For Black Men, Barriers To Mental Health Care Can Be Complex : Consider This from NPR The start of a new year can push us to think about how we take care of ourselves – our bodies or our minds. And for some people that can mean seeking help for mental health issues like depression and anxiety.

In some ways, being open about pursuing treatment for mental health concerns is becoming more commonplace. But for men who are socialized not to express vulnerability and keep emotions in check, seeking therapy may feel taboo.

Black men must also contend with the long history of neglect and abuse that has influenced how generations of African-Americans feel about health services, a lack of Black mental health professionals, and the understanding that shielding emotions are a way to face the pressures and dangers of racism.

Host Michel Martins talks with writer Damon Young, author of What Doesn't Kill You Makes You Blacker: A Memoir in Essays, and psychologist Earl Turner of Pepperdine University, on making therapy more accessible for Black men.

For Black Men, Barriers To Mental Health Care Can Be Complex

  • Download
  • <iframe src="https://www.npr.org/player/embed/1149272590/1149299919" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

MICHEL MARTIN, HOST:

The start of a new year often pushes us to think about how we take care of ourselves, whether it's our closets, our finances, our bodies or our minds. And for some people, that means getting professional help. Therapy can be an important element. And in recent years, being open about mental health concerns and seeking therapy to address them has become a lot more common.

(SOUNDBITE OF ADVERTISEMENT)

UNIDENTIFIED PERSON #1: A new beginning.

UNIDENTIFIED PERSON #2: Hi.

UNIDENTIFIED PERSON #3: Good morning.

UNIDENTIFIED PERSON #2: Morning.

UNIDENTIFIED PERSON #1: Their next chapter - made possible with a little help from their Talkspace therapist. Talkspace - get personally matched today with a therapist who can give you a little help, too.

MARTIN: And the idea of improving your life with the help of therapy has shown up in places you might not expect. Like the music of Kendrick Lamar.

(SOUNDBITE OF SONG, "UNITED IN GRIEF")

KENDRICK LAMAR: (Rapping) I went and got me a therapist. I can debate on my theories and sharing it (whoa). Consolidate all my comparisons. Humbling up because time was imperative (whoa). Started to feel like...

MARTIN: And the surrealist imaginings of Donald Glover's "Atlanta."

(SOUNDBITE OF TV SHOW, "ATLANTA")

SULLIVAN JONES: (As Everette Tillman) Earn, I know it can be hard to disconnect, but we can't have productive sessions with your cell phone on, Earn.

DONALD GLOVER: (As Earnest "Earn" Marks) It's important. I can't pay for this if I don't do this.

MARTIN: And "Rothaniel," the standup special from Jerrod Carmichael, the host of this year's Golden Globes. At some points, the critically acclaimed special played more like a therapy session than a comedy routine.

(SOUNDBITE OF TV SHOW, "JERROD CHARMICHAEL: ROTHANIEL")

JERROD CARMICHAEL: Been trying to be very honest because my whole life was shrouded in secrets. And I figured the only route I haven't tried was the truth.

MARTIN: Therapy in popular culture isn't new. From TV shows, like "The Bob Newhart Show" to "Frasier" to "In Treatment," to movies like "Ordinary People" and "Good Will Hunting," therapy has been a vehicle for laughs and drama. But portrayals of Black men in therapy have been rare.

(SOUNDBITE OF ARCHIVED RECORDING)

LAMAR: One of my favorite lines in the album is where we say, you really need to go to therapy. We learned to hold all that shit in.

MARTIN: That scarcity of representation on screen reflects the reality, as research findings from the CDC show. The research indicates that Black men experience similar rates of anxiety and depression as white men but are only about half as likely to seek mental health services.

HARRIET WASHINGTON: The distrust stems from the fact that the health care system is flawed, deeply flawed, and treats African Americans differently.

MARTIN: Harriet Washington is author of the book "Medical Apartheid: The Dark History Of Medical Experimentation On Black Americans From Colonial Times To The Present." She told NPR that the long history of neglect and abuse has influenced how generations of African Americans feel about health services.

WASHINGTON: African Americans have an understandable wariness, which is cheating us of years of life and health.

MARTIN: There's also a lack of representation in the mental health professions. Altha Stewart was president of the American Psychiatric Association from 2018 to 2019 and was the first Black person to serve in that role. And she says an inability to find a Black provider can cause a lack of faith in the system.

ALTHA STEWART: I get calls from people right now asking, can't you refer me to a Black psychiatrist? And because there are so few of us, I'm limited in how many of those people's referrals I can make to their satisfaction.

