.

That is really the point. Not every stressed body needs a harder workout. Some need a safer way back to themselves. Pilates cannot remove every source of stress from a person’s life, but it can offer something wellness culture rarely values enough: strength without punishment, effort without panic, and movement that helps the body feel less like a battlefield.

Wellness culture loves to moralize intensity. It loves to make people believe that if a workout hurts enough, drains enough, or demands enough suffering, then it must be working. But exhausted bodies are not always asking for more force. Sometimes they are asking for a different relationship with effort. One rooted in breath. One rooted in attention. One rooted in the possibility that health need not feel like punishment to be real.

Pilates offers that possibility. It asks the body to work, but not to abandon itself in the process. And for women whose nervous systems have been running on fumes for far too long, that shift can matter more than another hard workout ever will.

References

Aibar-Almazán, A., Hita-Contreras, F., Cruz-Díaz, D., de la Torre-Cruz, M., Jiménez-García, J. D., & Martínez-Amat, A. (2019). Effects of Pilates training on sleep quality, anxiety, depression, and fatigue in postmenopausal women: A randomized controlled trial. Maturitas, 124, 62–67.

Chen, Z., Ye, X., & Wang, Y. (2020). Effect of Pilates on sleep quality: A systematic review and meta-analysis. Frontiers in Neurology, 11, 158.

Fleming, K. M., & Herring, M. P. (2018). The effects of Pilates on mental health outcomes: A meta-analysis of controlled trials. Mental Health and Physical Activity, 15, 110–130.

Hamasaki, H. (2020). Effects of diaphragmatic breathing on health: A narrative review. Medicines, 7(10), 65.

Ma, X., Yue, Z.-Q., Gong, Z.-Q., Zhang, H., Duan, N.-Y., Shi, Y.-T., Wei, G.-X., & Li, Y.-F. (2017). The effect of diaphragmatic breathing on attention, negative affect and stress in healthy adults. Frontiers in Psychology, 8, 874.

Price, C. J., & Hooven, C. (2018). Interoceptive awareness skills for emotion regulation. Frontiers in Psychology, 9, 798.

The most direct postpartum evidence supports the idea that a structured mat Pilates program can reduce IRD and improve abdominal performance, at least in the short term. In primiparous postpartum women, a 4-week mat Pilates program conducted at high frequency (50 minutes per session, 5 days per week) was associated with significant reductions in IRD and waist circumference and improved abdominal muscle endurance compared with controls (Lee et al., 2023). That matters because it suggests Pilates is not just “good for posture” in an abstract way; it can produce measurable changes when delivered with consistent dosage and clear progression (Lee et al., 2023).

There is also evidence that mat Pilates-based exercise may reduce IRD outside the early postpartum window, which is important for the many women who did not have “perfect” postpartum care, wrapping, rest, or rehab support. In climacteric women with DRA, a 12-week Pilates-based program reduced IRD across multiple abdominal regions (Silva et al., 2024). This population is not postpartum, so generalization requires caution, but the finding is still clinically relevant because it suggests that Pilates may influence IRD even when the body is operating under different hormonal conditions and timelines (Silva et al., 2024).

Smaller clinical reports are consistent with these outcomes, though they are not decisive on their own. A case report documenting mat Pilates in a primiparous postpartum woman observed reductions in IRD and improvements in trunk muscle endurance, aligning with the concept that Pilates-based training can improve both structural measures and functional capacity (Gahlot et al., 2024). Case reports cannot tell us what will happen for most people, but they often illustrate the “how” behind the observed improvements (Gahlot et al., 2024).

If we zoom out, Pilates falls within a broader family of interventions that target deep core coordination and trunk stabilization. A meta-analysis examining core stability exercise in postpartum women reported reductions in DRA measures using both caliper and ultrasound distances, supporting the overall premise that targeted stability training can reduce IRD (Oktaviyani et al., 2022). This is relevant because many programs labeled “Pilates-inspired” share overlapping elements with core stabilization protocols, including controlled breathing, progressive loading, and emphasis on deep abdominal engagement (Oktaviyani et al., 2022).

A literature review of exercise approaches for pregnant and postpartum women with DRA concludes that non-surgical, exercise-based interventions can reduce DRA, while also noting that current evidence does not establish one method as universally superior (Gruszczyńska & Truszczyńska-Baszak, 2018). That point is crucial because it reframes Pilates as a valid option within conservative care, rather than a singular miracle modality that must work for everyone in the same way (Gruszczyńska & Truszczyńska-Baszak, 2018).

Some studies also suggest that multimodal strategies may support conservative outcomes. For example, research on abdominal binders paired with strengthening exercises indicates improvement in postpartum DRA-related outcomes (Patwardhan et al., 2021). Although this is not Pilates-specific, it supports a practical clinical reality: for some individuals, external support plus progressive strengthening may be beneficial, and Pilates can operate as one structured strengthening approach within a broader plan (Patwardhan et al., 2021).

“Fixing” DRA: Anatomical Measures Versus Function

This is where the internet gets dramatic. Many discussions treat DRA as if it were real only when the “gap” closes, as if the body were a zipper and you needed the right trick. The literature is more nuanced. Changes in IRD are important, but functional outcomes, such as endurance, trunk stability, and symptom improvement, are also clinically meaningful and may not perfectly mirror IRD changes (Gruszczyńska & Truszczyńska-Baszak, 2018; Lee et al., 2023). In the Pilates study by Lee et al. (2023), improvements were not limited to IRD; waist circumference and abdominal endurance also improved, supporting the idea that Pilates may influence both structure and performance (Lee et al., 2023). From a conservative care perspective, this distinction matters because many women are seeking improved support, comfort, and confidence in movement outcomes that can be meaningful even when anatomical change is modest.

Variability, Measurement Issues, and Why the Results Don’t Always Match

The magnitude and durability of IRD reduction with Pilates-based exercise likely depend on postpartum stage, baseline severity, connective tissue tolerance, intervention dosage, and measurement method. Silva et al. (2024) report IRD reductions in climacteric women, but postpartum DRA involves different tissue conditions and remodeling contexts, so findings should not be treated as interchangeable (Silva et al., 2024). Meta-analytic findings also show variability in effect sizes and statistical significance across studies of core stability interventions, which reinforces the need for better-designed randomized trials with standardized protocols and consistent measurement strategies (Oktaviyani et al., 2022). In other words, the evidence supports Pilates as promising and clinically relevant, but it also supports honesty about heterogeneity in outcomes.

Clinical Implications

Based on available research, Pilates can be a valid conservative strategy for DRA management, particularly when implemented as a structured, progressive program emphasizing deep core coordination and controlled load exposure. The best-supported framing is that Pilates may reduce IRD for some individuals and can improve abdominal endurance and trunk stability, especially when dosage is sufficient and progression is appropriate (Lee et al., 2023; Oktaviyani et al., 2022). Because outcomes vary, Pilates is best presented as part of individualized conservative care, not as a guaranteed standalone fix for every presentation of DRA (Gruszczyńska & Truszczyńska-Baszak, 2018). Clinically, this suggests monitoring both structural measures (e.g., ultrasound or calipers) and functional outcomes (e.g., trunk endurance, symptom changes) to track meaningful progress, rather than relying solely on gap size (Lee et al., 2023).

De Resistance

Pilates appears to be a clinically reasonable conservative intervention for DRA, with evidence indicating potential reductions in IRD and improvements in abdominal endurance and trunk stability in postpartum and hormonally influenced populations (Gahlot et al., 2024; Lee et al., 2023; Oktaviyani et al., 2022; Silva et al., 2024). However, the extent of anatomical “fixing” varies, and the literature supports Pilates most strongly when it is delivered as a structured component of a broader core stabilization strategy that prioritizes deep core engagement and progressive loading (Gruszczyńska & Truszczyńska-Baszak, 2018; Patwardhan et al., 2021). The most evidence-consistent promise is not a guaranteed full closure of IRD for every person, but a meaningful improvement in abdominal wall function that many women experience as increased stability, reduced doming, and improved movement confidence over time (Lee et al., 2023).

References

Gahlot, P., Singh, R., & Shah, J. (2024). Ab. No. 113 Effects of mat Pilates program on inter-recti distance, waist circumference, and trunk muscle endurance in a primiparous woman with post-partum diastasis recti: A case report. Journal of Society of Indian Physiotherapists, 8(1), 74–75. https://doi.org/10.4103/jsip.jsip_abstract_58

Gruszczyńska, D., & Truszczyńska-Baszak, A. (2018). Exercises for pregnant and postpartum women with diastasis recti abdominis – Literature review. Advances in Rehabilitation, 32(3), 27–35. https://doi.org/10.5114/areh.2018.80967

Lee, N., Bae, Y., Fong, S., & Lee, W. (2023). Effects of Pilates on inter-recti distance, thickness of rectus abdominis, waist circumference, and abdominal muscle endurance in primiparous women. BMC Women’s Health, 23(1). https://doi.org/10.1186/s12905-023-02775-5

Oktaviyani, F., Pamungkasari, E., & Murti, B. (2022). Effect of core stability exercise in preventing diastasis recti abdominis among normal birth delivery postpartum mothers: A meta-analysis. Indonesian Journal of Medicine, 7(2), 188–199. https://doi.org/10.26911/theijmed.v7i2.536

Patwardhan, S., Pawar, V., & Patil, S. (2021). Effect of conventional abdominal binder on diastasis recti abdominis in post-partum women. Journal of Evolution of Medical and Dental Sciences, 10(30), 2255–2259. https://doi.org/10.14260/jemds/2021/461

Silva, E., Bortolli, T., Vesentini, G., & Marini, G. (2024). Effectiveness of Pilates-based exercises on the diastasis recti abdominis in climacteric women: A randomized controlled trial. ABCS Health Sciences, 49, e024207. https://doi.org/10.7322/abcshs.2022071.2135

In my Psychology of Women Class, we were asked what we thought America might look like for women in 2075. I already knew who they meant.

Not all women, white women.

Specifically, white, cisgender, heterosexual women. That’s who “progress” in this country has always been designed for. I sat there thinking about how absurd it is to speak about the “future of women” while ignoring the women who have done the most to build it.

White women have never been the architects of fundamental change in America; they’ve been the financiers and the beneficiaries. Their wealth, dowries, and family names helped maintain the very systems that positioned Black, Native, and Latina women as chattel; laborers, caretakers, and the moral backbone of white comfort. It took Black women to move this country forward, and history proves it.

When white suffragists like Susan B. Anthony and Alice Paul refused to include Black women in their fight for voting rights, it took Nellie Quander, International President of Alpha Kappa Alpha Sorority, Incorporated, to write directly to First Lady Eleanor Roosevelt, demanding recognition and inclusion for Black women in the movement (Quander, 1938). Without that pressure, we would have been erased from that history entirely.

That pattern hasn’t changed. Hillary Clinton had every credential, yet white women overwhelmingly voted against her. Vice President Kamala Harris represented the most qualified leadership this country had ever seen, but again, white women refused. The numbers do not lie: according to exit polls from both 2016 and 2020, over 70% of white women voters sided with the party of patriarchal restoration. As usual, they chose proximity to power over solidarity with other women.

So when people ask what the next fifty years will bring, I don’t talk about equality. I talk about exhaustion. Because if history has shown anything, it’s that Black women carry the moral and emotional weight of this country, only to be discarded when the credit comes due. Stewart and McDermott (2004) wrote that movements fail when they depend on the invisible labor of marginalized women without redistributing power. That’s precisely where we are now.

Matlin and Foushée (2022) explain that chronic racialized stress dysregulates the HPA axis, the part of the brain responsible for managing fear and trauma. Black women are experiencing neurological decline not because we are weak, but because we have been conditioned to endure too much for too long. We are dying younger because everyone expects us to hold them up.

By 2075, I don’t believe Black women will reach parity with men or with white women. Not because we lack ability or intellect, but because we lack allyship. Not from white men. Not from white women. And often, not even from our own men.

We are done leading every charge for free.

We are done being the moral conscience of movements that forget our names once the cameras turn off. We have given this country everything: our labor, our brilliance, our organizing, our resilience. The following 50 years should be spent resting, rebuilding, and redirecting our genius toward our own liberation.

For change to happen by 2075, society would need to do far more than elect a woman or post a slogan. It would require:

• A radical confrontation of racism within feminism.

• Accountability for how white women use political power.

• Structural protections against patriarchal backlash.

• Real representation of Black, Native, and Latina women in medicine, law, and policy.

