Depression Hits U.S. Blacks Harder Than Whites

Black Americans are more likely than whites to suffer severe, untreated and disabling depression, U.S. research shows. Researchers at the Harvard School of Public Health analyzed data on 6,082 people who took part in a national survey conducted between 2001 and 2003.

They found that 17.9 percent of white Americans had depression at some point in their lives, compared with 10.4 percent of blacks of African descent and 12.9 percent of blacks of West Indian or Caribbean descent.

Rates of depression in the 12 months before they were surveyed were 7.2 percent for Caribbean blacks; 6.9 percent for whites; and 5.9 percent for blacks of African descent.

Among those who reported depression at some point in their lives, rates of depression in the 12 months before they were surveyed were 56.5 percent for blacks of African descent; 56 percent for Caribbean blacks; and 38.6 percent for whites.

"Fewer than half of the African Americans (45 percent) and fewer than a quarter (24.3 percent) of the Caribbean blacks who met the criteria (for depression) received any form of major depressive disorder therapy," the study authors wrote. About 57 percent of white Americans with major depression received treatment.

"In addition, relative to whites, both black groups were more likely to rate their major depressive disorder as severe or very severe and more disabling," the researchers reported in the March issue of the Archives of General Psychiatry.

Investigating why blacks may be less likely to develop depression and why they fare worse when they do develop the condition may help improve understanding about depression.

"Future research should explore the extent to which social support systems, including religious participation and psychological resources, such as high levels of self-esteem, can provide some protection to the black population from exposure to adverse social conditions." the study authors wrote.

Theory: Problems in Black Community Traced to Slavery

Interview with Omar G. Reid, Psy.D.

It's a new theory that's been raising interest, eyebrows, and some ire. Omar G. Reid, Psy.D., along with his colleagues at Pyramid Builders Associates in Roxbury, Mass. have posited that many problems within the black community today can be directly traced to slavery.

Their theory, that many African-Americans are suffering from what they call Post Traumatic Slavery Disorder (PTSlaveryD), points to the high numbers of blacks in prison, on drugs, and living in single-parent households as evidence of the lasting effects of the way blacks learned to cope with the trauma of slavery.

New England Psychologist's Catherine Robertson Souter spoke with Reid to get a better understanding of this theory and how the clinical work he and his colleagues are doing at Pyramid Builders has helped clients overcome their issues and rejoin society.

Q: On what do you base your theory?
A: The National Center for Post Traumatic Stress Disorder, a center for multigenerational legacies of trauma down in New York, has done extensive work, looking at different groups and how trauma or slavery has impacted them over the years. The center has done extensive research and has robust information on different groups like Cambodians, Japanese internees … groups that have had effects from trauma, especially like slavery or the Holocaust, over the years.

Q: You believe that current societal problems found within the black American community can be traced to slavery. Specifically, what problems?
A: If you go to the U. S. Census Bureau, there are a couple of things. One is the high incarceration rate for black males; another is the dropout rate. Another is the large number of female-headed households. The key thing about our theory is this is not about blaming whites. This has nothing to do with reparations. We are saying that a lot of the problems that blacks face today can be traced back to slavery.

Let me give you an example. I'm working with a man who is 49 years old. He has five children and doesn't take care of any of them. His father had no relationship with him. When he did some research, [he found that] his grandfather and grandmother weren't ever married and his great-grandfather was a buck on the plantation.

During slavery, black men were forced to have sex to breed babies. The problem is that you numb yourself. You don't get close to your children or the women because they were going to be sold. At one point, this [reaction] was functional but now it's dysfunctional because it's continuing. The cycle never stopped. After slavery ended, there was no one saying, 'Let's regroup, let's go get some counseling.' That was not available.

Another thing is that a lot of black males reject education. Even in black colleges, black males do poorly. They have a 33 percent graduation rate at a black college. During slavery in certain areas, people who were caught reading were killed. So education was not something you went after. This was exacerbated after [the Civil War] because even with an education you still couldn't get a job. A lot of blacks didn't even think about education as a way to make it in the mainstream.

