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‘Bear Our Pain’: The Plea For More Black Mental Health Workers

By Yuki Noguchi (NPR)

Two decades of life experience made a mental-health activist of Kai Koerber. When he was 16 and a student at a Parkland, Fla., high school, a gunman killed 17 people, including one his friends.

“I really did suffer a domestic terrorist attack, and that’s not something that happens to you every day,” Koerber says.

But as a young Black man growing up in the South, Koerber had already faced threats of racial and police violence routinely, and those experiences, too, shapedhis relationship with the world. He’s coped with that stress, he says, through a lifelong practice of meditation. And after the school massacre, Koerber also sought emotional support from a therapist with a deep empathy for his personal traumas.

“Finding a Black therapist really saved me some time, and there was more connection, in terms of the kinds of struggles that I might feel or the the kinds of ways I might think about certain scenarios,” Koerber says.

Now a rising sophomore at the University of California, Berkeley, Koerber says having access to good mental health care is critical to both preventing and dealing with the after-effects of violence.

Racism’s burden

The need for mental health support is more evident than ever, especially among Black Americans, say people who study and experience the burden of racism. People of color were already dealing with heavy loads from a pandemic that continues to claim a greater proportion of Black, Latino and Native American lives and a greater share of jobs. Now there’s the emotional reckoning following George Floyd’s murder, which has stirred up a kind of collective trauma.

Meanwhile, the economic barriers to accessing mental health care have only increased.

Dr. Rhea Boyd says many members of the Black community feel emotionally raw and tapped out.

“We haven’t been asked to publicly bear our pain as frequently as we are now, and we haven’t had to witness other Black folks publicly baring their pain about it as frequently as we are now,” says Boyd, a Bay Area pediatrician who studies the effects of police violence.

She says racism’s toll threads through the psyche, manifesting in many ways, and shaping the youngest of brains. She worries most about Black girls, for whom suicide risk is increasing — not just among teenagers, but among preteens as well.

The need for mental health support, in other words, is great. But the history of meeting that need is not, says Dr. Ruth Shim, a psychiatrist at the University of California at Davis. The American system’s abuse of African Americans spans generations — from forced experimentation to committing black civil rights activists to mental institutions.

Misdiagnosis prevalent

Misdiagnosis of Black people,Shim says, is still prevalent today — often by non-Black doctors who misread emotional cues like anger.

“We look at these things and call them ‘disruptive behaviors,’ we misdiagnose young people with things like ‘conduct disorder’ instead of the result of chronic trauma from racism,” because many physicians haven’t experienced it, Shim says.

For many Black patients, access to mental health treatment often comes in places of last resort: Jails, schools, emergency rooms. And studies show that African Americans tend to be given psychiatric diagnoses that are incorrect or especially severe or less treatable — such as schizophrenia instead of depression or bipolar disorder — and that can lead to inappropriate treatment. So, not surprisingly, Black patients who do get treatment tend to fare worse than white counterparts.

“I do think changing the workforce and changing the face of the workforce is probably the most critical thing that we can do now to start to address some of these issues,” Shim says.

The scarcity of Black mental health professionals in the U.S. is now an acute problem, says Dr. Altha Stewart, a Memphis psychiatrist who became the first Black president of the American Psychiatric Association two years ago.

“I get calls from people right now asking, ‘Can’t you refer me to a Black psychiatrist?’ And because there are so few of us, I’m limited in how many of those people’s referrals I can make to their satisfaction,” Stewart says. And that contributes to a lack of faith in health care among African Americans.

Stewart sees some signs of hope. In recent years, Black celebrities in sports and entertainment — like former NBA star Ron Artest, radio personality Charlamagne Tha God and actress Taraji P. Henson — started openly advocating for the importance of mental health screening and support. She says more Black faith leaders in churches and mosques are partnering with programs that help them connect congregants to treatment.

But at the moment, Stewart says, in the aftermath of the killing of George Floyd, the need is simply too great. “This was one bridge too many, one act too many, one heinous crime too many. It’s something too much.”

Examining the Link Between Racism and Health

Author: The Bronfenbrenner Center for Translational Research

Psychology Today

When the mind senses a potentially harmful situation, it tells the body to prepare by increasing its heart rate, breathing, and blood pressure. This response helped earlier humans outrun or fight predators and enemies.

Today’s stressful situations, more likely a challenging interaction at work or a misbehaving child, result in the same physical reactions even though we are less likely to experience physical danger. The problem is, when this stress response is repeated frequently over time, evidence shows it leads to health problems including depressionanxietyinsomnia, heart disease, skin rashes, and gastrointestinal problems—just to name a few.

Now a growing body of evidence demonstrates that racial discrimination triggers this stress response. As a result, racial minorities may experience more health problems compared to others. One review of 121 studies published in 2013 found that youth between the ages of 12 and 18 who experienced discrimination were significantly more likely to experience mental health problems such as depression and anxiety compared to those who did not experience discrimination. Another review of 66 studies found that black American adults who perceived they were subjected to racism were more likely to experience mental health problems and more likely to report a lower quality of life.

A lead researcher in the field is Anthony Ong, a professor of human development in Cornell University’s College of Human Ecology. Ong explains that experiencing discrimination or mistreatment regularly can affect health through eroding a person’s self-esteem and by robbing marginalized individuals of opportunities.

