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July 8, 2020
When Christine M. Crawford, MD, MPH, was doing her psychiatric rotation in medical school, she knew psychiatry was her calling. But when she shared that she decided to become a psychiatrist instead of specializing in another field of medicine, the response she received was one of disappointment.
“One person asked why I didn’t want to become a ‘real’ doctor,” Crawford said. “Another asked why I would want to work with ‘those’ people.”
Crawford said it was challenging to hear this from those closest to her—individuals she knew to be compassionate, smart, and supportive to others. Crawford, who is Black, said at that point she truly understood the depth of mental health stigma in the Black community.
“Ironically, as my career as a psychiatrist progressed,” she said, “I came to learn that many who responded most negatively to my career choice were the very people I was dedicating my life to helping—African Americans who silently live with mental illness for fear of being judged.”
The stigma of mental health isn’t new to the Black community. Dr. Martin Luther King Jr. reportedly had severe depression during periods of his life and refused psychiatric treatment, even when urged to seek care by his staff. Unfortunately, that scenario continues to be common today, with African Americans not seeking mental health care because of stigma.
“We can all work together to recognize and address this challenge,” Crawford said. “But to do so, we must understand where it comes from and why it is so ingrained in our culture.”
The root of mental health stigma among Black people can be traced back to slavery. At that time it was commonly thought that slaves were not sophisticated enough to develop depression, anxiety, or other mental health disorders.
“From those historic misconceptions, we learned to ignore mental illness or call it other terms, like ‘stress’ and ‘being tired,’” Crawford said. Such nuanced descriptions for depression and other mental illnesses that the Black community adopted and passed on from generation to generation led to underestimating the effects and impact of mental health conditions. Also, it strengthened beliefs that a psychiatric disorder is a personal weakness. Crawford explained that “all these factors created a culture that is fearful and uninformed about mental illness.”
African Americans develop mental health conditions at a rate equal to anyone else. They also experience trauma as a result of living within a society of systemic racism.
According to Mental Health America, Black people experience direct traumatic stressors (including being heavily policed or being the victims of physical and verbal attacks), indirect stressors (such as the effects of viewing the video of the killing of George Floyd), and transmitted stressors (from traumatic stress passed from one generation to the next).
Despite these challenges, however, Black people are far less likely to seek care. Statistics tell us that about 25% of African Americans seek mental health care, compared to 40% of whites. Unequal access to health care is one major contributor to this disparity. Crawford added that other factors include “the lack of cultural sensitivity by health care professionals, African Americans feeling marginalized, and the reliance on family, community, and spiritual support instead of medical or psychiatric treatment—even when it is critically necessary.”
Each one of us can take steps to become an ally to someone—especially in the Black community—who is experiencing mental illness.
We can all work to:
Each one of us can make a difference in the lives of those who need mental health support.
“By recognizing that the Black community has unique experiences when it comes to mental illness, we—as citizens of the world—are beginning to chip away at the stigma that permeates through culture,” Crawford said.
McLean Hospital recognizes the barriers that prevent African Americans from accepting mental illness as something treatable and nothing to be ashamed of. Through a collaboration with the Boston chapter of the NAACP, McLean’s Deconstructing Stigma campaign is addressing this issue.
Volunteers are bravely telling their personal stories to showcase mental health in communities of color:
“Stigma is an evil roadblock that makes people feel ashamed of the struggle they are going through every day and makes them afraid to seek help.” – Ivy
“Mental illness does not discriminate. No matter what age, color, or religion, anyone can live with mental illness.” – Richard
“Mental illness in the Black community has long been a touchy topic. The overriding belief is you don’t go to therapy or counseling or take medicine. You go to church. And you don’t talk about your business to anybody. You put on your big girl pants and keep it moving. That’s what I did, except I wasn’t going anywhere.” – Cynthia
We live in a diverse world, and each day we interact with people of a variety of backgrounds. The more we understand differences that make us distinct, the more we’ll understand there is no shame in having a mental illness—regardless of our culture and background.
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