That same attitude is now dysfunctional because a lot of black males don't pursue higher education, don't take school seriously or reject it because it's considered being white. Another issue is work. I went to a forum years ago on racism and a lot of whites said, 'Blacks don't want to work - they are lazy.'

But, we have a different work experience compared to Europeans or other foreigners. If you came from Russia or England or Ireland, and you worked, you could move up. For blacks that came here, working hard meant early death. The work ethic is totally distorted for black Americans.

Q: And the point is that this attitude gets passed from father to son, father to son. What about the women?
A: Well, the roles were switched. For years, black women were the only ones allowed jobs - as nannies or maids. There was no such thing as a nuclear family on the plantation but it was further distorted once people left the plantation because the black man was sort of emasculated - he couldn't get a job.

Black women were forced into a position where they became the economic breadwinner of the home. It's the way things have worked. Even today, she can get a job - she's black and a woman, filling two quotas. The other thing with black women is that they still come with some of the old slave mentality - especially those who are dark skinned.

For example, my last client is a 47 year old black woman who was suicidal. She is a dark-skinned black but she grew up in a household where her sisters were light-skinned. When we did a family tree, we found that her great grandmother was the offspring of the slave master.

Now, she's the only dark-skinned one. In her home, she got it from relatives that she was ugly and it was reinforced by black media and the community. A lot of blacks are really damaged not necessarily from white society, but from within their own community - from ideologies, from beliefs that are held over from slavery.

Q: How do you treat this problem?
A: What we do in treatment is to teach them to look at their family history and show them how this came about and how their thinking has been distorted. It's very difficult to tell people to pull themselves up by their bootstraps when they psychologically think that they can't. It's like that old thing where you have the dog in a cage and you shock it and after a while it doesn't go out.

You could sit down and counsel a black guy, 'Now go out and get a GED and go get a job.' They can't do it. They have to be hand held and walked. We also help them develop higher income skills to survive. We have had a 99 percent success rate with all the men who have come to us.

Q: Meaning what? What is "success"?
A: Meaning that they are now able to function in society - get involved, get a job, drop down the alcohol and drugs.

Q: There has been some resistance to your theory. Why? A: We've been attacked by some of the black middle class. They say, 'Well, I made it.' And I say to them, look at your family history. If we compared you to the black guy who's sitting in state prison, your background is still different.

Yes, there is a black middle class, but the majority is poor and uneducated and doing poorly and statistics show it. Connecticut just put out new statistics: One out of 14 black males is incarcerated - compared to one out of 2,790 white males. We only make up 12 percent of the US population but we make up almost 60 percent of the prison population.

Q: What kind of response have you gotten within the world of psychology?
A: From folks who understand trauma we've gotten a lot of praise. No one's really looked at how the mass of blacks was affected by the slavery legacy. There are now a lot of black psychologists, black social workers contacting us to come speak. It's starting to become a movement.

We are working on coming up with our own "DSM" [description]. So, if someone has a client come in and they are dealing with what we call PTSlaveryD, how does that translate to lay terms under the regular system, the mainstream? That's going to be out in January.

We plan to continue to do more talk shows, radio, etc., and offer the book for diversity programs in colleges. We have problems, not from whites, but from the black elite, the blacks who are well to do. They look at it as playing the victim role. When you give them the statistics, using the Census Bureau, all they can say is "Well, we don't know why that is."

Well, we're telling you this is what is causing these numbers to be like this. This is not something we've made up. Statistics show what is going on with blacks in general and we're saying that there's a cause for that.

Battling Depression Among Blacks Means Confronting Racism's Legacy

by Aaron Levin

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

"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, hyper-vigilance, 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 over-diagnosed for psychosis and paranoid schizophrenia, but under-diagnosed 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."

Post-Traumatic Slavery Disorder: A New Adjustment Disorder Diagnosis

By Marcella Bombardiere

Sekou Mims's son was 16 when he experienced a sudden psychotic breakdown. Over three months, the Black teenager had a series of delusions - that white police were following him, that white strangers on a train were staring at him menacingly. He'd hyperventilate walking down the street. All his delusions revolved around racism

After a month long psychiatric hospitalization, Mims's son recovered. Now, six years later, he attends college part-time and works as a driver and a computer consultant. But Mims, a social worker in the Boston public schools, thought it was strange that the young man had become so obsessed with race. After all, ''the kid didn't go through one-10th of what I went through,'' he said, never mind the racism Mims's father and grandfather experienced as Black men in America.

