Photo by Vlad Tchompalov on Unsplash
Over the last few posts, my writing has evolved into focusing on underserved populations. People of color have long been an underserved population in mental health. The last couple years in American society has been filled with racial issues which affects the African American community in many different ways. Focusing on underserved populations allow clinicians to consider ways that we can provide outreach to these groups to help them to receive the help they need. Mental health and substance abuse has clearly become pop culture trends at the moment as any and everyone is now talking about these issues. For clinicians, it is our duty to support underserved populations, especially when the trends have faded.
Mental Health and the Black Community
Mental Health America (MHA) reports that approximately 20% of Black Americans are more likely to report serious psychological distress than adult whites. MHA also reports that Black teenagers are more likely to attempt suicide than white teenagers but are less likely to die from suicide than white teenagers. Additionally, Black Americans are more likely to be victims of serious violent crime than are non-Hispanic whites which makes them more likely to meet the criteria for post-traumatic stress disorder (PTSD).
Within these statistics, there are a lot of in-group differences. Black Americans are comprised of many different cultural backgrounds which influence attitudes and beliefs about mental health which are not always accounted for in these statistics. The black community may experience feelings of lack of representation, lack of connectedness to therapists, distrust, conflict between the relationship between therapy and faith/spirituality, misunderstanding or misinformation about the process of therapy, worry about the power dynamics in the therapeutic relationship, shame at being diagnosed with a mental illness, shame regarding personal strength and values, clash of cultural values, mistrust of the field of mental health as another form of control due to diagnosis (especially when medication is included in treatment), concern regarding the quality of care compared to other racial/cultural groups, and financial worries about the access to and level of care.
For clinicians working with members of the black community, it is important to recognize the depth of feelings regarding mental health. The black culture is extremely proud of the knowledge that the race survived one of the most heinous acts of mankind. The black community is proud of the knowledge that not only did the race just survive, but the culture found a way to thrive and grow against all the odds. Mental health represents an area that is similar in the sense of the lack of control over the circumstances and the illness that people of color face. Mental health represents an unknown variable that for many people, the effects are minimized and so previous coping mechanisms are utilized to battle this unknown variable. And of course, the previous coping mechanisms can either be maladaptive or ill-equipped to manage the mental health symptoms.
Many people may view slavery as being very much in the past. However, for the black community, the history of slavery is still very much rooted in the culture and the minds of Black Americans. Residual effects of slavery are still very present, not just in the form of racism towards Black Americans, but for some Black Americans, it affects the way they experience people who are white, privileges of the dominant culture, and sometimes, anger and loathing towards themselves and the black community. There are so many underlying effects of slavery and racism that people of color deal with daily, it is important recognize how the value of strength manifests itself in people of color. Therefore, appearing weak is extremely difficult for many people of color to handle. Unfortunately, the amount of work that it takes to be strong all the time, eventually takes a mental toll.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not list racial trauma or race-based stress as a disorder or mental illness. Racial trauma or race-based stress comes from dealing with racial harassment, racial violence, or institutional racism. It is often compared to post-traumatic stress disorder (PTSD) as the symptoms are similar with irritability, hypervigilance, and depression. This is not to say that every person of color that deals with racial issues will develop racial trauma or race-based stress. The lack of recognition of the trauma that people of color suffer from in this country is highlighted by the lack of recognition in the DSM-5.
Sherri Williams, Ph.D noted in her article that after the shooting of Michael Brown in Ferguson, Missouri in August 2014, many of the residents in Ferguson experienced trauma and mental distress per the study published in the Journal of Traumatic Stress. The problem that many communities such as Ferguson deal with is that after traumatic incidents, the resources are very limited to assist the residents to cope with the psychological impacts of these events. Additionally, without official recognition in the DSM-5, many counselors do not view events such as Ferguson as triggers for the general population. Even if there was a diagnosis in the DSM-5, some counselors may still discount these events if clients did not reside in these areas.
Dr. Williams also talked about her personal struggles with race in her article, she noted some questions that many people of color are faced with when dealing with possible mental health issues. If people of color already face so many deficits, why add another stigmatized identity to the list? Why offer another reason for the world to doubt one’s value and place in the world? So many people stay quiet and suffer in silence because of rationalizations such as these. Black Americans are triggered by so many social events, but are unsure of who to talk about these events and may even question if they should seek help. So, for many people, faith is the only place they may seek help; whether through pastors and ministers or through their relationship with God. I have worked with clients who feel as if they are betraying their faith in God by seeking therapy. It is extremely important that as clinicians we do not reduce these feelings or dismiss them because they have grave impact on the clients’ experience of and progress in therapy. It is essential that clinicians recognize how deeply ingrained spirituality and the value of strength is embedded in black culture and the DNA of the black community.
For many African Americans, suffering in silence may seem normal because of the long history of segregation and isolation. Additionally, because of cultural stereotypes, many people of color view psychotherapy as something that only the dominant culture uses. It is also important to remember that many people in the black community are distrustful of the medical profession due to past issues such as the Tuskegee experiment. To facilitate and encourage the black community to seek help, outreach has to be done to build bridges to mend these past hurts and to demonstrate the importance of seeking professional help for mental illness.
Lastly, many clinicians also discount the daily microaggressions that African Americans deal with, such as being followed in stores, lack of police presence in inner city areas, excessive police aggression in inner city areas, social media messages, workplace aggression by superiors, and so on. Clinicians often overlook the damage that microaggressions such as these cause to self-esteem and self-worth, not to mention the emotional experiences that people of color go through from the constant triggers they experience. Dr. Williams also talked about her own personal experience with a white clinician who could not grasp her experience as a black woman. This is why terms such as intersectionality were created to help clinical professions understand the personal experiences of people of color. As counselors, we all know the importance of having clients share their experiences without judgement. We want to encourage these experiences so that people of color will be willing to seek the help they need to treat racial trauma.
Charmaine Perry is a counselor who works mostly with adults and couples in central New Jersey. Her passion is mental health and writing and finding ways to incorporate these two fields to advocate for mental health services for African and Caribbean Americans.