People of Colour and Mental Illness: Stigma and Culture

**This is a paper I did for a college course.**Introduction

In the current society, mental illnesses are not viewed in a positive light. There are stigmas for each diagnosis. These stigmas, defined as “a mark of shame or discredit, or an identifying mark or characteristic” (Merriam-Webster), affect many people, and depending on a person’s identity, the stigmas may be more intrusive. When it comes to people of colour who suffer from mental illness, the layers of how difficult it is to live a decent life become deeper and more complex. People of colour have to learn to navigate what it means to be non-white and struggling with their mental health. To break this down even more into gender, those who identify as men and those who have to identify as women have different levels of acceptability. In comparison to white people of either gender who are more likely to be accepted and more likely to be able to access professional help, the struggles that mentally ill people of colour are also tied into cultures. The research will define mental illness as “any of a broad range of medical conditions (such as major depression, schizophrenia, obsessive compulsive disorder, or panic disorder) that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause marked distress or disability and that are typically associated with a disruption in normal thinking, feeling, mood, behavior, interpersonal interactions, or daily functioning” (Merriam-Webster). This paper will not only explore how people of colour address their mental illnesses, it will also address how non-people of colour and people of colour without mental illnesses perceive them.

This topic is important because while mental illnesses as a whole is becoming more visible to the public, there is still a lot of stigma out there. With such high statistics surround mental illness in general such as, at least 10 million people experiencing a severe mental illness that affects their ability to function on a daily basis, this research is imperative. As a person with mental illnesses, I have become very passionate about this research in order to not only understand my own diagnoses but also in order to understand how cultural stigmas affect me and why.

History of Mental Illness and Modern Day Representation

Throughout history, mental disorders have been at the border of our society. It was not until the last decade or so until mental disorders started being treated as a serious social problem. Before, those who showed symptoms of neuro-abnormalcy were placed into mental asylums in order to protect their families’ social status and reputation. In 18th century America, these negative attitudes persisted and lead to the institutionalisation of mentally ill individuals. The hospitals they were placed in were often overcrowded and understaffed. This also means that mental illness has been continually misunderstood, so discrimination and stigmas have flourished. Misinformation has spread like wildfire to the masses. Even psychologists in the 1950s thought negatively of those they treated.

From 1950 to 1996, the general perception of mental illness was much more negative than it is today. It was also one that was cruel and very narrow. In the 1950s, the public view of mental illness was very extreme and was based in fear and misunderstanding. This was realized when social scientists began to address questions about exactly how the people understood this issue. The results were that the public was afraid of them. It was to the point that the psychiatric thinking of the time was also laden with misconceptions. An interview that was conducted, and it show that over 3,000 Americans had a “strong tendency… to equate mental illness with psychosis and to view other kinds of emotional, behavioral, or personality problems in non-mental health terms—as, 'an emotional or character difference of a non-problematic sort.'” (Phelan, Link, Stueve, Pescosolido 2000) It showed just how much the American people devalue those with mental illnesses.

In the modern day, while mental illness is now treated more seriously, the stigmas surrounding them remain. Many times, those who promote these stigmas do not understand what having a mental disorder means, which makes the very little they do know based in fear. This misunderstanding is enhanced by many people claiming to have mental disorders to appear cool or because they may show one out of many symptoms. Most of what the public understands of mental illnesses comes from the media and the majority of the time, the media will often misrepresent these disorders. Mental illnesses are shown by the stereotypical assumptions, in a negative light or completely incorrectly. Kristin Fawcett of U.S News quoted professor of psychology at the University of California–Berkeley Stephen Hinshaw as saying, “The worst stereotypes come out in such depictions: mentally ill individuals as incompetent, dangerous, slovenly, undeserving.”

While the media has slowly become more accurate and more humanising in its portrayal of mentally ill individuals, Hinshaw says that what is still needed are the realistic daily struggles mentally ill folks deal with. Some common misrepresentations are the following: people with mental illnesses are violent or criminal; people with mental illnesses look different; they are childish and silly; all mental illnesses are severe or all alike; psychiatric hospitals do more harm than good; people with mental illnesses cannot recover.