MARTIN: CONSIDER THIS - depression and anxiety are on the rise among many groups, but encouraging Black men who would benefit from mental health services to seek them is a particular concern for African Americans in the field. But how to change that, when the barriers to getting help come from within and without? That's coming up.

(SOUNDBITE OF MUSIC)

MARTIN: From NPR, I'm Michel Martin. It's Saturday, January 14.

ERLANGER TURNER: You know, it's a complex question to understand why men are less likely to seek help.

MARTIN: Erlanger Turner, who goes by Dr. Earl, is a licensed psychologist and associate professor of psychology at Pepperdine University in Los Angeles. He says that from a very young age, boys, not just Black boys, are taught which feelings and behaviors are OK.

TURNER: And so this idea about how we're socialized, from a gender perspective, to be more self-reliant and control our emotions makes it really difficult sometimes, as we grow up, to not be comfortable sharing those sort of vulnerable parts of ourselves.

MARTIN: And Turner says that by the time boys become men, many feel the range of emotions permitted to them is very narrow.

TURNER: I think anger is a very normalized emotion for males. Like, we can be angry. We can be upset. We can verbalize that. But if we're anxious, if we're worried, if we're sad or depressed, those are things that we can't openly share sometimes in our friendships or with our family.

MARTIN: Turner says Black men may also contend with a restrictive definition of what constitutes manhood within their own families, where shielding emotions is seen as a way to face the pressures and dangers of racism.

TURNER: There is a protective nature to some of that. And so I do understand why some parents do still encourage their male sons to, like, you know, not show this fear because you could be, you know, targeted by others for a lot of different reasons.

MARTIN: Turner points to Black male celebrities like Kendrick Lamar and Jay-Z and professional athletes who've come out in support of therapy. And he says he hopes that that kind of visibility helps to shift the perception of therapy for Black men.

TURNER: There's been NBA players that talk about their experiences in going to therapy, as well. And I think all of those examples are really pivotal to, like, reduce some of the stigma.

MARTIN: And Turner agrees with Altha Stewart that having a therapist who looks like you can be crucial.

TURNER: So if they have a white therapist, is the therapist comfortable talking about race and discrimination? And if their client has issues that come up around that, well, they probably are not going to want to bring it up to that clinician. And so that's, I think, another reason why they may prefer to work with a Black therapist because they can understand like, OK, this person understands my experiences.

MARTIN: Coming up...

DAMON YOUNG: For me, in terms of my own pursuit of therapy, it's just - I guess it's just me making an effort to take care of my entire body.

MARTIN: That's when we return.

(SOUNDBITE OF MUSIC)

YOUNG: I'm fortunate. I'm privileged to be in a position where I can afford it because if you were to ask me this question, you know, maybe 10 years ago, then, you know, I'm still dealing with the same anxiety, still dealing with the same neuroses and whatever. But I wasn't in a position where I could afford to seek therapy.

MARTIN: Damon Young is a writer and columnist and author of "What Doesn't Kill You Makes You Blacker: A Memoir In Essays." He's written and spoken about his own struggles with mental health. He says in his experience, though, the decision to access mental health care isn't just about affordability. Growing up in a mostly Black neighborhood in Pittsburgh, he says he thinks about when his dad went grocery shopping.

YOUNG: There's a Whole Foods that exists in Pittsburgh. And my dad would go to Giant Eagle, which was the - I guess the, quote, unquote, "regular supermarket," and never thought to go to Whole Foods. And I feel like there were just some invisible barriers that exist that communicate to people that, you know what? This thing, even though I might be able to access it, is not for me.

MARTIN: As we said, Young has been in therapy. And I asked him what brought him to that decision and what he thinks can get in the way of other men seeking therapy.

YOUNG: For me, there wasn't necessarily, like, an epiphany or an impetus that I could just point to as, like, OK, this is the thing that happened or this is the reason why I decided I need to do it. It was just the thing that - you know what? I need to start being more mindful of taking care of myself. And this is just another aspect of that. So there wasn't necessarily, like, a stigma I had to overcome. It was more of just a I need to do this in order to be a responsible adult.

MARTIN: Do you remember, though, how you thought about it or heard about it? One of the reasons I ask is that the culture is all around us, just like the pop culture of therapy, for the most part, until very recently, has been very much of a specific demographic. Like, there's, like, Woody Allen. Therapy plays a big part in his comedy and his movies. And then there was the character of Tony Soprano, and then there was, like, "The Bob Newhart Show." That's a very specific demographic. And if you get your cues about what you're supposed to do from the culture, you would not necessarily have seen that until very, very, very recently. So I was just wondering if you recall how you first - the thought first occurred to you.