• Acknowledgment of how our womanism and feminism have built the blueprint for every significant social advancement in this country.

Until that happens, I don’t expect equality. What I hope is clarity. Because we are not saving this nation again. We have earned the right to rest, to rebuild, and to live without being everyone’s foundation.

And if America truly wants a future worth saving, it can start by learning what real work feels like without Black women doing it for them.

With clarity and care,
Zsanine

Every story we read or tell affects our brains.
Not in a scary, science-lab kind of way, but in a real way.
Our brains remember how a story made us feel. They hold on to what hurt, what healed, and what we had to survive to keep going.

When I say “the Black girl brain,” I’m talking about the way our minds have had to grow, bend, and rebuild under pressure. We’ve had to be alert since childhood — learning early when to speak, when to shrink, when to smile so people feel safe around us. That kind of constant calculation? It’s neurological. It wires the brain to look for danger even in peace.

The weight we carry

Science calls it a stress response. We call it “trying to make it through the day without snapping.”
Chronic stress changes how the brain handles memory and emotion. It’s not weakness, it’s adaptation.
When the world keeps demanding that you stay strong, your brain learns to stay ready.

And still, somehow, we create beauty.
We tell stories, we laugh, we dance, we build community.
Every poem, lyric, and “girl, let me tell you what happened” moment we share is medicine. It’s cognitive repair, even if nobody calls it that.

The flip side: joy as brainwork

Culture and creativity keep our neurons alive.
Reading, music, prayer, journaling, art, all of it.
When you read Toni Morrison or sing along to Beyoncé, your brain lights up the same regions that process love and memory. That’s neuro-resilience. That’s joy as a scientific act.

And listen, rest counts too.
Sleep, food, boundaries, silence, all of it feeds the brain.
Science backs that up, but our grandmothers knew it before any journal ever printed it.

What I hope you take away

The Black girl brain is not broken. It’s brilliant. It’s flexible. It’s proof that we’ve been surviving and innovating simultaneously. If trauma can leave a mark, then joy can, too.
And every time we tell our stories, we’re rewriting our wiring, turning pain into pattern, memory into meaning.

Before You Go

I want to hear from you.
What stories shaped your brain?
What book, song, or memory do you keep returning to when you need to remind yourself who you are?
Drop it in the comments or share it with a friend who gets it.
Because our brains remember what we feed them, and I want us all to start feeding them joy on purpose.

Let Me REMIND You:

Han, S., Fleischman, D., Yu, L., Poole, V., Lamar, M., Kim, N., … & Barnes, L. (2022). Cognitive decline and hippocampal functional connectivity within older Black adults. Human Brain Mapping, 43(16), 5044–5052. https://doi.org/10.1002/hbm.26070

Kamara, D., Gangishetti, U., Gearing, M., Willis‐Parker, M., Zhao, L., Hu, W., … & Walker, L. (2018). Cerebral amyloid angiopathy: Similarity in African-Americans and Caucasians with Alzheimer’s disease. Journal of Alzheimer’s Disease, 62(4), 1815–1826. https://doi.org/10.3233/jad-170954

McDougall, M., Choi, J., Magnusson, K., Truong, L., Tanguay, R., & Traber, M. (2017). Chronic vitamin E deficiency impairs cognitive function in adult zebrafish via dysregulation of brain lipids and energy metabolism. Free Radical Biology and Medicine, 112, 308–317. https://doi.org/10.1016/j.freeradbiomed.2017.08.002

Chen, C., Yang, K., Nan, H., Unverzagt, F., McClure, L., Irvin, M., … & Kahe, K. (2023). Associations of telomere length and change with cognitive decline were modified by sex and race: The REGARDS Study. American Journal of Alzheimer’s Disease & Other Dementias, 38. https://doi.org/10.1177/15333175231175797

Esquivel, N., García, Y., Lores, B., Gutiérrez, M., & Martínez, C. (2020). Characterization of aged male BALB/ccenp mice as a model of dementia. Laboratory Animal Research, 36(1). https://doi.org/10.1186/s42826-020-00038-0

Taylor, C., Pritschet, L., Yu, S., & Jacobs, E. (2019). Applying a women’s health lens to the study of the aging brain. Frontiers in Human Neuroscience, 13. https://doi.org/10.3389/fnhum.2019.00224

Every time we hear “dementia,” most of us automatically think Alzheimer’s. But that’s only one piece of the story. There are several kinds of dementia, and understanding which one is showing up can be the difference between getting help early and being brushed off until it’s too late.

And for Black women who are still told “you’re stressed” instead of “let’s run a cognitive screen,” that difference matters even more. So let’s slow this down together. Grab your tea, your matcha, your brunch plate, whatever you need. Let’s walk through what’s really going on inside the brain when we talk about dementia.

Dementia Isn’t One Disease: It’s a Whole Neighborhood

Think of dementia like a neighborhood. Alzheimer’s is the biggest house on the block, but it’s not the only one there. “Dementia” isn’t a diagnosis; it’s a term for when memory, reasoning, or daily functioning start breaking down due to more profound changes in the brain. Researchers like James and Bennett remind us that dementia is a syndrome, a set of symptoms that can come from several different diseases. Some start with blood flow issues, some with protein buildup, and others from years of trauma or inflammation. And do you know what the sad truth is? Not every doctor knows which house you’re standing in. A global review found that even trained clinicians disagree on dementia diagnoses. That’s how fuzzy and biased the process still is.

Alzheimer’s Disease: the One Everyone Talks About

This is the most common form. Under a microscope, you’d see sticky clumps called amyloid plaques and twisted fibers known as tau tangles. They choke off neurons, starting in the hippocampus (where memory lives) and spreading outward. So first it’s short-term memory. Then it’s decision-making. Eventually, it’s speech and personality. But Alzheimer’s doesn’t look the same in every brain. Black women often experience mixed dementia. Alzheimer’s changes are mixed with blood flow problems. When multiple processes overlap, the brain deteriorates faster. It’s like several fires burning at once.

Vascular Dementia: the One Hiding in Plain Sight

This one often follows strokes, hypertension, or anything that messes with blood flow. It’s also one of the biggest reasons Black women get diagnosed late or misdiagnosed altogether. Our blood pressure, our pregnancies, our stress, all of it affects our vascular health. When small vessels clog or burst, brain cells suffocate. The result? Memory lapses, confusion, mood swings. The hardest part? It’s preventable!!

So what that means is that if it is caught early, it can be stopped!

Managing blood pressure, sleep, and stress can help slow it down. But that requires doctors who take our symptoms seriously, and too many still don’t.

Lewy Body Dementia: the Misunderstood One

This one is tricky. It comes with hallucinations, movement issues, and sudden shifts in alertness. It’s caused by clumping of a protein called alpha-synuclein inside neurons. Doctors often mistake it for depression or “just aging.” That’s why so many Black families say, “Mama started seeing things” or “She’s just not herself lately,” and no one connects it to Lewy body dementia until years later. This type reminds us that sometimes what looks “spiritual” or “emotional” in our families might actually be neurological.

Frontotemporal Dementia: the One That Looks Emotional Before It Looks Medical

This one hits the front and side parts of the brain that control language and personality. People may become impulsive, withdrawn, or start saying things that feel “out of character.” For Black women, that’s often labeled as “attitude” or “burnout.” Rarely do we hear a doctor say, “Let’s check her frontal lobe.” Frontotemporal dementia teaches us something powerful. When our personalities shift, it’s not always emotional; it might be neurological.

Mixed Dementia: the One Most of Us Actually Have

Most people, especially later in life, don’t have a single precise diagnosis. They have a blend: Alzheimer’s plus vascular disease, sometimes with Lewy bodies mixed in. That overlap speeds things up. It makes symptoms blur together, and it makes diagnosis harder, especially for Black patients who are already under-tested and under-imaged. This is where brain scans matter. Structural MRI can help distinguish, but access to imaging remains a privilege. Too many of us never even get the scan.

A Little History, Because the Ancestors Already Knew

Centuries before brain scans, the Persian physician Avicenna (980–1037 CE) described dementia as “a loss of intellect due to moisture and heat in the brain.” He didn’t have modern tools. He just observed patterns. And that’s what we’ve always done too. Watched our elders, noticed shifts, and tracked changes. We’ve always been our own data.

So What Do We Do With This?

We learn the language before we’re forced to speak it. We pay attention to speech, mood, sleep, and balance. We ask for specific tests: cognitive screens, sleep studies, and neuroimaging when possible. And we stop letting “just tired” or “just stress” be the final answer. Because “forgetfulness” isn’t always harmless, it can be the first whisper of something bigger. And we deserve doctors who don’t shrug off those whispers.

Next week, we’re breaking down what prevention really looks like when it’s personalized for us because dementia isn’t inevitable, and neither is being ignored.

References

Cerullo, E. et al. (2021). Interrater agreement in dementia diagnosis: a systematic review and meta‐analysis. International Journal of Geriatric Psychiatry, 36(8), 1127–1147.
Clinton, L. et al. (2010). Synergistic interactions between Aβ, tau, and α-synuclein. Journal of Neuroscience, 30(21), 7281–7289.
Gustavsson, A. et al. (2022). Global estimates on the number of persons across the Alzheimer’s disease continuum. Alzheimer’s & Dementia, 19(2), 658–670.
James, B. & Bennett, D. (2019). Causes and patterns of dementia: an update in the era of redefining Alzheimer’s disease. Annual Review of Public Health, 40(1), 65–84.
Kelly, M. et al. (2022). Applying diagnostic criteria for dementia with Lewy bodies. Alzheimer Disease & Associated Disorders, 37(1), 88–91.
Persson, K. et al. (2016). Fully automated structural MRI in clinical dementia workup. Acta Radiologica, 58(6), 740–747.
Rasquin, S. et al. (2005). Effect of diagnostic criteria on post-stroke dementia prevalence. Neuroepidemiology, 24(4), 189–195.
Taheri-Targhi, S. et al. (2019). Avicenna and his early description and classification of dementia. Journal of Alzheimer’s Disease, 71(4), 1093–1098.
Tartaglia, M. et al. (2011). Neuroimaging in dementia. Neurotherapeutics, 8(1), 82–92.
Younes, K. et al. (2018). Auto-antibodies mimicking frontotemporal dementia. SAGE Open Medical Case Reports, 6.

Alzheimer’s disease is not a single pathology; it is an intersection of genetics, stress biology, and lived environment. For Black women in the United States, each of these dimensions converges inside a healthcare system built on omission. Genetic risk factors such as ABCA7 variants and differences in amyloid and tau expression combine with lifelong environmental exposures, chronic stress, poor sleep, vascular burden, and systemic inequity to alter the neuropsychological trajectory of the disease. This article urgently examines the neurobiology, neuroimaging, and cognitive profiles of Alzheimer’s in Black women. It applies psychologist Gary Klein’s “pre-mortem” framework: identifying early neurological stress signatures before they become irreversible decline.

Genetic Factors: The Blueprint That Is not Destiny

Black women are more likely to carry the ABCA7 genetic variant, a risk allele associated with disrupted lipid metabolism and amyloid deposition (Stepler et al., 2022). Unlike the APOE-ε4 allele that dominates white Alzheimer’s studies, ABCA7 explains a disproportionate share of risk among African Americans.

Large-scale genomic analyses reveal that race-specific molecular pathways shape protein folding, inflammation, and neuronal repair differently (Seifar et al., 2024). However, most genome-wide association studies still underrepresent Black participants, limiting translational accuracy.

Read more

Black women in the United States are developing Alzheimer’s disease at a faster rate and at a younger age than any other demographic group. This is not biology alone; it is the neuropsychological footprint, a term used to describe the unique cognitive and psychological effects of living inside a healthcare system designed to dismiss, delay, and deny care to Black women from birth. The intersecting forces of chronic stress, vascular disease, reproductive trauma, and diagnostic bias have built a perfect storm where cognitive decline is accelerated, yet often ignored. This article unpacks how that happened, what it reveals about the country’s values, and why this crisis demands more than awareness; it requires accountability.

The Urgent Need for Action

The Alzheimer’s Association reports that Black Americans are about twice as likely as white Americans to develop Alzheimer’s or related dementias, and that Black women bear the heaviest burden of all. Epidemiological research confirms that age-adjusted rates of dementia in Black women outpace every other population in the U.S., often beginning 5–10 years earlier.

