May 27, 2017
I sat on the floor in the bedroom and thought long and hard about it. How could I affix that belt to the door and wrap it around my neck to take my life? I was overwhelmed with sadness and guilt and I wanted it to end. I also thought it would be easier for everyone if I wasn’t here.
My single mother had three kids, but our landlord said she could only have two children living in the apartment. She accepted the terms; the alternative was homelessness. Our story was that my twin brothers officially lived with my mother but I lived with a relative, and if anyone saw me on the property we were to say that I was just visiting so my mother wouldn’t get evicted.
I felt like I had to hide myself, not be seen. I tried to take up as little space as possible until I felt incredibly small, worthless. But the fact is I was visible. I was taking up space, eating food, needing clothes, needing resources that our family really did not have.
I knew how hard it was for my mother to find low-income housing. I knew how hard it was for her to keep three constantly growing kids clothed and fed. And I knew how hard it was to keep feeling the shame of living in poverty and the sorrow of feeling like a burden on my family. Since I was the one who wasn’t supposed to live in the apartment, I thought it would be best if I didn’t live at all. So I seriously thought about ending my life. I was 8 years old.
Depression has been a constant part of my life since then. A lot of people don’t know that. Like most black people it’s not something I talk about openly with everyone. I’m already black, a woman, and overweight. Why add another stigmatized identity? Why give people another reason to doubt my capability? Why threaten my professional reputation? Why be vulnerable? As a community, some of us either suffer in silence or keep our mental health issues between us and the Lord.
But our silence is killing us. Health disparities that include higher rates of some cancers, diabetes, hypertension, obesity, and other serious illnesses among African-Americans lead to premature deaths. Physical conditions can often be related to untreated mental health issues.
Race and racism both play a significant role in black people’s vulnerability to mental health distress and our reluctance to seek treatment, Kevin Washington, Ph.D., president of the Association of Black Psychologists, tells SELF. “Racism and our response to it kills us more than anything."
The Psychological Scars of Racism
In the days after the shooting of Michael Brown, an unarmed black teenager, by a white police officer in Ferguson, Missouri, in August 2014, the St. Louis suburb erupted in protests. Demonstrators and police clashed. Military tanks rumbled down streets. Even after the war zone atmosphere subsided, people were left reeling. St. Louis clinical psychologist Marva Robinson, Psy.D., helped provide mental health services for the black residents of Ferguson in the wake of the events. She tells SELF that she witnessed a community that was “traumatized, devastated, torn apart, and left without the appropriate resources to help it rebuild.”
Many of the residents in Ferguson experienced trauma and mental distress, according to a 2016 study published in the Journal of Traumatic Stress. Black residents of Ferguson who participated in the study had significantly higher rates of post-traumatic stress disorder and depression than white residents in the months after protests.
The tragedy in Ferguson—and the psychological toll it took on people there—was at once an extreme example and a microcosm of the damaging effects of institutionalized racism in this country. The same conditions that are present there exist across the nation, Robinson says, and this race-based trauma that black people often encounter leaves them susceptible to mental health conditions and in need of treatment.
Black people are 10 percent more likely to report serious psychological distress than non-Hispanic whites, according to the U.S. Department of Health and Human Services Office of Minority Health. People who experience racial microaggressions—insults, invalidations, and interpersonal slights (subtle and often unintentional)—are more likely to show symptoms of anxiety and depression, according to a 2014 Journal of Counseling & Development study. Research demonstrates that racism can adversely affect mental health in direct and indirect ways. It can inflict psychological trauma, create unfavorable socioeconomic conditions that increase the risk of psychiatric disorders by as much as threefold, and lead to negative feelings of self-worth and wellbeing.
“Every day you are struggling against a known traumatic event called racism,” Robinson says. “At every turn you’re reminded that you are a second-class citizen and you don’t have access to things that you should. That’s damaging to the psyche."
Going It Alone
Even facing a heightened risk of mental health issues, many of us don't seek treatment. Research shows that as many as two thirds of people with depression don't get treated, and that black people are less likely to get treatment than non-Hispanic whites.
“There’s a history of being denigrated or dehumanized and not wanting to have one more thing be wrong,” Washington says. Mental health doesn’t top the priorities list. “We don’t have time to be sad or depressed because we have too many things we have to deal with right now.”
Washington notes that many black people may expend a lot of energy using "high-effort" coping strategies to deal with the prolonged psychosocial stress imposed by racial discrimination—a behavioral predisposition called John Henryism. (The name comes from the story of an African-American folk hero from the 1800s who bested a machine in a steel-driving contest but died immediately after due to overexertion.) Studies show a link between this kind of active coping strategy and high blood pressure.
John Henryism is often applied to black men, but women are not immune to the fallout from constantly fighting oppression and inequality. Centuries-old archetypes project black women as having bodies and nerves of steel and make it unacceptable to show vulnerability. The strong black woman stereotype, historically used to justify abusing and oppressing black women, now calls for them to be impenetrable, twice as good as their white counterparts, and to never appear fragile. That’s a luxury black people feel they cannot afford in a world that already perceives them negatively.
These notions of strength and weakness extend into perceptions of mental health and treatment thereof. Some black people see therapy as a “white thing,” says Monica A. Coleman, Ph.D., a professor of constructive theology and African-American religions at the Claremont School of Theology who has written two books about her experiences with depression. White people can afford to be human, be vulnerable, seek mental health care; black people can’t.
