There are several areas to examine that tell us why African Americans will not partake of the medical model or ask for an invitation to the drug company’s medication orgy.
First and foremost is the discrimination barrier. One must take a chronological view of the African American experience in this country with its history of slavery, racism and dehumanizing of this population.
This long and devastating oppression is the foundation for mistrust, for underlying expectations that the system, in general, is not going to meet the needs of African Americans.
We are aware that racism still exists, that the degrading experiences of the older generations are transferred to the succeeding generations through narratives and then confirmed by current racial conflicts.
Racism exists and is a foundation for this community’s low participation in mental health and related systems of care.
We add to this the stigma that continues to be attached to “mental illness” within our society. African Americans are not isolated from the fear of carrying and being labeled “mentally ill.”
The stigma doubles when added to racism and reinforces the perception that being Black and labeled mentally ill are designations to avoid.
“The first thing they say is “Oh, she’s crazy.” Always acting crazy, you know what I mean? You don’t wanna be referred to as crazy. You might want to be referred to as mentally ill, you know. ‘Cause mentally ill sounds more better than “Oh, I’m crazy!” You know what I mean? Oh, there’s definitely a stigma”. http://www.sciencedirect.com/science/article/pii/S0890406510000435
The third barrier is embedded in the mental health systems of care. Being Black and labeled mentally ill puts the individual at a disadvantage when trying to access care. African Americans point to the white-dominant attitudes that prevail among doctors and other treating specialists and lack of cultural sensitivity.
African Americans report that they receive fewer sessions, are more quickly hospitalized and directed to medication treatments instead of therapy because of racial disparity. They point out that Caucasian doctors do not take into account that African American women are heads of households and, as such, have obligations to multiple people and cannot spend time or funds in treatment.
They report that most treating individuals are Caucasian and this makes them feel uncomfortable.
When asked by an interviewer about trying to contact a helping person in a mental health clinic, the individual stated that in the initial phone call, he was identified as Black and he believes that his needs were not addressed because of his race:
These are things that we, I think, as blacks—we’re not told about… If you make a phone call and they discover that you are black, then they transfer you to someone else, and by the end of the day, you don’t wanna talk to anyone. You say, Forget it, I’ll just sit here and keep it to myself… So we have to get information…by word of mouth from somebody else. We really don’t get it from the professionals or the agencies or the people who (handle) it. We just get it from a friend. You know. And hopefully, you had a white friend to tell you.” http://www.sciencedirect.com/science/article/pii/S0890406510000435
In a similar situation, an individual described the mental health clinic that I worked in as a cold and uninviting place where she felt unwelcome because of her race.
This opinion was voiced by a senior African American woman with whom I was doing an “intake.” She was clearly uncomfortable during the interview– clasping her handbag tightly in her lap. Her posture was stiff and she had been answering questions with only “yes’ or “no” responses.
With encouragement and after a cup of tea, she relaxed sufficiently to tell me that she had come only because her primary doctor wanted to “rule out” depression as the cause of her severe stomach pain before he sent her for testing.
She was, indeed, depressed , but refused counseling and said that she would “take care of it” herself. It turned out that she also had an ulcer.
Cause of Depression
The fourth issue is the cause of depression. They perceive that the predominant biologically-based view of mental illness is antagonistic to their view of mental illness as primarily because of life stress, poverty, discrimination and the violence within the African community today.
“I know a lot of black people that’s depressed. Every black person I know is depressed…We’re born into a depressed (state). What we live with and adjust to…I have nothing against white people…But what we live through and go through… a white person couldn’t handle it.” http://www.sciencedirect.com/science/article/pii/S0890406510000435
They pointed to specific causes of their depression as being relationship-based and because of problems with partners, children, grandchildren and friends. The issues that made them feel depressed were deaths through murder, drug overdose, gang violence, physical abuse, incarceration of loved ones, etc.
One participant stated:
“Uh, one of the things that affected me is the two children that died so close together and left me with the one about what I wished I’d had done and it gets to me, sometimes. And that’s really depressing.” http://www.sciencedirect.com/science/article/pii/S0890406510000435
Within this community (and other communities where poverty and marginalization take place) the environment is so harsh and hopeless that it is difficult for privileged individuals to conceptualize.
Self-care is an important part of self-esteem and emotional well-being. There is little time, money or energy for this in the Black woman’s schedule. Self-deprivation is sad and demeaning . The following quote is one that we need to hear:
“And I think another reason why people get depressed in my opinion, is we neglect ourselves. Particularly black people, black women. We don’t have any good men to rely on. We’ve had children too early in life. And we neglect ourselves. We’re so busy doin’ for and trying to do the things that we should do and make up for it, we don’t take the time to get our hair done, go to the spa, go get a facial, get a pedicure, ya know.” http://www.sciencedirect.com/science/article/pii/S0890406510000435
Living a life of deprivation and abuse that has been endured for generations is what is being described and the chemical imbalance theory simply does nothing to explain the sadness and hopelessness of these lives.
In an environment filled with the sounds of sirens, cries, gun shots and the deafening sounds of silence when someone is being abused in secret, we hear that the medical model is another form of oppression. To be informed that you have a chronic brain-based illness is just another degrading experience.
The symptoms of depression are well known to African Americans and they view these symptoms in the context of their difficult lives. They are not denying or ignoring their symptoms.
In one of the studies that used a mixed focus group to question African Americans on their perceptions of depression, their use of mental health resources and their traditions, it was made clear that the individuals are very aware of the symptoms.
They identify the following: sadness, being tired and having little energy, irritability and weight loss or gain. Many described headache and body pains and others pointed to increased cravings for drugs or alcohol.
Those interviewed believed that these symptoms were to be expected because of their difficult lifestyle.
They pointed to the specific causes of their depression as being relationship-based and attributed to problems with partners, children, grandchildren and friends. The issues that made them feel depressed were deaths through murder, drug overdose and deaths of young children.
How does one cope with depression given an environment that entraps one in despair and deprivation?
The answers from those who were interviewed were strong and clear. They reach out to family and they depend upon their religious institutions to give them strength, care and comfort. The importance of intimate relationships with others and with God was the dominant theme.
A significant number of individuals pray during the day, with friends and in their churches and they ask for strength and for help for their friends and family Many of these individuals also noted that they stay busy and this gives them a sense of being in control of the situation.
Black Americans, as per this study, say that they have experienced the pain of depression for a long time. African Americans have developed their coping strategies based upon their experiences with racism and discrimination, the stigma associated with mental illness, interactions with a culturally insensitive mental health system and their cultural traditions regarding mental health.
We can learn much from the lived experiences of African Americans in our society.
- We can appreciate how they view the majority population and that insight leads to self-evaluation and an opportunity to connect with them differently. Perhaps in relating to an African American individual, we can ask about their family, their spiritual foundation and where they get their strengths.
- We can empathize with the difficulties in their lives.
- We can learn why they avoid the mental health system and put more effort into building trust. We can be consistent with them and not promise what we cannot deliver.
- We can confirm their own views and acknowledge that the system is insensitive and ask what would make it better for them. We can find alternatives to medication and research ways to provide counseling with people with whom they can relate.
- We can learn about the importance of intimate caring relationships to strengthen and support the resilience of people in states of emotional pain.
Depressed man photo available from Shutterstock