YOUNG: I mean, I think that to your point, it was the sort of thing that I associated not necessarily with race but with class, with a sort of upper-middle-class sort of person who could afford and who also had the space in their life to be able to pursue, to be able to just sit on somebody's couch for a couple hours a week and talk to this person about what's going on in their life. I think that what kind of led me or kind of what maybe pushed me - and again, this isn't really, like, this great impetus or great epiphany, but it was this - you know what? I have this anxiety which I've dealt with my entire life. I'm in a space now where I'm in front of a lot of people. I have a lot of responsibilities, not just with my work, but with my family. And so I need some help.

YOUNG: I wanted to ask about Jerrod Carmichael, the comedian. He hosted the Golden Globes. Last year, he premiered this stand-up special. You know, it was extraordinary because it was almost like a therapy session. It was almost like you saw him kind of going through his emotions in real time. And during the special, he makes the decision to come out. I just - I was just wondering what you thought about that. I kind of felt like it did something. It was - it felt kind of like a watershed. I don't know. What about you?

YOUNG: Yeah, I - it was - his special was one of the - I guess, the best standup specials that I probably ever seen. And I don't even know if I would call it a stand-up special because there's something different that he was doing with the audience that is - you know, that I haven't really seen in stand-up. Now, I have seen it before, you know...

MARTIN: That it was performance art, might be a better way to - I don't...

YOUNG: Yeah, like, it - you know, I think the first time I saw a stand-up comic do a thing like that was with Hannah Gadsby and her special "Nanette" a few years ago. And so Jerrod Carmichael's stand-up special kind of had those same sort of elements where he's not necessarily telling jokes, you know, even though there were some parts in it that were meant to make you laugh. But it was - one, it was, you know, him coming out in a way. And also, you know, there was a vulnerability there that was just so rare and so visceral and so - and, to be honest, intimidating because, you know, I attempt to be vulnerable in my work, but when I saw him do that, I felt like my vulnerability still had places to go.

MARTIN: On the other hand, though, I'm thinking about the recent death of Stephen "tWitch" Boss. He was a dancer. He was a big part of "The Ellen DeGeneres Show." He died by suicide. And there have been a number of Black young men and men of a certain age who have died by suicide. And it's just - that has - it just seems - statistically it just seems sort of that there's something going on. And I just wonder if you have any sense of what you think that might be.

YOUNG: I mean, I can't speak to any of those particular circumstances because I don't know what was going on in their lives. But, you know, I go back to a point that you made earlier about how therapy was associated with people like Woody Allen. And, you know, I've always thought that even though that sort of humor is associated with, like, a certain class, if anyone's going to be neurotic, if anyone is going to have anxiety, it's going to be someone who is from the 'hood. If any environment is going to make someone need therapy, then it's the environment that so many of us come from, and, you know, plus America plus racism, plus all of the things that are associated with being Black in America. You know, when you think about the causes and you think about, you know, the environmental factors that cause anxiety and that could cause neuroses, if anyone is going to need therapy, it's probably going to be us.

MARTIN: What I think I hear you saying is this is a both-and problem. On the one hand, there are real external barriers to people getting the kind of care they need, whether that's mental health care or physical health care. On the other hand, there are some internal barriers that keep people who particularly may need it from accessing that care.

YOUNG: Yeah, I think - and again, I don't necessarily think that this is a specifically Black male thing. I think that that might be a male thing where, you know, we've been socialized to - you know, to be silent and to not, you know, express any pain or not emote. And I feel like if you are a man at this point, you need to get past that because there's enough out there to show that, hey, there is space for you to show emotion and to feel and to grieve. In fact, people around you need that from you so that the only emotion you express isn't anger all the time.

MARTIN: Do you mind if I ask, since you've been kind enough to get kind of personal with us, is that when you have pursued therapy, did you feel it helped?

YOUNG: I did. I did. Yeah, it definitely did help.

MARTIN: What does it do?

YOUNG: For me, it just made me feel lighter. And obviously, that's in a - like, more of, like, an existential sense, right? I just felt like I was able to take some of the things that I was carrying around with me and finally have a place to put them.

MARTIN: That was Damon Young. He is a writer and author of the book "What Doesn't Kill You Makes You Blacker: A Memoir In Essays." And if you or someone you know may be considering hurting yourself or even taking your own life, please call or text 988. You'll reach the Suicide and Crisis Lifeline. It's CONSIDER THIS FROM NPR. I'm Michel Martin.

(SOUNDBITE OF MUSIC)

Copyright © 2023 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.