African-American Adjustment Disorder Awareness Association

History of Black Adjustment Disorder

2011-09-12T16:03:00.000-07:00

by Kenny Anderson

From the Portuguese slave forts established on the Gold Coast of Africa, Ghana in 1482, to the poverty-stricken hyper-segregated communities that many Blacks in America still live in today has been an Adjustment Disorder.

Adjustment disorder (AD) is a psychological response to an identifiable stressor or group of stressors that cause(s) significant emotional or behavioral symptoms, A stressor is generally an event of a serious, unusual nature that an individual or group of individuals experience.

The stressors that cause adjustment disorders may be grossly traumatic; the more chronic or recurrent the stressor, the more likely it is to produce a disorder. The ongoing adjustment disorder Blacks have experienced is the constant stressor of racial oppression that’s rooted in our acute stress reaction to slavery.

Indeed, Blacks’ historical experience of racial oppression has caused psychopathologies.Captured by Portuguese and other European slave traders, Africans had to go from Adjustment Disorders in slave forts to Adjustment Disorders on slave ships, where they were stacked like sardines in the unventilated hulls.

Professor S.E. Anderson described the conditions on the bottom of these ‘death ships’: “The screams, moans, crying, coughing, wretching, wailing, prayer cries, are all around you, in you. The pains, open sores, pus, mucous, blood, human waste, foaming drool, the chain cuts – gashes, flies, parasitic bugs, rats, filth, the hot smothering stinking air are all around you, in you. In fact, you have merged your being with the total ‘African Agony’ on board a vessel moving away from the Motherland”.

Arriving in American ports, after surviving the dreaded ‘Middle Passage’ voyage, Black slaves had Adjustment Disorders of being in a strange land, horrorified, traumatized, humiliated, sold on auction blocks, enslaved, separated from family, relatives, and countrymen; branded, whipped, stripped of name and cultural identity; held in slave bondage for 246 years (1619 – 1865).

Though slavery ended, the Reconstruction Era beginning in 1865 was a period of Black ‘Re-enslavement’, where Blacks with no resources to be free after being so-called emancipated, were forced back on the plantation in debt peonage as sharecroppers.

With no money Blacks had to finance their re-enslavement by borrowing money for supplies, food, and rent from the plantation owners (former slave masters). Being indebted neo-slaves, Blacks were super-exploited to remain constantly behind in their debts; they could not stop sharecropping until they paid off their debt.

Black re-enslavement was made possible by legislation passed by Southern states after the American Civil War known as ‘Black Codes’, laws designed to control the labor, movements, and activities of Blacks. Southern legislators believed Blacks were predestined to work as agricultural laborers and domestics. The Black Codes regulations left Blacks with little freedom and guaranteed a new slave workforce!!

In order to guarantee the enforcement of the Black Codes, the terrorist Ku Klux Klan (KKK) organization was founded by veterans of the Confederate Army and supported by Southern government officials. The KKK’s purpose was to restore white supremacy in the aftermath of the Civil War by terrorizing, lynching, and murdering Blacks, particularly Black men.

Psychologically, after the jubilation of emancipation and then re-enslaved and terrorized, Blacks suffered from an Adjustment Disorder with a specific depressed mood known as the ‘Blues’.

During the Reconstruction period Blacks became ‘dismally low in spirits’; fell into a ‘deep funk’ of powerlessness, worthlessness, over-burdenedness, madness, downheartedness, heavy-heartedness, broken-heartedness, mournfulness, and sadness.

In his book, ‘The Spirituals & The Blues’, Theology Professor James H. Cone stated: “Slavery is the historical background out of which the Blues were created. Suffering and its relation to Blackness is inseparable from the meaning of the Blues. Without pain and suffering, and what that meant for Black people in Mississippi, Tennessee, and Arkansas, there would have been no Blues.

The Blue mood means sorrow, frustration, despair, and Black people’s attempt to take these existential realities upon themselves and not lose their sanity. The Blues are not art for art’s sake, music for music’s sake. They are a way of life, a lifestyle of the Black community; and they came into being to give expression to Black identity and the will for survival.”

