Mental Health In The Black Community
“ Mental illness is real. And like everything else in life, it operates on a spectrum. Though there are common symptoms, everyone experiences it differently. Yet so many people live in shame, hiding their struggles, not seeking help. We, as a culture, have not fully acknowledged how much help is needed. The only real shame is on us for not being willing to speak openly. For continuing to deny that mental health is related to our overall health. We need to start talking, and we need to start now.”
-Oprah Winfrey, African American Media Executive, Actress, Talk Show Host, Television producer, and Author
A DILEMNA
Mental health in the black community has become a major topic of discussion due to a shift in the level of stigmatization. Stigma was presented in the form of unconstructive attitudes, beliefs, and behaviors that caused fear, rejection, avoidance, and discrimination against individuals with mental health issues. Through the use of language, the misunderstanding of the severity of the issue, the disregard for personal relationships and actions spawned from certain social behaviors, negative beliefs and prejudice has kept people from getting the appropriate medical attention to resolve their mental health issues. Sensationalize media coverage is partly to blame for the stigmatization of mental health and the spread of misconceptions about people that are affected by mental illness. Jokes are made about mental illness in mainstream entertainment and the news is becoming more of an outlet for reporting tragedies stemming from mental health issues, labeling those that suffer from mental health issues as “psychopathic” and “insane”. Increased public stigma contributes to the lack of self-esteem, difficulties in establishing relationships and can negatively impact family ties. Labeling, stereotyping, and cognitive separation using terms such as “us” and “them” are the actions that perpetuate a public health stigma. Stigma can also be induced on oneself, causing help-seeking behaviors to not be pursued because of attitudes of avoidance due to lowered confidence and self-esteem. Those suffering from mental disorders abstain from accepting help because of the fear of being publicly shamed, having their quality of life changed, increasing the level of social separation, and overutilizing family resources for help. This causes people to not seek treatment and assistance early, resulting in more severe and incapacitating emergency situations.
BACKGROUND
Since the inception of psychiatric medicine, it was thought that people suffering from mental illness were living an unhealthy lifestyle and religious groups had attributed ones’ mental state with demonic entities. A shift in attitude in the late 1800s led to the creation of psychiatric hospitals mechanically restrained its patients to provide treatment. Actions such as this further stigmatized mental health patients because it presented the image of the patients not being able to control their behaviors and are a danger to themselves and others. Psychiatric training has had reformations over the decades and is also taught to primary care physicians. Unfortunately, there are many cases of physicians acknowledging the usefulness of psychiatric medicine for supplementing with patient treatment but make disparaging remarks for its effectiveness in treating the most mentally ill patients. This idea creates the basis of the idea that psychiatrists are not real doctors because they do not touch patients or go about standard physician procedures. The conflict originates from many people’s cultural biases about appropriate treatments having psychiatric assistance as one of the last places to reach out to. Studies have shown that physicians in primary care can identify less than 50% of patients showing symptoms of depression and anxiety; their focus is mainly on making a physical diagnosis, so a physician is not primarily looking for emotional symptoms for psychological conditions. One would think that African American physicians would be better able to recognize the signs of mental illness, especially with African American patients due to cultural relatability, but studies show that physicians trained in Western medicine have the same notions of mental illness regardless of cultural circumstance.
HISTORY BEHIND MISTRUST
Cultural mistrust stemming from centuries of historical discrimination has presented black people with daily racial microaggressions and stressors that shifted the worldview of African Americans everywhere. Dr. William Smith of the University of Utah has coined the term “racial battle fatigue”, which is when an oppressed group has a physiological and psychological strain due to being exposed to continuous racial discrimination and microaggression. Intersectionality is important to factor in the treatment of African Americans experiencing racial battle fatigue because the therapist needs to be able to fully conceptualize the scope of the experiences and influences leading to the mental health issue. Black men, in particular, have many misconceptions about them that aid in the mistreatment and mishandling of their mental health issues. Therapists must consider the cultural ramifications of gendered racism on the emotion, physiology, and psychology of the black male. The motivations, dreams, activities and personal wellness can be greatly affected by all genders. Culturally sensitive mental health services require that therapists to be able to discern and identify the occurrences of ethnoracial bias, microaggressions and racial oppression in a patient’s life and even during the session.
