To keep the proper context, please read Part 1 for the bulk of my story before continuing with the post below.
“I Don’t Want People to Think I’m Crazy”
African American women are always trying to help others and we put ourselves last. With depression, that becomes less of a priority among African Americans because of the stigma associated with it, and the discomfort. “We need to openly disclose the feelings and emotions involved in the process, and create and maintain an ongoing healing process to get close to optimal health,” Dr. Holden says.
Unique Factors for African Americans
“As African Americans, we don’t acknowledge our pain and we don’t speak about it,” says Williams. “Our attitude is, ‘Don’t tell your business to other people,’ because it’s a sign of weakness. From the days of slavery on, you’re taught to have the attitude that you do what you have to do, and you don’t complain.”
At one of their events, Williams says Mo’Nique talked about her depression: “She told us she thought therapy was something just for White people. She was taught to take a Tylenol and cocktail and go to sleep.”
Dr. Holden: Influence and chronic stress have a great impact on mental health. African American women are disproportionately affected by disorders and health issues. On top of that, coping and dealing with the challenges of everyday life can be overwhelming. Take for instance, lupus – stress has major impact on this disease as it does obesity, diabetes, heart disease. We’re putting our lives at risk from a physical standpoint.
Depression, anxiety, exposure to racism, discrimination, violence, poverty can exacerbate and precipitate the depression, mood and anxiety disorders. Distrust of the medical system and mental health system. If they want help, a sense of system is not a comfortable environment for them. There’s a lot of complication and difficulty navigating systems of care (healthcare, insurance, etc.).
Stressors that worsen depression: identity issues, feeling as though they have a positive self perception. When you have the influence of the media, ideal body image, what is supposed to be normal for African American girls may not be achievable and it affects them. Self-perception issues. Unresolved trauma (unacknowledged physical/mental/sexual abuse) and negativity is internalized and creates extreme stress. There’s more of this for African Americans. Victims of crimes, imprisoned, more African Americans imprisoned than other ethnic groups. Job employment issues- unemployment, difficulty at work, economic and financial standing.
Lack of African American Data – Deterrents
We don’t have much data on African Americans and mental illness for various reasons. Williams agrees that as a people, we are either “undiagnosed or underdiagnosed.” African Americans do not participate in clinical trials as much as other ethnicities and the medicines may work differently in various ethnic groups.
According to The National Alliance on Mental Illness (NAMI), a nonprofit advocacy organization, some studies suggest that African Americans metabolize medications slower than Whites, but often receive higher doses of psychiatric medications, which may result in increased side effects and decreased medication compliance.
NAMI reports that culture biases against mental health professionals prevent many African Americans from accessing care due to prior experiences with historical misdiagnoses, inadequate treatment, and a lack of cultural understanding; only 2% of psychiatrists, 2% of psychologists and 4% of social workers in the U.S. are African American.
One segment of African Americans is impoverished, but we also need to look at other cohorts- those who are educated and professional African American women who also have issues- how workplace affects personal and relationships. Data and statistics about depression among African Americans do not acknowledge accomplished women who still have to deal with difficult situations. Often they will put off getting care because they have so much work to do, a business to run, and clients to please.
Studies only sample a small percentage of African American women from a limited area like impoverished, or already in treatment facilities versus regular everyday women dealing with stresses. Some of the diagnostic tools used to assess depression may not accurately reflect the experiences we have as African American women, things may be presented that are/not in the DSM44 category of depression, not culturally relevant or responsive—which in turn lowers the numbers of those who positively endorse depression. Fewer African American go to behavioral/mental health specialists—if we’re not going to be treated, we may not be counted. We may get our med or referrals from a PCP instead. Issues that we see as physical problems may come from depression, but they are brushed off with, – ‘You just need to relax more.’
“The Way We Do Mental Healthcare Needs to Change”
Legislation is trying to modify governance of use of mental health and substance abuse services. If your insurance won’t pay for it…you probably won’t seek the services. Similarly, the clinical environment may not respect the culture of the people they’re trying to serve- lack of African American professionals available in their area. Encourage more African Americans to mental health fields and build our clinical environment and workforce.
Dr. Holden: “We need better mental health policies—more integrated policies that include mental and behavioral health. Decrease system, not criminalizing people that have mental illness, strengthen science phase, research and funding, program development and policy issues. Improve fragile safety net of local and state programs- substance abuse and alcohol, not fragmented, but more integrated.
- Lack of insurance coverage, increase utilization of services by African Americans
- High cost of pharmaceuticals- deterrent
- Treatment plan
- Address mental health of homeless population, impoverished communities, newly released from jail and re-integrating in society—can’t find job, no more support–mental health is at bottom of list of priorities
- Increase school-based mental health services for youth—more emphasis on prevention than management. Psychologist from health county school system goes from school to school if they don’t have an on-site counselor.
- Continue to build culturally tailored screening tools so they are based on the needs of African American women– gender and culture.
