Mental Health Care and the Black American Reality

By Robby Seabrook III

The following is an opinion-research piece written and conducted by the author, with his thoughts and reflections. 

Being black is difficult. From microaggressions to racist housing policies to underfunded black neighborhoods, the stress of being a black person can take its toll. Even getting assistance with mental strife is difficult for us.

As of 2007, there are 40.1 million black people in the United States. 7.5 million of them have a mental illness. Black women are more likely to be diagnosed with depression, on average, compared to black men. Roughly, one quarter of black people seek mental help.

It may be because of our past, riddled with slavery and other hardships, that we were expected to be “tough”; able to overcome any and everything thrown our way. There are also many, well-documented barriers between black people and access to psychological care, be it distance, lack of mental health professionals, lack of information, or many other reasons. Black people’s attitudes towards seeking help aren’t exactly pro-therapy, although younger African-Americans tend to be more open to that and other forms of mental health assistance. According to a University of Wisconsin-Madison study, middle-aged and older Black people are less psychologically open than their younger counterparts, which means they are less likely to share their issues and seek help. This has been the case for quite some time, but the change is happening within our youth.

For me, my suffering, and my first mental health challenge, began in 2014. I was finally working in the music/tech industry, my peers respected me, I had the attention of the women I wanted. Things weren’t half bad. Though I had some concerns as to where my career was going, and I was anxious that I might not ever be financially stable, I managed to live with those.

But in August, I arrived at work only to find out that I didn’t have a job anymoreeffective immediately. I knew that the company would eventually fold, but the company moving on without me so suddenly was jarring. I still wanted to write, but didn’t know how to make that happen. I was still dating, but once I settled down, l had more time to really think. I had no job, I was struggling to be hired anywhere else, and now I was trying to uphold a relationship with barely any money, and career goals that were just a wistful dream, in addition to feeling like a failure. In the fall and winter of 2014, I gave up on trying to hide my depression from my girlfriend, and I decided to tell her of my suffering. She rode with me.

Most of my time was spent alone in my room, sinking lower and lower by the day. I was barely going outside, wasn’t shavingit was bad. My mother, I believe,  wanted to send me to therapy, but I brushed it off. A lot of crying, a lot of outbursts, a lot of feelings of worthlessness that would not go away. I even had an anxiety attack, where the entire right side of my body went numb. I remember seeing my body convulsing in the mirror and thinking I was having a heart attack. I continued to oscillate between moments of frightening lows and rare highs. My girlfriend and I eventually broke up for reasons totally outside of my mental state; a betrayal of trust. When I decided to end it because I was so hurt over her lying to me, she told me that the real reason I was leaving her was because I couldn’t find a job and it was “messing with my head.” That hurtful comment and the listlessness of being newly single, trying to find a job while trying to find out who your friends truly are, was a lot for me. I honestly didn’t feel better until late 2015, where my picture got published in a print magazine and my writing got published online. I should have seen a mental health professional, but I didn’t. It wasn’t that I felt getting help was “weak” or anything of the sort; I was just deathly afraid of being medicated. I ended up taking online therapy in late 2016 because how anxious I was and how obsessive my thoughts were. A majority of my time in therapy circled back to one clear point: I needed to stay present and also had to set time aside for my own healing. The results lead to a much more thankful and mindful version of myself, with a clear understanding of what matters to me and what doesn’t. It was one of the best decisions I’ve ever made; it saved my life, my friendships, and my perspective.

I wasn’t totally alone, however. My friend since high school, “Carl”, (who is of Dominican descent), has had experiences with his own mental health. Diagnosed with anxiety disorder in our senior year of high school and depression, his condition spiked over time. I never knew how deep it went, but once we sat down and talked, I learned a lot more about my friend:

“I remember nights where I would stay up and think ‘I’m really not gonna play basketball,’ as crazy as that sounds. That’s what I really wanted to do with my life. So, senior year comes, I’m playing varsity basketball, I’m happy; then my body just started feeling weird. I was be gasping for air, little by little. Eventually I wake up one morning with a panic attack. So I go to the doctor, they give me a couple exams, sent me back home. When I get home my heart starts racing. I went to the doctor, and I think they said it was 170 BPM, so they thought I was on drugs. For about 3-4 days, I was like that.”

His anxiety diagnosis prevented him from participating during the rest of the basketball season. He was also diagnosed with mitral valve prolapse, a heart condition. His anxiety affected him more than his heart, yet he blamed his heart and other injuries because he didn’t want to be stigmatized:

“I never really told anybody, even to this day. When I tell people about my senior season, and they ask how it went, I always say it was an injury. I’ll blame an ankle or whatever, because unfortunately, I don’t want people to judge me in the sense of thinking of ‘Oh wow, he suffered from anxiety?’ It’s crazy, the more that I put it out there, the more I find out that so much people have suffered from it, especially minorities.”

