The Silent Epidemic Among Black Men
When I first got the blues, they brought me over on a ship,
Men was standin' over me, and a lot more with a whip.
And ev'rybody wanna know why I sing the blues.
--B. B. King,
"Why I Sing the Blues"
Suppose black men were suffering through an epidemic. What if the disease struck as many as 20 percent of all African American men during their lives, and what if 15 percent of those with the most severe strain of the illness died? Imagine that the disease made men miss work, and made them less motivated and productive when they were on the job. Imagine further that even black men at the top of their professions were affected, rendered less decisive, their judgment impaired. And what if, in an effort to ease the pain of the disease, many African American men medicated themselves with addictive, deadly drugs? What if black families were being destroyed by this illness? What if many of the men suffering from this disease lost hope so completely that they placed little value on human life--theirs or anyone else's? And, finally, what if, while all this was happening, next to nothing was being done to get black men treatment and medications that are 80 percent effective against the disease?
I have no doubt about what would happen. African Americans would be in the streets, charging that black men were the victims of the most vicious form of racism. We would demand action. We would be outraged, and justifiably so.
Yet untreated depression is doing all these things to black men in America. In fact, it probably affects African American men more adversely than it does the general population. "Mental Health: Culture, Race and Ethnicity," the 2001 supplement to the Report on Mental Health by U.S. Surgeon General David Satcher, says that "racial and ethnic minorities collectively experience a greater disability burden from mental illness than do whites."
The release of Dr. Satcher's original Report on Mental Health in 1999 was a landmark moment for America. This was the first comprehensive report on the state of the nation's mental health issued by America's "physician-in-chief." It is both an inventory of the resources available to promote mental health and treat mental illness, and a call to action to use and improve those resources. It paints a portrait of mental illness, filling the canvas with the faces of America, revealing that the direct and indirect effects of mental illness cut across all the nation's dividing lines, whether race, religion, gender, economic level, or education.
But the supplemental report highlights the disparity that exists for black men in mental health as it does in relation to most health problems. For example, African American men are more likely to live with chronic illnesses--and studies show that living with chronic health problems increases the risk of suffering from depression. In its 2002 report, "The Burden of Chronic Diseases and Their Risk Factors," the federal Centers for Disease Control and Prevention points out that African American men have the highest rates of prostate cancer and hypertension in the world. The report also says black men are twice as likely as white men to develop diabetes, and suffer higher rates of heart disease and obesity. The American Cancer Society's 2003 "Cancer Facts and Figures" found that black men are more than twice as likely as white men to die from prostate cancer. We also are more likely than others to wait until an ailment reaches a serious stage before we seek treatment. According to a report issued by the Congressional Black Caucus Foundation in 2003, men in general are three times less likely than women to visit a doctor, and African American men specifically are less likely than white men to go to a doctor before they are in poor health. This is the case for physical ailments. Factor in the stigma attached to mental illness, and add other barriers that keep us from getting help, and it's easy to see why black men are even less likely to seek treatment for depression.
So, I maintain that what I described above--or worse--is happening to black men. But the nation, including the African American community, is silent. The silence on the subject among blacks is due, in part, to our lack of a vocabulary to talk about depression.
We call depression "the blues" in the black community. We're taught to shrug off this mental state. For many of us, it is not just a fact of life; it is a way of life. When bluesmen wail, "Every day I have the blues" or "It ain't nothing but the blues" or similar words from a thousand songs, they do more than mouth lyrics. They voice a cultural attitude. They state the accepted truth at the heart of their music: Having the blues goes along with being black in America.
In addition, from the time we are young boys, black males have ingrained into us an idea of manhood that requires a silence about feelings, a withholding of emotion, an ability to bear burdens alone, and a refusal to appear weak. The internal pressure to adhere to this concept of masculinity only increases as we confront a society that historically has sought to deny us our manhood.
The internal wall that keeps black men away from psychotherapy adjoins external barriers built just as high, if not higher. Mental health practitioners are overwhelmingly white, with the proportion of black psychiatrists, psychologists, and psychoanalysts estimated at less than 3 percent of the nation's total. This means that even if black men break through self-imposed barriers and seek professional help for mental problems, it may be difficult to find someone with whom they can build the rapport that allows a patient to reveal his most intimate secrets. As Dr. Richard Mouzon, a prominent black clinical psychologist in Atlanta, puts it, "We grow up knowing that it's dangerous to give up too much of yourself to the white man."
There's no denying that access to mental health care is restricted for Americans in general. In private health insurance policies and government medical assistance programs, psychotherapy too often is considered a luxury rather than a medical necessity. It often has been said that in America the only people with a guaranteed right to health care are the inmates of our jails and prisons. That's even truer of mental health care. (Unfortunately, it is a right that is of marginal value; while many African American men receive their first and only treatment for mental illness behind bars, that treatment is apt to be directed at keeping them under control rather than alleviating the effects of their illness.)
Our health care system assures preventive measures and early intervention for mental health problems only to the privileged, just as it does for physical health problems. The disparity is so great in minority communities that, for many, mental illness receives attention only when it reaches a florid stage--in public hospitals' emergency rooms and psychiatric wards--or, worse, in its aftermath, when people with mental illness may end up behind bars and in morgues.
The consequences of untreated mental illness are dire. And the tragedy of the worst outcomes can be no greater than when the disorder is depression, one of the most common and treatable mental illnesses. The disease is painful, potentially fatal, but 80 percent of those who get treatment get better. Yet, quite sadly, only 25 percent of those who need help get it. African American men are especially prone to put ourselves in mortal danger because we readily embrace the belief that we can survive depression by riding out the illness, allowing it to run its course. The internal walls we build to keep out the world, and the walls society builds to isolate us, cut us off from the help we need. So we suffer, and we suffer needlessly.
