By Daniel Meng-Saccoccio

Introduction

Mental health struggles are prevalent across the United States. However, communities have varying perspectives on mental health difficulties and different methodologies on how to approach them. The African American community has historically been oppressed within America, inducing the culture’s stigma against mental health treatment, which in turn has increased the mental health challenges they experience today. By exploring the roots of African American mental health stigma and its impact on the prevalence of mental health struggles within the community, as well as highlighting barriers to obtaining mental health resources and discovering effective remedies, society can better understand, visualize, and execute mental health treatment for the Black community.

Roots of African American Mental Health Stigma and its Impact Today

The mental health stigma within the African American community began long ago. William Sessions lived most of his life in Harnett County, North Carolina on his grandparents’ farm after escaping an unhealthy home environment with an absent father and alcohol-addicted mother. When Sessions was young, he admired his grandmother for keeping the family together despite her alcohol addiction and depression. However, Sessions notes his grandmother was unable to talk about her difficulties as there was a taboo on mental health and she did not want to be seen as crazy.[1] The fear that Sessions, his grandmother, and others within their community feel is rooted in injustices that American society has historically imposed upon them. Dr. Ruth White from USC’s Suzanne Dworak-Peck’s School of Social Work explains these roots: a widespread survivalist mentality was borne from slavery and racism which oppressed Black citizens into silence; now, trying to raise mental health with African Americans may be taken as an affront to their survivability, as “they have survived so much adversity and now someone is going to say there is something wrong with us.” (White, paragraph 5) Additionally, blacks comprise 33% of the imprisoned population despite making up only 13% of American adults today. Mass imprisonment spurs fear of legal punishment and prevents African Americans from reaching out for mental assistance, as others could view them as dangerous and unstable rather than in need of support.[2] However, one of the strongest yet most elusive sources of the mental health stigma is the medical exploitation of the community. In 1932, the United States Public Health Service (USPHS) worked with the Tuskegee Institute to perform a study about syphilis, also called “bad blood,” on 600 African American men. 399 of the men had syphilis, while the other 201 did not. The participants were promised health benefits in exchange, such as free medical tests, food, and insurance for their burial. By 1943, penicillin emerged as the optimal treatment for syphilis. However, neither the USPHS nor the Tuskegee Institute offered penicillin to the participants. By 1972, the study was declared “ethically unjust” by the Associated Press, as the risks of the study were too great when compared to the lack of treatment the men were promised – not all participants survived.[3] The study ended that year, but its ramifications are long-term, as African Americans remain suspicious of medical and federal institutions claiming to help them when said institutions withhold needed treatments from the community. With a racism-induced survivalist mindset, mass imprisonment, and medical exploitation on their heels, the African American community has faced a disproportionate number of historical challenges that have induced added hesitation in raising mental health discussions and seeking treatment.

Barriers to Accessing Mental Health Treatment and Effective Solutions

Although some mental health resources were available to African Americans in the past, their ineffective execution strengthened existing stigma which resulted in little to no support for the community. Dr. Ghate Vijay, another interviewee from the Southern Oral History Program, was born in India and received his medical education there. He then trained and worked at Dorothea Dix Mental Hospital as a forensic psychiatrist. He mentions how doctors often sent mentally healthy patients to Dix when no other options were available to them.[4] However, in the segregated South, African American patients were rarely sent to Dix; instead, they went to the neighboring Cherry Hospital, which was both less funded and less humane to its patients. Thus, for families like Sessions’ and his grandmother, their fear of discussing mental health and being labeled as crazy was not without reason. The admission of mentally healthy patients to Dix and Cherry likely strengthened the African American community’s belief that such institutions were exploitative and punishing rather than supportive. Tiffanie Cotten, who talked with the Southern Oral History Program about her work as an African American counselor, used her mother’s difficulty with substance abuse as fuel to become involved in healthcare and work as a substance abuse counselor. She admits that mental health is more difficult to treat compared to substance abuse.[5] Although Cotten does not provide reasoning for her claim, turning to the community’s present adaptations to their historical oppression may offer insight into the difficulty in treating mental health. The National Alliance on Mental Illness (NAMI) explains how African Americans often immerse themselves within their family or faith communities rather than seeking professional support, likely due to lingering institutional distrust. Additionally, socioeconomic challenges continue to afflict the community; in 2018, 11.5% of Black adults lacked health insurance, limiting available treatment options. Even for those fortunate enough to see counselors such as Cotten, 63% of African Americans currently believe mental health conditions indicate weakness, leading them to discuss other topics like substance abuse in mental health’s stead. These factors affect most of the African American community; NAMI reports that “only one in three Black adults who need mental care receive it.” (NAMI blog, paragraph 5) To provide large-scale and meaningful mental health care to the community, it is crucial to acknowledge the present and historical barriers. NAMI suggests culturally competent care, where African Americans find providers who are African American themselves or have experience and training in treating Black people. Afterward, patients should evaluate whether they felt respected or if any progress was made.[6] Breaking institutional distrust may be the first step in paving the way for the African American community’s ultimate healing. Additionally, White applauds continuing to move the cultural narrative so Black people can feel more at ease in seeking mental health support. Black celebrities such as Jay-Z, Kerry Washington, Michelle Obama, and Gabrielle Union have publicly discussed their mental health battles and ensuing therapy, which could inspire a new norm where mental health is given more attention. Lastly, White asserts policy changes and mental health education are critical components for breaking the mental health stigma within the community.[7]

References

“Black/African American Mental Health Identity and Cultural Dimensions.” NAMI, National Alliance on Mental Illness, https://nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Black-African-American.

Cotten, Tiffanie. Interview with Joanna Ramierz. 29 June 2018 (Y-0016). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28271/rec/16.

Sessions, William. Interview with Joanna Ramierz. 27 June 2018 (Y-0049). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28319/rec/48.

Vijay, Ghate. Interview with Caroline Efird. 1 Feb 2019 (Y-0064). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill. https://dc.lib.unc.edu/cdm/compoundobject/collection/sohp/id/28077/rec/60.

“Tuskegee Study – Timeline – CDC – NCHHSTP.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 22 Apr. 2021, https://www.cdc.gov/tuskegee/timeline.htm.

White, Ruth. “Why Mental Health Care Is Stigmatized in Black Communities.” USC Suzanne Dworak-Peck School of Social Work, 12 Feb. 2019, https://dworakpeck.usc.edu/news/why-mental-health-care-stigmatized-black-communities.

[1] To learn more about William Sessions, listen to his interview. He talks about his grandmother from 9:09 – 11:08.

[2] Read the full version of Dr. White’s work here.

[3] Click here for more information about the Tuskegee Study.

[4] Dr. Ghate Vijay’s interview discusses mental institutions from 1:12:02 to 1:14:21.

[5] To hear more about Tiffanie Cotten’s career opinions, listen to her interview from 0:34:31.4 to 0:35:36.6.

[6] See NAMI for more information on African American mental health barriers and means of overcoming them.

[7] White’s work in learning about the African American community’s relationship with mental health can be found here.