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PART I:
A HISTORICAL OVERVIEW AND CONTEXTUAL FACTORS
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Chapter 1
African-American Mental Health: A Historical Perspective
Priscilla A. Gibson
Ramona W. Denby
Mental health for African Americans is an intimately connected history. It can be translated into a survival mechanism with the influence of race as a driving factor (Hines-Martin, Brown-Piper, Kin, & Malone, 2002; McNeil & Kennedy, 1997). Historically, African Americans differ from every other group as they entered this country involuntarily and experienced demeaning systems to control their behavior through slavery (McNeil & Kennedy). The history of African Americans and their mental health needs is a difficult history indeed. Many scholars and researchers would argue that the social and psychological ills that African Americans face are directly related to various historical aspects of slavery. As indicated throughout the chapters in this book, it is evident that whether one is discussing teenage pregnancies, substance abuse issues, psychiatric problems, child welfare concerns, familial issues, or issues pertaining to gang violence, slavery continues to have an impact on the psychosocial lives of today’s African-American population.
Although some may disagree about the influence of slavery on the mental health of African Americans, others espouse that this very denial influences the mental health of African Americans as well as those who deny the connection. For some African Americans, emotional stressors affect internal perceptions such as self-esteem and external behaviors that are compared to Whites (McNeil & Kennedy, 1997). Hines-Martin et al. (2002) note that, historically, African Americans experienced racism, intolerance, exclusion from quality health care, limited economic resources, and negative tive experiences with health care research. Other influential factors include devaluation and mistreatment (Boulware, Cooper, Ratner, LaVeist, & Powe, 2003). Wideman (1984) provides a detailed explanation on how these factors affect his daily life and sanity:
It was a trick I’d learned early on. A survival mechanism as old as slavery. If you’re born black in America you must quickly teach yourself to recognize the invisible barriers disciplining the space in which you may move. This seventh sense you must activate is imperative for survival and sanity. Nothing is what it seems. You must always take second readings, decode appearances, pick out the obstructions erected to keep you in your place. Then work around them. What begins as a pragmatic reaction to race prejudice gradually acquires the force of an instinctive response. A special way of seeing becomes second nature. You ignore the visible landscape. It has nothing to do with you. It will never change, so you learn a kind of systematic skepticism, a stoicism, and, if you’re lucky, ironic detachment. I can’t get to the mountain and the mountain ain’t hardly coming to me no matter how long I sit here and holler, so mize well do what I got to do right here on level ground and leave the mountain to them folks think they own it. (p. 221)
There is no denying that the stress of racism and discrimination affect mental health (Hines-Martin et al., 2002; McNeil & Kennedy, 1997; U.S. Department of Health and Human Services, 2001).
The sociopolitical influence of race also affects the amount of literature on the mental health history of African Americans. There is a paucity of information. Another is the contemporary view of mental health services. In some segments of the African-American community, there is a stigma associated with the use of mental health services (Neighbors, 1985). What is even more of a compelling mental health issue is that many African Americans have been unwilling to discuss the topic of mental health as a major cultural topic. Historically, African Americans have maintained that deviant behavior, psychiatric disorders, and drug abuse issues were topics that were more closely aligned with the majority culture. African Americans, being a God-fearing people, would argue that one needs only to call upon the Lord thy God to solve all of one’s worldly concerns. In fact, it has been noted that African Americans who do seek help with their mental health concerns are more likely to obtain the assistance of someone in their informal social network or church affiliation (Neighbors, 1985).
This chapter provides historical information on the mental health of African Americans. Included would be the role played by African Americans as well as a description of the major periods and important. The chapter also offers a new approach to view and work with the mental health concerns of African Americans in a culturally sensitive manner. The chapter concludes with a summary and ancillary classroom activities.
MAJOR PERIODS AND THEIR INFLUENCES
There are three major periods affecting African-American mental health. Those periods are slavery, emancipation, and systemic issues unique to twentieth-century America.
Slavery
Slavery was a defining period for African Americans. Whitaker (2002) calls the history of mental health for African Americans “shameful” and connected to the status of being free or being enslaved. As discussed later in the book, Samuel Cartwright, a doctor from the South, diagnosed slaves with two types of insanity, draptomania and dysaesthesia aethiopis. Draptomania described those slaves who attempted to escape. A diagnosis of dysaesthesia aethiopis was given to those seen as idle and disrespectful of the master’s property (Whitaker, 2002). In the 1840 census, there was a higher percentage of insanity among slaves in the North as compared to their peers in the South (Whitaker, 2002). Whitaker attributes the increase to Whites telling census workers “all of the Negroes in their communities were crazy” (2002, p. 171). With this type of communication, Whites began to socially construct a view of African Americans that became fact, and thus institutionalized.
During this period, Africans used self-help for assistance with concerns in the form of the extended family (Martin & Martin, 1985). Older slaves were accorded with the status of being wise and consequently, sought out for advice. Early African Americans used spirituality and the Black churches for emotional relief from problems of oppression (Schiele, 2000). This furthered the misperception that African Americans lived a “trouble free existence” and that they received “special care and supervision” under the institution of slavery (Vega & Rumbaut, 1991).
