By: Jayson Blair
When I first went to a therapist office, a little more than 15 years ago, there was an intake form that included a long list of conditions under a question about family medical history. Diabetes? Check. Heart disease? Check. Auto-immune diseases? Check. Cancer? Check.
When I reached the section on mental health disorders – depression, bipolar, schizophrenia and other seemingly exotic conditions that I did not recognize – there was nothing to check. I was unaware of any family history with mental illness. I can remember where I was sitting when I filled out that form, in part, because of what I would find out in the coming years.
Despite what I thought in that moment, my family history was littered, like craters in a battlefield, with mental illness. My parents later told me about an aunt who had schizophrenia. I discovered another aunt was diagnosed with bipolar disorder by a glance into her medicine cabinet while looking for aspirin. One close family member was told that she had either bipolar or schizophrenia by doctors in her 20s and that she ignored it for the next four decades.
Much of this tradition of not discussing nor treating mental illness in 2003, I would find out in the years later in working with black clients and their families, is a legacy of slavery, of culture and of legal and ever-present de facto segregation.
In one of the most striking chapters “I Know Why the Caged Bird Sings,” by Maya Angelou, she writes about how in the fictional town of Stamps, “segregation was so complete that most Black children didn’t really, absolutely know what whites looked like – other than they were different, to be dreaded ” The chapter, called “Lay My Burden Down,” provides a poignant portrayal of the impact of separation through segregation. As Maya Angelou so eloquently illustrates, how poor and cruel treatment of black Americans has led to an alienation that persists in many aspects of life.
When people turn their minds back to this nation’s past of legal segregation and its impact, the most prominent elements that come to mind are the educational impact. Images of yellow school buses, forced into action by judges, moving students from segregated neighborhoods into integrated schools is a common picture in news articles looking back on that era. In the second position are pools, water fountains and lunch counters. The lens most readily captures the bearing of unequal education and accommodations.
What is harder to frame is the influence and the power of America’s history legacy of segregation in healthcare, which still presents lingering challenges to us today, 65 years after the U.S. Supreme Court, in Brown vs. the Board of Education of Topeka, overturned its 1896 ruling allowing state-sponsored segregation.
What they often do not think about is that era’s impact healthcare. My father’s family tells stories of having to have local doctor in the South Carolina low country sneak them in the back-door to get assistance. My mother’s family tells stories of having to take their medical care into their own hands. While the enforcement of Brown vs. Board of Education decision and President Lyndon Johnson’s implementation of the Medicare program forced integration of hospitals and clinics, New Deal Era geographic redlining that marked many black neighborhoods as “hazardous” for banks offering loans, made it difficult black Americans to escape the devastation, and de facto segregation, that followed as white Americans fled to the suburbs.
This created two healthcare systems even post-segregation, according to Alvin F. Poussaint, a psychiatrist, and Amy Alexander, a journalist, who wrote a book that shares its name with the Maya Angelou chapter. In “Lay My Burden Down: Suicide and the Mental Health Crisis among African-Americans,” Dr. Poussaint, a clinical professor at Harvard Medical School, and Ms. Alexander argue that there are historical, cultural and social factors that make black Americans reluctant to seek or trust healthcare, and they offer counsel on how everyone from the layperson to providers can help.
Dr. Poussaint and Ms. Alexander argue that one of the most difficult elements of dealing with the mental health struggles in the African-American community have to do with the common “blues and poverty” myth, which holds that it only makes sense for those who are poor are more likely to be depressed. This, they argue, causes people to link their depression, for example, to their circumstances, mistaking environment for a clinical condition. Science tells us that while poverty can complicate emotions and lead to frustration and sadness, it does not create the full cluster of symptoms of any mental illness. Public health officials are facing a similar challenge today with the opioid crisis, where scholars say that doctors and drug dealers targeted rural communities for competitive business reasons and to avoid law enforcement, but the correlation between the fold of opioids and poor communities has led the public health response to initially focus on poverty, when, in fact, the energy should have gone toward treating addiction in all communities.
They point out that in the area of mental health, as stigma is having less of an overall impact, the problems are getting worse. Suicides among black youth jumped 114 percent from 1980 to 1995. The Centers for Disease Control estimated in 2016 that the suicide rate for black American teens increased, but much more slowly than the general population, due to educational efforts targeting stigma, education and access to healthcare like the ones lead by Dr. Poussaint and Ms. Alexander.
While sustained focus needs to be placed on these issues in the African-American community, it is also time to give-back and export some of those lessons to benefits to other demographic groups, including individuals struggling with stigma and access to care overseas and in pockets of the American tableau, including, strikingly, the Alaskan Native community.
Then, perhaps, we can finally begin to help each other – all of us – lay our burden down.