Omar G. Reid is a psychologist who was training at Boston Medical Center at the time of Mims's son's illness. While he wasn't involved in his son's treatment, Reid told Mims that Black and Latino males were showing up ''in droves'' with similar symptoms. Today, Reid conducts support groups for troubled Black men, many of whom say they can't understand why they feel so much general anger and nervousness when ''my life hasn't been too bad.''

Mims, Reid, and Larry Higginbottom, another black social worker, recently taught a symposium at the Simmons Graduate School of Social Work and are writing a book about what they call ''post-traumatic slavery disorder'' - a derivative of post-traumatic stress disorder. They are holding workshops to propose to fellow professionals that drug abuse, broken families, crime, and low educational attainment in segments of the Black community can be directly linked to the trauma of slavery, and that ''Black people as a whole are suffering from PTSD,'' Mims said.

These Boston clinicians were not the first to note the lingering psychological effects of slavery. Harvard University psychiatrist Alvin F. Poussaint wrote in 2000 about ''posttraumatic slavery syndrome,'' calling it ''a physiological risk for Black people which is virtually unknown to white Americans.''

In a book Poussaint co-authored on Black suicide, ''Lay My Burden Down,'' he wrote: ''A culture of oppression, the by-product of this nation's development, has taken a tremendous toll on the minds and bodies of Black people.''

Now, Mims, Reid, and Higginbottom - none with backgrounds in academia - have taken it upon themselves to try to educate other mental health workers about their theory, and promote a curriculum and therapy based on the idea. They would like to see what they call ''PTSlaveryD'' entered into diagnostic manuals.

''We can't wait for the mainstream to validate us because it'll be the day before we're on our deathbeds,'' Mims said. Mims, 46, grew up in poverty in Boston and spent a number of his adolescent years in reform school for petty crimes and assaults. Later, he joined the Nation of Islam and worked in human services for the court system and a halfway house, before earning a master's degree in social work.

Reid, 44, grew up in the Nation of Islam and spent 14 years working as a psychologist in Boston Public Schools. He recently earned a doctorate in psychology, and has a practice counseling private clients and contracting with schools for educational assessments.

Higginbottom, 49, a Baptist and one-time stockbroker, worked in community centers in Boston before getting his social work degree. He counsels families through a Department of Social Services contract, and all three men together lead support groups sponsored by various agencies.

Hundreds of years of slavery, followed by decades of legal discrimination and racism, are widely accepted as factors contributing to the poverty of many African-Americans. Poussaint points out in his book that more young Black men are in the criminal justice system than in college. But the idea of a specific mental health problem linked to slavery goes a step further.

However, critics argue that these ideas perpetuate a culture obsessed with victimization.''Some people are just looking for reasons to fail, and this notion of a post-slavery syndrome falls into that category,'' said Ward Connerly, an African-American who campaigned against affirmative action in California. ''There is great harm done with something like this. We don't want young Black kids to grow up thinking they are weak and can't look after themselves.''

In their working paper, Reid, Mims, and Higginbottom lay out a case for links between slavery and behavior in the Black community today. They point out that slaves were punished if they knew how to read, and draw a comparison to the stigma attached to education today. ''If you go to any elementary or middle school today and talk to Black kids, they say, `I failed all my classes, it's cool,''' Reid said.

They write about how male slaves were not allowed to stay with their families, and then cite the number of poor Black men today who father numerous children with different women.
One notable difference between the writings of these social workers and that of Poussaint is that Poussaint calls the trauma associated with slavery a syndrome, not a disorder. A disorder is something much more specific, while ''the trauma of slavery goes across all diagnoses and no diagnoses,'' Poussaint said in an interview.

''There is a background anxiety there for Black people, like a background noise affecting their day-to-day operations in the world,'' he said. ''Slavery was profoundly traumatic for Black people and we're not over it yet.''