If you’re in a rural area, it’s also difficult trying to get access to mental health services- who wants to drive an hour or more for a doctor visit? Also, if your insurance company has limited providers in its network, you might not seek help if you’re stuck with a provider you don’t feel comfortable with.
Practical Coping Methods
To get over depression, you have a right way and a wrong way. According to Williams, we self-medicate with drugs, alcohol, gambling, and shopping when we’re broke just to ease the pain. Dr. Holden agrees: “Coping mechanisms such as substance abuse, food (which is sometimes overlooked), and alcohol are addictions—maladaptive ways to cope. Over-engaging in helping others takes the attention away from them and takes the focus off by taking care of kids, mom, and everyone else. We need to look in the mirror and empower ourselves.” Williams agrees and says that when she was going through depression, “I was last on my to-do list.”
“I support spiritual counseling for African Americans an adjunct or complement to professional counseling. In general the church may not be as welcoming to acknowledge that these [mental health] issues exist. We are now seeing a lot of health ministries in the church, but there is still a sense of “pray it away.” Prayer can be a part of healing and coping, but not the only way. Talking to a therapist or psychiatrist, and even perhaps prescribing medication is an ideal model. I’m not big on medication but some people can benefit from it. Medication should not be a band-aid effect for surface symptoms and not get to the root of the problem. Use of medication plus counseling, support groups, is great. Use a psychologist and a psychiatrist. But a stigma about medication and pills still exists in African American community, and people are leery of it.”
Psychotherapy helps get through deeper issues of stress and depression. Some people cannot pinpoint the root of their hurts, and they need help identifying negative life events or personal feelings. In addition, social support, such as talking with friends and family (without shame), and meditation, prayer and spiritual fellowship, relaxation techniques, exercise has been shown to decrease serotonin levels in the brain which increases endorphins—get moving—yoga and stress management. Your approach to care—move toward better health.
My daughter is in the second grade now, and it’s been hard for me raising her without her father. It has taken me all this time to understand that although I cannot make up for his absence, she needs me to be fully present in mothering her, and giving her the love and attention she craves. It’s normal for her to come up to me and say, “You’re the best mommy in the whole world!,” and I have to resist the urge to tell her that she’s wrong. I’ve always loved her and cared about her, but there was always something blocking a full connection with her—I just didn’t know what it was. I had to get myself together and take a good look at how my behavior and my own depression about circumstances in my life affected my relationship and interactions with her. I no longer feel bad for not being “Ms. Super Hands-On Mom,” but I also no longer neglect her emotional needs.
Now that I reach out to her and make myself emotionally available, I am doing my part to keep her love tank full—regardless of how I am feeling from day to day. I communicate with her in her top two love languages: affection and words of affirmation. She lights up when I give her a spontaneous hug or kiss, praise her, or call her by one of my affectionate nicknames just for her. It has always been hard to discipline her because she is so strong-willed (like me), but since I’ve started responding to her with her love languages and become a happier person in my own right, she acts out much less than she used to.
For years I had only given her part of me and essentially tolerated her presence. Now I welcome her presence, miss her when she’s not around, and enjoy her company when she is. I cannot imagine how my life would be right now without her.
Taking a Little Time
It is challenging to get K to give me some quiet time to myself to concentrate on my projects when she is at home. Like most youngsters, she often wants it her way or no way, so discipline has been an issue as well. Sometimes I yell at her when I get frustrated and she has ignored my calm pleas for quiet or waiting until I’m done with a task. I used to respond to her with yelling and impatient remarks, which of course did not improve her behavior. But I did finally get on solid ground with her by spending more time with her. Here are some revelations I had to internalize:
It’s all about her. In her eyes, whatever she has to say to me or show me feels like it is of utmost importance. I can clearly tell that the way she likes to give and receive love is the same way she shows it—with hugs, cuddling, kisses, and “I love you” and “You’re the best mommy in the whole world” (which by the way, feels great to hear her say, especially when I don’t feel like I am).
Make time just for her. My daughter enjoys free play (she really enjoys the UNO card game and Bingo, and wants someone to play with her every day!) and one-on-one time, so I have to segment times when I can give her attention. This time is set aside just for her, and other things I need to get done, such as cleaning, cooking dinner, or completing a project, have to wait during this time period. It could be 2 hours a day, or two split 30-minute segments. But she needs to know that I’m focused on her during that time.
Be a little more flexible. When I get into a “mode” I like to concentrate without interruptions, and I can be impatient sometimes when I encounter obstacles to finishing a task. Although every child needs to acknowledge limits you set as a mom, recognize that she will still interrupt you at times. Occasionally will let her interrupt me without reminding her of the rules, when I know she is just reaching out for me or is having a “needy” day.
The bottom line is, when I show her more attention than I have, I am giving her what she needs and filling her love tank. Her father is not around, so I have to give her whatever I can. It only costs a little time, but it’s worth it!