Dysthymic Disorder (depression) and Generalized Anxiety Disorder (GAD) have affected my life since adolescence. Counseling has been an integral part of my life since my mid-twenties. I have always believed in the power of talking about issues and problems and can attest to the value of counseling. For the first time, I have a relationship with a counselor, here at Des Moines Pastoral Counseling Center, who walks with me as I explore the experiences and meanings of living as a black woman in a predominantly white world. Racism, external and internalized; discrimination; profiling; and, the residue of slavery compound daily in the lives of black people. Many black people disagree with my decision to receive counseling, based on a host of very real reasons.
Black people are under constant scrutiny and judgment by the majority culture—clothing, hair, the car we drive, where we live, our personality, our religion and spirituality, our employment or lack thereof. Our cultural climate is measured against that of the majority and usually found wanting. Dichotomous messages and double standards are applied arbitrarily. For instance, we are told that we must be employed and self-sufficient, but we are profiled if we dress too well or the car we drive is too nice. Moving about in the world is a matter of safety. Because of the factors listed above, I am always a target, emotionally as well as physically.
In my years of counseling, my issues and problems as a black woman went unaddressed. They were not so much discounted or ignored as they were not considered. They were not on anyone’s radar, including mine. I was treated as a white woman with black skin. The discrimination and oppression to which I was subjected “could happen to anybody.” It was years before I recognized the mistreatment and exploitation for what they were. The ebony ceiling is much lower and much thicker than the glass ceiling.
Virtually all of my counselors have been white males. I did have one Native American Indian female counselor and one black male counselor. When I began working with my counselor, here at the Center, in January 2013, I became comfortable enough, after a few months, to explore the painful topic of race relations. We discuss ways in which racial tension and strife contributed to the trauma in my life and continue to do so. I am subjected to all the issues and problems experienced by white women, compounded by race.
According to the National Alliance on Mental Illness (NAMI), “Common mental health disorders among African Americans include major depression; attention deficit hyperactivity disorder (ADHD); suicide, among African American men; and posttraumatic stress disorder (PTSD).” Additionally, African Americans are more likely to be exposed to violence and “make up about 40% of the homeless population. African American children are more likely to be exposed to violence than other children.” Clinicians often receive little or no training in cultural competency as a matter of course. Because of either conscious or unconscious provider biases, black people are often misdiagnosed or receive a poor quality of care. Providers not trained in cultural competence may not recognize mental health symptoms. NAMI also reported that “men are more likely to receive a misdiagnosis of schizophrenia when expressing symptoms related to mood disorders or PTSD.”
In the chemical dependency treatment field, the desire of a client to confront racial issues is discounted as an excuse, an avoidance strategy to skirt the fact that the individual is drinking and using drugs to her or his detriment. For all clients, substance use is treated as a causality rather than an outcome, seen as primary rather than a stress response and coping strategy. Psychological factors are not considered.
“Only about one-quarter of African American people seek mental health services, compared to 40% of whites,” reports NAMI. The 25% rate surprised me as I thought the percentage was much lower. Many barriers impede access to mental health services for black people, among them:
- Location of services/lack of transportation
- Lack of childcare
- Lack of complete information
- Fear of being committed to a hospital psychological unit
- Lack of financial resources
- Lack of insurance
- Fear of ridicule by family and friends
- Perception of counselors as mind-reading psychics
- Told by clergy, family members, and peers that their life would improve if they attend church and believe in Jesus.
- Distrust of mental health professionals, medical professionals, and white people
- Fear of lack of confidentiality, that what they discuss will be used against them
- Fear of incarceration
- Fear of appearing weak and unable to control themselves or manage their lives or to control those around them. For instance, “I’d be alright if my kids would stop driving me crazy.”
- The perception that they are emotionally healthy and stable and that everyone else needs to change.
- Like many non-minority people, they know they need to change which seems daunting.
Out of necessity, the black community has formed some social supports that sustain them in times of stress and emotional upheaval, such as:
- Religious faith
- Close-knit family networks; extended family; there are few secrets in the black community
- Racial pride
- Emotional strength and resilience which can sometimes lead to discounting of their emotional pain as they are told they have little or no reason to “complain.”
Finding a compatible counselor can be a discouraging process, and some people give up. NAMI suggests asking prospective counselors the following questions:
- Have you treated other African Americans?
- Have you received training in cultural competence or on African American mental health?
- How do you see our cultural backgrounds influencing our communication and my treatment?
- How do you plan to integrate my beliefs and practices in my treatment?
Will family members be involved in my treatment? What if I do not want my family members involved?
Engaging the black community takes time and effort. The Center has taken a step in the right direction to encourage black people to enlist mental health services with the satellite office in the Drake University area. Further efforts could include using black people in marketing and advertising and recruiting black counselors and staff.
I encourage black people to seek mental health services as an essential addition to the social supports already in place. I truly believe that, with earnest effort, virtually everyone can benefit from counseling. To schedule an appointment or for more information about the services offered at the Center, call 515-274-4006.