Poussaint would like to see the American Psychiatric Association and the American Psychological Association set up committees to study the mental health implications of racism, but he said these ideas produce ''a lot of rolling of the eyes,'' among other mental health professionals.

However, there is plenty of research to back up the idea that trauma can resound through multiple generations, whether the trauma originates with the treatment of Native Americans, Holocaust victims, or Cambodian genocide, said Yael Danieli, a clinical psychologist, trauma specialist, and director of the Group Project for Holocaust Survivors and their Children.

Danieli said politicians are resistant to the idea of multigenerational trauma, because it brings up the specter of reparations, and because addressing long-term trauma rarely fits in with short-term political considerations.

The treatment for post-traumatic slavery disorder that Higginbottom, Reid, and Mims propose varies depending on whether someone is suffering from depression, schizophrenia, or something else, but it involves examining the individual's family history as a way to understand his or her present problems.

''We have to take a more culturally relevant look,'' said Higginbottom. ''Somebody's got to be the disciples.''

Dr. Joy DeGruy Leary Talks About Her Provocative New Book Post Traumatic Slave Syndrome

By Silja J.A. Talvi

Racism erodes our very humanity. No one can be truly liberated while living under the weight of oppression, argues Dr. Joy DeGruy Leary in her new book, 'Post Traumatic Slave Syndrome: America’s Legacy of Enduring Injury and Healing'.

Leary, who teaches social work at Portland State University, traces the way that both overt and subtle forms of racism have damaged the collective African-American psyche—harm manifested through poor mental and physical health, family and relationship dysfunction, and self-destructive impulses.

Leary adapts our understanding of Post Traumatic Stress Disorder to propose that African Americans today suffer from a particular kind of intergenerational trauma: Post Traumatic Slave Syndrome (PTSS).
The systematic dehumanization of African slaves was the initial trauma, explains Leary, and generations of their descendents have borne the scars.

Since that time, Americans of all ethnic backgrounds have been inculcated and immersed in a fabricated (but effective) system of race “hierarchy,” where light-skin privilege still dramatically affects the likelihood of succeeding in American society.

Leary suggests that African Americans (and other people of color) can ill afford to wait for the dominant culture to realize the qualitative benefits of undoing racism. The real recovery from the ongoing trauma of slavery and racism has to start from within, she says, beginning with a true acknowledgment of the resilience of African-American culture.

“The nature of this work,” Leary writes in her prologue, “is such that each group first must see to their own healing, because no group can do another’s work.”

What kind of reaction have you received to your book? And has that reaction differed based on who is in the audience?

Overall, the response has been very positive, although I’m sure the naysayers are out there. The difference in reaction is noticeable when I deal with grassroots folks in the African-American community. With them, the response has been extremely emotional. It’s as though I’m speaking people’s personal stories, which seems to give them a feeling of hope.

Of course, I’m not the first person to initiate this kind of work into the intergenerational nature of trauma in the African-American community. What I did differently is that I pulled from many different historical sources and scholarly disciplines. In essence, I created a “map” of knowledge so that people could see how African-American self-perception has been shaped.

Throughout your book, you emphasize that an acute, social denial of both historical and present-day racism has taken on pathological dimensions. You write that this country is “sick with the issue of race.”

The root of this denial for the dominant culture is fear, and fear mutates into all kinds of things: psychological projection, distorted and sensationalized representations in the media, and the manipulation of science to justify the legal rights and treatment of people. That’s why it’s become so hard to unravel.

Unfortunately, many European Americans have a very hard time even hearing a person of color express their experiences. The prevailing psychological mechanism is the idea, “I’ve not experienced it, so it cannot be happening for you.”

Truly, how can anyone tell me what I have and have not experienced? This is a very paternalistic manifestation of white supremacy, the idea that African Americans and other people of color can be told, with great authority, what their ancestor’s lives were like and even what their own, present-day lives are like.

The result for those on the receiving end of this kind of distortion is an aspect of PTSS. People begin to doubt themselves, their experiences, and their worth in society because they have been so invalidated their whole lives, in so many ways.