With all the harmful stigmas that come with the label of being mentally ill, this research has become incredibly pertinent. In the United States alone, approximately 43 million people suffer from a mental illness every year (NAMI). To break that number down, that means about 1 in every 5th adult has a mental illness. This also means that 1 in every 5 youths between the ages of 13 and 18 experienced a severe mental disorder and 1 in 25 adults suffer from a severe mental disorder. Simply put, these numbers are alarming. This trend continues into statistics that the NAMI report, such as how many homeless have a serious mental illness and/or substance abuse problem; and the consequences of not getting treatment are sickening. NAMI reports that suicide via mental illness is the 10th leading cause of death in the United States.

Literature Review

According to Edward Chang in his article, “Relationship between loneliness and symptoms of anxiety and depression in African American men and women: Evidence for gender as a moderator,” while there have been many studies done that have concerned loneliness (presenting as being homesick) in college students, a study that focuses explicitly on African American students has not. Chang writes that loneliness is often a predictor of anxiety and depression, which is relevant as it has been found that “negative affective conditions” are a mental health concern for this demographic of Americans. The article states that women in comparison to men scored higher in terms of being lonely. The symptom of loneliness can often be a predictor for anxiety and depression. For the African American demographic, loneliness is unfortunately the only predictor for suicide.

In the study, Chang had 168 student participants who all self-identified as African American. They rated themselves on a scale of non-lonely thoughts to characterising feelings of loneliness. Their anxiety was measured on the Beck Anxiety Inventory, and focused on the most common feelings of anxiety in level of severity. Symptoms of depression were measured by the Beck Depression Inventory.

A person’s race is not only a potential factor for mental illnesses. A person’s ethnicity can affect how they are treated and what kind of services they are able to access. In Leisa Ruglass’ article, “Racial/Ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-Based treatment”, women are matched with a therapist who was the same ethnicity as they were in trials to treat post-traumatic stress disorder (PTSD) and substance abuse disorders(SUDs). While the study eventually showed that there was not a significant difference in attendance, the results were promising. At least when it come to white women.

The PTSD symptoms that white women experienced did drastically diminished, even with mismatched therapist. Racially different women saw no change. However, this article shows that there is a concerning difference in treatment when it comes to white women and women of other races. Racial minority clients “are more likely to evidence negative social and health consequences related to their PTSD and SUD, have less access to evidence-based care, and are more likely to underutilize and drop out of care compared with their White counterparts.” (Ruglass, 2014) So the question remains: what is the best way to treat minority women suffering from PTSD and SUDs? With treatment from any therapist, both black and white women showed improvements. While it is always encouraged that those struggling seek help, it is important to recognise the racial differences when it comes to treatment.

Racial and ethnic minority men and women have always found it more difficult to access help for various reason. Asian Americans are a good example as to how upbringing can be detrimental when it comes to taking care of one’s mental health. The Stanley Sue et. al article, “Asian American Mental Health: A Call to Action” mentions several issues when it comes to addressing the mental health of Asian Americans. As with many racial minorities, mental health services need to start recognising that it is not only white people who are struggling with mental health. This shows that there is so little known about the pervasiveness of mental health concerns in this demographic of Americans, as well as Pacific Islanders. This group is more likely to suffer from PTSD, and they are also less likely to present other severe mental disorders. A noticeable trend is that Asian Americans are less likely to use mental health services than white Americans. A reason for this is lack in English language proficiency, as well as a lack of services that offer services in Asian languages. Asian Americans are also less likely to confide in others that they are struggling. Much of this can be attributed to the cultural bias when it comes to mental disorders.

Erum Nadeem , Ph.D. Jane M. Lange , M.S. Dawn Edge , Ph.D. Marie Fongwa , Ph.D. Tom Belin , Ph.D.Jeanne Miranda , Ph.D.’s article, “Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?” discusses poor women who are at risk for depression, and those who are ethnic minorities who are unlikely to get the help needed—specifically Black and Latina women. Immigrant Latinas are even less likely to get help than those born in the United States, compared to their white counterparts. African American women are a minority when it comes to seeking mental health care. The authors discuss that people who are ethnic minorities are presented with many barriers, including lack of transportation and health insurance. Depression is already a much stigmatised condition and those who suffer from the condition do report a higher stigmatisation than those who are not. While many women face stigmatisation for mental illnesses, Latina and Black women are more likely to face extreme stigmatisation when talking to health care providers.