TRANSITIONING
Stigma is heavily influenced by cultural values, the attitudes and beliefs behind stigma would be different for each demographic. African Americans have a stigma that specifically impacts seeking out mental health treatment and overall treatment participation. The main reason is that black people are more likely than white people to believe that mental instability derives from spiritual causes rather than physical health and depression. This causes African Americans to believe that treatment though psychotropic medication is not as effective as prayer and counseling methods. The denial of the medication also perpetuates the stigma of antidepressant drugs being inefficient and addictive. This belief stems from an NIMH-H sponsored publication that showed that serotonin specific reuptake inhibitors are not as effective on black patients as they are on other demographics. To prevent the spread of such rhetoric, pharmaceutical companies need to change their approach to their research. Drugs that are developed in primarily white populations cannot be expected to have the same efficiency for African Americans. More research in black communities needs to be had in order to reduce stigma. People also need to be educated on the severity levels and outcomes of different disorders in addition to the wide array of symptoms and characteristics of mental health instability. The narrative of most depression is very severe, tied to violent behavior, and cannot be sufficiently treated are some of the notions that the public needs to be educated on. The public needs to be aware of the importance of promoting mental health treatment along with overall mental wellness, biological and environmental stressors and the need for a holistic approach to reach the desired outcomes. The National Alliance on Mental Illness is the leading federal organization that develops initiatives to reduce the stigma and offers resources to its many different chapters. The organizations’ local chapters educate members of the community and provide social support for the members of the community. Historically Black Colleges and Universities collaborate with NAMI to organize meetings, hold studies, and facilitate an environment that promotes culturally competent education efforts. The leadership of churches and other religious institutions also do their part in creating better mental and physical outcomes. These spaces prove to be the first avenue African Americans seek help for their emotional and mental distress because it presents a person with a sense of belonging and offers social support. Counseling by members of the clergy has proven to be an effective treatment in certain mental health issues in the black community through interpersonal communication, self-care workshops, and seminars and providing referrals to medical and mental health services.
THE HORIZON
There has been a paradigm shift within the past decade regarding mental health wellness efforts. With racial discrimination being reported as frequently as it has been during the Civil Rights Era, Black Americans have had to find coping mechanisms through clinical interventions. These undertakings have been approached by many organizations from a community standpoint in the hopes of reducing the psychological distress of black families. One way to prevent mental instability that derives from race discrimination is to put children through racial socialization. This is important because it influences a child’s beliefs as to how the world operates, makes the child confront his or her own beliefs about themselves and others, and allows the child to develop strategies and skills to cope with racism along with managing inter- and intrapersonal interactions. Preventing Long-term Anger and Aggression in Youth, the NIMH sponsored community initiative, aims to reduce the aggressive behavior in children through sport participation. Therapists work alongside coaches in underserved populations to help the children realize their anger and how it originates from racialized issues. Along with educating the young black boys on how to properly manage what they internalized towards a positive outlet, they also have a supplemental parent support group to assist in managing their mental health wellness. The results of the program have shown that the children had become more sensitized to their emotions and were able to identify, experience, and address their environmental stressors better than those in the same background not in the program.
MORE PROGRAMS
Another intervention that aims to address the most common black stressor of discrimination is the Black Parenting Strengths and Strategies Program that teaches black families how to positively facilitate the early development of their child. While the program does not directly work with children, it provides parents with strategies on how to monitor, discipline, promotes positive parenting, and instilling racial socialization strategies. Studies have shown that intentional racial socialization practices lead to higher socioemotional functioning, increased academic achievement, better cultural competence, healthier behavioral attitudes, and heightened self-esteem. EMBRace is another racial socialization program that has its focus on educating black youth. The program facilitates discussions about the race between the black children and their caregivers to manage the trauma and stress that derives from discrimination experienced during the child’s development. These conversations are held in five 90-minute sessions with a therapist with cultural competency training moderating the experience. Educators, researchers, and psychologists curated this program to best present prompt and workshops for the needs of the participant. Many of these programs provide parenting and family building resources in the hopes of giving protection to the children of disenfranchised communities that usually have poor mental health outcomes.