Attempts to encourage European Americans to join in on a more honest, national dialogue about “race” and racism often results in defensive posturing and positioning. Common responses include “slavery happened a long time ago,” or people saying that they’re tired of being made to feel guilty about something they didn’t do. How do we respond to this detachment from the crucial issues of the legacy of slavery?

It’s irrelevant that you weren’t alive during slavery days. I wasn’t there either! But what we as a nation face today has been heavily impacted by our history, whether we’re talking in the gulf between the haves and have-nots; education gaps between white and black children; or the racial disparities in our prisons. I don’t believe in making people feel “guilty.”

We have to recognize that remnants of racist oppression continue to impact people in this country. Much of my work really is about black people looking at ourselves and understanding how our lives have been shaped by what we’ve been dealt. I don’t want to wait for permission to examine this or to hear that looking back into our histories is somehow counterproductive.

An eye-opening experience for you was your first visit to New York’s largest and most overpopulated jail facility, Rikers Island. What kinds of insights did you gain about PTSS from talking to imprisoned African-American young men about their lives?

It was remarkable to see their physical disposition. They walked into the room with their heads held low, shuffled in, for lack of a better word, [they looked like] slaves. They had lost their way, and there was no light in their eyes whatsoever. Young people typically have a high level of energy. While there was a feeling of angry rebelliousness, the prevailing feeling of hopelessness was staggering.

It’s also significant that it took about a half-hour for them to realize that I was talking to them, not at them. In that brief moment, I felt as though I gave them hope. Their body language had already changed by the time they were getting ready to leave. They had become students by the end of our time together.

These young people are being raised by these institutions, and then unleashed back into their communities to wreak havoc. Most of these young men grew up in poverty, and they have the experience of being black and poor in a materialistic society that says if you have nothing, you are nothing.

In comparison, when I was in Africa I witnessed incredible poverty unlike anything I had ever seen before. I always talk about how tall and proud the people walked. Their greatest shame was their lack of education, not their lack of wealth. But in America, you are what you have, what you wear.

You write about the fear that many African Americans have of being “exposed” or having family or community “dirty laundry” aired. “Never let them see you sweat,” as the expression goes.

Shame is such a big issue in our society in general. What many African Americans have internalized is a sense of shame about just not being “good enough.” That’s a horrible thing to be sentenced to for your life.

When a person walks around with that sense of shame and self-hatred, they are likely to function poorly in society, no matter who they are. Add the extra layer of racist socialization, of being devalued, and what it means to be just human in America, and all those things just makes the shame worse.

We as African Americans don’t get a pass on all the problems that humans have to deal with in life: finances, career choices, personal crises, relationships, and so forth. But when we add that to this intergenerational trauma in the context of a society that is in denial about its racism, people’s lives can become overwhelmed, even frozen in place.

I’m saying let’s just take a few of those burdens off of people’s shoulders. Look at what we, as African Americans, have been able to do even with those burdens on our shoulders. Can you imagine what we could accomplish if some of those burdens were removed?

African American Mental Health Statistics

*African-Americans

Approximately 12% of the U.S. population -- 33.9 million people – identify themselves as African American.The African American population is increasing in diversity as immigrants arrive from many African and Caribbean countries. Over half of the Nation's African Americans population (53%) live in the South; 37% reside in the Northeast and Midwest combined; 10% live in the West.

In 1997, nearly one-fourth of all African American earned more than $50,000 a year. Yet, as a whole, when compared to other racial and ethnic groups living in the U.S., African Americans continue to be relatively poor. In 1999, about 22% of African American families lived in poverty, compared to 13% for the United States as a whole and 8% for non-Hispanic white Americans.

Poverty level affects mental health status. African Americans living below the poverty level, as compared to those over twice the poverty level, are 4 times more likely to report psychological distress. African Americans are 30% more likely to report having serious psychological distress than Non-Hispanic Whites.