“Although increasing evidence suggests that chronic exposure to unfair treatment or day-to-day discrimination increases the risk for poor health, the overall dearth of data on biological mechanisms indicate it’s important to continue studying this topic,” Ong said.

He published a study last year of more than 200 African-American adults followed over the period of a decade. Participants filled out questionnaires about everyday mistreatment such as being called names, insulted, threatened, or harassed. They also answered questions about larger occurrences of unfair treatment, such as being discouraged from continuing their education, not receiving a loan or being hassled by the police.

Participants also underwent blood tests to identify 22 biomarkers of diseases including heart disease, diabetes, nerve problems and inflammation.

Ultimately, participants who reported experiencing more discrimination were in poorer health. Ong said that’s because experiencing discrimination on a regular basis, even small instances of daily mistreatment, lead to “wear-and-tear” on the body over time.

“Our findings suggest that coping with chronic experiences of day-to-day mistreatment and discrimination can elicit a cascade of response that over time ‘weather’ or damage the physiological systems that regulate the body’s stress response,” he said.

Ong published a second study of 152 Asian-American college students, who kept a diary of their daily events, moods, and physical health for two weeks. The study found that when participants experienced mistreatment, what Ong calls “daily microaggressions,” they reported poorer sleep quality and shorter sleep duration the following day. Participants who experienced reported more “stigma consciousness”—that is, they believed discrimination influenced their daily interactions with others—were more likely to experience poor sleep quality on nights after they reported experiencing mistreatment.

“Being constantly vigilant to race-related threats in the environment may keep you from getting a good night’s sleep,” Ong explained.

The broad take-home message here is that racial discrimination can lead to health problems that detract from minorities’ quality-of-life over the course of a year or even a lifetime. 

This article may have been edited for content

April Green


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Is extreme racism a mental illness?

By Alvin F. Poussaint, MD

Clinical Psychology News

The ungodly massacre of nine black worshippers at a church in Charleston, S.C., reignites the question: Is extreme racism a mental illness? The prime murder suspect, a young white man, allegedly hated black people and hoped to incite a race war. Media outlets categorized the alleged perpetrator as deranged, demented, and delusional. Nevertheless, mental health professionals are reluctant to classify racial terrorists as mentally ill.

The American Psychiatric Association contests extreme racism (as opposed to ordinary prejudice) as a mental health problem. The psychodynamics of extreme racism were all but ignored until the 1960s. After multiple racist killings in the civil rights era, a group of black psychiatrists sought to have extreme bigotry – not ordinary bigotry – defined as a mental disorder. The association’s officials rebuffed the recommendation, arguing that so many Americans are racist that even extreme racism is normative and better thought of as a social aberration than an indication of individual psychopathology.

Some felt that a mental illness diagnosis would serve as an excuse and absolve perpetrators of personal responsibility for their gruesome acts. Others believed a psychiatric diagnosis would open doors to an insanity defense plea that might lead to exoneration. However, such fears do not hinder diagnosing mental disorders in other capital murder defendants. Raising these extraneous issues evades the point.

Similar questions have arisen with regard to genocide. Whether individual Nazis exterminating Jews were insane or merely acting out the extremes of a pathologic society is an ongoing debate. Describing these killers as evil falls far short of a psychological evaluation. Reports document that Hitler suffered from diagnosable paranoia. Were his followers ill as well? There is a point at which the cultural norms with regard to racism clearly separate from extreme racism, a manifestation of serious individual psychopathology. Societal racism facilitates incorporating bigotry into a person’s racist psychotic and antisocial dysfunction. Many murderous paranoid schizophrenics have had racial targets at the core of their psychotic delusions. The criminal justice system (perhaps a step ahead of psychiatry) now refers to such violence as hate crimes – but that tells us little about the offender’s psychological state.

Not everyone professing a prejudiced belief about a particular group is mentally ill. On the contrary, most racism is learned behavior. Racism in a broad sense may be adaptive human behavior; homo sapiens are hard wired with a tendency to fear strangers and protect their own turf to foster their survival.

Racist attitudes that interfere with an individual’s ability to work with people from a particular group should not in itself be considered mental illness. However, if that person believes he has to kill black people, such ideation must be examined as an expression of a mental disorder. Acting out extermination fantasies is readily classifiable as a delusional and a psychotic disorder. To continue perceiving extreme racism as normative and not pathologic is to lend it legitimacy.

The psychiatric profession’s primary index for diagnosing psychiatric symptoms, the DSM-5, does not include racism, prejudice, or bigotry in its text or index. There is no support for including racism (affecting perpetrators or victims) under any diagnostic category. Unfortunately, too many psychiatrists believe that extreme racism cannot and should not be recognized as a potentially treatable symptom of mental dysfunction.

Anecdotally, I have known psychiatrists who treated patients who projected their own unacceptable behavior and fears onto ethnic minorities as scapegoats. Often, their strong racist feelings were tied to fixed belief systems impervious to reality checks, reflecting symptoms of mental dysfunction. These colleagues have told me that as their patients became more aware of their own problems, they grew less paranoid – and less prejudiced. Community and family members should know that they can seek professional help for individuals who exhibit violent racist thinking.

It’s time for mental health professionals to examine their resistance to accepting extreme racism as a symptom of serious mental illness. Such a focus in the future may prevent tragedies like the Charleston massacre.

Dr. Poussaint is professor of psychiatry at Harvard Medical School, Boston.

April Green


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