Escaping from sharecropping and Klan terror, Blacks from the South migrated to New York, Philadelphia, Chicago, and Detroit. They brought the Adjustment Disorder Blues with them and had Adjustment Disorders adjusting to a new but familiar Northern cities Blues of racism, segregation, lack of jobs, and poor ghetto neighborhoods.

Malcolm X had remarked that ‘Blacks merely went from down south to up south’. Being in a new, unfamiliar overcrowded urban environment, Blacks felt alienated and longed for family and friends down home. Being lonely and in despair many fell into drinking whiskey and using drugs to escape the stress filled depressive realities of the urban Blues.

Professor Cone’s above mentioned point that the Blues has been a way of life for Blacks in America was captured in the ‘Last Poets’ poem entitled ~ ‘True Blues’:

True blues ain’t no new news
‘bout who’s been abused
for the blues is as old as my stolen soul
I sang the Blues when the missionaries came
passing out Bibles in Jesus’ name
I sang the Blues in the hull of the ship
beneath the sting of the slavemaster’s whip
I sang the Blues when the ship anchored the dock
my family being sold on a slave block
I sang the Blues being torn from my first-born
and hung my head and cried
when my wife took his life and then committed suicide
I sang the Blues on the slavemaster’s plantation
helping him build his ‘free’ nation
I sang the Blues in the cotton field
hustlin’ to make the daily yield
I sang the Blues when he forced my woman to bed
Lord knows! I wished he was dead
I sang the Blues on the run
duckin’ the dog and dodging the gun
I sang the Blues hangin’ from the tree
in a desperate attempt to break free
I sang the Blues from sunup to down
cursing the master when he wasn’t around
I sang the Blues in all his wars
dying for some unknown cause
I sang the Blues in a high tone, low moan
loud groan, soft grunt, hard funk!
I sang the Blues on land, sea and air
about who, when, why and where
I sang the Blues in church on Sunday
Slavin’ on Monday
Misused on Tuesday
Abused on Wednesday
Accused on Thursday
Fried alive on Friday
And died on Saturday
Sho’nuff singin’ the blues
I sang the Blues in the summer, fall, winter and spring
I know sho’nuff that the blues is my thing
I sang the backwater blues
Rhythm and blues
Gospel blues
St Louis blues
Crosstown blues
Chicago blues
Mississippi Goddam blues
The Watts blues
Harlem blues
Hough blues
Gutbucket blues
Funky Junkie blues
I sang the Up North Cigarette Cough blues
The Down South Strung Out On The Side Of My Mouth blues
I sang the blues black
I sang the blues blacker
I sang the blues blackest
I sang about my sho’nuff blue blackness

The ‘Blues’ is deeper than a DSM IV definition of depression. The true Black Blues is existential, it is ‘Blues to the Bone’; it is a spiritual ailment from the unrelenting, grinding stress and strain of daily racial oppression from the cradle to the grave; where one is hurt to the core; one’s essence is wounded and in pain; one’s inner vitality is gone - tapped out; the soul has been depleted; one lives but is ‘dead inside’ (zombie), living a suicidal lifestyle wanting to die, expressed graphically by many young Black men today, “I don’t give a fuck, I’m just fucked up, take me out – kill me!”

The historical experience of Adjustment Disorder by Blacks in America has been defined by Dr. Joy DeGruy-Leary as ‘Post-Traumatic Slave Syndrome’ (PTSS). DeGruy-Leary states that Blacks have never healed from slavery – the ‘Black Holocaust’. The original enslaved Africans were never treated for their severe trauma. After slavery ended nothing was done to help Black ex-slaves recover from trauma; nor was anything done to treat Blacks re-enslaved by Black Codes during Reconstruction.

For one hundred years (1865 – 1965) of Civil Rights struggle, no measure was put in place to provide mental health services to Blacks who had suffered from Klan terror, lynchings, racist murders, repressive Jim Crow laws, and diabolical Tuskegee Syphilis experiments. Even in the post-Civil Rights era, most Blacks today who suffer from on-going racism, massive poverty and unemployment, homelessness, violence, drugs, and psychological duress don’t receive mental health services.

DeGruy-Leary says that there has never been a period of time when Blacks in America were given the information and opportunity to heal from our racial oppression-based Adjustment Disorder injuries. So the psychopathologies have continued, passed down from generation to generation ~ without Blacks being conscious of its origin, symptoms, and treatments.

