Recognizing Depression and Suicide Risk in Black Men

Health advocates say warning signs that lead to suicide often go unnoticed — particularly among young men of color. Guest host Tony Cox discusses the issue with Dr. Alvin Poussaint of Harvard Medical School and with John Head, author of Standing in the Shadows: Understanding and Overcoming Depression in Black Men.

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TONY COX, host:

From NPR News, this is NEWS & NOTES. I'm Tony Cox. Ed Gordon is on vacation.

Authorities are trying to find out why a teen-ager whose father is one of the most respected coaches in the National Football League would take his own life. Eighteen-year-old James Dungy was found dead in his apartment just outside Tampa, Florida, last Thursday. His funeral is today. His father, Tony Dungy, coaches the Indianapolis Colts. A preliminary medical examiner's report confirms Dungy committed suicide, but the exact cause of death will not be determined for four to six weeks pending toxicology findings. The second oldest son of the NFL coach had been involuntarily admitted to a hospital in October after taking an overdose of painkillers, and at the time he reportedly told a sheriff's deputy he was depressed.

Health advocates say such a tragedy as this helps underscore a significant fact, mainly that warning signs that lead to suicide often go unnoticed, particularly among young men of color. Today then we take a closer look at why that seems to keep happening and what if anything can be done to change this downward spiral that claims too many lives each year. Dr. Alvin Poussaint is a psychiatry professor at Harvard Medical School and a national director of KidsPeace, a national children's crisis charity that helps young people overcome life-threatening traumas and personal crisis. He joins us from Philadelphia today.

Doctor, nice to have you on.

Dr. ALVIN POUSSAINT (Harvard Medical School): Good to be here. I'm in Boston actually, not Philadelphia today.

COX: Well, we'll move you up the coast just a little bit. Also on the line is John Head, a former mental health reporter and author of the book "Standing In The Shadows: Understanding and Overcoming Depression in Black Men." John has personal experiences that may help shed light on the subject, and he joins us now.

I hope you are in San Francisco. Are you, John?

Mr. JOHN HEAD (Author, "Standing In The Shadows"): Yes, I am.

COX: OK. We've got that one right. Let me ask both of you to chime in on this. I want to start with you first, Dr. Poussaint. What strikes you about this suicide? Are there signs that were missed?--because there seems to have been two faces to this young man. On one side, happy and polite, and on the other side, deeply troubled beneath the surface.

Dr. POUSSAINT: Well, it's hard to speak about it directly. I think apparently there was one suicide attempt, which is a clear sign that he's suicidal and likely very, very, very depressed. I don't know what happened after that. But when it gets to the point of attempted suicide, usually a person has been suffering from depression of some type for quite a while. I think the problem is that often people don't recognize--that is people from the outside don't recognize that the person is direct--and particularly sometimes with African-American men is there's notion that because of their machismo or they're macho or they're tough and so on that they can't be suicidal to the point that a lot of people believe that African-Americans in general and particularly African-American youth and men don't commit suicide and even believe that it's black women who commit suicide more frequently. And that is absolutely the reverse with black men committing suicide, at least about four times to five times the rate of black women. In...

COX: Let me ask John to join in.

Dr. POUSSAINT: Yeah.

COX: John, do you think that there is a tipping point? Was there something that could have signaled that young Dungy was in danger or was about to take his own life?

Mr. HEAD: Well, I agree with Dr. Poussaint that the first attempt is a definite indicator and should be taken very seriously, but we really need to know more about suicide and particularly in the black community because there's not a whole lot of work on it. In fact, Dr. Poussaint's book, "Lay My Burden Down," is the only thing out there that really takes a close look at this, and it's a groundbreaking book. It really needs to be read. We need to have a conversation in the black community about this issue, and his book would be an excellent place to start.

COX: You know, one of the things that I discovered in doing some research for our discussion today was that there is an equal percentage of black and white males who suffer from depression which is certainly one of the underlying causes of suicide but blacks because--according to this report at least, we are more uninsured, we are therefore more often untreated and that leads to a higher rate of suicide. Dr. Poussaint, speak to that please.

Dr. POUSSAINT: Well, whites have a higher rate. White men have a much higher rate than black men, almost two to one, but I think it is true that a lot of black people don't have access to a lot of mental health care and also there hasn't been enough outreach to the black community about the availability of health care and the education about what mental health is and what depression is all about and other kinds of mental disorders. So there's a great deal of disparity in the way the black community has been approached by the mental health-care system.

Some of it has been attitudes ingrained in the black community. For instance, many still feel that while depression is really not an illness or depression is really a sign of weakness, so they tend not to seek help. But sometimes when they do, think that the mental health workers, psychiatrists, psychologists, social workers, need to be more attuned and realize that depression occurs in blacks. Frequently it's overlooked or sometimes the workers are culturally insensitive to what black people are trying to say to them and don't listen with a keen ear for all the indications that the person might be depressed and are showing some of the signs and symptoms.