Emancipation
Freedom from slavery did not remove the problems that African Americans encountered with mental health diagnoses. During this period, African Americans became at-risk for being locked in asylums because of the definition of sanity (Whitaker, 2002). Sanity was defined by the behaviors that slave masters valued such as “docile, hardworking laborer who paid him proper respect” (Whitaker, 2002, p. 171). Those who eschewed this behavior found themselves in asylums, jails, and the poorhouse. Whitaker documents that the incidence of insanity for Blacks increased fivefold during emancipation. In addition, doctors continued to publish medical information that associated being Black with insanity or limited intelligence. For example, in 1886, J. M. Buchanan stated that the Negro had limited brain growth and in 1921, W. M. Bevis wrote that Negroes were “prone to psychotic illness … because they were descendents of ‘savages and cannibals’” (p. 172). Whitaker notes that E. Franklin Frazier responded that Whites might be labeled as insane because of these assertions, which resulted in threats to his life. During emancipation there were other influential Blacks such as Frazier who disagreed with the prevailing notion of Blacks as inherently insane and/or of limited intellectual abilities.
Twentieth Century
Mental health of Blacks during this period was characterized by inferior treatment and severe mental health diagnoses. For instance, African Americans were diagnosed with schizophrenia instead of depression (Whitaker, 2002; see Chapter 3 for further discussion). The prevailing thought was that Blacks did not react to “grief, remorse, etc.” and were “happy-go-lucky” (Whitaker, 2002, p. 172). By the 1930s, research on African Americans began showing they had “higher rates of insanity” than Whites (Vega & Rumbaut, 1991), which may be evidence of racist diagnostic patterns in response to increased resistance to adverse conditions faced by African Americans. Interestingly, children from poor families were more likely to have mental health issues than those children from wealthier families (McLeod & Shanahan, 1996). This seems to suggest that family poverty histories have an impact on children’s mental health status. African-American children are more likely to live in poverty than other children, so they are more likely to receive a mental health diagnosis than other children.
THEMES FROM THE LITERATURE
Important themes provide additional historical perspective on the mental health of African Americans. These have been identified as (1) incidence of mental health disorder, (2) relationship with mental health service providers, and (3) service utilization.
Incidence of mental health disorder. When compared to other racial groups, African Americans had higher rates of psychiatric disorders but lower rates of comorbidity disorders (Fellin, 1996).
Relationship with mental health service providers. Historically, African Americans are less likely to enter the mental health system and when in that system, they are more likely to encounter difficulties with their service providers. Fellin (1996) found that African Americans are more likely to seek help from their informal social support systems. Homma-True, Greene, Lopez, and Trimble (1993) state that African Americans are fearful of the mental health system. Similarly, Collins et al. (2002) found that African Americans are less confident in their doctors and less likely to have health insurance. The lack of cultural knowledge and sensitivity by service providers has been listed as barriers to service utilization (McNeil & Kennedy, 1997). Starting in the 1970s, this area has received greater attention from service providers and their organizations (Parham, 2002).
Service utilization. McNeil and Kennedy (1997) identified the four As that affect mental health service usage. These are availability, accessibility, acceptability, and affordability. Community-based mental health service utilization by African Americans has been described as low to nonexistent (Snowden, 1998). Neighbors (1985) found that African Americans have a negative view of mental health services, seeing them as ineffective or unacceptable. Hines-Martin et al. (2002) state that African Americans face barriers to mental health services at the individual, environmental, and institutional levels.
Influencing factors may be that African Americans tend to get the most severe labels (McNeil & Kennedy, 1997). For example, Whitaker (2002) and others have been cited throughout this text indicating that African Americans and people with low incomes are more likely to be diagnosed with schizophrenia than those with higher incomes. Padgett et al. (1994) found that African Americans are less likely to use outpatient facilities but according to Snowden and Cheung (1990), they are more likely to be hospitalized in psychiatric facilities.
A RENEWED APPROACH
Adhering to two tenets of the life course perspective approach that incorporates history and culture (Hutchison, 2005), not repeating the difficulties of the past in the mental health area and embracing culturally sensitive services are essential. The general goal of the mental health system ought to be to assist African Americans in the most culturally sensitive manner possible (Denby, Rocha, & Owens-Kane, 2004). Understanding the culture of African Americans will assist in providing culturally sensitive mental health services-when needed from the formal system. The following provides information about service delivery, research, and racism that might be helpful:
Service delivery. It is suggested that identifying the unique sociocultural needs of African Americans is important (Snowden & Hu, 1997; Wang, Berglund, & Kessler, 2001). Denby et al. (2004) suggest viewing environmental threats such as “poverty, discrimination, cultural bias, suicide, depression, physical health problems, substance abuse, and other more general factors that create stress” (p. 74). Gibson and McRoy (2004) recommend assisting clients with cultural maintenance, which values African and African-American’s heritage. In addition, attending to language, behavior, coping style, and religious beliefs are essential (Wagner & Gartner, 1994). These authors note that the phrase “bad nerve” might be used to describe many thoughts, feelings, beliefs, and psychomotor states and behaviors. As stated previously, African Americans use their informal social support systems for mental health concerns. For...