Diabetes an Epidemic in Black America

2010-09-14T12:26:00.000-07:00

by Kevin Chappell

Nearly 21 million people in the United States, or 7 percent of the population, have diabetes. And another 54 million people are believed to have the beginning stages of diabetes.

Every minute of every day, another American develops type 2 diabetes. Among African-Americans, the numbers are even more daunting. One in 7 Blacks has the disease, and African-Americans are twice as likely as Whites to develop diabetes.

At the rate that diabetes is progressing, it is predicted that for every two African-American children born today, one will develop diabetes--type 2 diabetes, which used to be called "adult onset diabetes."

But with more Black children than ever before being diagnosed with diabetes, medical professionals are rethinking their entire approach to the disease--and raising the question: Has diabetes become an epidemic in Black America?

"We're seeing shortening of life spans, people are dying earlier from heart disease, strokes," says Dr. Duane Smoot, chair of the medical department at the Howard University Hospital.

"There are just so many problems associated with diabetes. It causes aging of your blood vessels, so hardening of the arteries occurs more frequently. It causes people to have more problems with aging. We talk about aging gracefully, but with this disease, it makes it more difficult to have a good quality of life.

We have very firm data that tells us that diabetes itself had reached epidemic proportions in this nation as a whole, but more specifically in the African-American community."

Dr. Wayman Wendell Cheatham, medical director at the Medstar Research Institute in Washington, D.C., agrees. "We should be very, very concerned. I am terribly concerned," Cheatham says.

"Diabetes is a major killer. It doesn't only cause people to lose their vision, lose their kidneys, lose their limbs, diabetes reduces life expectancy significantly. People die of heart attacks and strokes because diabetes. It is one of the more underlisted causes of death of all causes ... With the trend line that we're on, it's a terrible epidemic."

Dr. James Gavin, past president of the American Diabetes Association, defines an epidemic as a disease that spreads "beyond a local population, lasting a long time and reaching people in a wider geographical area," he says. "Many classify diseases as a pandemic once the disease reaches worldwide proportions."

So what caused this explosion of diabetes in the Black community?

Gavin and others believe that genetics have played a large role. However, given that the population gene pool shifts very slowly overtime, the current epidemic of diabetes can't solely be attributed to genes.

Many health professionals are attributing a large part of the problem to the drastic slowing of active lifestyles, and the drastic shift in diet to one that now consists largely of processed foods.

The result: Black children and adults, particularly females, are more overweight now than ever before. One study on physical activity found that, by the age of 18, Black girls have a decline in physical activity twice that of White girls the same age.

"Obesity and diabetes go hand in hand," says Dr. Joyce Richey, diabetes researcher and assistant professor at the Keck School of Medicine at University of Southern California.

"The obesity issue is the trigger, and we have a genetic background that sets off that trigger. The result is a diabetes epidemic ... When you become obese, you become less responsive to the insulin that your body is putting out. Then your body realizes that you are becoming resistant, and starts putting out more insulin. Diabetes occurs when your beta cells become so impaired that you are not able to compensate for that resistance that you have."

Richey and other researchers are working feverishly to unravel the mystery of fat, particularly what is it about fat, or in fat, that triggers diabetes. "What we are finding out is that we've always thought of fat as being dormant, taking up space for sure, but not much else," she says.

"But what we are finding out [now] is that fat is like an organ that is secreting things into our system. Fat is not good, especially belly fat. That's the fat that is very unhealthy."

Richey says eating healthy and increasing physical activity are keys to stemming the diabetes epidemic. Catching the disease in its earliest stage is also key. When the disease is in its "pre-diabetes" stage, actions can be taken to prolong, if not prevent, its onset.

A landmark study sponsored by the National Institutes of Health indicated that people with pre-diabetes lowered their risk of developing type 2 diabetes by more than half by losing 5 to 7 percent of their body weight, getting at least 30 minutes of physical activity five days a week and eating healthier.

In addition to lifestyle changes, researchers are also developing new classes of drugs that decrease the rate of developing diabetes if taken early in the disease's progression. Other drugs restore the ability of the pancreas to make insulin more normally and release it more normally.

But presently, nothing can replace the self-determination of a person to keep his or her diabetes in check. Just ask Regina Barrett. The Washington, D.C., native has battled diabetes for five years. And so far, she's winning the fight.