Need for Mental Health Care

Whether African Americans differ from whites in the rate of mental illness cannot be answered simply. For African Americans living in the community, overall rates of mental illness appear to be similar to those of non-Hispanic whites. Differences do arise when assessing the prevalence of specific illnesses. For example:

African Americans may be less likely to suffer from major depression and more likely to suffer from phobias than are non-Hispanic whites. Somatization is more common among African Americans (15%) than among whites (9%). Moreover, African Americans experience culture-bound syndromes such as isolated sleep paralysis, an inability to move while falling asleep or waking up, and falling out, a sudden collapse sometimes preceded by dizziness.

While non-Hispanic whites are nearly twice as likely as African Americans to commit suicide, suicide rates among young black men are as high as those of young white men. Moreover, from 1980 - 1995, the suicide rate among African Americans ages 10 to 14 increased 233%, compared to 120% of comparable non-Hispanic whites. African Americans are over-represented in high-need populations that are particularly at risk for mental illnesses: People who are homeless. While representing only 12% of the U.S. population, African Americans make up about 40% of the homeless population.

People who are incarcerated. Nearly half of all prisoners in State and Federal jurisdictions and almost 40% of juveniles in legal custody are African Americans. Children in foster care and the child welfare system. African American children and youth constitute about 45% of children in public foster care and more than half of all children waiting to be adopted. People exposed to violence.

African Americans of all ages are more likely to be victims of serious violent crime than are non-Hispanic whites. One study reported that over 25% of African American youth exposed to violence met diagnostic criteria for post-traumatic stress disorder (PTSD). Among Vietnam War veterans, 21% of black veterans, compared to 14% of non-Hispanic white veterans, suffer from PTSD, apparently because of the greater exposure of blacks to war-zone trauma.

Availability of Mental Health Services

The public mental health safety net of hospitals, community health centers, and local health departments are vital to many African Americans, especially to those in high-need populations. African Americans account for only 2% of psychiatrists, 2% of psychologists, and 4% of social workers in the United States.

Access to Mental Health Services

Nearly 1 in 4 African Americans is uninsured, compared to 16% of the U.S. population. Rates of employer-based health coverage are just over 50% for employed African Americans, compared to over 70% for employed non-Hispanic whites. Medicaid covers nearly 21% of African Americans.

Use of Mental Health Services

Overall, only one-third of Americans with a mental illness or a mental health problem get care. Yet, the percentage of African Americans receiving needed care is only half that of non-Hispanic whites. One study reported that nearly 60% of older African American adults were not receiving needed services.

African Americans are more likely to use emergency services or to seek treatment from a primary care provider than from a mental health specialist. Moreover, they may use alternative therapies more than do whites.

African Americans of all ages are under represented in outpatient treatment but overrepresented in inpatient treatment. Few African American children receive treatment in privately funded psychiatric hospitals, but many receive treatment in publically funded residential treatment centers for emotionally disturbed youth.

Appropriateness and Outcomes of Mental Health Services

While few clinical trials have evaluated the response of African Americans to evidence-based treatment, the limited data available suggest that, for the most part, African Americans respond favorably to treatment. However, there is cause for concern about the appropriateness of some diagnostic and treatment procedures.

For example, when compared to whites who exhibit the same symptoms, African Americans tend to be diagnosed more frequently with schizophrenia and less frequently with affective disorders. In addition, one study found that 27% of blacks compared to 44% of whites received antidepressant medication. Moreover, the newer SSRI medications that have fewer side effects are prescribed less often to African Americans than to whites.

Finally, even though data suggest that blacks may metabolize psychiatric medications more slowly than whites, blacks often receive higher dosages than do whites, leading to more severe side effects. As a result, they may stop taking medications at a greater rate than whites with similar diagnoses.

Do Blacks Face More Stress Than Whites?

