I’m Not Crazy
Black America’s Discomfort with Mental Illness
2009-05-04
Dr. Sharon Dodd-Kimmey

Recently, the unrequited love/stalker flick “Obsessed handily beat the schizophrenic/savant/magic Negro movie “The Soloist” in box office sales.  By all accounts African American audiences were largely responsible for that difference. That means either Obsessed was a just a more interesting movie than The Soloist and/or that Black folks are just way more comfortable with the image of White psycho woman than a Black psychotic musician. If the latter is true, it would be all too consistent with how African Americans regard the condition of mental illness in everyday life. 

Forensically trained medical doctors, such as me, are tasked with assessing and treating a variety of mental health disorders.  They range from a single occurrence of depression to more chronic and recurring mental conditions, such as schizophrenia.  But in most instances by the time a person comes to the attention of a Forensic Psychiatrist in a correctional setting, the situation has gone way too far, and the subject has already been adjudicated for a crime or is facing severe legal charges.  One of the most common and exhausting challenges we face, in general and in forensic psychiatry is the issue of non-compliance with treatment or in too many cases, no treatment at all. And as you may have surmised, many of the people in this circumstance are African America.

So why do we delay or not seek the appropriate treatment for mental/emotional anguish, symptoms or discord?  Mental disorders can be found worldwide.  Its presentation is recognizable and similar around the globe. There exists, however, a set of shared beliefs, or culture, which influences our acceptance of a condition and the motivation to seek treatment.  Why are many racial and ethnic minorities less inclined to seek treatment? 

The answers are varied and rooted in many social challenges -- coping styles, systematic mistrust, financial constraints, accessibility, lack of culturally similar professionals and a troubling lack of culturally- based research.

Yet the most formidable barrier to treatment is the associated stigma.  Regardless of culture, no meaningful discussion about mental illness can occur without recognizing the solid truth of this cluster of negative attitudes or beliefs about mental illness.  Studies have found that, in general, ethnic minorities place more stigmas on mental illness than our white counterparts.  Our attitudes breed fear, shame, avoidance and discrimination against mentally ill individuals.  Our lack of  knowledge makes it more likely that mentally ill individuals will be stereotyped as dangerous or unintelligent when often the polar opposite is true.

The mentally ill person’s own attitude or belief system is pertinent as well.  It matters if others will see their symptoms as real or imagined.  These factors influence how an individual make sense of the experience.  In my discussions with patients and families, certain themes recur about mental illness.  They want to know what causes them to have these experiences.  I tell them in simple terms we don’t really know what causes a person to develop mental illness.  But what we do know is that it’s a disorder of the brain.  I’ve found that people are more willing to accept the condition if prefaced under the umbrella of a medical condition.  The aim is to relieve the individual from self critical questions, such as, “What kind of person would succumb to these symptoms?” or “Am I weak because I have these experiences?”

The meaning a culture attaches to a psychological condition has real consequences on whether a person will seek any treatment or the appropriate treatment.  In general, African-Americans take an active approach to facing personal challenges, as opposed to avoiding them, which is more typical of other cultures.  We are more inclined to handle our distress “on our own,” or with the assistance of spiritual guidance. 

I am reminded of a college friend who approached me years after we were into our respective careers.  He confessed that he had not totally embraced the notion of mental illness until he witnessed first hand, the “fire” in the eyes of one of his mentally disturbed church members.  He prayed and accompanied the church member to the nearest Emergency Room.  He was so moved by the experience that the next Sunday, he titled his sermon, “Ya’ll Better Take Your Medicine!”

Mental illness is real!  It won’t go away simply by ignoring it.   Treatment is the pill for the ailing value which we place on mental illness.  It’s not just for crazy people.