Severe Disorders
Bipolarism is a severe mental health disorder involving episodes of mania (emotional ranges of extreme highs and lows, and energetic restlessness) and depression. The prevalence of bipolar disorder in African-Americans is the same as with other racial groups, but due to a lack of reporting, African-Americans suffer more because they are provided services at a later stage (Ourselves Black). This is true for other illnesses as well, such as depression in which African-Americans report more severe symptoms than White populations due to late intervention. Various cultural stigmas from systemic racism contribute to the reduced rate of mental health service seeking in African-Americans. When it comes to bipolarism, another treatment barrier for Black populations the misdiagnosis of bipolarism as schizophrenia. Blacks are misdiagnosed with schizophrenia more than other racial groups due to biases about social deviancy, education level and differential access to mental health care (Schwartz and Blankenship 2014).
Historically, the start of the disproportionate association of Black people, and Black men especially, with schizophrenia occurred during the 1960s and had links to the Civil Rights Movement. In his book, The Protest Psychosis: How Schizophrenia Became a Black Diseaseopens in new window, psychiatrist and sociologist Jonathan Metzl writes about how the activism and charged racial climate of the late 1960s led to the change of language used to determine paranoid schizophrenia in the DSM's (Diagnostic Statistical Manual) second edition. The initial language stated that schizophrenia was a reaction to events that cause a splitting of the personality in generally calm people who outside of the split present normal behavior. This definition was easily applied to White housewives or White men who committed crimes. However, in 1968, schizophrenia became a defined as aggressive hostile behavior that is consistent with delusions. Metlz claims that the perpetuation of consistent, naturally hostile, and aggressive behavior referred to Black activist who were perceived as hostile toward police and paranoid of police, when they were in fact working to bring racial equality to their community through the right to protest.
Societal Treatment Barriers
Historical and societal stereotypes centered around Black people's perceived strength has caused treatment barriers by creating cultural stigmas that have led Black people to seek mental health services less than White populations. For many Black women the “Strong Black Women” schema, by promoting the idea that Black woman “be psychologically durable yet do not engage in behaviors that preserve psychological durability” (Watson and Hunter, 2016), has caused mental health issues for Black women through suppression of emotions, and deterred many of them from seeking care. For Black men, the need to be “tough” and the stereotype of criminality often deter Black men from seeking services. Due to the underutilization of mental health resources and the stigmas that associate shame in asking for help, many African-Americans lack the adequate mental health literacy to explain what is happening. Dr. William Lawson of Howard University Hospital's Psychiatry Department shared that Black patients are more likely to “use culturally-specific terms like ‘falling out' or ‘having too much tension,' instead of saying they are sad or unhappy.” (Ourselves Black, 2018). This language illustrates the need for cultural competency when dealing with African-American clients.
Another reason why cultural competency requires more attention, is the fact that among many African-Americans is a mistrust of mental health professionals and doctors. Historical mistreatment through unethical abuse and testing of African Americans in cases such the Tuskegee Syphilis Experiment, and the current stereotypical biases toward Black people, keep many African-Americans who do have mental health literacy from seeking care. In OEMA, we strive to increase the number of psychologists of color and provide platforms that support culturally competent research such as CEMRAT2, the Commission on Ethnic Minority Recruitment, Retention and Training in Psychology Task Force.
Vicarious Stress
Due to police brutality and other race related stressors, Black populations face high levels of vicarious stress. Vicarious race related stress occurs when the impact of discrimination is felt at a communal level, causing people of color to fear that certain racist incidents that happened to other Black people may happen to them as well. In a 2018 studyopens in new window, researchers found that Black people feel stress due to police killings so much so that causes them to take off an estimated additional 1-7 mental health days off from work (Bar et al, 2018).
Proactively Fighting the Mental Health Stigma
2018 was a record year for mental health innovation among African Americans. Black psychiatrist, Dr. Jessica Clemons launched @askjessopens in new window, an Instagram page aimed at the alleviating the mental health stigma in Black communities through a weekly podcast, mental health tips and anecdotes, and by providing followers with a safe space to ask questions about mental health. Two Georgia siblings developed and app called "notOk"opens in new window , which allows people to quickly send alerts with GPS locations to loved ones when they are feeling physically or mentally unwell. Kevin Dedner, a public health advocate, created a mental health app for Black men in the Washington, DC area called Henry Healthopens in new window. The app allows participants to take a mental health assessment and be paired with a mental health professional that meets their needs. Despite the mental health disparities that African-Americans face, these innovations indicate that awareness is spreading, and the future is bright when it comes to overcoming cultural mental health stigmas in the African-American community.