The Call for Accountability. As Vyas et al. (2023) remind, cardiovascular disease mortality among Black patients remains persistently higher than in their white counterparts, reflecting deeply rooted disparities in access to timely and preventive care. Alzheimer’s doesn’t emerge from nowhere; it grows from the same soil.

The Biological Cost of Chronic Stress

The neuroscience is clear: the brain keeps the score.

Chronic stress triggers prolonged activation of the hypothalamic–pituitary–adrenal (HPA) axis, keeping cortisol levels high and damaging the hippocampus, the brain’s center for memory and learning.

Research by Balaji et al. (2025) shows that Black women who experience trauma early in life often develop persistent dysregulation of stress systems, a biological echo that extends into adulthood. Williams and Lewis (2019) expand this by showing that gendered racial microaggressions are directly associated with depressive symptoms and physiological stress responses in Black women.

This isn’t about “resilience.” It’s about wearing down. Arline Geronimus called it “weathering” in 1992; the cumulative toll of living in a body that must constantly adapt to hostility. This concept of ‘weathering’ refers to the gradual deterioration of health due to the chronic stress of living in a society characterized by racism and discrimination. Alzheimer’s, in that sense, is the end-stage of chronic disbelief.

Vascular and Reproductive Pathways

Neurodegeneration rarely acts alone. The body’s entire vascular system feeds it.

Hypertension, diabetes, and preeclampsia, conditions that disproportionately affect Black women, are now recognized as major dementia accelerants. The small blood vessels that feed the brain are slowly damaged, starving neurons of oxygen and nutrients.

Vyas et al. (2023) highlight this same vascular vulnerability as a key driver of cardiovascular mortality, while Chung et al. (2024) note elevated hypertensive pregnancy disorders among Black women. These pathologies are not isolated; they’re connected.

The brain doesn’t distinguish between vascular and neurological trauma; it just deteriorates under both.

Diagnostic Bias and the Data Gap

Even when symptoms appear, diagnosis comes late, if at all. Standard neuropsychological assessments are normed on white, middle-class populations. When Black women perform “below average,” clinicians often attribute it to education, effort, or “cultural difference,” not early cognitive decline. By the time Alzheimer’s is officially named, much of the brain tissue has already been lost. Oliveira et al. (2018) described how racial and socioeconomic inequalities drive late-stage cancer diagnoses; the same logic applies here. Structural racism is not just a social condition; it’s a measurable neurological hazard. Chory and Bond (2024) add another layer: inequities in preventive care access persist even in high-resource systems, proving that exclusion is policy, not accident.

Alzheimer’s as a Mirror of National Values

When the fastest-growing form of dementia disproportionately impacts Black women, it says something about what this nation protects, and what it doesn’t. America still treats Black women’s pain as exaggeration, their intellect as expendable, and their health as negotiable. Alzheimer’s exposes those truths on a PET scan. This disease is not just killing memory, it’s indicting the system that forgot us first.

Coming Next (Paid Article Preview)

Next in this series:

When Stress Becomes Structure: How Alzheimer’s Looks in Black Women on a Neuropsychological Level

We’ll examine what chronic stress does to the Black female brain long before diagnosis, mapping how trauma, hypertension, and emotional labor reshape neural networks responsible for memory and regulation. Using psychologist Gary Klein’s “pre-mortem” framework, we’ll explore what prevention looks like before pathology, how to identify, measure, and intervene in the earliest cognitive shifts rather than waiting for decline to confirm what stress already predicted.

References (Zsanine’s format)

Oliveira, M. et al. (2018). Disparidades na mortalidade de câncer colorretal nos estados brasileiros. Revista Brasileira De Epidemiologia.
Vyas, A. et al. (2023). Cardiovascular disease burden and major adverse cardiac events in young Black patients. Journal of the American Heart Association.
Balaji, U. et al. (2025). Social connectedness and well-being among Black women who experienced adolescent sexual trauma. Psychological Trauma.
Williams, M. & Lewis, J. (2019). Gendered racial microaggressions and depressive symptoms among Black women. Psychology of Women Quarterly.
Chung, H. et al. (2024). Season of delivery and risk of hypertensive disorders of pregnancy. Preprint.
Washington, H. A. (2006). Medical Apartheid. Harlem Moon.
Roberts, D. (1997). Killing the Black Body. Vintage.
Cooper Owens, D. (2017). Medical Bondage. University of Georgia Press.
Menakem, R. (2017). My Grandmother’s Hands. Central Recovery Press.
Geronimus, A. T. (1992). “The Weathering Hypothesis.” Ethnicity & Disease.
Morris, M. W. (2016). Pushout: The Criminalization of Black Girls in Schools. The New Press.

Breast cancer is not only a physiological condition; it is a neurological crisis. The disease and its treatment significantly alter brain structure and function, particularly in regions that govern attention, memory, and executive processing. For Black women, this neurological burden extends far beyond chemotherapy. Chronic racial stress, socioeconomic inequity, and cultural trauma interact with biological mechanisms to create a compounded cognitive load. This paper urgently examines the neuropsychological effects of breast cancer within the sociocultural context of Black women’s health, challenging the narrow lens of conventional biomedical research and proposing a broader, justice-oriented model of survivorship and neurorehabilitation.

Cancer research has primarily centered on cellular pathology and tumor remission, leaving the brain’s role underexplored. Chemotherapy-related cognitive impairment, commonly termed chemo brain, is now recognized as a measurable neurological condition (Kesler et al., 2017). Magnetic resonance imaging demonstrates reductions in gray-matter density within the prefrontal cortex and temporal lobes, areas that control attention, processing speed, and working memory. These changes appear as early as one month after treatment begins. For many women, the outcome is persistent cognitive dullness, mental fatigue, and slower executive function.

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The Elders told us that love was this beautiful thing.

Disney showed us that we had to be trapped in an attic, lose a glass slipper, be a devout warrior princess for our family, be a certain height, shape, or shade to be loved.
On Sundays, love was patient, love was kind, never prideful, loud, or boastful.
But love SHOWN, tuh, was found at the bottom of a bottle and beat our mothers in the face. Was the revolving bedroom door of mothers far and wide. Some fathers, too, if they weren’t out getting the milk.

Love meant silence.
Love meant loyalty.
Love meant survival.

Love walked into our bedrooms and told us that if we said anything, our little brothers would be taken away. Love was called “struggle.” Love was called “pain.” Love was, “stop lying on my family, I know your ass is just being fast.” Love meant silence.

It’s the aunties who told us to “pray about it,” the mothers who called it tough love, the systems that punished us for reacting to our own pain.

In all honesty, what kind of character-building exercise was this? This was worse than boot camp, now that I think about it. I would hate to compare the militarization of children in third-world countries to that of a black girl’s survival tactics as a child on American soil, but you know what, damn it, if I might be close. And as grown women, we are psychologically out of whack.

According to the Centers for Disease Control and Prevention (2022), domestic violence is defined as a pattern of coercive behavior, physical, psychological, sexual, or economic, used to maintain control over another person. It is not always intimate, but it is always about power.

For Black girls, that power imbalance has historical roots. Violence against us didn’t begin in adulthood or even in our own homes; it began centuries ago, during colonization and the transatlantic slave trade. Black women were legally unrapeable, their bodies seen as property, their pain dismissed as character. The same system that forced our ancestors to give birth in fields now punishes us for saying we’re in pain (Feimster, 2011; Roberts, 1997). So when we say “love,” we’re often naming the first place we learned fear.

Fear, when introduced early, becomes muscle memory.

You learn to love people who make your chest tighten. You learn to argue and call it passion. You learn to stay, because leaving feels like danger too. And before long, chaos starts to feel like home. They call it butterflies, I call it anxiety, and you need to run, but whatever makes your boat float.

That’s the part nobody wants to talk about. When love and fear keep switching places, your brain doesn’t know which one to trust. You crave the person who hurts you because the calm that follows feels like relief. That’s how the cycle keeps you loyal (Dutton & Painter, 1993; Carnes, 1997).

We call it “ride or die.” We call it “being a good woman.” The world calls it “strong.” It’s none of that. It’s a nervous system that’s been running on high since childhood (van der Kolk, 2014; Williams & Mohammed, 2009). And then they have music, movies, and all the societal norms around you to feed it to you to make it seem like it’s right, even though it feels devastating.

This is where the psychology gets dark. Prolonged exposure to stress and fear creates what clinicians call hypervigilance, even when none is present (van der Kolk, 2014). It’s why some of us can’t sleep unless we hear movement in the house. Why do we replay arguments in our heads, trying to find the line where things turned left? Why some of us “read the room” faster than anyone else, because our lives depended on it.

The American Psychological Association (2023) notes that chronic exposure to interpersonal violence is associated with anxiety, depression, low self-worth, and identity disturbance. But for Black girls, those symptoms don’t always get labeled.

They get called “attitude.” They get called “defiance.” They get called “strong.”

Let me REMIND you: what looks like strength is often a stress response.

Many of us are still running on the same adrenaline we built in childhood. We don’t know rest; we only know recovery. That’s why we love men we have to fix. That’s why we confuse “he needs me” with “he sees me.” It’s not a choice. It’s programming.

And when the world keeps telling you that your only value is in endurance, it’s hard to see survival as a symptom. That’s why Black girls lead with attributes and accolades instead of identity, because who we are never feels safe enough to show up first.

Superwoman Schema

It’s what happens when you’re raised to believe strength is your only safe place. So you keep showing up, showing out, and holding it together, because breaking down has never been an option. Rest starts to feel like a risk.

Then, you add what Dr. Sherman James called John Henry to prove you’re not lazy, that you belong, that you can handle it (James, 1994; Hudson et al., 2016). And before you know it, exhaustion starts to feel like accomplishment. The world keeps clapping for our overwork, calling it excellence and drive. I honestly cannot stand when people tell me, “You got this.” To me, it’s the laziest form of “I ain’t got time for you, but be well.” It’s a slap in the face. It also lets me know where I am with you. They don’t realize how much of a shock it is to the system to hear those words. And let’s be crystal: that’s not resilience. That’s chronic stress dressed up as character.

Research connects these same behaviors to higher cortisol, high blood pressure, and higher rates of depression (Thomas et al., 2021; Watson & Hunter, 2016). So what the world calls the Strong Black Woman is really our nervous systems doing crisis management, our brains adjusting to survive a world that never permitted us to rest. Hence why a certain 92% are trying to do just that, yet people are furious and do not understand why it is much warranted and much deserved. It’s not just political, it’s psychological.

That same wiring follows us into relationships.

When your nervous system has been trained to earn peace through pain, love that feels calm starts to feel suspicious. You are side-eyeing every single move made. We confuse tension with passion. We mistake fixing people for intimacy. We find comfort in chaos because stability feels like a setup. And then there is even the chaos setup that still feels like a setup because once you have reached a point where you are safe in your own solitude, when someone wants to interrupt that, you are questioning the motive.

That’s not love. That’s our early programming replaying itself. Studies show that survivors of chronic family or partner violence often reenact familiar power dynamics as adults, not because they want to, but because their brains equate predictability with safety (Teicher et al., 2016; van der Kolk, 2014). The mind wants what it recognizes, even when what it recognizes hurts. And until you get to a point where you are no longer fighting yourself, it’s always going to feel this way.

So when we keep choosing men who need saving, jobs that drain us, or friendships that demand our silence, it isn’t a flaw in judgment; it’s a trauma loop.

Our culture just taught us to call it loyalty.

But let me REMIND you: survival is not the same thing as love.

Every generation of Black girls has paid the cost of confusing the two. EVERY. We’ve built whole identities around being dependable in the middle of danger. And the hardest part of recovery isn’t leaving the person or the situation, it’s learning that peace doesn’t mean boredom. It means your body finally believes it’s safe.

You don’t owe anyone your silence, your suffering, or your strength.

Sources

American Psychological Association (2023). Report on chronic interpersonal violence and psychological outcomes.

Carnes, P. (1997). The Betrayal Bond: Breaking Free of Exploitative Relationships.

Centers for Disease Control and Prevention (2022). National Intimate Partner and Sexual Violence Survey: 2016/2017 Report on Intimate Partner Violence.

Dutton, D. G., & Painter, S. (1993). Emotional attachments in abusive relationships: A test of traumatic bonding theory. Violence and Victims, 8(2), 105–120.

Feimster, C. (2011). Southern Horrors: Women and the Politics of Rape and Lynching.

Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jackson, J. S. (2016). The relationship between socioeconomic position and depression among a U.S. nationally representative sample of African Americans. Social Psychiatry and Psychiatric Epidemiology, 51(3), 418–427.