"The changes that I have made are lifestyle changes," says the 51-year-old. "They are not temporary. They are things that, if I want to continue to feel good, if I want to do the best that I can, I have to do. I want to know that I have done all that I possibly can to fight the disease. Right now, I feel healthy, even having diabetes."

DIABETES By The Numbers

*DEATHS: Diabetes was the sixth leading cause of death listed on U.S. death certificates in 2002. This ranking is based on the 73,249 death certificates in which diabetes was listed as the underlying cause of death. According to death certificate reports, diabetes contributed to a total of 224,092 deaths. Diabetes is likely to be underreported as a cause of death. Studies have found that only about 35 percent to 40 percent of decedents with diabetes had it listed anywhere on the death certificate and only about 10 percent to 15 percent had it listed as the underlying cause of death. Overall, the death rate among people with diabetes is about twice that of people without diabetes of similar age.

*HEART DISEASE AND STROKE: Heart disease and stroke account for about 65 percent of deaths in people with diabetes. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes.

*HIGH BLOOD PRESSURE: About 73 percent of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.

*BLINDNESS: Diabetes is the leading cause of new cases of blindness among adults aged 20 to 74 years. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.

*KIDNEY DISEASE: Diabetes is the leading cause of kidney failure, accounting for 44 percent of new cases in 2002. In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease. In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant.

*NERVOUS SYSTEM DISEASE: About 60 percent to 70 percent of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems. Almost 30 percent of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling). Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.

*AMPUTATIONS: More than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes. In 2002, about 82,000 non-traumatic lower-limb amputations were performed in people with diabetes.

*ESTIMATED COSTS OF DIABETES IN THE UNITED STATES: $132 billion, with $92 billion in direct medical costs and $40 billion in indirect costs (disability, work loss, premature mortality).

*TYPE 1 AND TYPE 2 DIABETES: Type 1 diabetes (also known as juvenile-onset diabetes) accounts for 5 percent to 10 percent of all people with diabetes. Type 2 diabetes accounts for the majority of people with diabetes--90 percent to 95 percent.

How DIABETES Is Ravaging The African-American Community

*Thirteen percent (3.2 million) of all African-Americans aged 20 years or older have diabetes.
*Twenty-five percent of African-Americans between the ages of 65 and 74 have diabetes.
*African-Americans are 1.8 times more likely than Whites to have diabetes.
*One in 4 African-American women over 55 years of age has diabetes.
*African-Americans are almost twice as likely as Whites to develop diabetic retinopathy (blindness).
*African-Americans are as much as 5.6 times more likely than Whites to suffer from kidney disease as a result of diabetes complications.
*African-Americans are 2.7 times more likely than Whites to suffer from lower-limb amputations.

Source: American Diabetes Association

Study Examines Unhealthy Behaviors in Response to Stress

2010-06-14T17:28:00.000-07:00

May 18, 2010

When people are under chronic stress, they tend to smoke, drink, use drugs and overeat to help cope with stress. These behaviors trigger a biological cascade that helps prevent depression, but they also contribute to a host of physical problems that eventually contribute to early death.

That is the claim of University of Michigan social scientist James S. Jackson and colleagues in an article published in the May 2010 issue of the American Journal of Public Health.

The theory helps explain a long-time epidemiological puzzle: why African Americans have worse physical health than whites but better psychiatric health. "People engage in bad habits for functional reasons, not because of weak character or ignorance," says Jackson, director of the U-M Institute for Social Research.

"Over the life course, coping strategies that are effective in ‘preserving’ the mental health of blacks may work in concert with social, economic and environmental inequalities to produce physical health disparities in middle age and later life."

In an analysis of survey data, obtained from the same people at two points in time, Jackson and colleagues find evidence for their theory.

The relationship between stressful life events and depression varies by the level of unhealthy behaviors. But the direction of that relationship is strikingly different for blacks and whites.

Controlling for the extent of stressful life events a person has experienced, unhealthy behaviors seem to protect against depression in African Americans but lead to higher levels of depression in whites.

"Many black Americans live in chronically precarious and difficult environments," says Jackson. "These environments produce stressful living conditions, and often the most easily accessible options for addressing stress are various unhealthy behaviors.