This article originally appeared in Jet Magazine 

Stress is defined as a body condition that occurs in response to actual or anticipated difficulties in life. Noting the ordinary, day-to-day pressures Blacks face in America in addition to the racial obstacles Blacks constantly battle in this country. Do Blacks face more stress than Whites? Many experts on the subject say yes. Dr. Harold W. Jordan, chairman of the psychiatry department at Meharry Medical College in Nashville, TN, says that Blacks have experienced more stress than Whites since slavery. He says that slavery is still evident in this country because of the shackles of racism, which is the primary source of stress for Blacks. "Blacks started out in this country as slaves and in many situations have not been freed from slavery," according to Dr. Jordan. "We have Black churches being burned down all over the country. We've got Blacks living in ghettos and in poverty. We've got Black young men dying on the streets. We've got Black young men disproportionately represented in jail. We're still in slavery," Dr. Jordan explains. He notes these situations add stress to Blacks' lives. "The stress is even worse today because there are some Whites who think that we have it made, and they become insensitive to our needs because they assume we've `mace so much progress in the last 30 years,'" Dr. Jordan reveals. He also notes White America's view of Blacks as "lazy or criminals" is shallow because they don't take into consideration that Blacks have more pressures than Whites. Physical stress affects the body while mental stress affects the mind. A recent study in the Journal of the American Medical Association found that mental stress leads to a greater chance of having a cardiac event, such as a heart attack, progressive chest pain, an operation or even death. Many Blacks fall victim to such mental stress. Dr. Jordan cites other consequences of mental stress such as depression and schizophrenia, in addition to its contribution to medical illnesses such as heart disease and hypertension, which are both higher among Blacks than Whites, he says. Dr. Robert Davis, president of the Association of Black Sociologists, says that Blacks face more stress than Whites because Blacks must put forth extra effort in the work force in order to prove themselves just as capable as their White colleagues. "We have to work twice as hard to get recognition so that there are no negatives on the job," says Dr. Davis. "You have to put out twice as much and be twice as good just to negotiate the system which brings about a certain amount of stress." Stress is heightened for Blacks as they move into the corporate world, adds Dr. Davis, who is also director of institutional assessment and a professor of sociology at North Carolina A & T State University. "As we move into corporate America, very often we do not have a critical mass of people of color to use as a support network. Either you're dealing with this on the margins or integrating into the mainstream, and very often that'll have its baggage in terms of stress," Dr. Davis believes. The Princeton Survey Research Associates in New Jersey recently conducted a survey which revealed that 65 percent of the adults polled said they felt stress at least one day a week compared with 55 percent in 1983. While Americans are at their wits' end in stress, Dr. William D. Richie, an assistant professor of psychiatry at Howard University in Washington, D.C., and director of Inpatient Psychiatry at Howard University Hospital, feels that Blacks and Whites face equal stress, but Blacks should try to respond to stress in a more productive manner. "We're all going to have stress. The bottom line is how you handle it," says Dr. Richie, who notes that drug and alcohol abuse and other compulsive behaviors are often negative, "learned ways" some Blacks use to handle stress. He suggests seeking counseling for those who have difficulty coping. "It's not a genetic thing. African Americans face different stressors," adds Dr. Richie, who says that Blacks not only experience racism from other races, but they also encounter racism from one another due to the various complexions of skin color. Dr. Yvonnecris Smith Veal, president of the National Medical Association and medical director of the United States Postal Service, New York Metro Area, believes Blacks have more stress than Whites because of the economy. "We have jobs. We have access to dollars, but not everyone has a satisfactory wage. If socioeconomically disadvantaged, you can anticipate more stress because there are more issues to deal with," says Dr. Veal. She also reveals that mental stress impacts our total life and that it can aggravate any disease state that's in existence. "Stress is really an emotional state that may lead to vital and mental signs of the symptom that affects an individual's ability to perform. This all leads down the pathway to complicate other disease states," maintains Dr. Veal. Dr. Thomas Parham, president of the Association of Black Psychologists, believes that Blacks face more stress than Whites because Blacks are oppressed by Whites. "White people are typically the ones who are in control. It is always the oppressed person who will experience more stress than the oppressor," says Dr. Parham, who is assistant vice chancellor for counseling and health services at the University of California at Irvine. He says that Blacks must interact with their environment in ways fundamentally different than Whites, which causes stress. "You have to engage in behaviors that require you to be more cautious when walking down the street at night or watching the color of clothes you wear. Being followed at the mall because you're Black or being corrected more by the teacher because you're Black increases stress," says Dr. Parham.