His mental health became tougher to deal with later in life:

“In college, my worst bout with anxiety and depression happened when my cousin passed away. I was 18, he was 21, he was the first person I ever had close to me pass away. It’s like survivor’s guilt, why am I here, why didn’t I go, I’m not even happy on this earth, so it should’ve been me.”

Another friend of mine, “Pat”, detailed his mental health struggles to me:

“My father kidnapped me when I was a child. When I told him I wanted to go home, he beat me. I was always afraid of him. I always go back to that moment, that’s where that fear came from, because I was always afraid of that moment. I repressed it for so long.”

This harrowing experience from his childhood manifested into a mental health disorder, later in his life. He also recognized that another aspect of his upbringing has been affecting him:

“I think the peak of of seeing how bad mental issues could get, was when I was in college. I was nervous about this test and blacked out in class, fainted. I had to be taken to the hospital, I couldn’t take it anymore. My mother had to drive up to Richmond, from Norfolk. They diagnosed me there; I have panic disorder, and that’s when I found out about it. I do carry a lot of stuff with me, and it’s been going on since I was a kid. I used to worry about my mom, paying the bills. This is that stuff that kids aren’t supposed to worry about. I was 6 or 7 years old. I was afraid to ask my mom for stuff for Christmas, because I didn’t want us to be poor. I took her struggles, onto myself. I still do it ’til this day.”

Both of my friends sought outside help, with differing results. Pat told me about his experience with therapy first:

“When I first got diagnosed with panic disorder in college, I didn’t take any medicine for it. I was going through the situation in 2013. I got prescribed Paxil at that point. I am supposed to take this medicine every day. If I don’t take my pill, I’m constantly shaking, I have a problem with being in social situations where there are a lot of people. If I don’t take my medicine, it takes me a little while longer to unwind and go to sleep. It’s just something I have to take to live.”

He also expressed an honest assessment of his own self-care practices:

“My mother is telling me now that I need to see a group therapist, because there’s a lot of unresolved things that I haven’t dealt with. I think it’s more on me, it’s feeling like ‘What will people think of me, if I do this?’ It’s tough. I know I’m an ass. I need to go get myself checked, but I’m also doing a better job taking care of myself now. I wasn’t taking care of myself at all, and that’s why a lot of this happened. I don’t want to be labeled crazy, I don’t want people to see that side of me.”

Up next was “Carl,” sharing a mostly ineffective bout of therapy:

“I did go to therapy, in college, I did see a counselor for a couple days, and I just felt like the counselor couldn’t relate to what I was going through. I told him at one point, especially after my cousin had passed, he thought it was a little insane, every time i leave my house and I say bye to my mom, I know that could be the last day I come back, because of what’s happened to people around me, he thought that was a crazy way of living.”

Carl’s counselor was white, wasn’t from his neighborhood, and could not relate to his upbringing. It can be extremely difficult to open up to a mental health professional who is unlike you in nearly every way, and who doesn’t understand your day to day realities. Proper mental care hasn’t been available for blacks and people of color for that long; and less than 4 percent of members of both the American Psychiatric Association and the American Psychological Association are black. But why might that be? What really goes into that, why is this the reality of being black when seeking therapy? I asked Phil Inabinette, a mental health counselor in Norfolk, Virginia.

“When we (African-Americans) were going to school in the late 1800s, it wasn’t for STEM, it was just something we weren’t into because we weren’t really exposed to it. The first black psychiatrists and psychologists didn’t really pop up until the 50s and 60s, which isn’t that long ago. You had black theorists like Frederick Douglass, but he wasn’t a doctor, he really didn’t deal with human psychology. You didn’t really have a whole lot of people just getting into the field, and that’s become generational. That’s really never been something we’ve pushed our children into, and It’s because it’s not something that we recognize.”

Dr. Lisa Martin, a psychologist based in NYC, also lent some perspective on why the very idea of mental health hasn’t done enough for black people, and why they aren’t as involved in it.