These behaviors may alleviate stress through the same mechanisms that are believed to contribute to some mental disorders — the hypothalamic-pituitary-adrenal cortical axis and related biological systems."

Since negative health behaviors such as smoking, drinking alcohol, drug use and overeating (especially comfort foods) also have direct and debilitating effects on physical health, these behaviors — along with the difficult living conditions that give rise to them — contribute to the disparities in mortality and physical health problems between black and white populations.

These disparities in physical health and mortality are greatest at middle age and beyond, Jackson says. Why? "At younger ages, blacks are able to employ a variety of strategies that, when combined with the more robust physical health of youth, effectively mask the cascade to the negative health effects," Jackson said.

"But as people get older, they tend to reduce stress more often by engaging in bad habits." Black women show heightened rates of obesity over the life course, he points out.

In fact, by the time they are in their 40s, 60 percent of African American women are obese. "How can it be that 60 percent of the population has a character flaw?" Jackson asks.

"Overeating is an effective, early, well-learned response to chronic environmental stressors that only strengthens over the life course. In contrast, for a variety of social and cultural reasons, black American men’s coping choices are different.

"Early in life, they tend to be physically active and athletic, which produces the stress-lowering hormone dopamine. But in middle age, physical deterioration reduces the viability and effectiveness of this way of coping with stress, and black men turn in increasing numbers to unhealthy coping behaviors, showing increased rates of smoking, drinking and illicit drug use."

Racial disparities in physical illnesses and mortality are not really a result of race at all, Jackson says. Instead, they are a result of how people live their lives, the composition of their lives. These disparities are not just a function of socioeconomic status, but of a wide range of conditions including the accretion of micro insults that people are exposed to over the years.

"You can’t really study physical health without looking at people’s mental health and really their whole lives," he said. "The most effective way to address an important source of physical health disparities is to reduce environmentally produced stressors — both those related to race and those that are not.

We need to improve living conditions, create good job opportunities, eliminate poverty and improve the quality of inner-city urban life. "Paradoxically, the lack of attention to these conditions contributes to the use of unhealthy coping behaviors by people living in poor conditions.

Although these unhealthy coping behaviors contribute to lower rates of mental disorder, over the life course they play a significant role in leading to higher rates of physical health problems and earlier mortality than is found in the general population."

Poverty Goes Straight to the Brain

2010-05-27T06:56:00.000-07:00

By Brandon Keim

Growing up poor isn’t merely hard on kids. It might also be bad for their brains. A long-term study of cognitive development in lower- and middle-class students found strong links between childhood poverty, physiological stress and adult memory.

The findings support a neurobiological hypothesis for why impoverished children consistently fare worse than their middle-class counterparts in school, and eventually in life, particularly African-American children who suffer disproportionately from racism related poverty and stress.

"Chronically elevated physiological stress is a plausible model for how poverty could get into the brain and eventually interfere with achievement," wrote Cornell University child-development researchers Gary Evans and Michelle Schamberg in a paper published Monday in the Proceedings of the National Academy of Sciences.

For decades, education researchers have documented the disproportionately low academic performance of poor children and teenagers living in poverty. Called the achievement gap, its proposed sociological explanations are many.

Compared to well-off kids, poor children tend to go to ill-equipped and ill-taught schools, have fewer educational resources at home, eat low-nutrition food, and have less access to health care.

At the same time, scientists have studied the cognitive abilities of poor children, and the neurobiological effects of stress on laboratory animals. They’ve found that, on average, socioeconomic status predicts a battery of key mental abilities, with deficits showing up in kindergarten and continuing through middle school.

Scientists also found that hormones produced in response to stress literally wear down the brains of animals.

Evans and Schamberg’s findings pull the pieces of the puzzle together, and the implications are disturbing. Sociological explanations for the achievement gap are likely correct, but they may be incomplete.

In addition to poverty’s many social obstacles, it may pose a biological obstacle, too.

"A plausible contributor to the income-achievement gap is working-memory impairment in lower-income adults caused by stress-related damage to the brain during childhood," they wrote.

To test their hypothesis, Evans and Schamberg analyzed the results of their earlier, long-term study of stress in 195 poor and middle-class Caucasian students, half male and half female.