“I think there is also the stigma that’s tied to our relationship with the medical industry,” Coleman tells SELF. “The ways in which we’ve been abused by medical systems, not trusting them with our bodies with good reasons—forced sterilizations, the Tuskegee experiment.”
Robinson agrees: "There’s always been this history of teaching us where our place is and where it isn’t. So you are born out of a legacy of trauma—historical trauma—and in the current day you still experience it. It only makes for individuals to be distrustful of larger institutions.”
But by not seeking help when mental health issues arise, she says, African-Americans often do not get treatment until they are in dire need. “We tend to stuff things down, hold it within, and keep moving forward until something happens and a person has an acute crisis and they’re forced to have an interaction with an institution because of some sort of a psychiatric break." Black people are less likely than white people to receive medication or outpatient counseling for major depression and more likely to end up in the emergency room.
Church and Therapy
For many black people, the church is where they turn for mental and emotional relief. That can be good but also problematic, says Coleman, author of Bipolar Faith: A Black Woman's Journey With Depression and Faith. She says that charismatic worship, holy dancing, and spirituals can be useful resources for African-Americans to manage stress. “Being able to express how you feel is a great form of self-care.” Being connected to a congregation can also give a person a sense of community, ritual, discipline, and routine, things that support health and wellbeing. “Studies show that having faith is good for your health," she says. "People who have faith and pray and have some sense of a greater power tend to heal faster and feel better.”
But black people’s dependence on the church only for mental wellness can be problematic. “So many people take their problems to their clergy first,” Coleman says. “The average clergy person is ill-equipped to deal with most of the stuff that comes to us.”
She adds that sometimes messages about mental health and spirituality clash. Some traditions hold that "if you’re not well or great or happy it’s because of a lack of faith, [or] because you haven’t prayed right, because you haven’t given right,” she says. “Those kinds of things negate the experiences that people have around mental health.”
Faith leaders can help their black parishioners by not stigmatizing mental health conditions and by being connected to mental health professionals and providing referrals, Coleman says. In turn, mental health professionals must also understand the ways in which black people’s spiritual connections are linked to their culture, Washington says. Incorporating faith traditions into mental health care can lead to better outcomes for patients.
But finding a therapist can be hard. African-Americans living in medically underserved communities may encounter a dearth of qualified professionals, often compounded by limitations due to health insurance or lack thereof. And there are less obvious challenges, too, Washington warns, like the insidious seeping of racism into patient care. Robinson concurs, adding that some of the unconscious bias that mental health professionals possess makes it difficult to find a clinician equipped to deal with black people’s unique experiences.
The first time I went to see a counselor, in my 20s as an undergraduate, I was referred to a white female clinician who was in her 50s. When we talked about one of the things that bothered me the most—the racism and sexual harassment that I experienced on my job—she asked me if I was sure people were disrespectful and unprofessional toward me because I’m a black woman. Maybe, she suggested, it was just my “attitude.” I’ve only seen black women therapists since then.
If finding a therapist is hard, finding a black mental health professional can feel impossible. African-American psychologists made up just 5.3 percent of the active psychology workforce in 2013, according to the American Psychological Association. Noting that "black clients are more likely to continue therapy beyond the first few sessions when seeing a black therapist," and that until recently, "access to preventive mind health services was limited to the wealthy, usually white middle class," the website africanamericantherapist.com lets people search for black therapists in major cities.
Opening Up to Opening Up
Addressing these hurdles to effective care is imperative—but first black people struggling with mental illness have to admit they need help and go out to seek it. And that often doesn't happen. Washington, along with members of the Association of Black Psychologists, is trying to change that with grassroots initiatives to get trusted leaders in black communities to encourage open, productive dialog about mental health. His barbershop initiative coaches barbers to talk to their clients about mental health. He is also calling on black sororities and fraternities, which have a long history of performing community service for African-Americans, to make psychological wellbeing a focus.
Having more of these open conversations in the black community can help destigmatize mental health issues and seeking treatment, says Jill Harkavy-Friedman, Ph.D., vice president of research at the American Foundation for Suicide Prevention. TV shows and celebrities raising awareness about mental health issues also help to start community conversations, she says. Fox's hit Empire addresses one character's bipolar disorder and his family's complex reaction to it. Last fall, hip-hop artist Kid Cudi wrote publicly on Facebook about the "shame" of struggling with anxiety and depression and checking himself into an inpatient treatment center. In her memoir, released this month, actress Gabourey Sidibe reveals, "When I first told [my mother] I was depressed, she laughed at me. Literally. Not because she’s a terrible person, but because she thought it was a joke. How could I not be able to feel better on my own, like her, like her friends, like normal people?"
“Knowing that there are other people who feel the same way and there are things they can do about it has tremendous impact,” says Harkavy-Friedman, whose foundation consulted on an episode of the BET drama Being Mary Jane in 2015 when a black woman character on the show committed suicide.
For me, seeking mental health services became necessary when the depression became overwhelming. I knew I couldn’t pray it away like my sanctified Grandmama, and I couldn’t ignore it anymore if I really wanted to live beyond the pain. Whether it was the toxic job-related discrimination I faced in my 30s, or the sorrow of losing close loved ones, experiencing a string of disappointments and the stress of going through a doctorate program in my 40s, depression cycled through every decade of my life.
But I’ve worked to manage it and seek help. Most importantly, I started to view caring for my mental health as a revolutionary act, a form of resistance to the forces of oppression that were threatening to extinguish me, a working-class black woman. I come from a legacy of people who fought simply to be and I view my effort to fight my depression as a battle for freedom.