Mental Health in the Black Community

News & Notes kicks off a new series on mental health. We get insight on mental illness and racial disparities in mental health care from Dr. Annelle Primm — director of minority and national affairs for the American Psychiatric Association — and Dr. William Lawson, professor and chairman of the department of psychiatry at Howard University College of Medicine.

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FARAI CHIDEYA, host:

And on a broader level, we're going to ask the question is there a mental health crisis in the black community? If so, what can we do about it? With us, we have Dr. William Lawson. He's a professor and the chairman of the department of psychiatry at Howard University College of Medicine. And Dr. Annelle Primm, she's the director of minority and national affairs for the American Psychiatric Association. Welcome.

Dr. ANNELLE PRIMM: (Director of Minority and National Affairs, American Psychiatric Association): Hi.

Dr. WILLIAM LAWSON (Professor, Chairman of the Department of Psychiatry, Howard University College of Medicine): Thank you.

CHIDEYA: Well Dr. Primm, I'm going to start with you. We just heard this story of reaching rock bottom and then coming up. It's pretty easy to understand that you have a problem if you have made a suicide attempt, but first, let's back up a little bit. What are signs that you may not be functioning well on an emotional and mental-health level? What should people look for in themselves, or even in family members?

Dr. PRIMM: People should look for a change in mood - you know, being sad or irritable or very anxious - a change in how they feel about themselves, having low self-esteem, and a change in their sense of well-bring, changes in sleep, appetite, energy level and so forth - many of the things that Brian Copeland spoke about.

CHIDEYA: I want to as you this first, Dr. Primm, and also Dr. Lawson. How do African-Americans face these challenges in terms of is there a different way due to race or socio-economics or culture that black Americans are walking this road of dealing with mental health than perhaps other communities?

Dr. PRIMM: Well, culture and race definitely play a role. The fact that African-Americans are often looked upon negatively, unfortunately, in our society, owning up to having a mental health need is really a double-whammy and really contributes to the stigma surrounding mental illness.

I think also from a cultural standpoint, the fact that religion and spirituality are so central in the African-American community, people may believe that their mental health issues may represent a failure of faith. They may turn to their clergyperson for help and may not realize that they need to get professional help from a mental health professional.

CHIDEYA: Dr. Lawson, what about both - you know, are people getting the diagnoses they need in the black community, the help that they need, or even willing to go ask for help?

Dr. LAWSON: Well, I think that - you mentioned the term crisis. I'm not sure that there is a crisis. I remember when I was growing up in a rural, predominately African-American community, there were several suicides at my high school. And later on, it was only in medical school that I discovered that black people didn't kill themselves and didn't get depressed.

So a lot of the data that we now have showing this incredible increase in suicide rates for African-American men I think is more that we're much more willing to get in and label it as such.

But despite that, we found that many times, many folks simply do not discuss it, certainly with family or others. And because we haven't had the access to service and because of the stigma, we've developed alternative ways of dealing with these kinds of issues, by either not talking about it - there's a phenomenon that we call John Henryism, where people become compulsive workers to mask feelings of depression, despondency and wanting to do themselves in. And there's many instances in which folks commit what I call slow suicide, the person who drinks themselves to death, the AIDS patient who ceases taking their medication, the individuals who become involved in all kinds of high-risky behavior, such as pulling a toy gun on a policeman in a high-crime area.

These are all suicide attempts, but they wouldn't be labeled as such traditionally.

CHIDEYA: I want to go to something that you mentioned, the increasing rate, at least according to statistics, of suicide among black men. You were essentially saying that a lot of times in the past, that seems to have been covered up. So is there an increasing problem, in your opinion, or is it part of the human condition that's been with us for a while?

Dr. LAWSON: I think it's probably a combination of both. I think overall there's been an increase in depression and suicide in the U.S., but I think that much of the increase in African-American men is a good deal of recognition of labeling suicide. I've just seen too many instances of going to the coroner's office, in one case we had a young man lying there with a bullet hole in his head and a gun in his hand. And the coroner said aha, somebody shot this young man and put a gun in his hand, because black people don't commit suicide.