One thing in the black community and some other racial groups, too, often blacks will express their depression through bodily symptoms; that is, headaches, stomach aches, pain and so on. That's a presenting symptom, but really what they're talking about is, `I'm feeling depressed. And I'm feeling lousy. And my body feels lousy,' but because of the stigma about mental illness, they are not as likely to say, `I'm having a mental problem and I'm depressed. They may complain about physical symptoms as a way of minimizing the feeling of stigma.

COX: Let me bring John in on that because, John, we know that you had personal experiences in this area. And briefly I'd like for you to--without going into detail about what caused your depression necessary, how were you able to come through it?

Mr. HEAD: Well, I actually went through, looking back, more than 20 years of untreated clinical depression and had cycles of being up at a normal level and then down in the depths. And as time went by without treatment, those cycles and the depths got to be longer and longer. And I finally reached the point where I felt the only way to end that cycle was suicide. And I actually went through what I consider to be a dress rehearsal for suicide, taking all the steps except for the final step. And for--I stepped away and didn't do it, but I really was at that point where I thought that that was the only way that I was going to get any relief from the pain I was going through. And a large part of it was simply not being able to talk about what I was going through and, and what I talk about, not having the cultural vocabulary to even put into words what I was feeling.

COX: Well, John, what made you at that moment, the moment of truth, if I can put it in those terms, stop?

Mr. HEAD: Well, I think what made me stop is that I thought about my three sons and I grew up without a father in the home. And I thought about how much worse it would be for them not only to grow up without me but to grow up with me having left them the way I was planning to leave them and to put that burden on them, to have them perhaps even thinking that they were a cause of what happened. And so I definitely did not want that to happen. That's went I decided I really had to get help not only for myself but for my family.

COX: Dr. Poussaint, let me ask you this. Are there class differences in terms of those who suffer depression or is that even relevant?

Dr. POUSSAINT: Well, I think it's relevant if you realize that poverty puts a big burden on people in every way, socially, economically, just strains, the neighborhoods they live. I would render a guess, although it has been, you know, documented entirely, that poor people suffer much more depression than probably middle-class people as a group; that is, they're under more stress and they suffer more trauma. And frequently a lot of trauma and stress can induce depression, but it's also very clear that people across the social economic level whether they are rich or in between or poor suffer depression and can commit suicide because of that depression.

COX: You know, John, you mentioned in your attempt--it wasn't an attempted suicide; it was a considered suicide. Let's put it that way--that it was some 20 years ago. And I want to find out how old you were at that time because the research suggests that the age range from 15 to 24 for black males as particularly the most dire time when they are subject to this. How old were you when that happened?

Mr. HEAD: Well, actually what I said was that I went through more than 20 years of untreated depression...

COX: Oh, OK.

Mr. HEAD: ...but the attempt was actually about 10 years ago and I was 45 at that point. And, you know, it took me that long I think to get to the point where I really felt completely hopeless and didn't think there was any way to find a cure for what I was going through.

COX: Do you have sons who are now in that danger age range?

Mr. HEAD: I do. And I have spoken with them and I speak with them and I try to get them to speak with me if there are things that are troubling. And what I worry about in that age group is, you know, the idea that some people in that age group have that life really doesn't have any value, not only their lives but the lives of others. And, you know, that's something that we really have to fight again and, you know, get that idea out of their heads of our young people, especially our young men.

COX: Let's talk as we bring this to a close, Dr. Poussaint--we have less than a minute to go--let's look at some solutions we can offer. We've sort of outlined what the issues are, the problems are, but what can we do about it?

Dr. POUSSAINT: Well, I think that we have to educate the black community and by that I mean the institutions in the black community, particularly hospitals and clinics but also including the church, about what the signs of depression are and to help to eradicate the feeling of stigma; that is, we have to encourage people not only to seek help from professionals but also to talk about these things within the family, within the community and that people should understand that when they are having mental health issues, that they should talk and people should be open to listening to them. And they shouldn't be judgmental or they shouldn't deny their problems or say, `Snap out of it.' They should listen and be supportive...

COX: All right.

Dr. POUSSAINT: ...and even encourage that person to get help.

COX: That's a good place for us to stop. Also I'd like to mention that I know that you have in conjunction with KidsPeace, a Web site that people can go to get...

Dr. POUSSAINT: That's right. It's...

COX: ...some--TeenCentral.net. I wanted to make reference to it.

Dr. POUSSAINT: TeenCentral.net.

COX: Dot-net.

Dr. POUSSAINT: Teen-agers can go there with...

COX: OK. We've got to...

Dr. POUSSAINT: ...all sorts of problems where they can get information on help.

COX: All right. We've got to run out. Dr. Poussaint, thank you very much, psychiatry professor at Harvard Medical School and national director of KidsPeace, and John Head, author of the book "Standing In The Shadows: Understanding and Overcoming Depression in Black Men."

Gentlemen, thank you very much.

Mr. HEAD: Thank you.

Dr. POUSSAINT: Thank you.

COX: This is NPR News.

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