James, S. A. (1994). John Henryism and the health of African Americans. Culture, Medicine and Psychiatry, 18(2), 163–182.

Roberts, D. (1997). Killing the Black Body: Race, Reproduction, and the Meaning of Liberty.

Teicher, M. H., Samson, J. A., Anderson, C. M., & Ohashi, K. (2016). The effects of childhood maltreatment on brain structure, function, and connectivity. Nature Reviews Neuroscience, 17(10), 652–666.

Thomas, A. J., Witherspoon, K. M., & Speight, S. L. (2021). Gendered racial socialization of African American women: A cultural framework. Cultural Diversity and Ethnic Minority Psychology, 27(1), 49–59.

van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma.

Watson, N. N., & Hunter, C. D. (2016). An initial study of the Strong Black Woman schema and its relationship to mental health. Journal of Black Psychology, 42(5), 424–452.

Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.

Woods-Giscombé, C. L. (2010). Superwoman schema: African American women’s views on stress, strength, and health. Qualitative Health Research, 20(5), 668–683.*

Doctors strip Polycystic Ovary Syndrome (PCOS) of its neurological weight when they call it cosmetic. They reduce it to “extra hair,” acne, or infertility and erase the fatigue, memory lapses, depression, and brain fog that wreck daily life. That language isn’t neutral. It shields insurers from paying claims, funnels Black women into beauty aisles, and keeps pharmaceutical companies from investing in neurological research.

PCOS affects 5–10% of women worldwide (Azziz et al., 2016). Black women live with the compounding weight of racism and sexism in medicine, and when we present with symptoms that cut into our focus or mood, doctors code them as vanity. That dismissal doesn’t describe PCOS; it protects profit.

The Neurological Theft

PCOS doesn’t just sit in the ovaries. It destabilizes the brain. Researchers have documented structural differences in the hippocampus and frontal cortex regions that govern memory, mood, and executive function (Cooney et al., 2020). Women with PCOS show measurable deficits in memory and attention (Barry et al., 2011) and face sharply higher risks of depression, anxiety, and psychiatric disorders (Brutocao et al., 2018).

Doctors often reframe these neurological changes as personality flaws. When dopamine disruption blocks focus, Black women hear they’re lazy. When serotonin imbalance drives irritability, they become aggressive. When gray matter changes weaken memory, they tend to listen less when they’re stressed or inattentive. PCOS robs women of neurological stability, and medicine blames us for the theft.

The disorder also assaults mental health through stigma. Elevated androgen levels heighten anxiety and depression (Balıkçı et al., 2014; Hussain et al., 2015). Physical markers like acne, hirsutism, and weight struggles drag women into social isolation, body dissatisfaction, and diminished self-esteem (Bachega et al., 2023; Snyder, 2006; Zaman et al., 2023). Women often describe feeling “different” from peers because society links femininity to smooth skin, thin bodies, and “acceptable” hair. The cosmetic industry weaponizes that difference.

Researchers now agree: PCOS is a complex disorder with reproductive, metabolic, and profound psychological implications. It influences mood, cognition, and overall quality of life (Almhmoud et al., 2024; Norman & Teede, 2018). Ignoring the neurological and psychological weight of this disorder doesn’t just fail women; it commodifies them.

Who Profits From the Cosmetic Frame?

Corporations turn cosmetic framing into a business model.

• Pharmaceutical companies lock PCOS inside the fertility box. They market birth control, IVF, and egg-freezing while avoiding costly neurological research (Palomba et al., 2015). They push weight-loss drugs like Ozempic as one-size-fits-all solutions, even though GLP-1s do nothing for neurological decline (Rubino et al., 2022).

• The beauty and wellness industries often exploit stigma. They sell laser treatments, acne serums, diet teas, and skin procedures to women desperate to erase visible markers of PCOS. Dermatologic symptoms associated with androgens can become endless profit streams (Ach & Feryel, 2024; Tomlinson et al., 2017). Geller et al. (2011) demonstrated how markets intentionally divert women toward cosmetic fixes rather than advocating for systemic care.

• Insurance companies save billions by hiding behind the cosmetic label. They deny neuroimaging, block therapy tied to PCOS, and resist long-term hormonal monitoring. Dewani et al. (2023) traced how these denials shift costs to patients and keep women trapped in a cycle of consumerism.

Every time medicine calls PCOS cosmetic, insurers protect margins, pharma companies expand markets, and the beauty industry fattens its bottom line. Black women pay a high price in terms of memory, focus, and stability.

The Unanswered Question

If science proves that PCOS alters neurotransmitters, shrinks gray matter, and wrecks quality of life, why do doctors still call it cosmetic?

Because cosmetics equal control, cosmetics build markets. Cosmetic lets insurers avoid accountability. Cosmetics protect industries that already profit from stigma.

And when Black women lose memory, clarity, and cognitive health, medicine shrugs. That erasure isn’t accidental. It echoes a century-long pattern from Stevens’s 1913 lie that Black women don’t feel pain to the ongoing exclusion of mental health from maternal mortality rates. Calling PCOS cosmetic continues a tradition of monetizing Black women’s neglect.

Call to Action

This is Zsanine for REMIND Lab... remember….

PCOS is neurological. When doctors label it cosmetic, they protect insurers, boost pharma profits, and hand our bodies to the beauty industry. That framing is not ignorance; it is strategy. Until we rip away the cosmetic mask, Black women will keep paying the price with our minds.

References

Ach, T., & Feryel, A. (2024). Deciphering the role of androgen in the dermatologic manifestations of polycystic ovary syndrome patients: A state-of-the-art review. Diagnostics, 14(22), 2578. https://doi.org/10.3390/diagnostics14222578

Almhmoud, H., Alatassi, L., Baddoura, M., Sandouk, J., Alkayali, M., Najjar, H., … & Zaino, B. (2024). Polycystic ovary syndrome and its multidimensional impacts on women’s mental health: A narrative review. Medicine, 103(25), e38647. https://doi.org/10.1097/md.0000000000038647

Azziz, R., Carmina, E., Chen, Z., Dunaif, A., Laven, J. S. E., Legro, R. S., & Lizneva, D. (2016). Polycystic ovary syndrome. Nature Reviews Disease Primers, 2, 16057. https://doi.org/10.1038/nrdp.2016.57

Bachega, F., Baracat, M., Simões, R., Maciel, G., Lobo, R., Soares, J., … & Baracat, E. (2023). New comprehension on polycystic ovary syndrome and sexual function: A systematic review and meta-analysis. https://doi.org/10.20944/preprints202309.1520.v1

Balıkçı, A., Erdem, M., Keskin, U., Zincir, S., Gülsün, M., Özçelik, F., … & Ergün, A. (2014). Depression, anxiety, and anger in patients with polycystic ovary syndrome. Nöro Psikiyatri Arşivi, 51(4), 328–333. https://doi.org/10.5152/npa.2014.6898

Barry, J. A., Hardiman, P. J., & Saxby, B. K. (2011). Cognitive functioning in polycystic ovary syndrome. Human Reproduction, 26(9), 2462–2468. https://doi.org/10.1093/humrep/der222

Bazmi, S., Sepehrinia, M., Pourmontaseri, H., Bazyar, H., Vahid, F., Farjam, M., … & Shakouri, N. (2024). Androgenic alopecia is associated with a higher dietary inflammatory index and a lower antioxidant index score. Frontiers in Nutrition, 11, 1433962. https://doi.org/10.3389/fnut.2024.1433962

Brutocao, C., Zaiem, F., Alsawas, M., Morrow, A. S., Murad, M. H., & Javed, A. (2018). Psychiatric disorders in women with polycystic ovary syndrome: A systematic review and meta-analysis. Endocrine, 62(2), 318–325. https://doi.org/10.1007/s12020-018-1692-3

Cooney, L. G., Lee, I., Sammel, M. D., Dokras, A., & Allison, K. C. (2020). Brain structural differences in women with polycystic ovary syndrome: A VBM study. Psychoneuroendocrinology, 113, 104544. https://doi.org/10.1016/j.psyneuen.2019.104544

Dewani, D., Karwade, P., & Mahajan, K. (2023). The invisible struggle: The psychosocial aspects of polycystic ovary syndrome. Cureus, 15(12), e51321. https://doi.org/10.7759/cureus.51321

Geller, D., Pacaud, D., Gordon, C., & Misra, M. (2011). State-of-the-art review: Emerging therapies: The use of insulin sensitizers in the treatment of adolescents with polycystic ovary syndrome (PCOS). International Journal of Pediatric Endocrinology, 2011(1), 9. https://doi.org/10.1186/1687-9856-2011-9

Hussain, A., Chandel, R., Ganie, M., Dar, M., Rather, Y., Wani, Z., … & Shah, M. (2015). Prevalence of psychiatric disorders in patients with a diagnosis of polycystic ovary syndrome in Kashmir. Indian Journal of Psychological Medicine, 37(1), 66–70. https://doi.org/10.4103/0253-7176.150822

Kim, Y., Chae, K., Kim, S., Kang, S., Yoon, H., & Namkung, J. (2025). Risk of mental disorders in polycystic ovary syndrome: Retrospective cohort study of a Korean nationwide population-based cohort. International Journal of Women’s Health, 17, 627–638. https://doi.org/10.2147/ijwh.s490673

Moghadam, Z., Fereidooni, B., Saffari, M., & Montazeri, A. (2018). Polycystic ovary syndrome and its impact on Iranian women’s quality of life: A population-based study. BMC Women’s Health, 18, 65. https://doi.org/10.1186/s12905-018-0658-1

Norman, R., & Teede, H. (2018). A new evidence‐based guideline for assessment and management of polycystic ovary syndrome. The Medical Journal of Australia, 209(7), 299–300. https://doi.org/10.5694/mja18.00635

Palomba, S., Santagni, S., Falbo, A., & La Sala, G. B. (2015). Complications and challenges associated with polycystic ovary syndrome: Current perspectives. International Journal of Women’s Health, 7, 745–763. https://doi.org/10.2147/IJWH.S70314

Rubino, D. M., Greenway, F. L., Khalid, U., O’Neil, P. M., Rosenstock, J., Sørrig, R., & Garvey, W. T. (2022). Effect of weekly subcutaneous semaglutide vs placebo as an adjunct to intensive behavioral therapy on weight loss in adults with overweight or obesity. JAMA, 327(2), 138–150. https://doi.org/10.1001/jama.2021.23619

Snyder, B. (2006). The lived experience of women diagnosed with polycystic ovary syndrome. Journal of Obstetric, Gynecologic & Neonatal Nursing, 35(3), 385–392. https://doi.org/10.1111/j.1552-6909.2006.00047.x

Tomlinson, J., Pinkney, J., Adams, L., Stenhouse, E., Bendall, A., Corrigan, O., … & Letherby, G. (2017). The diagnosis and lived experience of polycystic ovary syndrome: A qualitative study. Journal of Advanced Nursing, 73(10), 2318–2326. https://doi.org/10.1111/jan.13300

Zaman, S., Yunus, S., Noor, K., Asif, U., Hayat, R., Raana, G., … & Khan, M. (2023). Assessment of body image distress in women with polycystic ovarian syndrome. PJMHS, 17(4), 299–302. https://doi.org/10.53350/pjmhs2023174299

But when she ranted that Pilates wasn’t for everyone, she wasn’t just flaunting classism and ableism; she was also exposing a level of colorism that’s all too familiar in the Black community. And to be that loud, with over a million followers, from a woman who in another era would have been considered “passing,” is its own form of violence.

Pilates was created by a man who lived with chronic health conditions, who himself would have been considered disabled. Joseph Pilates built his method, “Contrology,” inside an internment camp, where he taught imprisoned men to move, breathe, and strengthen their nervous systems to survive. He passed the foundation of his method to immigrant women; women who were degraded in one breath and threatened with deportation in the next. That is the authentic lineage of Pilates: survival under oppression. Yet today, Pilates is being sold back to us as an elite practice, stripped of its neurological roots.

“It’s physical therapy meant to heal your neurological system from the inside out.”

Zsanine R. Gross

Joseph Hubertus Pilates was born on December 9, 1883, in Mönchengladbach, Germany. He was born frail, afflicted by rickets, asthma, and rheumatic fever, illnesses that shaped both his childhood and his lifelong drive toward strength and rehabilitative movement (Pilates Anytime, 2024; Pilates Lessons, n.d.; World Pilates Confederation, n.d.).

