I have been going to the Community Mental Health Center since I was in fourth grade. In all of the years, I can count on one hand the number of times that I have seen a Black person there, either therapist or patient. I have had a similar experience when visiting the social worker’s office at Brookline High School. While there is a small contingent of Black and Latino students who visit the office, mainly the people I see there are White. I was curious to know: Why has there always been a higher concentration of White people seeking help for mental health issues? One of the reasons I became interested in looking into the relationship of race and the attitude towards mental illness—more specifically depression—was because I wanted to understand what my life might have been like had I not been adopted by a White couple. I was diagnosed with depression the summer before my sophomore year of high school. My parents were instantly supportive of whatever I needed to do in order to get better, and were more than willing to pay for any extra therapy or medication that I might need. What would have been the case if I had been adopted by a family of color or not been adopted at all but stayed in South America? My impression is that mental illness (i.e. depression, bipolar disorder, and schizophrenia) is not something that is readily talked about in African American culture, but what are the reasons behind this? I thought about doing some research to find an answer.
I initially started out reading journal articles, but I quickly found that they were not going to provide me with all the information that I needed or wanted. I wanted to interview someone who might have experience in what I was researching. Multiple people recommended that I talk to Dr. Vick, the head of the African American Scholars Program at Brookline High School, for he would have insight into what I was trying to understand. I was also really interested in what people closer to my age felt about whether there was a stigma around depression and mental illness in the Black community. The two people that I talked to—one former student and one current student at BHS—showed me something that I was unaware of before: the younger generation is not conscious of a stigma. When I asked a boy in one of my classes what he thought, all he said was, “I guess,” not really seeing or understanding what I was talking about in his everyday life. The girl I talked to simply said that her parents understood that depression and mental illness existed, but they simply didn’t understand why any of their children would suffer from it. After these conversations, I came to the conclusion that I wasn’t going to get much help from people my age. At this point, I became stuck. I hadn’t had much luck finding books that covered my topic, and it was simply by chance that I stumbled upon Willow Weep for Me: A Black Woman’s Journey Through Depression and Black Pain: It Just Looks Like We’re Not Hurting by Terrie M. Williams. These two books offered me the most insight into the culture surrounding mental illness, and more specifically depression in African American culture. I discovered a number of reasons why there is so much silence around mental health issues. There is a legacy of mistrust for the medical community, a sense of shame for having something wrong with you, as well as an inability to pay for therapy.
According to many of my sources Black people and people of color often feel the need to present themselves in a strong light and not display any potential weakness. This drive has risen from the years of oppression that many minorities have faced, where the only option for survival was to be strong. Even in recent years, people of color have struggled to prove their intelligence and worth. “Not even 20 years ago, you had the bell curve come out of Harvard University, saying that Black and Latino folks are genetically less intelligent” (C. Vick, personal communication, February 14, 2012). For a person of color to admit that he or she has any type of problem especially a mental health problem might be seen as validating the argument that he or she is less intelligent and strong than White people. This mindset is further perpetuated by the stereotypes of Black people in American society.
In the memoir Willow Weep for Me, Meri Nana-Ama Danquah describes the stereotypes she has been up against her entire life. The “supposed birthright to strength, [that] black women were supposed to be strong—caretakers, nurturers, healers of other people—any of the twelve dozen variations of Mammy, [and that] emotional hardship [was] supposed to be built into the structure of [her] life” (Danquah 19). As a Black woman, she denied the fact that she was suffering from severe depression for decades, simply because she didn’t feel that it was possible for her as a Black woman to become depressed. Later on in life, when she had finally accepted the fact that she was a depressive, when she tried to talk about her experience by writing a memoir about her life, she was disregarded and humiliated. Meri describes a conversation that has stuck with her for years. It starts off with a White woman responding to the information that Meri was writing a book about Black women and depression. The woman said, “it’s just that when black women start going on Prozac, you know the whole world is falling apart” (Danquah 20). Meri responded, “When black women start going on Prozac, their whole world has already fallen apart. They’re just trying to piece it back together” (Danquah 20). The fact that this was the woman’s first impression when she thought about Black women and depression shows just how imbedded the stereotype of the Black woman as a caretaker is in not only Black and African American culture, but also in White culture.