In that study, which found a direct link between poverty and stress, students’ blood pressure and stress hormones were measured at 9 and 13 years old. At 17, their memory was tested.

Given a sequence of items to remember‚ teenagers who grew up in poverty remembered an average of 8.5 items. Those who were well-off during childhood remembered an average of 9.44 items.

So-called working memory is considered a reliable indicator of reading, language and problem-solving ability — capacities critical for adult success.

When Evans and Schamberg controlled for birth weight, maternal education, parental marital status and parenting styles, the effect remained. When they mathematically adjusted for youthful stress levels, the difference disappeared.

In lab animals, stress hormones and high blood pressure are associated with reduced cell connectivity and smaller volumes in the prefrontal cortex and hippocampus. It’s in these brain regions that working memory is centered.

Evans and Schamberg didn’t scan their human subjects’ brains, but the test results suggest that the same basic mechanisms operate in kids.

"Brain structures change with stress and are affected by early-life stress in animal models," said Rockefeller University neuro - endocrinologist Bruce McEwen. "Now there are beginnings of work on our own species. The Evans paper is an important step in that direction."

McEwen also noted that, at least in animals, the effects of stress produce changes in genes that are then passed from parent to child. Poverty’s effects could be hereditary.

The findings, though compelling, still need to be replicated and refined. "They’re not really saying which causal events were stressful. They’re just measuring biological markers of stress," said Kim Noble, a Columbia University psycho-biologist who studies the relationship between child poverty and cognition. Other mental consequences of poverty also need to be measured.

"I think that different cognitive outcomes have different causes," said Noble. "Something like working memory might be more associated with stress, whereas language might be associated with hours spent reading to your children."

But Noble still said the study "was very well-done. They have an impressive data set." And though some details remain incomplete, she said, evidence of connections between poverty and neurobiology are strong enough to justify real-world testing.

"Policy changes that affect environments that might affect cognitive development and brain change — that’s the ultimate future of the field," she said.

Racism Related Stress

2010-05-27T06:47:00.000-07:00

According to Utsey (1998), race-related stress is the discomfort experienced by African Americans who observe or directly experience racial discrimination in their daily lives at the individual, cultural, or institutional level.

Harrell (2000) utilized the term ‘racism-related stress’ (rather than race-related stress) to emphasize the link between stress and racism, thereby focusing on the environmental experience of racism rather than just on the racial group membership of an individual.

The multidimensional layers of racism (individual, institutional, and cultural), as described by Jones (1997), is a basis for much of the literature on race-related stress.

Individual racism typically occurs on the personal level, where racial prejudice is acted out, either consciously or unconsciously within some interpersonal interaction.

Institutional racism is an institutionalized version of the individual act of racism in which institutional practices and policies are based in the belief of racial superiority of one group over another.

Cultural racism is demonstrated through the assertion of the dominant group's cultural heritage and values (i.e., traditions, language, arts, values) over the values, beliefs, and traditions of all other groups. These levels of racism are both insidious and chronic and likely test the individual and collective resources and resolve of Black people.

Racism-related stress, perceived discrimination, and racism have been linked with many psychological and health related variables such as negative self-esteem, concentration difficulties, intrusive thoughts about specific racism encounters, and increased risk for mental and physical illness such as depression, anxiety, hypertension, or headaches (Clark, Anderson, Clark, & Williams, 1999; Essed, 1990; Landrine & Klonoff, 1996; Lopez, 2005; Outlaw, 1993; Utsey, Ponterotto, Reynolds, & Cancelli, 2000).

The cumulative effect of the stress and strain of daily racism has been shown to negatively affect the health and well-being of Black people and diminish their quality of life (Ponterotto, Utsey, & Pedersen, 2006).

Fitness a Problem for African-Americans

2009-09-23T07:04:00.000-07:00

Study Finds More Obesity in African-Americans Given Heart Stress Tests
By Daniel J. DeNoon

Too many Americans suffer from poor fitness and obesity. African-Americans are at particularly high risk, a new study shows.

Carl J. Lavie, MD, is co-director of cardiac rehabilitation and preventive cardiology at the Ochsner Clinic Foundation in New Orleans. Lavie and colleagues collected data on more than 5,000 men and women aged 52-74 who underwent treadmill heart stress tests at the Ochsner Clinic.