As a child, he was bullied by peers in part because of his physical frailty and possibly because of his last name, which older children reportedly mocked as “Pontius Pilate.” Some of these accounts say that around age five, he suffered an injury that damaged his eye. However, the sources for the eye injury are less consistent and appear mainly in Pilates history summaries and studio tradition rather than peer-reviewed scholarship.

Despite his health challenges, Pilates developed a passion for anatomy, movement, and healing. Under the influence of his father (a gymnast/mechanic) and his mother (who had naturopathic leanings), he began studying bodily structure, animal movement, Western athletics (gymnastics, boxing, diving), and Eastern disciplines. These studies intensified his resolve to overcome physical limitations. By his early teens, sources say he had rebuilt his physical strength sufficiently to model for anatomical charts.

In 1912, Pilates moved to England. With the start of World War I in 1914, being a German national, he was interned in camps (first in Lancaster, then on the Isle of Man). During internment, Pilates taught fellow internees physical conditioning, self-defense, and devised ways to allow even bedridden or infirm prisoners to move, including using springs from beds to create resistance mechanisms, a precursor to his apparatuses (e.g., the Reformer, Cadillac) (Pilates Anytime, 2024; Pilates Lessons, n.d.; World Pilates Confederation, n.d).

Pilates is more than muscle & posture: it’s nervous system rewiring, cognitive sharpening, and pain-regulation. Below are key mechanisms + studies you can lean on.

1. Neuroplasticity & Structural Changes

   • Movement + controlled breath patterns stimulate changes in brain structure (gray matter volume, connectivity), especially in the prefrontal cortex, hippocampus, and cerebellum. These are the areas tied to executive function, working memory, attention, and spatial awareness.

   • Chronic pain diminishes gray matter, especially in regions like the hippocampus and prefrontal circuits; exercise + mind-body routines (Pilates-adjacent) counteract that decline.

2. Pain Perception & Central Sensitization

   • The nervous system becomes sensitized, overreacting to threats and interpreting signals as pain even when there’s little or no tissue damage. Pilates and Pain Neuroscience Education help reframe this, reduce fear/avoidance, and train brain circuits (insula, anterior cingulate, etc.) to dampen overactivation.

   • Breath work, alignment, and motor control (hallmarks of Pilates) help reset brain signals about what movement & bodily state feel like, reducing catastrophizing, and reducing neurological amplification of pain.

3. Cognitive Improvements: Attention, Executive Function, Visual-Motor Skills

   • Pilates demands focus: coordination, precision, shifting weight, balancing, and remembering movement patterns. That works on memory, attention, and inhibitory control.

   • Dual-task Pilates (movement + cognitive load) forces the brain to do more: maintain posture/control and process a mental task. Helps with multitasking, processing speed, and flexibility of thought.

4. Emotional Regulation, Stress & Hormonal Effects

   • Mind-body work modulates stress by lowering cortisol and increasing parasympathetic (“rest & digest”) activation. Stress strongly interacts with neural circuits of pain & cognition.

   • Regular practice improves mood and reduces anxiety/depression, which in turn improves cognitive performance and pain thresholds.

     

So why would they want to make Pilates so inclusive and keep it away from Black women? Capitalism! That's it. Nothing overly complicated. It's a story that has been told over and over. Once we get our hands on it and make it popular, they get up in arms about it, and, baby, they want to make it theirs alone.

1. Lineage Erasure. Joseph Pilates trained Kathy Stanford Grant, a Black woman who went on to teach at NYU/Tisch for decades and directly shaped the method (Dawn Pilates, 2020). Yet her central role is rarely mentioned in mainstream Pilates histories. Her presence is proof that Pilates was never meant to exclude us — but erasing her ensures today’s practitioners believe Black women were never there.

2. Legal Gatekeeping. After Pilates’ death, attempts to trademark the name meant that white men in courtrooms suddenly controlled access to “official” Pilates certification. This legal policing of the name didn’t just define who could teach, it defined who got visibility, legitimacy, and clients (Balanced Body, Inc. v. Pilates, Inc., 2000). Black instructors, already underrepresented in fitness spaces, faced yet another barrier.

3. Whiteness as the Marketing Standard. Fitness marketing in the 1980s and 1990s, when Pilates surged in popularity, overwhelmingly portrayed thin white women as the ideal student (Markula, 2004). During this time, we referred to it as the Supermodel ERA. Everyone wanted to be tall and thin. Little did we know about photo distortion. That representation coded Pilates as a white woman’s space. Black women entering those rooms were marked as outsiders before they even unrolled a mat. Sometimes, I still show up as the only black girl in the room of 12 reformers.

4. Medical Neglect. The health system reinforced the exclusion. Even as evidence showed that mindful movement reduces pain and strengthens cognition, Black women were denied referrals for pelvic floor therapy, postpartum rehabilitation, or neurological exercise. Instead, hospitals profited from surgeries and prescriptions (CDC, 2023). The absence of a medical prescription for Pilates-style rehab meant Black women were never told it was an option.

5. The Larger Pattern. This isn’t unique to Pilates. White wellness industries have done the same to yoga, tai chi, and even African dance. Strip the practice of its context, claim ownership, sell it as elite, and erase the people of color who carried it. That’s how Pilates, a system born from disability and taught through immigrant and Black lineage, became coded as “not for us.”

So when influencers today repeat that Pilates “isn’t for everyone,” they are not just making a classist remark. They are echoing a century-long project: pushing Black women out of practices that were always ours to begin with.

References

• Balanced Body, Inc. v. Pilates, Inc., 2000 WL 204482 (S.D.N.Y. 2000).

• Centers for Disease Control and Prevention. (2023). Racial/Ethnic Disparities in Pregnancy-Related Deaths. Atlanta, GA: U.S. Department of Health and Human Services.

• Dawn Pilates. (2020, June 8). Remembering Kathy Grant: A first-generation Pilates master teacher. Retrieved from https://dawnpilates.com/remembering-kathy-grant

• Latey, P. (2001). The Pilates method: History and philosophy. Journal of Bodywork and Movement Therapies, 5(4), 275–282. https://doi.org/10.1054/jbmt.2001.0228

• Markula, P. (2004). Tuning into the female body: Women’s fitness programs as postfeminist practices. Sociology of Sport Journal, 21(4), 440–456. https://doi.org/10.1123/ssj.21.4.440

• Pilates Anytime. (2024). Pilates history: Who was Joseph Pilates? Retrieved from https://www.pilatesanytime.com/blog/legacy/pilates-history-who-was-joseph-pilates

• Pilates Lessons. (n.d.). The lawsuit that freed Pilates. Retrieved from https://pilateslessons.org/the-lawsuit-that-freed-pilates

• World Pilates Confederation. (n.d.). History of Pilates. Retrieved from https://worldpilatesconfederation.org/history-of-pilates

September is here, and it’s heavy. This month is Suicide Prevention Month, PCOS Awareness Month, and Pain Awareness Month. These aren’t hashtags for us. They’re the fault lines where Black women’s lives, minds, and futures are decided by people who don’t listen to us.

Here’s what you’ll read this month.

Free for everyone:

• Are Black Women Allowed to Be Broken Before We Break?

“Suicide rates among young Black women are rising, but medicine keeps calling our cries for help ‘strength.’ This month we’re asking who gets to survive and why it’s not us.”

• Who profits when PCOS steals our focus, mood, and memory, and they call it cosmetic?

PCOS is often characterized by weight, hair, and fertility issues. But it robs Black women of memory, focus, and mood. Who benefits from calling a neurological crisis a cosmetic one?”

• From 1913 to 2025: Why Are Black Women Still Fighting a Lie About Our Pain?

“A century-old lie in medical textbooks taught doctors that Black women don’t feel pain. That lie still stalks exam rooms today, and it’s killing us.”

• Pilates Could Rewire Black Women’s Brains and Cure Us, but That Would Be Too Much Like Right

“They want you in pain because they don’t work for you; they work for the FDA.”

Founders (paid members):

• If Our Brains Shrink After Birth, Why Does Medicine Pretend It’s Just Hormones?

“Brain scans prove postpartum shrinkage is neurological. Yet suicides and depression in Black women are dismissed as ‘just hormones’ and excluded from maternal mortality counts.”

• What would change if we treated PCOS as a brain–body traffic jam instead of ‘irregular periods’?

“Neuroendocrine chaos, insulin resistance, and inflammation collide in the brain. PCOS is a neurological crisis medicine that keeps being mislabelled, and Black women pay the highest price.”

If Pain Erases Gray Matter, Why Are Black Women Still Taught to Endure Instead of Being Treated?

• “Chronic pain erodes the brain, but medicine still trains providers to tell Black women to endure it."

This deep dive exposes the neuroscience and the lie that has lasted over a century.”

Podcast debut

This month, I’m also launching The Psychology of It All. My new podcast is taking these stories off the page and into your ears. Science, history, truth. Raw and direct.

Founders will get first dibs on the Q&A tied to the launch.

Founders, mark your calendars: our private live Q&A will be on Friday, September 26th, at 7:00 PM. Bring your questions, your notes, and your voice. This is where we go deeper together.

How to support:

If you’re ready to step into the private room and fund this research, become a Founder (paid member) today.

If that’s not where you are yet, you can still support this work by purchasing Never Voluntary.

Every purchase fuels the fight: https://nevervoluntary.com.

This is Zsanine for REMIND Lab and the Grayt Coutures… Remember… they weren’t afraid to erase our stories. We can’t be scared to tell them.

I want to share something deeply personal with you. Many of you are familiar with my work, which focuses on the health of Black women, primarily their mental well-being and the neuropsychology of it all. I've fallen madly in love with Pilates and its benefits for mental clarity, addressing maternal trauma, and how this movement can serve as a practical, non-pharmaceutical medicine for us. What you may not know is how much of that comes from my own experiences. You have absolutely no idea how much work I have done on my own before I even bring it to paper.

I, very much like you, am a product of this system.

When I look back at the history of Black women in this country, I see a thread that runs through generations: our bodies being used, studied, controlled, and dismissed without our consent. From the forced sterilizations of our grandmothers to the way Black women's pain is still minimized in hospitals today, to the lack of research on how pregnancy and birth impact our brains, we've been treated as experiments instead of as whole human beings. And no one cares. Even our CDC numbers. They don't include our homicide, suicide, or murder rates. That doesn't include the number of times that doctors have made up the lies that it was our "blood pressure" when it really was their malpractice.

The data is staggering:

• Black women in the U.S. are three times more likely to die from pregnancy-related causes than white women.

• Black mothers are more likely to experience postpartum depression but less likely to receive treatment.

• Only a fraction of neuroscience research includes Black women, leaving our unique health experiences invisible.

This is not just history. It's happening now. And it is unacceptable.

That's why I created Never Voluntary; not just a store, but a movement.

The Neurological Collection is the core collection of the store. They are bold, unapologetic pieces that declare what we know to be true: our bodies are not experiments. Our minds are not disposable. Our existence is not up for debate. There are seven lines total. Seven is my favorite number. It is the number of perfection and completion. You will see new collections emerge, and as we get closer to seven, you will know that we are one step closer to the truth.

Every single purchase directly funds REMIND Lab, my research initiative devoted to uncovering how pregnancy, racism, and trauma impact the neurological health of Black women. Half of every dollar you spend goes straight into building the research that has too often been denied to us.

When you wear these words on your chest and the satin scarf on your head, you're not just making a fashion choice; you're making a statement: We never chose to board those ships, to pick cotton, to be maids in their homes, wet nurses for their children, bed wenches for their husbands, or test subjects for their experiments so that their versions of medicines could be pushed forward and seen as miraculous.

We demand a future where our health is not a footnote, where our pain is not dismissed, and where our lives are not negotiable. We require sanctuaries that protect us, not systems that dissect us. We demand that every medical textbook confess the truth that pain is not "stronger" or "weaker" by race; it is the same. And we will not stop until every hospital in this nation, the nation we built with our blood, our wombs, and our labor, is forced to see us, hear us, and protect us.

✨ Shop the collection today → www.nevervoluntary.com

✨ Share this with your sisters, daughters, aunties, and friends.

✨ Stand with us in building REMIND Lab.

USE CODE RELF TO SAVE 30% ON YOUR PURCHASES!!

We carry the weight of generations, but we also have their power. Thank you for being part of this fight.

With love + fire,

Zsanine

Do you see the pattern? Black women show up when everything is burning down. We run toward the flames, we save the crying child, we get the programs back on track, and we make the company profitable again. And then the second it’s safe, the second they can step back in, we’re erased.