When I went to interview Dr. Vick, he stressed the importance of the church in Black and Latino culture. Black and Latino people tend to first seek help from members of the church before they even consider seeking help from a mental health professional. In fact, “clergy [are] contacted more often than psychiatrists or general medical doctors; [while] psychiatrists and general practitioners [are] only contacted about one-sixth of the time” (Payne 355). According to Dr. Vick the church “has been the foundation of Black life” for a long time, and not just physical health issues are brought to the attention of the church, but also mental health and financial health issues. He said that every single Sunday when he goes to church, the congregation is “praying on these people who are experiencing this problem” offering their support and help to the people who are seeking it. Terrie Williams, the author of Black Pain, agrees. According to her, “the Black church has historically been a rock for our people, from the earliest slavery times through freedom, Reconstruction, Jim Crow, civil rights, and straight up to today. It has often been the one place where we could find ourselves praised for who we were when everything around us said we were not even human, let alone precious” (Williams 199). Williams offers more insight into the reasons why the church has been such a dominating presence in Black culture from the very beginning. The church is built into the cultures of Black and Latino folk in a way that makes the separation of the two almost impossible. Clergy members are present at important “developmental milestones” (Payne 355) in people’s lives such as birth, marriage, and through the grieving process. The chance of a Black or Latino person seeking help from a mental health professional is slim, but the chance of a member of one of these groups seeking mental health care from a member of the church is much higher. One of the things that the church can offer that a trained medical professional might not be able to is an unbiased ear. God will still love and accept someone, no matter the terrible thoughts that the person may tell God, and no matter the flaws that someone possesses (Williams 203).
The tendency to seek help from the church before turning to a mental health professional comes from a long history of distrust of the medical establishment in Black and Latino culture. Like in the case of Meri Danquah, the treatment that many Black and Latino people receive is emergency therapeutic care—talk therapy or medication—that only occurs when a person reaches the point of posing a risk of self-harm or harming others. There is rarely preventative care, which keeps symptoms from getting to this extreme. Not only is this a byproduct of the distrust in the system, but also a lack of available resources. The rate of unemployment for Black and Latino people is double the rate of unemployment for White people, while the number of White people employed for over twenty years is eight times the size of that of Black and Latino people who have been working for over twenty years ("Economic News Release: Table A-2. Employment status of the civilian population by race, sex, and age"). In order for someone to receive preventative treatment, he or she must have the ability to pay, and that involves either a large amount of money or the presence of health insurance. With the current rates of unemployment of Black people, many don’t have the access to funds that would cover the cost of preventative care. In fact 25% of African Americans are uninsured ("Mental Health America"). The issue is that “if you don’t have employment you don’t have [health insurance]. So if you don’t have health insurance you’re not going to get mental health care” (Dr. Vick). Because of this, the only time at which mental health care is available is when the symptoms get to such an extreme that you are a danger to yourself and the people around you.
Black people may hesitate to seek treatment from the medical establishment because of events such as the Tuskegee experiments and the Guatemala Syphilis Experiments. In the case of the Tuskegee experiment, the United States government took a group of three hundred and ninety-nine impoverished Black men (who were in the late stages of syphilis) and 201 Black men who did not have the disease who were to act as a control group. Not only were the men never told what they were being treated for, but when “penicillin became the standard treatment for the disease in 1947, the medicine was withheld from the men. . . . By the end of the experiment, twenty-eight of the men had died directly of syphilis, one hundred were dead of related complications, forty of their wives had been infected, and nineteen of their children had been born with lifelong syphilis” (Williams 247-248). It is events like this that have contributed to the Black community’s distrust of the medical establishment. In the past African American people received poor and even criminal medical treatment simply because they were considered less than their White counterparts.
It is still the case that on the whole, Black people receive subpar medical care. In Black Pain Terrie M. Williams describes the story of Debra, “a twenty-five-year-old Ivy league graduate” (Williams 245). During her sophomore year of college Debra started suffering from a bout of depression. When she sought help from the school counselor, she was diagnosed with “antisocial personality disorder (what most folks call ‘sociopathic’), even though at the time most studies on the disorder were over ten years old and about male prison inmates!” (Williams 245). Debra was diagnosed as suffering from antisocial personality disorder after only a few sessions. She wasn’t given the chance to fully explain what she was feeling before she was labeled as having a disorder that is usually associated with White men in prison. Williams compares Debra’s situation to that of ten Black men coming into an emergency room, all with different ailments, “one person has a broken leg. Another has a cracked skull. Another has a broken finger, and so on. All ten of the patients are given the same-size Band-Aid and told they are going to be fine. . . . Now, imagine ten more Black people, all suffering from depression in varying degrees and forms, being prescribed the same medication. The horror of this scenario is that it happens all the time” (Williams 245). While it is not absolutely clear that the color of Debra’s skin was the determining factor in the kind of care she received, given the long history of inadequate care that the Black community has been subjected to, it is safe to assume that the color of her skin did in fact have something to do with her poor treatment, or her perception of poor treatment.