The major findings:

*On average, African-American men in the study were three years younger than the white men, yet African-American men's fitness capacity was 7% lower than that of white men. The difference is considered significant.

*On average, African-American women in the study were four years younger than the white women. Yet African-American women's fitness capacity was 3% lower than that of white women. This difference is not considered significant.

*African-American men were more likely to be obese than white men: 44% vs. 33%.

*African-American women were more likely to be obese than white women: 37% vs. 27%.

*African-American women were also more likely than white women to be severely obese: 19% vs. 11%.

"Even correcting for obesity, African-Americans are slightly less fit," says Lavie. "Everyone in the country needs to be thinking about their weight and their fitness. Our data support [that] this is of even greater urgency in African-Americans."

Lavie's study appears in the December issue of the journal Chest. Lavie notes that the best predictor of premature death is poor physical fitness. He points to studies showing that the best way people can reduce their risk of early death is to improve their exercise capacity.

"The message here is that both obesity and fitness are very important to all races and genders," he says. "But in African-Americans, we need even greater attention not only to reducing weight, but in improving fitness. The two go together but are separate, too."

Obstacles to Fitness
Sheila P. Davis, PhD, is professor of nursing at the University of Mississippi Medical Center in Jackson. She has studied African-American children living in the rural south and found high levels of obesity and low levels of fitness.

"Being African-American myself, I can conjecture about what is happening," says Davis. "In the South, in terms of obesity, the differences are not that marked. To call it a black obesity problem is to miss the point -- we have an obesity problem. In terms of fitness, we are more similar than dissimilar.

There are no genetic differences. But there are things within the culture that we incorporate that might be responsible for some of the differences." Unfortunately, she notes, many African-Americans face restraints on becoming more physically active.

Black children in poor communities attend schools that lack gyms and physical education teachers. And a person can't just put on running shoes and go for a jog or a walk in a community where personal safety due to crime and violence is an issue.

"Those restraints exist," Davis says. "If they were removed, we would see more equalization in terms of fitness." This does not excuse poor diets or sedentary lifestyles, Davis notes.

She says there is a critical need for aggressive interventions to improve diet and exercise for African-American children and teens.

Racism May Affect Black Men's Health

2009-09-23T06:44:00.000-07:00

By Susan Brink

Terry Davis didn't know he was having a stroke, much less that, as an African-American male, he had a three to four times greater risk of suffering one than a white man.

When a transient ischemic attack, or ministroke, hit nearly a year ago, he was 49. He woke up early, felt a little slackness on his right side, a little slowness in his speech.

A professional tennis teacher, he canceled the day's lessons and, thinking more sleep was what he needed, went back to bed. His wife, Carrie, still feels guilty that she got a little annoyed with his lethargy that day. "I thought, 'Snap out of it. Help me get the kids going,'" she says. Davis is fine now.

But the stroke scared him about his future, and the futures of his four sons, ages 8, 16, 18 and 21. These days, they all keep a more watchful eye on one another's health habits. Statistically, black men in America are at increased risk for just about every health problem known.

African-Americans have a shorter life expectancy than any other racial group in America except Native Americans, and black men fare even worse than black women. Some of it can be chalked up to poverty, the most powerful determinant of health, or to lifestyle factors. But even when all those factors are accounted for in studies, the gap stubbornly persists.

Now researchers are beginning to examine discrimination itself. Racism, more than race, may be cutting black men down before their time. It is possible, they believe, that the ill health and premature deaths can be laid -- at least in part -- at the feet of continuous assaults of discrimination, real or perceived.

"We have always thought of race-based discrimination as producing a kind of attitude," says Vickie Mays, psychologist and director of the UCLA Center on Research, Education, Training and Strategic Communication on Minority Health Disparities.

"Now we think we have sufficient information to say that it's more than just affecting your attitude. A person experiences it, has a response, and the response brings about a physiological reaction."

Stress response The reaction contributes to a chain of biological events known as the stress response, which can put people at higher risk of cardiovascular disease, diabetes and infectious disease, says Namdi Barnes, a researcher with the UCLA center.

That protective response includes the release of cortisol, often called the stress hormone. It increases blood pressure and blood sugar levels and suppresses the immune system. For many African-Americans, these responses may occur so frequently that they eventually result in a breakdown of the physiological system.