I know that suffering firsthand. I dealt with untreated clinical depression for most of my life--into my forty-fifth year, in fact. Anyone looking at the outlines of my life probably would not believe that. They would say good fortune has followed me. I was born in the small town of Jackson, Georgia, which I remember as a good place to grow up, even in the era of segregation and overt racism. I had an older sister and three younger brothers. My mother raised us alone, having divorced my father when I was about four years old. She gave us so much of herself that I don't ever recall feeling deprived of a father. Her mantra was that all things are possible. She worked long hours as a beautician and pushed us to work hard in school to make sure we were prepared to take advantage of all of life's possibilities.
We lived in town, where we had armies of children our own ages as playmates and friends. Of course, we always had one another, despite the moments of sibling warfare in which opposing parties threatened to banish the other from the household by any means necessary. The summer was my favorite time. We spent much of it on my grandparents' farm. My grandmother showered me with love, and my grandfather taught me to work hard and take pride in even the most menial job.
We all did well at our studies, though one of my teachers early on wrote an evaluation of me that placed me in the category of borderline mentally retarded. She said I did not participate in class and, in fact, seemed unable to respond to simple questions. My mother refused to believe her. She argued that my "problems" were nothing more than shyness and a stammer that made speaking in front of others an embarrassing ordeal. She insisted that I not be held back or in any way separated from my peers as long as I was able to demonstrate adequate skills on paper--which I could.
When I reached the third grade and came under the tough-love tutelage of a teacher named Mrs. Doris Lummus, I began to blossom. I scored above grade level on the first standardized test I took. I gained confidence. The grades on my report card went from mostly F's (that stood for "fair," or average, back then) to mostly G's (for "good") and a few E's (for "excellent"). From that point on, I was blessed with teachers who believed in me and encouraged me to believe in myself. At home, of course, there was always Mom, reinforcing the teachers.
This also was the time of my life that I fell in love with baseball. There's no getting away from it: I was not much of an athlete. I was neither as strong nor as fast as my teammates. But I threw myself into the game with a dedication far beyond the most unbridled youthful enthusiasm. During the summer, I persuaded my brothers to get up with me at dawn and hike down to the baseball field for practice sessions. They hit ground ball after ground ball to me at my shortstop position. I fielded and threw to first base, often wildly; the balls were wet and slick after rolling through dewy grass. In the afternoon there were regular team practices, each of which I approached with an intensity that others would have reserved for championship games. Back home, late into the night, I practiced swing after swing with a leaded bat I had fashioned. I swung half right-handed and half left-handed, so I could become as great a switch-hitter as Mickey Mantle. Then I took the bat and held it one-handed and at arm's length, flexing it up and down so I could develop wrists as strong and quick as Hank Aaron's.
I had a reputation around town as a baseball maniac. Looking back with a better understanding of how my brain works, I believe it would be more accurate to say that baseball brought out my manic side. That state of single-mindedness, boundless energy, and belief that any goal was within my reach took me beyond the limits of my mediocre physical talents. It got me through an Atlanta Braves tryout camp. More than two hundred players showed up, all determined to live their dream. Only two were invited to the Braves' minor league spring training camp. I was one of the lucky two. It wasn't until I got down to West Palm Beach, Florida, and practiced and played alongside the likes of Dusty Baker and other future Major League stars that I learned I was not going to be a professional baseball player. For a while, though, I stood on a manicured field, looked up at palm trees, and smelled the scent of the ocean carried on a mild breeze. And I knew I was in a place millions of boys dream of reaching, but where very few actually arrive.
That is just one highlight of what many would consider a charmed life. I was the first in my family to finish college, graduating with honors from Georgia State University with a degree in journalism. My good luck with teachers had continued. One of my professors at GSU was a wonderful man named George Greiff. He took me under his wing; he became my mentor and a father figure for me. We stayed close until his death, more than thirty years after I met him. George not only taught me what I needed to know to become a journalist, he also used his contacts to help me get my first job after graduation. Classmates who could match my talents struggled to find jobs in the field, but I left school with a job waiting for me at one of the nation's leading newspapers, the Detroit Free Press.
At the time of my move to Detroit in the summer of 1973, I had never spent more than a few days anywhere outside of Georgia. Experiencing a place so culturally different from the one in which I grew up was exciting to me. New friends at the Free Press took great delight in sharing the joys of Detroit's ethnic neighborhoods and restaurants. I was a twenty-two-year-old single man living in a place where almost everything was new to me. And 1973 was an especially exciting time to be a black journalist in urban America. That year, Tom Bradley was elected the first African American mayor of Los Angeles; Maynard Jackson--for whom I would eventually work--won the same post in Atlanta; and Coleman Young would make the same kind of history in Detroit only a few months after I arrived in the Motor City. This small-town Georgia boy was like a dry sponge taking its first dip in water. I soaked it all up.
Discovering the joys of Detroit's spicy stew of cultures was one thing. Surviving the city's climate was quite another. The seemingly nine-month-long northern winter did me in. My coworkers took bets on what I would wear next in an attempt to keep warm. Finally, as a snow and ice storm hit Detroit on April 1 (I considered this the city's April Fool's present to me), I packed my car and drove south. I headed home to Georgia, where I had a standing job offer from the Atlanta Journal, the city's afternoon daily.
From the Hardcover edition.