Since I have been going to therapy for many years, it has never seemed like a big deal to me, and I don’t mind telling people that two, sometimes three, times a week I see a therapist. However, I have lucked out with therapists; never once have I felt that they aren’t helping me to their full potential. This is often not the case for Black men and women. It has been found that especially for African American women their negative “perceptions of their counselor and the counseling process develop as early as the first session” (Ward 471). Ward tells the story of a woman who had a similar experience to that of Debra when she sought counseling. Suffering from Seasonal Affective Disorder (SAD) the woman simply wanted someone to talk to about the depressed feelings she experienced when the weather got cold and gloomy during the winter. Thinking it might be helpful; she eventually gave in to the idea of seeking a counselor. However, within “the first 30 minutes the counselor [told her that she] need[ed] to see a psychiatrist for medication. . . . He didn’t even spend any time getting to know [her]; he immediately started talking about medication” (Ward 471). All she wanted was someone to talk to; however the counselor instantly started talking about her taking drugs. While this woman’s story and Debra’s story have different outcomes, the feeling that they both weren’t worth listening to remains the same. Because both Debra and the woman did not get a very good impression of the therapist they went to see, it affected their willingness to return to see a therapist in the future. Both therapists didn’t seem to have the time or deem the women worthy enough to actually listen to, and because “actual clients’ perceptions of counseling and counselor behaviors determine to a large extent the effectiveness of therapy” (Ward 471), the therapy failed for both of them.
Another reason why it’s hard for a Black person to go to a therapist is the attitude that a White therapist will not understand what he or she is feeling and will assume that all Black people are the same. It has been proven that “African American clients appear to prefer African American counselors” (Ward 472). In fact, when faced with the prospect of having therapy with a White psychiatrist some Black people felt that they had to prove to the therapist that not all Black people fit into the typical stereotype of a Black person, such as that all Black women are welfare moms (Williams 243). Therapy is supposed to be a safe place, where someone is able to talk about the things that are bothering him or her. If a person is spending their therapy sessions trying to show that they aren’t just another stereotype, they don’t really have the chance to talk about what is bothering them and get better. In fact, it sometimes takes finding a Black therapist for a Black person to feel safe and comfortable (Williams 243).
In her book, Terrie Williams addresses the problem of not talking about traumas that have happened to you. Williams tells the story of Yvonne, a young woman suffering from severe depression. From a young age Yvonne was conditioned to believe that she was worthless. Being the darkest skinned member of her family, her elder brother mercilessly teased her, while her “Mom and Dad had nothing to say—[they] didn’t defend her, didn’t console her” (Williams, 34). As she got older, whenever someone complimented her on her looks, her mother would respond with: “yes, but too bad her hair isn’t a better grade.” Yvonne came to equate Black with being ugly, so when her father started raping her, she didn’t feel like she deserved help, and her mother’s hostile attitude made her feel that she didn’t have anyone to turn to (Williams, 34). Yvonne’s sense of worthlessness was so deeply ingrained, that she never once considered seeking help. However, alongside her lack of self-worth came the shame of admitting that she was suffering from depression, and then being branded as crazy. Meri Nana-Ama Danquah suffered from a similar situation as that of Yvonne. Meri felt that because she was supposed to be a strong black woman (Danquah, 19) she was weak if she admitted that she was suffering from depression. The sense of shame comes from the stigma of being labeled as crazy. Shame, seeming weak, and the fear of being labeled as crazy are three of the things that Williams lists as “Five Reasons We Hide Our Pain” (Williams, 10); however to me those three things are closely related. The fear of seeming weak, as well as the fear of being branded as crazy directly relate to shame. Both Meri and Yvonne were ashamed of possibly being depressed, of being mentally ill and in need of help.
The research I have done has been discouraging; it shows that the likelihood that an African American person will seek treatment for a mental health issue is slim. Being depressed is often seen as a White person’s illness (Williams 40), as it many times requires seeing a therapist, or being in an outpatient or inpatient program, which is expensive, and requires either a fair amount of money or excellent medical insurance. And those who have sought help have often been diagnosed wrongly. This information has made me realize that had I not been adopted by a White couple, I probably would not have been encouraged to talk about my anxiety or depression. Also I probably wouldn’t have received the same quality of mental health care that has helped me since fourth grade.
I am hopeful, though, that the stigma around seeking treatment by a Black person who is depressed can be lessened if there is good treatment more readily available. It won’t instantly change the existing stigma, but better treatment that costs less money will give more people the opportunity to get help. Another thing that would probably increase the number of African Americans seeking treatment would be an increase in the number of Black therapists and social workers. As of 1999 only “2 percent of psychologists and 4 percent of social workers” ("Mental Health America") were Black. The most important way to start changing attitudes is to educate young people before the stigma of mental illness is too engrained into their ways of thinking. There must be better outreach to children in schools. As things stand now, according to Karen Kennedy, a social worker at Brookline High School, often times the reason that Black students end up visiting one of the school’s social workers or psychologists is because of a conduct problem. She feels that too often these students have been diagnosed with ADHD, when in fact their behavior may be related to an untreated psychological disorder, which leads to acting out in class (K. Kennedy, personal communication, May 2, 2012). It is important that African American children are taught that it is okay to say that something is wrong or that they are feeling down. If the stigma around mental illness were lessened, the problems that students face could be dealt with earlier and with appropriate treatment. But change cannot happen only within the Black community, the environment of American culture must also change in order to prevent the further inhalation of the “smog” of racism (Tatum 7).
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