Mental Health Stigma in African American Communities

By: Suzanna Chen

“As scared as black folks are of cops, we’re even more scared of therapy.”

- CNN host Van Jones during an interview with the music icon Jay-Z, 2018

Recently, it has been brought to our attention the horror of racial prejudice motivated police brutality against the Black communities. Even though everyone experiences some form of discrimination at some point in their lives – such as the frequent occurrences of sexism and body-shaming - African Americans experience the most discrimination in quantity and severity, with Hispanic Americans and Asian Americans closely follow them (Chao et al., 2012).

The overt racism present in the recent broadcasted tragedies is alarming and disheartening, even for people who are not directly impacted by it. Personally, the spiraling thoughts resulted from the news stories had been so overwhelming that seeking professional help had been necessary. My experiences had led me to wonder if the people directly impacted by the tragedies had been getting the psychiatric assistance they might need – since racism is associated with numerous psychological consequences, including depression, anxiety, substance use disorders, and post-traumatic stress disorder (PTSD), according to Sandra L. Shullman, Ph.D., president of the American Psychological Association (APA).

It came as a surprise that despite the similar mental illness ratios between racial groups, only about 30% of African American adults received professional mental health treatment compared to the American average of 43%. One may have automatically assumed that the significantly lower treatment rate is due to racial discrimination and perhaps the unideal socioeconomic situation in the Black communities. However, an equally crucial yet lesser-known obstacle for African Americans to receive treatment is the deep-rooted stigma surrounding psychological illnesses in their communities.

Mental health and illnesses are stigmatized to varying degrees in every ethnic and racial community around the world. Some of the factors worsening our instinctive avoidance towards this topic include the hyperbolic portrayals of mental illness is media and wide-spread horrific myths regarding psychiatric treatment.

According to a 2008 study by Alvidrez et al., it was found that even among the Black participants who were already diagnosed with a mental condition, over a third still feels that “mild” disorders – such as depression and anxiety – would be considered “crazy” in their friend circles. Moreover, about a quarter of them would consider mental health an inappropriate topic even in discussions with family members. It is almost unimaginable for them to consider sharing their struggles with a therapist, which they compared to as airing their “dirty laundry” in front of a stranger. Under this scrutinizing view of psychological disorders, we have witnessed many tragic cases where one could have drastically benefited from professional help yet refused to accept it.

Many factors adversely influence the long-standing stigma within the Black communities.

One of the reasons behind this profoundly negative view of mental illnesses is their frequent association with weakness. In a research conducted by African American psychologist Monnica T. Williams, she shared that even among her patients whom she deemed “deeply impaired”, many still avoid professional assistance because they did not want to be one of “those people".

The relation between psychological illnesses and weakness is especially impactful for Black men, as a demanding expectation of masculinity had been imposed upon them. Hafeez Baoku – author, director, and host of The Roommates Podcast – has described his experiences with the stigma with the words “Black men grow up in a culture that tells us ‘men are not supposed to cry,’ that we ‘should deal with problems on our own.’” This stereotypical view enforces the idea that males would be labeled as “less than a man” once admitting their struggles with mental health. Furthermore, it spreads the messages that living with a mental condition is a shameful personal secret; and speaking out or actively seeking help would be equivalent to an outward admission of personal and family failures – as it demonstrated that one’s “problems” cannot be handled internally. So, out of fear for these negative labels, many members of the Black communities – with a majority of men – resort to self-medication methods, including usages of drugs, alcohol, and social isolation. These attempts at “fixing” problems only lead to increased rates of substance use disorders and worsening of mood disorders’ symptoms.

Another factor of influence on the stigma is the negative experiences of Black patients in psychiatric treatments. Perhaps due to the disbelief in the mere idea of “mental illness” in Black communities, only 2 percent of the psychiatrists in the American Psychiatry Association – the nation’s and World’s largest platform of mental health professionals – are identified as African Americans. This factor has a tremendous impact on the efficiency of therapies, as they require high levels of interpersonal communications and cultural knowledge. For example, many African Americans would, unfortunately, suffer from PTSD due to racism-induced trauma, which, for therapists not familiar with its impact on their minority patients, might not be a topic of importance in treatment. The neglect of treatment specifically addressing such trauma might result in poor therapeutic results of the Black clients, further adding to their distrust towards the legitimacy of mental health treatment. Moreover, the lack of cultural understanding also results in high rates of misdiagnosis for African American patients. According to the National Alliance on Mental Illness (NAMI), African American women are likely to experience physical symptoms – such as body aches and pains – along with mental health conditions. Descriptions of such symptoms might not alert a mental health professional who is not familiar with their minority clients' situation, leading to missed opportunities for possible early intervention. Similarly, according to a 2019 study by Rutgers University, mental health evaluators’ lack of knowledge makes them likely to misunderstand Black male patients’ symptoms of mood disorders and PTSD as symptoms of schizophrenia and other psychotic disorders; resulting in non-Hispanic Black men being five times more likely to be diagnosed with these disorders than non-Hispanic white males. Being misdiagnosed and ineffectively treated increase the already resentful and doubtful attitudes of African Americans towards mental health treatment, which constitutes parts of the stigma. Fortunately, as issues in the treatment processes are increasingly recognized, professionals on the field are suggesting reformations including the re-assessment of professional practices to incorporate core values of Black culture; familiarization of clinicians with the living conditions of Black patients in their communities; and increased research on the unique causes of mental health issues for Black Americans, such as traumatic experiences of racism. With these efforts being made, we will hopefully see positive changes in Black patients' therapeutic relationships and reduced negative attitudes towards psychiatric treatment.

Lastly, perhaps the most essential factor – affecting all people regardless of nationality and race – is the lack of education and awareness of mental illnesses. Without knowledge on this topic, mental distress will continue to be ignored and not recognized as diagnosable and treatable illnesses. We will continue to hear stories of people struggling, and possibly losing their battles, with these psychological disorders. Fortunately, with increasingly active advocacy from courageous mental illness survivors – “recovery soldiers” as many like to call them – the stigma is much less impactful in our current society than before. However, there is still an unfortunate lack of these voices in the African American communities; therefore, leading to the negative stereotypes being broadly influential. We need to raise our voices to spread the knowledge that it is okay to not be okay, it is okay to receive therapy, and it is okay to medicate.

Above includes some factors that impact the deep-rooted mental health stigma in the African American communities, including the wrongful association of mental conditions with weakness, the negative experience of Black patients in therapy and the resentment it causes, as well as the universal lack of education and awareness on these invisible illnesses. Of course, there are many more not listed – such as the impact of Black cultural and religious beliefs and the unconscious racial biases of mental health professionals on stigma. However, the matter of most importance is that once we have recognized the causes and consequences of this unreasonable stigma, we must work on removing it from people’s minds. In 2018 alone, there had been about 6.8 million Black Americans who have a diagnosable mental illness, according to the National Institute of Mental Health. It is time that we speak up, reach out for help, and offer help to those in need. Despite the time and effort it will take for us to shatter the long-standing stigma, a future generation growing up without emotional barriers to accessing professional mental health resources - that can help them live with a healthy mind - is worth fighting for.

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Mental Health Stigma in African American Communities

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