She was a chubby six-year-old when she first started slashing her arms with razor-sharp fingernails. Baxter, 35 and now a licensed social worker, theorizes that the cuts—one of about 15 types of coping strategies and non-suicidal injurious behavior—is a way to numb the pain in moments of self-doubt and self-hate. With a series of deep cuts, she says, she becomes unaware of her surroundings—or what she calls “missing in awareness.”
Baxter’s family-centered parents were frightfully aware of their daughter’s pain but perplexed by the novel marker of insanity. So they cloaked themselves in denial and shame. Her parents, immigrants from Barbados, grew up in a time when they had little access to mental health services. After they migrated to the U.S. in the early 1960s, they wilted under Jim Crow segregation in New York.
“My parents didn’t know what to do, or who to turn to. So they worked it away with two or three jobs. Or prayed it away,” said the Brooklyn-born mental health advocate, who lives with her husband in Hartford. “They feared my illness would bring deep, biting shame to the family.”
Baxter’s parents are not alone in their pain and shame. Although African-Americans have the same rate of mental illness as whites, nearly 60 percent do not receive care, according to a 2004 Mayo Clinic study.
Only about 30 percent seek counseling, and they tend to be overrepresented among inpatient or residential treatment patients and underrepresented in outpatient care, according to the U.S. Department of Health and Human Services report. In 2010, 19.7 percent of blacks 18 or older had a mental illness. And 4.4 percent of blacks ages 18 or older suffered from a serious mental illness.
The implications are far-reaching and grim. Societal factors such as high homicide rates, high school dropout rate, high unemployment nationwide, and even higher in urban communities, are indicators that increase African Americans’ chances of developing mental illness, according to a 2009 Health Disparities report by the Connecticut Department of Public Health.
African Americans also tend to be in poorer health than the larger society because they lack access to, or do not seek, adequate preventive services. Physical health, the report says, is linked to mental health and wellness.
Additionally, there tends to be a higher level of stigma and misunderstanding about mental illness in the black community, and it serves as a barrier to achieving mental well-being. That’s because many blacks fear icy sarcasm and further marginalization in an already racist and sexist society. African Americans and Afro-Latinos who decide to reach out often seek help much later after symptoms first manifest, said Dr. Gretchen Chase Vaughn, one of the few black private practice psychologists in Connecticut.
“It’s not just the stigma. All communities have that stigma. I think the stigma for us is a fear that the mental health system might not treat us well,” Vaughn said. “Often we get the image of the angry black man or the angry black woman when in reality our people are hurt or depressed by a society that tells them they are less than.”
Indeed, there are also other reasons people are hesitant to reach out for help, said James Siemianowsk, a former social worker and spokesperson for the Connecticut Department of Mental Health and Addiction Services.
“Mental illness is portrayed negatively. We have stereotypes of people who commit crimes. The reality is most people with mental illness are often victimized,” he said. “Another reason is that they won’t be employed. So the fear is justified.”
Baxter’s parents eventually overcame their fears and reached outside the family for help when they found their daughter sitting in a pool of blood that had flown out of her cuts. At first, close relatives and mental health professionals reacted with blank expressions or bewilderment that a black girl cut herself. Self-mutilation, they thought, happened only in the white community. It doesn’t. Baxter cut herself to numb the pain when she got depressed because of past traumas and present realities: repeated sexual abuse, verbal abuse and the reverberations from society’s racist and sexist perception about dark-skinned women.
“When most people talk about self-mutilation, they often think of movies like Girl Interrupted. They think of it as something that happens to white girls,” said Dr. Kevin Chapman, a professor at the University of Louisville’s Center for Mental Health Disparities. “The response she’s getting from a cultural perspective is mostly related to how we put mental health on a hierarchy of symptoms. Depression and anxiety are sanctioned. But when we talk about symptoms that aren’t popular in the black community, it is labeled as crazy. And that’s problematic.”
Wearing the Mask
Many experts attribute the high rate of stigma about mental illness among communities of color as multi-dimensional, namely economic, psychological and historical.
“We normalize trauma in the black community even though it affects us, our children and our children’s children,” said Kevin Muhammad, president of the Connecticut African-American Emancipation Challenge, a group that seeks to end the war on drugs.
And it dramatically impacts communities of color. Hence, psycho-education is important to reduce the stigma in an environment where people are often discouraged from discussing personal problems, or “air dirty laundry.”
There’s also the daily strain of wearing an emotional mask to hide the pain that stems from racism, unemployment and poverty. Many seek emotional support in the church and within their families rather than turn to health care professionals. The disruption of that social dynamic usually leads to tension, Chapman said.
According to a 2009 Yale study, poverty affects mental health. People in poverty are three times more likely to report psychological distress. African Americans are twice as likely to live below the poverty level and twice as likely than their white counterpart to be unemployed. Moreover, poverty rate among African-Americans was 3.6 times greater than the poverty rate among whites.
Many experts also agreed that the legacy of slavery impacts the way African Americans deal with mental distress. During slavery, frequent whippings, rape, and other indignities of bondage resulted in mental illness. Slaves hid their torment not just to avoid being seen as weak but also to survive. Over time, strength was equated with survival.
That stigma still exists and is further exacerbated by a historical fear among African-Americans to seek help from mental institutions that may not recognize their specific cultural issues and often misdiagnosed or mistreated their conditions.
Tony Castro had that experience when he visited Capitol Region Mental Health Center in Hartford. After a brief examination, his doctor diagnosed his condition as anxiety disorder. But on another visit to Hartford Hospital, they diagnosed his condition as a schizophrenic disorder. Castro visited CREC for follow-up treatment, where he was administered high doses of antipsychotic medication, which caused muscle stiffness. When his family noticed the dramatic change in his gait, they inquired further and realized that Castro, a recent immigrant from the Dominican Republic, was unaware of the new diagnosis. Castro thought he was still being treated for anxiety disorder.
“Without knowing the details or looking at [Castro’s] chart, I’d say there is no way the two diagnoses are linked.” Chapman said. “It’s laughable.”
And it is also scary. Several studies in the state and the nation find that blacks and their symptoms are over-diagnosed as schizophrenic.
Seeking Alternative Methods
Sometimes, failure to seek treatment for mental illness is not just a matter of shame but an emotional paralysis that overwhelms the patient, mental advocates say. So many have responded by turning to alternative treatments.
Swan Keyes, a California-licensed psychologist who practices communal healing with expressive art in Hartford, said her treatment includes the act of “putting the blame on societal factors rather than the individual.” Racism, poverty and lack of work are examples of societal factors that act as stressors and affect the psyche, said Keyes who also teaches a class on white liberal racism.
“It’s our society that’s ill,” she said. “That’s the problem we need to confront.”
Mental-health advocates such as Keyes encourage people to educate themselves about free resources that offer holistic healing, especially if they don’t have health insurance. And for those who seek help from mental institutions, the answer lies in cultural competency among mental health praticioners.
If we aim to decrease stigma, we should better understand the community and build rapport with people of color coming into the system, Chapman said, then many issues with stigma will likely decrease.
“Black pain is real. But so is the truth of full recovery. We can, in our own time, overcome the trappings of mental illness,” she said. “But at the end of the day, race absolutely matters, especially when we talk about the distribution of resources. You might be aware of your symptoms and want help but you don’t have access to quality care.”
This article is one of The Hartford Guardian’s two-part series that addresses health disparities in Connecticut. This article was made possible–in part–by the Connecticut Health Foundation.
*Mentally ill patients’ names have been changed to protect their identities. However, they will be present at our January 24, 2013 forum to discuss their pain and how they survived.
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