"This whole phenomenon of cumulative biologic stress is real," says Nicole Lurie, director of the Rand Center for Population Health and Health Disparities. The shorter life expectancy of black men has been an inflexible truth since slavery.

The gap has slowly narrowed throughout the last century, and the most recent improvement is attributed to lower accident and homicide rates, along with life-sustaining treatments for AIDS, all of which afflict a greater proportion of black men.

Still, heart disease, stroke, hypertension, diabetes, obesity and most cancers strike black men sooner, and cut them down more often, than white men.

And the higher incidence of disease among black men is set against a backdrop of an increased incidence of poverty, which carries with it a multitude of health problems.

Poor people smoke more, exercise less and are more likely to be victims of accidents and violence. It adds up to an average life span for black men that is 6.2 years less than for white men, and 8.3 less than the national average, 77.8 years, for all races and both genders.

"There's a whole boatload of things that are in the environments where they're more likely to grow up," Lurie says. "HIV, crime, that kind of stuff. There's a lot of extra dying going on from trauma." Explaining disparities Still, all the socioeconomic factors together don't fully explain racial disparities.

In a Feb. 9, 1990, study in the Journal of the American Medical Association, researchers compared black and white death rates per 100,000 people 35 to 54 years old and found the black rate 2.3 times higher.

When they adjusted the data for known risk factors such as smoking, alcohol intake and diabetes, the gap narrowed to 1.9 times, and when they adjusted further for income, it narrowed to 1.4 times.

How people live, die and get sick depends on economic class as well as race, but all of the adjustments combined didn't completely explain the black-white mortality gap, leaving about a third of the problem unexplained, the researchers found. "Life expectancy for everyone is increasing, but the disparities are not getting better," Lurie says.

Seeking to explain that gap, researchers have grown increasingly interested in the theory, based on a growing body of evidence linking stress to poor physical health, that racial discrimination can result in unremitting stress. That additional, continuing stress might explain some of the still mysterious gap.

UCLA's Mays was lead author on a paper published in the 2007 Annual Review of Psychology that examined studies looking at the responses of the brain and body to race-based discrimination.

Experiences of racial discrimination can set the brain up for what's known as the fight-or-flight response. If it happens over and over again, in large doses of vulgar taunts or small doses of perceived slights, parts of the brain become overwhelmed.

"Let's say something occurs where [security follows] me around in a store," Mays says. "I think that's racist. My blood pressure goes up. I get upset. Then I go to a different store. Someone appears to start following me. I am primed from a previous experience and I feel it again. We call it a micro-assault."

According to research into stress, such emotionally packed memories are held in a part of the brain called the amygdala, which regulates fear responses through the release of hormones such as cortisol.

At first, the release of cortisol acts as an anti-inflammatory agent in the body. But if the body continually overloads with the hormone, the protective system shuts down and then actually reverses, increasing inflammation, which is linked to high blood pressure, cardiovascular disease and possibly diabetes.

Mays believes, and argued in the recent paper, that scientists know enough about people's reactions to racial discrimination and also the body's response to stress to link the two. "The literature is building," she says. 'Toxic cocktail' Studies keep pouring out showing racial disparities in health.

A recent one in the September 2007 Annals of Epidemiology found that even in the so-called stroke belt of Southern states, where all races and both genders suffer the highest rates of stroke in the country, African-American men are stricken at the highest of the high rates.

The study's lead author, Dr. George Howard, chairman of the department of biostatistics at the University of Alabama at Birmingham, is not ready to finger discrimination as the primary cause.

"It's a whole toxic cocktail of bad things, but if I had to pick one, it would be socioeconomic status," he says. "It's clear that racism plays a role, but I don't think it's the 800-pound gorilla."

Depression Hits U.S. Blacks Harder Than Whites

2008-11-28T11:48:00.000-08:00

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

2008-11-25T18:19:00.000-08:00

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

2008-11-21T17:41:00.000-08:00

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

2008-11-21T17:34:00.000-08:00

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

2008-11-21T08:17:00.000-08:00

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

2008-11-20T18:10:00.000-08:00

*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?

2008-11-17T18:48:00.000-08:00

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.