Elaine Brown: The Forgotten Chairwoman

This is where Elaine Brown comes in, and we’re not letting her slip into the shadows.

Born in Philadelphia in 1943, she attended Philadelphia’s elite Girls’ High School and later studied at Temple University, UCLA, and Mills College (Brown, 1992). She trained as a classical pianist, wrote music, worked in Hollywood, and still gave her life to politics and activism. Quick pause: the baby was talented, okay? I know I’m supposed to stick to the facts, but put a Black woman in any era, any time of day, and we will take full advantage of it down to the nanosecond. When she joined the Black Panther Party in 1968, she brought not just intellect and discipline but also the ability to move through elite white spaces and grassroots struggles. She was Huey’s main girl, his woman.

By the time Huey Newton fled into exile, it was Brown’s education, organizational skill, and political clarity that positioned her to lead. She wasn’t a placeholder. She was qualified; more than competent; to carry the Panthers forward. And still, the men could not accept her authority (Brown, 1992).

Elaine Brown became the first and only woman to lead the Black Panther Party in 1974, after Newton fled to Cuba to avoid criminal charges (Brown, 1992). For three years, she carried the movement on her back: survival programs, schools, clinics, housing, and political campaigns. She turned the Panthers from a movement under siege into one with real community power. And Black women, we know this story; we’ve all been the ones holding it together for them. STOP IT! NO MORE.

Despite this, the men never respected her. Brown herself wrote, “A woman in the Black Power movement was considered, at best, irrelevant. A woman asserting herself was a pariah” (Brown, 1992, p. xx). When Newton came back in 1977, she was immediately pushed out. She went to him, her man, and told him how the men were degrading and abusing women in the Party, treating them like property. He sided with them. Not because she failed, but because she was a woman. She writes that Panthers even physically assaulted her when she asserted her authority (Brown, 1992). The revolution was comfortable with Black women as caretakers, never as leaders.

Misogyny and Sexual Profiling Inside the Panthers

The Party fought white supremacy but upheld male supremacy. Women were pushed into cooking, childcare, and clerical work, while men carried the guns and titles (Joseph, 2007). Even when women led programs or bore arms, they were rarely credited.

Women were also sexually profiled. Lumsden (2009) described them as “good mothers with guns,” valued only when they reinforced stereotypes. Theoharis (1998) showed how sexual pressure was normalized, with women coerced into relationships as proof of loyalty. Brown herself was expected to submit to Panther men sexually and was punished when she refused (Brown, 1992).

That was the hypocrisy: they demanded freedom from white supremacy while practicing patriarchy on their own women.

Psychology of Erasure

As bell hooks told us in Ain’t I a Woman (1981), too many so-called Black liberation movements failed to liberate Black women because they were obsessed with freeing Black men while leaving patriarchy intact. They wanted freedom as men, not freedom with us. And here’s the truth: they never even mentally freed themselves. Their minds were still chained to the same patriarchal lies they claimed to fight. That’s why Panther men could accept Brown only while Newton was gone. The minute he came back, they chose him, even if it meant letting the programs rot, because the thought of a Black woman in power was too much.

And nothing has changed. Black women are still dying on medical tables, in the streets, and in our homes (CDC, 2023). We are still not represented in boardrooms, precincts, or Congress. Black men are on social media telling the world why they prefer white women, when we never even asked. We are the only group of women in human history whose own men have been conditioned to reject us. And here’s the irony: the world copies us. Our bodies, our lips, our curves. And science itself reveals what they deny: all humans trace back to a single African woman, “Mitochondrial Eve” (Cann, Stoneking, & Wilson, 1987). We carry the Eve gene. We are the root of humanity. We are the mothers of civilization. Yet we are still treated like we are disposable.

Pull to the Present

The pattern hasn’t gone anywhere. Black women are the most educated demographic in America, yet we carry the highest student debt, nearly $39,000 on average compared to $31,000 for white women (AAUW, 2023). The median wealth of single Black women is just $1,700, compared to $27,000 for single white women (Insight Center, 2022). We are killed at more than twice the rate of white women (CDC, 2023). We are the fastest-growing group of entrepreneurs, yet we receive less than 1% of venture capital funding (ProjectDiane, 2023).

Vice President Kamala Harris proves the point. She’s the only Black woman to ever reach the vice presidency. And what has she gotten for it? Relentless racist and sexist attacks. She’s been called everything but a child of God, even when she’s been right about what is happening to American democracy every single day (Friedman, 2024; CAWP, 2023). Research shows many white Americans even vote against policies that would help their own families, like healthcare or social programs, just to make sure Black people don’t benefit (Frank, 2004; Hooghe & Dassonneville, 2018; Tesler, 2016). It’s the same script: better to lose everything than to let a Black woman lead. And how many Black men have convicted her of not being Black enough? Or locking up Black men on trumped-up charges, petty weed criminalities that weren’t even true without doing research? Only by listening to their white male counterparts? Sound familiar?

From boardrooms to cultural institutions to revolutionary movements, Black women are pushed into crises as saviors and martyrs. We save companies, families, and revolutions. We bring everything back from the edge. Then we are erased, replaced, and punished. Elaine Brown’s story is not just history; it is prophecy. It foreshadowed what happened to Brewer, Bozoma, Johnson, and Harris.

If we keep allowing her story to stay in the dark, we’ll keep riding this same Ferris wheel. Not on my watch. Not on this Substack.

We are not Mammies meant to soothe and patch until men reclaim the spotlight. We are not placeholders. We are not scaffolding for everyone else’s empires. We are permanent leaders. Elaine Brown proved it. They tried to bury her story.

Let me REMIND you.

References (APA 7th Edition)

• American Association of University Women. (2023). Deeper in debt: Women and student loans in the time of COVID. AAUW. https://www.aauw.org/resources/research/deeper-in-debt/

• Brown, E. (1992). A taste of power: A Black woman’s story. Pantheon.

• Cann, R. L., Stoneking, M., & Wilson, A. C. (1987). Mitochondrial DNA and human evolution. Nature, 325(6099), 31–36. https://doi.org/10.1038/325031a0

• Centers for Disease Control and Prevention. (2023). Homicide mortality by race/ethnicity and sex. National Center for Health Statistics. https://www.cdc.gov/nchs/pressroom/sosmap/homicide-mortality/homicide.htm

• Center for American Women and Politics. (2023, August). Tracking misogyny and racism directed at Vice President Kamala Harris. Rutgers University. https://cawp.rutgers.edu

• Frank, T. (2004). What’s the matter with Kansas? How conservatives won the heart of America. New York, NY: Metropolitan Books.

• Friedman, M. (2024, June 14). Rep. Jasmine Crockett responds after racist and sexist remarks in House hearing. NBC News. https://www.nbcnews.com/politics/congress/jasmine-crockett-responds-racist-sexist-remarks-rcna152108

• Gelles, D. (2016, December 5). Xerox names Jeff Jacobson CEO as Ursula Burns steps down. The New York Times. https://www.nytimes.com/2016/12/05/business/xerox-ceo-ursula-burns.html

• Insight Center for Community Economic Development. (2022). Lifting as we climb: Women of color, wealth, and America’s future. Insight Center for Community Economic Development. https://insightcced.org/reports/lifting-as-we-climb/

• Investopedia. (2023, September 1). Walgreens shares hit 24-year lows after CEO Rosalind Brewer steps down. Investopedia. https://www.investopedia.com/walgreens-shares-hit-24-year-lows-as-ceo-rosalind-brewer-steps-down-7964950

• Janis, I. L. (1972). Victims of groupthink: A psychological study of foreign-policy decisions and fiascoes. Boston, MA: Houghton Mifflin.

• Joseph, P. E. (2007). Waiting ’til the midnight hour: A narrative history of Black power in America. New York, NY: Henry Holt.

• Johnson, S. (2023). Walk through fire: A memoir of love, loss, and triumph. New York, NY: Simon & Schuster.

• Los Angeles Times. (2023, March 7). Former BET CEO Debra Lee details affair with co-founder. Los Angeles Times. https://www.latimes.com/entertainment-arts/tv/story/2023-03-07/debra-lee-book-i-am-debra-lee-memoir-bet-bob-johnson

• Lumsden, L. (2009). Good mothers with guns: Framing black womanhood in the Black Panther, 1968–1980. Journalism & Mass Communication Quarterly, 86(4), 900–922. https://doi.org/10.1177/107769900908600407

• NextTV. (2022, March 7). Bozoma Saint John’s Netflix exit—the mystery gets curiouser and curiouser. NextTV. https://www.nexttv.com/news/bozoma-saint-johns-netflix-exit-the-mystery-gets-curiouser-and-curiouser

• ProjectDiane. (2023). The state of Black women founders. DigitalUndivided. https://www.digitalundivided.com/projectdiane

• Reuters. (2023, September 1). Walgreens Boots Alliance CEO Rosalind Brewer steps down. Reuters. https://www.reuters.com/business/walgreens-ceo-rosalind-brewer-steps-down-2023-09-01/

• Selznick, D. O. (Producer), & Fleming, V. (Director). (1939). Gone with the Wind [Film]. Selznick International Pictures.

• Shainberg, J. (Writer), & Goldsmith, J. (Director). (1994). Corrina, Corrina [Film]. New Line Cinema.

• Tesler, M. (2016). Post-racial or most racial? Race and politics in the Obama era. Chicago, IL: University of Chicago Press.

• The Hour. (2018, January 4). One year after split, Xerox on upward trajectory under new CEO. The Hour. https://www.thehour.com/business/article/One-year-after-split-Xerox-on-upward-trajectory-12473621.php

• TheWrap. (2022, March 3). Netflix shakeup as Marian Lee replaces Bozoma Saint John as Chief Marketing Officer. TheWrap. https://www.thewrap.com/netflix-marian-lee-bozoma-saint-john/

• Uptown Standard. (2025, August 17). 300,000 Black women lost their jobs—and Trump’s policies are a major reason why. Uptown Standard. https://uptownstandard.com/2025/08/17/300000-black-women-work-signal-texans-20790471

• Wistajohnson. (2024, June 28). Visionary entrepreneur: Sheila Johnson, founder and CEO of Salamander Hotels and Resorts. WeBADD! Series. https://www.wistajohnson.com/blog/c651nz1egjpmx5jou2ef5f6kl3s93g

It's not an exaggeration. We're talking about significant changes in gray matter volume, enhancements in executive function, and interventions in trauma-related shrinkage of the hippocampus. This is Pilates as a cognitive tool, not a beauty standard. The medical field continues to overlook the unique ways Black women's brains are under assault—by chronic stress, systemic racism, medical violence, and hormonal shifts that disproportionately affect our neurology. Since no one is going to prioritize our cognition but us, it's crucial that we initiate this conversation now.

Let me REMIND you…

The Pregnant Brain Shrinks—And They Don't Talk About That Either

Research has confirmed that pregnancy changes the structure of the brain, particularly in the prefrontal cortex and hippocampus—regions responsible for memory, emotional regulation, and decision-making. One study found that pregnant women lost gray matter in specific brain regions and that these reductions were still present two years postpartum. This isn't "baby brain" as a myth. This is a structural brain change as a medical fact.

For instance, Buss et al. (2010) showed that elevated maternal cortisol levels during pregnancy correlate with reduced gray matter volumes in offspring, particularly in memory-related brain regions like the hippocampus. This means that the stress experienced by Black women during pregnancy can have a direct impact on the brain development of their children. Glynn et al. (2018) expanded on this by demonstrating how maternal trauma and stress—not just cortisol, but chronic emotional dysregulation—alter both fetal brain development and the mother's neural pathways.

Now here's where we, as Black women, need to zoom in. Because what the research doesn't say, but what we know, is that our cortisol levels are already high before pregnancy. Add institutional neglect, obstetric racism, and generational trauma to that equation, and the cognitive load becomes unbearable. No one is studying how our brains respond when we're forced to be both caregiver and survivor in a system that treats us like neither. This is an urgent issue that needs immediate attention and action. Pilates Isn't Soft. It's a Neurological Intervention

We need to stop calling Pilates "low impact" like it's somehow low value. The truth is, Pilates directly activates brain systems that regulate memory, attention, coordination, and emotion. It is a structured, intentional, closed-chain movement system that demands constant proprioceptive feedback. This isn't stretching. This is neuroplasticity in motion.