So I think these kinds of belief systems are a real hindrance in trying to understand some of the true epidemiology of this. And, again, I think that another - this rate is much higher than we think because we have other ways of doing it.

Some of the ways in which we deal with chronic diseases and health conditions, some of the disparities, I think, is a result of folks committing suicide.

CHIDEYA: Dr. Primm, not everybody has the same access to health care. Some of us have different health plans. Some people have no health plan. But then there's also the question of whether the people are using the resources they have. Some people say, well, I'll just talk to my friends, or I'll just go to church. Are those good alternatives to what we consider medical treatment?

Dr. PRIMM: Well, certainly, it is important to have family support and the support of friends when you're going through something like depression, but you really do need to see a health professional. We really stress the fact that mental illnesses like depression are treatable, but you need to see a qualified health professional to receive that treatment.

CHIDEYA: What about cultural issues with treatment? We're going to talk extensively tomorrow as part of this series about therapy, but there's not always - there sometimes can be things that are lost in translation across cultures. Do you think that people who go in either to talk therapy or to get medication or just even to get an evaluation have be aware that the person who's listening to them may not be hearing what they're saying in the same way?

Dr. PRIMM: That's absolutely a concern. We like to think that the mental health professionals who would evaluate and treat someone would be knowledgeable about that person's culture because culture does play an important role in terms of belief systems and even the way someone might express their illness.

For instance, with depression, sometimes a presenting complaint might be anger. And if a clinician doesn't realize that, they may be on their way to making the wrong diagnosis. So they may assume that someone who is suspicious has schizophrenia, but the suspiciousness could be a part of another syndrome, including a mood disorder.

And we know that this happens, that sometimes people are misdiagnosed with illnesses like schizophrenia, when really, what's going on is a mood disorder like depression.

CHIDEYA: Dr. Lawson, you mentioned all the ways that people could commit slow suicide. And it's not even just people committing suicide, but a lot of behaviors, like addiction, also have a parallel in people's mental health.

So moving out from the individual to the community, how important is it for mental health treatment and mental health wellness to be a part of the life of black communities?

Dr. LAWSON: I think it's extremely important. I mean, it's important to recognize that pretty much most of the many chronic diseases, almost all of them have worse outcomes when they're associated with mental disorders. We know that people have a heart attack and who also had major depression are much more likely to die.

We know that the biggest risk factor for non-compliance in terms of AIDS treatment is depression, because of people's failure to take their medication. And I'm glad you mentioned the issue of substance abuse because there's increasing evidence that in many cases, substance abuse also masks underlying mental disorders that can be treated.

Oftentimes, trying to treat the substance abuse alone is ineffectual, unless we recognize the underlying mental disorder, and also vice versa. Many in our community continue to believe that cocaine or a bottle of scotch are effective antidepressants, and they are not. And, in fact, they are also major risk factors for suicide because of the increase in impulsive behavior.

CHIDEYA: Dr. Primm, just quickly, where's a good place to turn for help if people are hearing this and want some?

Dr. PRIMM: Well, if people would like more information, the American Psychiatric Association has a Web site: healthyminds.org. We have access on that Web site to a new fact sheet called "Let's Talk Facts About Mental Health in the African-American Community." And there's other information there that would be of interest to African-Americans wanting to know more about mental illness and what to do about it.

CHIDEYA: Well Dr. Primm, Dr. Lawson, thank you so much.

Dr. PRIMM: Thank you.

Dr. LAWSON: Thank you very much.

CHIDEYA: Dr. Annelle Primm is the director of minority and national affairs for the American Psychiatric Association. She spoke with us from our studios in Washington, D.C. And Dr. William Lawson is a professor and the chairman of the department of psychiatry at Howard University College of Medicine. Be sure to check out our Web site. Our regular contributor, Judge Lynn Toler, shares her top 10 steps to achieving emotional acuity. Our Web site is nprnewsandnotes.org, and Lynn Toler's work is from her book, "My Mother's Rules: A Practical Guide to Becoming an Emotional Genius."

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