We have all seen recent headline after headline of the bewildering cases of people of color losing their lives, especially African American. What are the roots of this? What allows racism and discrimination to continue? And, what are its effects?
Although answers to these questions are too broad to answer here, the mental health and effects of African American people who consistently deal with racism serves as a good starting point. Mental health is an extremely important issue in the United States of America, as one in five adults are affected by a mental illness. This also affects African Americans, who make up 13.2% of the U.S. population. Of this small population, 16% of African Americans have mental health issues. Adult African Americans are 20% more likely to report serious psychological distress than adult whites. On top of this, in a study done in 2011, 54.3% of adult African Americans with a major depressive episode received treatment, as compared with 73.1% of adult Caucasian Americans. (1). These daunting numbers indicate a huge gap in mental health care cases between African Americans and Caucasian people.
There are several factors that have contributed to the degradation of the mental health of African Americans in the United States. Historical adversity, which includes slavery, sharecropping, and race-based exclusion from health, educational, social, and economic resources, have translated into socioeconomic disparities experienced by African American people. Due to lower socioeconomic status, African Americans are more likely to be impoverished, homeless, incarcerated, or have substance abuse problems -- all of which increase risk for poor mental health (1).
History demonstrates that people of color consistently receive inferior treatment and other health related health care services. An example of these disparities can be seen in the AIDS epidemic. African Americans represent almost half (47%) of all U.S. AIDS cases while they comprise only 12% of the population, a discrepancy that has been ascribed to racism by some researchers (2). Another clear example of health care inequity is evident in health care insurance. African Americans are twice as likely not to have health insurance compared to Caucasian people, although they constitute a smaller percentage of the population, 16.9% of African Americans have no form of health insurance, compared to 7.6% of Caucasian people (3). Although African Americans have higher mental health burdens, they are less likely to get help, due to fewer economic resources and to health care access. Such disparities can be devastating, especially when it comes to mental health where there is already a stigma about receiving care.
Racism is another factor adversely affecting the mental health of African American communities. Racism is complex and not easily defined because there are different categories of meaning. There are many ways to think about it, but the domains identified by Anderson and colleagues (2) are useful here:
Individual- The attitudes and acts that express a person’s prejudices. People look at the prevailing attitude of their group towards others utilizing mechanisms within the larger society to support their individual beliefs, and to discriminate according to these beliefs
Institutional- Nurtured by convictions of power and authority, individual racist beliefs are converted into discriminatory policies and procedures of the institution. Thus institutions help maintain the advantages of one group to valuable resources through biased policies.
Cultural- The result of the privileged group’s power to determine values, beliefs, attitudes, and practices to become legitimate expressions of its culture. (2).
Negative stereotypes and rejecting attitudes have led to distrust of authorities, including mental health professionals, by African American people. This in turn leads to more cases of poor mental health, much of which is unaddressed. Additionally, non-black mental health care practitioners may not be as culturally competent to treat issues that are specific to the African American community, and with less than 2% of the American Psychological Association’s members being African American this is a prominent issue (1). The combination of racism that African Americans experience, a mistrust of the mental health world, and a lack of appropriate care lends itself to a perfect storm.
Racism also feeds white privilege, which is a presumed benefit of group membership. White privilege begins at birth and accrues benefits throughout one’s lifespan. This privilege brings unearned resources and power to Whites while serving as a detriment to African American life. Moreover, symptoms of Post-Traumatic Slave Syndrome can emerge when an African American person perceives that his or her talents and identity are not seen because of the dominance of preconceived attitudes and stereotypes (2). This slight can be seen as a microaggression, which can manifest itself as unresolved psychological injury and subsequently debilitating symptoms. Debilitation from slights can result in the limitation of effective utilization of personal resources, the achievement of individual goals, the establishment of positive relationships, the satisfaction of family interactions, and the potential for life satisfaction. (2).
Epigenetic Change is a rather compelling phenomenon in the modern world of science. In a study of holocaust survivors it was found that PTSD, anxiety, depression, and other psychiatric diagnoses were found in higher prevalence in their offspring than controls. Also, it was found that PTSD contributes to the risk of depression, and parental traumatization is associated with increased disorders in offspring (4). Moreover, the same study showed that greater rates of family psychopathology were found in trauma survivors who develop PTSD than people without PTSD.
If the mental health issues of a generation can affect the likelihood of mental health issues in future generations, what may have been the effects of slavery on current generations of slave descendants? Some scholars believe that the legacy of trauma from slavery can create Post-Traumatic Slave Syndrome. (2). This syndrome is a result of multi-generational trauma experienced by African Americans, due to slavery and experiences of racism and discrimination, which produces distinct psychosocial outcomes in later generations of descendants, irrespective to direct experience with slavery.
Although the stress, emotional abuse, and psychological trauma caused by racism, invisibility, and discrimination exist, it is important to remember that people are resilient. Indeed, one scholar leveraged this resilience to develop a process for guiding African American males toward what is called Posttraumatic Growth (PTG) (5). PTG is defined as an individual's experience of positive change and resilience following a traumatic life event. Presented below is a list of specific recommendations for providing culturally sensitive PTG treatment options for African Americans (4).
1.) Deliberation and Remuneration: Restructuring individuals’ perceptions and outlook which aids in deriving meaning from traumatic events. It is important to appraise the traumatic event and acknowledge a client’s reaction to it as normal
2.) Disclosure of Race-Based Trauma: Counselors work to identify the trauma and help the client find significance in the discrimination by focusing on coping, resilience, and purposeful living.
3.) Social and Cultural Factors: Refers to accessing a network of people who provide the client with care and concern. A network provides the client with a sense of connectedness when sharing his or her experiences, as well as coping mechanisms. (4)
Individual-focused change is both useful and necessary, but solutions for effectively addressing mental health challenges and disparities in African-American communities will have to occur in tandem with resolving discrimination in institutions and society at large. In addition to closing the gap in detection and services, applying post-traumatic growth and other resilience models may help heal deep wounds and promote sensitivity and cultural appreciation.
Iban, E.J. (2017). The Current State of the Black Union: The Facts, the Stats, and the Solutions. Information Brief Series, Cornell Youth Risk and Opportunity Lab. Cornell University, Ithaca, NY.
1. Black & African American Communities and Mental Health. (2017). Mental Health America. Retrieved 21 December 2017, from http://www.mentalhealthamerica.net/african-american-mental-health
2. Franklin, A. J., Boyd-Franklin, N., & Kelly, S. (2006). Racism and invisibility: Race-related stress, emotional abuse and psychological trauma for people of color. Journal of Emotional Abuse, 6(2-3), 9-30.
3. Key Facts about the Uninsured Population. (2017, September 19). The Henry J. Kaiser Family Foundation. Retrieved from www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/.
4. Yehuda, R., Bell, A., Bierer, L. M., & Schmeidler, J. (2008). Maternal, not paternal, PTSD is related to increased risk for PTSD in offspring of Holocaust survivors. Journal of psychiatric research, 42(13), 1104-1111.
5. McDougal, S., III. (2016, September 2). Post Traumatic Growth with Black Males Who Experience Racial Trauma [Blog Post]. Retrieved October 20, 2017, from http://www.afrometrics.org/research-based-news/post-traumatic-growth-with-black-males-who-experience-racial-trauma