Gothe et al. (2016) found that mind–body exercise modalities like Pilates improve executive functioning and memory recall and reduce depressive symptoms in midlife women. They observed increased performance in working memory tasks after regular practice. Basso & Suzuki (2017) explored how movement impacts the brain on both a structural and chemical level, citing improved performance in executive tasks, greater neurogenesis, and enhanced BDNF (brain-derived neurotrophic factor) levels in adults who engage in coordinated physical movement.

If Black women are carrying the burden of constant hypervigilance, then what we need is not another boot camp or HIIT circuit. We need modalities that train the prefrontal cortex to recover from that hyperarousal. We need to regulate, not grind. Pilates trains interoception, body-led safety, and breath-to-movement synchronization, all of which directly communicate with the parasympathetic nervous system to restore a sense of internal calm. And if we know trauma compromises the brain's ability to regulate, then Pilates becomes not just helpful but urgent.

Black Women and the Science of Stress: We Need More Than Casual Movement

The idea that walking or dancing is enough for us to "stay healthy" completely ignores the very real neurobiological toll that racism has on the brain. Geronimus et al. (2006) introduced the concept of "weathering," explaining how Black women experience faster biological aging due to repeated exposure to stress. Their study connected this to higher allostatic load scores, cardiovascular decline, and cognitive deterioration that begins earlier than in white counterparts.

And let's not forget the deeper trauma narrative. Bryant-Davis et al. (2005) emphasized that trauma in Black women is often misdiagnosed, under-treated, or mistaken for strength. Black women are routinely excluded from culturally competent care. That exclusion extends to our movement spaces, which are often white-centered, fatphobic, and fixated on aesthetics over trauma-informed practice.

Pilates offers a somatic strategy for recovery that doesn't rely on verbal processing. It allows for self-guided, private neurological repair. It doesn't ask you to cause pain. It asks you to notice it, move with it, breathe through it, and re-pattern it. This is a form of care that empowers us to take control of our health in a way that we may have never been offered—let alone prescribed.

Functional Brain Changes in Pilates: The Imaging Doesn't Lie

This is where we bring in the functional imaging. Researchers using fMRI technology have observed increased activation in the dorsolateral prefrontal cortex, cerebellum, and default mode network during and after Pilates and similar mind–body movement. These are not just muscular changes. These are neurological events.

Zhang et al. (2020) found that participants practicing mindful movement showed heightened activity in regions associated with executive function, emotional regulation, and trauma processing. The brain isn't passive in Pilates—it's actively coordinating new information in real time. The cerebellum integrates balance and posture, while the prefrontal cortex is constantly engaged in sequencing and spatial planning. This is precisely the kind of integration we need when recovering from trauma, postpartum brain fog, or perimenopausal dysregulation.

And yet, nowhere in mainstream medicine are we seeing Pilates recommended to Black women as a protective measure for cognitive health. That erasure is intentional.

From Studio to Research Lab: Why REMIND Exists

This is where I pull the lens back.

As a future neuropsychologist and current researcher, I am building a body of work that centers movement as a clinical, science-backed strategy for protecting Black women's brains. I'm not just writing essays. I'm laying the foundation for what will one day become a research lab, a therapeutic model, and a fully integrated care system that prioritizes our neurological outcomes from fertility to menopause. This is a hopeful vision for the future of our health.

Pilates is not about a flat stomach. It's about functional brain recovery. It's about protecting the prefrontal cortex from another decade of executive burnout. It's about giving the hippocampus the oxygen it needs to fire again. It's about moving and feeling safe in a world that keeps trying to kill us softly.

If the medical system won't prescribe what works, REMIND will. If they won't build the studies, I will. And if they won't make space for our neurological survival, then I will make space so wide they won't be able to look away.

If the medical system won't prescribe what works, then REMIND Lab will. If they won't build the studies, then I will. And if they won't make space for our neurological survival, I promise you I will create a whole damn lane.

References | REMIND Style

Buss et al. (2010). Maternal cortisol over the course of pregnancy and child amygdala and hippocampus volumes. Proceedings of the National Academy of Sciences (PNAS). Prenatal cortisol linked to reduced gray matter in memory regions.

Glynn et al. (2018). Prenatal maternal stress and the fetal programming of infant neurobehavior. Developmental Psychobiology. Documented how maternal trauma alters brain plasticity in mothers and infants.

Gothe et al. (2016). Effects of mind–body exercise on cognitive function in older adults. Journal of Physical Activity and Health. Showed improved memory and mood with Pilates in midlife women.

Basso & Suzuki. (2017). Acute exercise effects on cognition and neurochemistry: A review. Brain Plasticity. Found movement improves executive functioning and increases BDNF.

Zhang et al. (2020). Mindful movement and brain activation: Evidence from fMRI. Neuroscience Letters. Demonstrated neurological activation during Pilates and trauma-sensitive practices.

Geronimus et al. (2006). Weathering and allostatic load in Black women. American Journal of Public Health. Explained accelerated biological aging due to chronic racial stress.

Bryant-Davis et al. (2005). The role of somatic healing in Black women’s trauma recovery. The Counseling Psychologist. Highlighted the neglect of culturally specific trauma care.

This isn't a formal review. This is me, talking to you, about a book that wrecked me and rebuilt me in the same breath. Paragraph by paragraph. Truth by truth. Just like we would in a real book club, where we share our personal experiences and insights, and where the book becomes a catalyst for deep, meaningful conversations.

Let me start here: I didn't expect to be triggered. I thought I was past that. But there I was, back in the hospital room, remembering the nurse who accused me of being on drugs. I hadn't taken anything. I was in a coma. I didn't even know I had delivered yet. And she was talking to me like I was some addict who needed to be managed. I looked down, and my stomach was still round. I didn't know where my baby was. And all I could whisper was, "Where's my baby?" The nurse, a white woman, didn't blink. She just told me they had taken her to the nursery. I said I named her Raegan, but let her choose the spelling. That detail has stuck with me for years—the way she said it like I didn't matter. Like the coma had turned me into a side character in my own life.

Reading Roberts made it all click. The way she outlines how Black women have always been treated in medical systems—as property, as threats, as experiments. Not as patients. Not as mothers. Not as people. She takes us from slavery to the so-called "crack baby" era to the push for long-acting birth control like Norplant and shows how each of these moments is not an isolated abuse—it's part of a long-term strategy. To regulate us. To shame us. To make sure we reproduce only under the terms of whiteness and the state. But understanding this, we are empowered to change it.

The chapter on Norplant sent me into a spiral. I wrote notes in the margins, as if I were arguing with a ghost. Judges were giving women the option: go to jail, or get Norplant implanted in your arm. Social workers weren't just offering Norplant; they were pushing it as if it were some gift. Like they were doing us a favor. What stayed with me was how none of it was treated as a force of nature. It was dressed up as "being responsible." Like controlling our fertility was the responsible thing to do, not for ourselves, but for society. We were supposed to feel grateful. What an absolute load of crap. Like someone had stepped in to save us from ourselves, that's the power of what Dorothy Roberts reveals: how deeply language is manipulated to make systemic harm sound like compassion.

Later in the book, Roberts breaks down how the image of the "unfit Black mother" was constructed on purpose. And I mean built. With media campaigns. With politicians' soundbites. With welfare policy. Black women were accused of being hypersexual, too fertile, unable to parent, and a burden on the state. And this image wasn't just harmful—it was used to justify legal action against the individual. Kids taken away. Mothers criminalized. Whole families are destabilized and then blamed for their instability. I kept thinking about all the women I know who have had their children watched closely by CPS, who couldn't give birth without feeling like someone in the room was waiting for them to fail.

And then, of course, there's the silence around our actual deaths. Around the fact that we're dying during pregnancy, after pregnancy, in childbirth rooms, and quiet suicides and murders, no one counts as "maternal." Roberts doesn't stop at describing the injustice. She demands that we name it. That we stop letting the state pretend it's neutral. We need to stop letting hospitals call this negligence. It's targeted neglect. And in many cases, it's violence.

This book is hard. But it's not hard because it's theoretical. It's hard because it's real. It's your cousin's story. It's your friend's postpartum nightmare. It's your mom's fear. It's your trauma reworded, recontextualized, and finally validated. Reading this book, you will feel understood and acknowledged.

I must admit, I've read this book more than once now. I mark it up like scripture. I keep it on the shelf close by, because every time I see another maternal death in the news, another Black mother ignored, another sterilization lawsuit from a prison, I know it's not new. And I go back to the book, and Dorothy is still there, reminding me that I'm not crazy. This is real. And we've always been the evidence.

In the paid version of this article, I'm going to break the whole thing down. Page by page. Policy by policy. Because if you're with me in REMIND Lab, you deserve to know exactly what we're fighting. This isn't a passion project. This is my life's work. And I want you to have every word of it, because this book is not just a personal reflection but a call to action for our work in the REMIND Lab.

But for now, read this book. Sit with it. Let it wreck you if it needs to. Then come back. Because we're not done talking about this. We're just getting started.

—

Citation:

Roberts, Dorothy. Killing the Black Body: Race, Reproduction, and the Meaning of Liberty. New York: Pantheon Books, 1997.

—

This is Zsanine for REMIND Lab… remember…

They didn't count on us remembering.

But we do. Every word. Every scar.

We're reading now. Together. And together, we can make a difference.

Do you know what your mother was going through when she was pregnant with you?

I mean, really, what did she survive?

Was she safe? Was she held? Was she heard? Or was she dodging eviction, choking on secrets, bleeding in bathrooms alone, or trying to hold it together in a clinic where they told her “it’s all in your head”?

Because here's what we know now: the nervous system doesn’t forget. Not hers. Not yours. Not the baby’s.

Black women are more likely to die during pregnancy, birth, or postpartum than any other group in America. That part’s not up for debate. But the numbers you see don’t tell the full truth, because the CDC does not count suicide or homicide in maternal death statistics (Centers for Disease Control and Prevention, 2022). That means if a Black woman takes her own life six weeks postpartum, she’s not counted. If she’s killed by an abusive partner while still bleeding from childbirth, she’s not counted. If she dies of a heart attack at 28 because of long-term birth trauma that was never treated, she’s not counted. This is not data. This is erasure.

Read more

Chronic stress.

The kind of stress that starts with racism and ends in heart failure, hemorrhage, or suicide.
The kind of stress that we carry in our blood, our brains, our uteruses, and still, no one treats it like a risk factor.

Black women have documented the truth for decades. We’ve always known that our maternal deaths were never about genetics—they were about systems of neglect.

• In Killing the Black Body (Dorothy Roberts, 1997), we learn how U.S. policies have always framed Black motherhood as dangerous and undesirable, from coerced sterilizations to welfare restrictions and abusive birth control trials.

• Battling Over Birth (Dána-Ain Davis, 2019) reveals the firsthand accounts of Black birthing people navigating hospitals where they were cut open without consent, dismissed while in pain, or left entirely alone. This is obstetric racism in real time.

• In The Pain We Carry (Natalie Gutierrez, LMFT, 2022), complex PTSD is reframed as a result of chronic systems—racism, medical abuse, poverty—not just single traumatic events. She names how trauma lives in our nervous systems.

• Pregnant While Black (Monique Rainford, 2023) directly ties the experience of Black maternity to a public health crisis: higher blood pressure, premature births, and poor outcomes are not accidental—they’re patterned responses to long-term stress and medical bias.

• Birthing Justice, edited by Julia Chinyere Oparah and Alicia Bonaparte, lays out the structural racism in healthcare that leads to unequal access to doulas, midwives, mental health support, and safe births.

Here’s what the medical world still refuses to say clearly:

Stress isn’t “just” a mental health issue; it’s a biological weapon against the bodies of Black women.

The weathering hypothesis (Geronimus, 1992) explains how the chronic stress of racism causes early physiological deterioration. Studies have shown that Black women’s cells age faster than white women’s by as much as 7.5 years (Geronimus et al., 2006).

High stress levels elevate cortisol, which in pregnancy:

• Weakens the immune system

• Increases inflammation

• Raises the risk of pre-eclampsia

• Contributes to low birth weight

• Is linked to preterm labor (Seng et al., 2011; Christian, 2012)

And yet… perinatal stress is not screened for in most OB/GYN practices.
You are not imagining this gap in care. It’s by design.

In 2022, the CDC published a report stating that 84% of maternal deaths in the U.S. are preventable. Among those, mental health conditions were a leading cause, especially suicide, substance use, and undiagnosed postpartum depression.

According to The Policy Center for Maternal Mental Health:

• Black women are twice as likely to experience postpartum depression as white women.

• Yet we are less likely to be diagnosed, and far less likely to receive treatment.