“I think in some ways yes, the mental health industry are providing more culturally competent care and it’s focused more in our training, so even if they are going to clinicians who aren’t of color, they have someone who is more likely to be able to understand and really help. At the same time, I think that the history with the mental health industry and black people in this country is so powerful that, even generations later, people are still weary of it. And it makes a lot of sense why. “

“The accessibility of the treatment itself. How welcoming the spaces are, the times/spaces that are available, the waiting list for spaces. There are a lot of things about where mental health care is provided, that are either gonna be really gonna be welcoming or supportive to folks of color, or really not. One of the things that we look at, in this work, such as how we engage folks of color, in mental health clinics and in hospitals. There are many places along the way, stages of getting into treatment, that really can put people off. If you’re talking to someone and they are not very kind, and you’re already ambivalent about whether or not you want care, and the person isn’t very welcoming, that already is gonna make you not feel safe. Or if you go into the room with a counselor, and they feel uncomfortable with you, this is particularly a problem for men of color. There are aspects of the mental health industry, where mental health is criminalized. I think in some spaces, that can be felt, If you’re a black man and you walk into a space and feel that people are scared of you.”

Lisa also expanded on the lack of black and person-of-color (POC) mental health professionals, and why they tend to enter into social work:

“I think systemic racism in psychology is part of it. I hope to be a part of looking at what are the requirements to get into school. Right now, in order to get a PhD in Psychology, you need to have several years of research experience. And most of the research jobs don’t pay. And getting a research job often requires connections. Already, that leaves you out of the playing field. It’s already stacked against you, before even trying to think about it. So I think that’s why you see folks of color entering into social work, because they have been doing a lot of good anti-racist, culturally aware work.”

Inabinette also thinks that insufficient number of black mental health professionals has an even further effect that keeps blacks from seeking assistance:

“It’s a generational fear, that ties into the fact that there aren’t that many African-Americans in the field. there’s a fear of ridicule of labeling, of exposure.’I know something may be wrong with me, but how do I go to the person who doesn’t look like me, and may not be able to relate to me, and tell them my problems?’ So because there aren’t familiar faces in the community, or the field, it becomes much harder for African-Americans.”

There is also more to the story; it’s just not that simple to get mental health assistance as a black person. There are various roadblocks between them and mental help, be it ideological issues, difficulty of access, fear, etc. Inabinette added his perspective to this train of thought:

“It also ties into the cycle of poverty. A lot of minority communities don’t have insurance, and a lot of the ones who do don’t have good enough insurance to get mental health help. Socio-economically, in urban areas, mental illness is not funded, and that’s generally where minority populations are.”

Location also plays a part in getting mental health assistance:

“For example Brooklyn, [has] high concentrations of African-American communities, but they don’t have an equal representation/distribution of health/wellness, social services, human services, opportunities. Access becomes even more limited, when it already was due to lack of insurance and other issues. In example, if there are only 3 mental health clinics in my borough, what’s the likelihood that I’m gonna go to one of those? And they likely aren’t anywhere near your neighborhood.”

He also explained how society’s unfair and problematic views on mental illness affect those who need it most, especially in the case of black people and other minorities:

“Up until very recently, mental illness has always been a shunned type of thing, socially; that’s just throughout history. So when you apply that with race and minorities, of course it would be even more shunned because of that old adage that African-Americans have to work harder to be recognized and acknowledged, so those mental health troubles get pushed back, or argued against if you start to show some form of mental illness.”

The resiliency asked of and required from black people also plays into how we manage our health. Some may feel that seeking help is a sign of weakness and it shows:

“African-American families didn’t have access in the 30s-70s to healthcare, and when they did, it was limited to self treating/diagnosing. Those things changed in the 80s-2000s, so we are still easing into taking care of ourselves physically, and being aware of health issues. Mental health is a health issue, and a lot of those have to be medically treated, by a doctor, by a psychiatrist or a psych, and psychiatrists can write prescriptions, they are medical doctors on some levels.”

He also draws a historical connection between getting help as a black person now, and America’s treatment of black people:

“Historically, we’ll come out of slavery, directly into segregation/Jim Crow, mental health treatment doesn’t become a thing until the 1900s. African-Americans weren’t getting this treatment in the late 1800s, early 1900s, unless they were test subjects. because they didn’t have access to anything. What happens over generations, those things become suppressed. How we as a culture, suppress things is by telling you that you have to “fight through”. That ties into not having access, not having funds, trying to answer our own problems.” The answer becomes, you’re strong enough to get through this. So if you constantly get told this, you hold tight to it, across generations.”

As we all know, the experience of being a minority includes a lot of varied difficulties. It’s also clear that most don’t understand our hesitance to take that step, how difficult it can be to get help, or the inherent biases that affect us. The issues are generational, they are fueled by institutional racism; it’s tough. Regardless, more care should be taken towards the issues black people face with mental health assistance.



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