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Battling Depression Among Blacks Means Confronting Racism's Legacy

The brutality of slavery and the unending humiliations of segregation have taken their toll on the mental health of black Americans.

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Engraving published in the Journal of Blacks in Higher Education, 31:136, Spring 2001

"I'm not a doctor, but I know depression like an avalanche victim knows snow," journalist John Head said at the E. Y. Williams Annual Symposium at Howard University last month. Head spent 20 years living with untreated depression and now works to increase awareness of the disorder within the black community in the United States.

"Depression destroys our belief in ourselves and our future, the very things that can lift us up," he said. "Racism is a factor in the lack of access to medical care, but it is also a catalyst in the need for mental health services."

Head's negative thoughts about himself and his abilities weighed him down during the course of his illness, despite his success as a journalist. He spent more than 20 years working for the Detroit Free Press and USA Today before becoming an editorial writer and columnist for the Atlanta Journal-Constitution. He wrote about mental health for the Journal-Constitution as part of a 1999-2000 Rosalynn Carter Mental Health Journalism Fellowship and is the author of the book Standing in the Shadows: Black Men and Depression, published in 2004.

Despite his professional success, he thought of himself as a fraud. He saw himself not as overcoming adversity, but as having been given some undeserved advantage.

"Even those who triumph over racism are not immune [to depression]," he explained.

Head placed his personal history of depression in the context of African-American history, as did speaker Alvin Poussaint, M.D., a professor of psychiatry and faculty associate dean for student affairs at Harvard Medical School.

No one gave any thought to the mental health of the first Africans on American soil, said Head. They weren't considered fully human by the slave-holding society in which they found themselves. In fact, more thought was given to analyzing the "pathology" of wanting to flee slavery than that which slavery caused.

Dr. Samuel Cartwright of New Orleans complained in 1851 that northern doctors were wrong to attribute mental health problems to slavery. In fact, he said, being free drove blacks insane. Earlier, Dr. Benjamin Rush, considered to be the father of American psychiatry, was an abolitionist and said that Africans were made insane by slavery in the West Indies.

The majority of slaves probably suffered from what today would be considered posttraumatic stress disorder.

"They were brutalized constantly," said Poussaint. "They had depression, anger, hypervigilance, anxiety. That legacy is still experienced today. Anger gets turned on each other and on their own children."

Black suicide was not rare in slavery times, despite common wisdom to the contrary, he said.

Even today, said Head, Americans focus on the physical brutality of slavery, rather than the psychic damage. Yet the constant humiliations imposed by slavery and the century of Jim Crow segregation that followed took their toll on the minds of African Americans.

The impact of racism is not random, he said. "It is psychological warfare in the most literal sense."

When, Head asked, will the psychic Suffering of African Americans be acknowledged, and what will be done about it?

There's reluctance in the black community to talk about depression much less about its causes, such as racism, he said. He noted that events like the Tuskegee experiment had a disproportionate effect on black views and led to widespread mistrust of the health care system.

In his experience, black men resist admitting to having emotional problems, so he speaks to them about physical symptoms, like lack of sleep or energy, then says, `Shouldn't you see a doctor?'"

"Fatalism is a form of surrender we cannot afford because it leaves us incapable of helping ourselves," said Head. "My own treatment was not a choice but a necessity for myself and my people. African Americans treated for depression are not immune to racism but are better equipped to resist it."

"Oppressed people become passive resistant when openness means getting beaten or killed," agreed Poussaint. "But underneath passive resistance is anger."

"People today who lack feelings of self-worth devalue their own lives, but they also devalue the lives of other black people," said Poussaint. "At least 85 percent of black crime is committed against other blacks. Homicidality in black youth results from devaluation, hopelessness, isolation. The problem is, we don't consider anger a mental health issue, but there is a lot of chronic anger out there."

Poussaint pointed out that he has had multiple firsthand encounters with America's racial attitudes. During his residency training at UCLA, he noted that he had only one black patient, thanks to a referral system that included only white psychiatrists. He finished his training in 1965, the year of the Watts riots in Los Angeles. A reporter asked him: "Why are black people so angry?" He replied, "I don't know—I haven't seen any."

He spent the next two years in Mississippi caring for civil rights workers and helping to desegregate health facilities. He joined the faculty of Tufts Medical School in 1967 and directed a psychiatry program in low-income housing developments.

In the projects, black people often refused him entry to their apartments. They feared and mistrusted a medical system that had been used to oppress them, especially with the use of involuntary commitment. At the same time, he said, many clinic workers were afraid of black men so they gave them the most severe diagnoses just to get them out the door.

"Blacks are overdiagnosed for psychosis and paranoid schizophrenia, but underdiagnosed for depression," said Poussaint. "Racism is interwoven into everything."

During his own psychotherapy, for instance, he began talking about racial issues to his white therapist, who dismissed them as irrelevant. "That's a reality issue," he told Poussaint. "Let's talk about your relationship with your father."

Poussaint agreed with Head that preventing and treating mental illness was important to the overall success of the black community.

"America is paying a high price for neglecting black mental health," said Head. "Untreated depression erodes our ability to nurture our children. The `cures' have been neglect or isolation in prison."

"The stronger, more positive we are, the better we can be in fighting racism," said Poussaint. "We have to start by emphasizing good parenting, and require high school kids to take parenting courses. We also need an open discussion of corporal punishment. One legacy of slavery is the use of the word `whipping' among blacks as a term for physical punishment. We have to make our children precious. It might turn things around and make them resilient."

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