Birth-related PTSD—known clinically as CB-PTSD (Childbirth-related Post Traumatic Stress Disorder)—affects up to 20% of new mothers, with rates significantly higher in Black birthing people who’ve experienced medical neglect, abuse, or unexpected surgery (Dekel et al., 2020).

But instead of being screened or treated, our trauma is often dismissed as:

• “Normal new mom nerves”

• “Too sensitive”

• “Strong Black woman syndrome”

We are told to be grateful that we survived childbirth.
But survival is not the same as care.

If the system won't protect us, we must come armed with knowledge and language that assert our power in every interaction.

Use these terms in your OB visits:

• “I’m concerned about the effects of weathering and allostatic load on my pregnancy.”

• “I want a perinatal mental health screening—today.”

• “Please document that I asked for screening for CB-PTSD.”

• “I need care from a culturally humble provider.”

• “What trauma-informed supports do you offer in labor and delivery?”

Bring a doula. Bring a friend. Record your visits. Period!
When you walk into a hospital as a Black mother, you are often entering a system that will not prioritize your life unless you force it to.

This is Zsanine for REMIND Lab... remember…
The revolution starts in the womb.
And this is your invitation to fund the science that will save us.

“Georgia law does not allow her to die.”

That is the appalling phrase doctors at Emory University Hospital are telling the mother of Adriana Smith, a 30-year-old Black nurse and mother who was declared legally and medically brain dead in February 2025.

Yet her body remains on life support.

Why?

Because a 9-week-old fetus — the size of a raspberry — was detected in her womb at the time of her death. Under Georgia's 6-week abortion ban (O.C.G.A. §16-12-141), that fetus is granted full personhood. That fetus, not Adriana. That fetus, not her grieving family. And so, she is no longer treated as a human being but as a gestational property of the state.

This fetus is not viable. It cannot survive outside the womb. There is no medical justification for keeping Adriana on machines. This is not “pro-life” — this is pro-power, and the Georgia law is being used to prove a point, not preserve life.

Let me be direct: the state is using a dead Black woman’s body as an incubator. Her mother is not allowed to bury her. Her children are not allowed to say goodbye. Her dignity has been hijacked by a law that needs to be overturned.

📎 Sources: NPR (2025), Georgia Code §16-12-141, Dobbs v. Jackson Women’s Health Organization (2022), Uniform Determination of Death Act (1981)

Legal Precedent and Constitutional Trespass

What Georgia is doing is not just immoral — it’s unconstitutional.

In Cruzan v. Director, Missouri Dept. of Health (1990), the Supreme Court affirmed a family’s right to withdraw life-sustaining treatment. Adriana Smith is not in a coma — she is dead. The family should have the legal right to bury her, as guaranteed under the 14th Amendment’s Due Process Clause.

In Texas, when Marlise Muñoz was declared brain dead in 2013 and pregnant, her family faced similar horror. But eventually, a judge ruled that the hospital was wrong to keep her on machines. The law recognized her death.

Adriana’s family has received no such justice. Georgia’s abortion law overrides both Cruzan and everyday medical ethics. It violates the family’s right to refuse unwanted intervention. It turns private grief into a public spectacle of control.

📎 Sources: Cruzan v. Missouri, In re Muñoz (2014), Relf v. Weinberger (1977)

From Gynecological Violence to Eugenic Legacy — and Now, Back Again

What’s happening in Georgia is not new.

Adriana Smith’s body being used posthumously — without consent, without dignity — is not some tragic oversight. It’s a policy outcome born from centuries of practice. What’s happening in Georgia is simply the 21st-century echo of a systemic war against Black women’s bodies — from forced labor to forced births to forced silence.

Let’s trace that bloodline:

• J. Marion Sims, lauded in medical textbooks as the “father of modern gynecology,” built his legacy on the torn, unanesthetized bodies of enslaved Black women like Anarcha, Lucy, and Betsey. These women did not give consent. They had no agency. They were treated as medical equipment and left without recognition or restitution.

• Fast forward to the 20th century, and we find Fannie Lou Hamer, a civil rights icon, who went into a Mississippi hospital for a uterine tumor and came out forcibly sterilized — a practice so common it had a name: the Mississippi Appendectomy. Hamer would later testify before Congress, declaring that “they sterilized me just like I was some kind of animal.”

• In 1973, just as Roe v. Wade was being decided, Minnie Lee and Mary Alice Relf, two young Black girls aged 12 and 14, were surgically sterilized in Alabama without their mothers’ informed consent. Their case, Relf v. Weinberger, revealed that over 100,000 poor women, many Black, had been sterilized using federal funds. In many cases, women were lied to, coerced, or operated on under pretenses.

• And now in Georgia, a dead Black woman is being used to sustain a fetus, not because her family requested it, but because the state has seized her body. They call it “protecting life.” But they’ve stripped her of the fundamental human right to die in peace.

Let me be blunt: when the state overrides a woman’s death to benefit a potential life, it is declaring that her existence was merely instrumental. Adriana Smith is not a person in their eyes — she is policy real estate.

There is no way to separate this from race, class, or history. Georgia’s law does not exist in a vacuum. It exists in the legacy of medical apartheid. Of plantation medicine. Of coerced sterilization. Of scientific racism.

And most hauntingly, it exists in a legal system that still cannot fully see Black women as owners of their bodies.

This is not just about abortion. It’s about who is allowed to be fully human. When a dead woman’s womb has more legal protection than her memory, her voice, or her mother’s right to bury her, we are not in the realm of medicine. We are in the realm of state-backed reproductive coercion.

And history tells us: when women — especially Black women — are erased from the decision-making table, they are always returned to one role:

The vessel.

📎 Sources: Medical Apartheid by Harriet A. Washington, Killing the Black Body by Dorothy Roberts, Segregation’s Science by Gregory Dorr

Neuropsychology: The Violence of Prolonged Denial

What’s happening to Adriana Smith’s family is not simply an emotional tragedy. It is a neuropsychological assault — a trauma that rewires the brain, paralyzes mourning, and traps survivors in a suspended state of pain.

When a loved one dies, the brain, especially the limbic system, which governs emotional regulation, begins the grief process through a neurochemical and cognitive unraveling of the attachment. Hormones like cortisol and norepinephrine spike, followed by slow recalibration as the prefrontal cortex accepts loss. But this process hinges on one essential truth: acknowledgment of death.

Adriana Smith’s mother, April Newkirk, has been denied that truth.

Instead of planning her daughter's funeral, she is forced to watch a machine-operated mimicry of life. There are no goodbye rituals, no eulogy, no final touch. Instead, there is a daily confrontation with a warm body, breathing by pump, yet unmistakably gone. This mismatch between what the senses perceive and what the mind knows is the psychological definition of ambiguous loss, which is uniquely corrosive.

According to Dr. Pauline Boss, who coined the term, ambiguous loss “freezes the grief process” and results in “unresolved trauma, identity confusion, and chronic anxiety.” Neuroimaging studies confirm that this limbo state activates the anterior cingulate cortex and amygdala, regions linked to prolonged distress and depressive rumination. In essence, the family becomes neurologically stuck, unable to heal.

And for Black families, this is not just individual trauma — it's intergenerational reactivation.

Neuroscientist Dr. Rachel Yehuda’s work on epigenetics has shown that traumatic stressors — like forced separation, state violence, or coerced bodily exploitation — can imprint themselves onto DNA, altering stress regulation for future generations. The denial of burial rights is not a neutral bureaucratic delay. It’s a reenactment of plantation-era practices where Black bodies were used, unburied, dissected, and discarded without ceremony.

Georgia’s law does not just criminalize bodily autonomy. It criminalizes grief itself.

And grief, healthy grief, is vital for survival. It is how the brain makes sense of finality, reintegrates memory, and allows the living to move forward. What this law does is neurologically stall that process. It weaponizes a corpse to perform the illusion of motherhood, all while eviscerating the mental and emotional health of the living.

This is not life support. It is a form of deprivation, sanctioned by the state and enforced through machinery.

📎 Sources: Boss (2000), Yehuda et al. (2016), The Neuroscience of Psychotherapy by Louis Cozolino

What We Must Demand — and How We Must Demand It

This is not just about asking. It is about strategic, multi-tiered demands—legal, medical, and cultural—because the system has already shown us it won’t course-correct without pressure.

We demand:

1. An Immediate Judicial Intervention in Georgia

The Georgia Supreme Court must issue a writ of mandamus or injunctive relief to stop the use of life-sustaining technology on legally deceased individuals, especially when the fetus is nonviable and the family opposes continuation.

• This demand is grounded in the 14th Amendment's Due Process Clause, which protects a family’s right to control posthumous decisions.

• Cruzan v. Director, Missouri Dept. of Health (1990) affirmed that families may withhold or withdraw life-sustaining treatment.

• The Uniform Determination of Death Act (1981), adopted by most U.S. states, including Georgia, clearly states that brain death is legal death.

• Georgia’s refusal to act in accordance with this standard is not only cruel — it’s unconstitutional.

📎 Legal Sources:

• Cruzan v. Missouri, 497 U.S. 261 (1990)

• Uniform Determination of Death Act (1981)

• O.C.G.A. § 31-10-16 (Georgia's adoption of the UDDA)

2. Federal Constitutional Challenge to Fetal Personhood Statutes

Fetal personhood laws, such as those in Georgia, must be brought before the federal courts as violations of bodily autonomy and family integrity under the Constitution.

• These laws are written without medical nuance and violate the principles established in Planned Parenthood v. Casey (1992), which, though overturned in Dobbs, emphasized that laws cannot create undue burdens that distort medical care.

• These statutes deny families a say in postmortem decisions and effectively criminalize grief when death and dignity conflict with the state’s ideological agenda.

• They should be challenged under substantive due process as outlined in Moore v. East Cleveland (1977), which protects family decision-making against governmental intrusion.

📎 Legal Sources:

• Planned Parenthood v. Casey, 505 U.S. 833 (1992)

• Moore v. East Cleveland, 431 U.S. 494 (1977)

• Relf v. Weinberger, 565 F.2d 722 (D.C. Cir. 1977)

3. Federal Legislation on the Right to Burial and Neuropsychological Integrity

We need a new federal bill, akin to the Pregnant Workers Fairness Act or Pregnancy Discrimination Act, that centers posthumous consent and family grief rights as healthcare rights.

• This law must recognize complicated grief, ambiguous loss, and trauma as diagnosable, documented conditions.

• It must restrict states from denying burial or medical closure based on gestational status, especially when the fetus is previable.

• This is not a religious debate — it is a public health mandate. As Boss (2000), Yehuda (2016), and Cozolino (2017) show, unresolved grief causes cognitive impairment, chronic illness, and multigenerational harm.

📎 Psychological Sources:

• Pauline Boss, Ambiguous Loss (2000)

• Rachel Yehuda, “Holocaust Exposure Induced Intergenerational Effects” (Biological Psychiatry, 2016)

• Louis Cozolino, The Neuroscience of Psychotherapy (2017)

4. National Public Hearings and Civil Rights Investigations

We demand that Congress and the Department of Health and Human Services (HHS) hold public hearings to investigate:

• How abortion bans impact Black maternal mortality and neuropsychological outcomes.

• Whether hospitals like Emory are violating civil rights statutes (e.g., Title VI of the Civil Rights Act) by failing to provide culturally competent care and trauma-informed options to Black families.

• Whether the state is engaging in coercive reproductive policy that echoes historical abuses, including those exposed in Buck v. Bell (1927) and the sterilization scandals of the 20th century.

We must treat this as a human rights issue, not a state-by-state skirmish. We must show up to city council meetings, court steps, medical board hearings, and digital platforms with the same fire they used to hijack our bodies.

📎 Historical and Legal Sources:

• Buck v. Bell, 274 U.S. 200 (1927)

• Title VI, Civil Rights Act of 1964

• Reports by the Guttmacher Institute and the Center for Reproductive Rights (2022–2024)

How We Must Demand It:

We don't ask politely for our rights. We document. We organize. We mobilize.

• Use FOIA requests to demand records from Emory and Georgia DPH.

• File complaints with the HHS Office for Civil Rights.

• Partner with Black maternal health collectives, doulas, and legal defense funds like the Abortion Defense Network.

• Educate others through platforms like Substack, TikTok, and Instagram, until this story spreads louder than their silence.

Adriana Smith is not a footnote. She is the moment. And what happens next will determine whether any of us, especially Black women, are allowed to rest in peace.