“Ethnic Variations in Mental Health Attitudes and Service Use Among Low-Income African American, Latina, and European American Young Women.” by Jennifer Alvidrez discusses how a group of Latina, African American, and White women were interviewed while waiting for their appointments about their take on mental illness and mental health services. Many women do not seek help, and women who fall into ethnic minorities are even less likely to seek access for mental health care. They are often underrepresented in mental health settings. African American and Latina women, even with insurance, are less likely to seek outpatient mental health services than their European American counterparts. The point is also made that exposure to the mental health care system is also prominent when it comes the psychiatric community seeking help.

The following article, “Racial/Ethnic Differences in the Correlates of Mental Health Services Use among Pregnant Women with Depressive Symptoms” written by Jen Jen Chang et. all, examines the mental health services that are used by pregnant women reporting prenatal depressive symptoms by race and ethnicity, specifically in Florida. This study is important as about 1 in 5 pregnant women in the United States have prenatal depression. Though this number is so high, the mental health needs of pregnant women more often than not go unmet. The study shows that white women were more likely to reach for helpful services, while Hispanic women were less likely. It is mentioned that while depression may occur at any moment in a woman’s life, her childbearing years are the most vulnerable for depression to appear.

“Mental health care preferences among low-Income and minority women” written by Erum Nadeen et. all talks about the mental health care preferences among low-income immigrants and United States born women with “an acknowledged emotional problem”. Ethnicity, depression, somatisation, and stigma are also examined in relation to these preferences. Nadeen re-stresses the fact that ethnic minorities are less likely to seek health care for mental disorders than white Americans. It is also pertinent to note that impoverished young women are more at risk for psychiatric disorders than those who are not. Nadeen also says that there is little known about what factors predict medication preferences of poor, minority women.

Finally, Trudy Narikiyo and Velma Kameoka discuss the perceived “causes of mental illness and help seeking preference among Japanese-Americans and White American college students” in their article, “Attributions of Mental Illness and Judgments About Help Seeking Among Japanese-American and White American Students.” The students were divided into groups of male and female groups and compared to explore the under used mental health services. The study showed that Japanese-American students are more likely to tie mental illnesses to social causes and to attempt to deal with them on their own than white American students before seeking help from others. Japanese American students, when they do seek outside help, are more likely to seek help from family members or close friends than from a professional.

Method: Interviews

To learn more about women and mental disorders tied with personal experiences, I came up with questions that I thought would give me a peek into the lives of others who also suffer from mental illnesses. These questions asked respondents to define their gender, race, and culture to get a sense of where they were coming from. Then the questions become more personal:

Do you think Mental Illnesses(MIs) are real or made up?

Do you have an MI(officially diagnosed or self diagnosed)? If yes: Do you mind sharing what it is? Was it trauma based?

Does it affect relationships? How so?

Does it affect your ability to function? How so?

If you do not have an MI: What do you think about MIs?

Have you heard of any of the stigmas surrounding MIs?

Do they affect you personally? If yes: how so?If no: do you agree with the stigmas?

Do they affect someone you know? If yes: how so?

If you grew up with culture, does your culture affect how MIs are perceived?

Do you think your skin colour affects your access to services?

Have you attempted suicide due to your MI? Have you considered/seriously thought of it?

Do you think your gender affects how your MI is seen?

While many of the questions are fairly general, there are a few that touched onto ideas that also affect myself, such as trauma based disorders and levels of functionality. Mental disorders, especially the more severe ones, like Post-Traumatic Stress Disorder and Dissociative Identity Disorder, are quite often associated to severe levels of trauma. However, if they were trauma based, I was not going to ask them to re-live that trauma if they did not offer to and only one offered to share that.

The first respondent, Ren, identifies as gender queer and prefers the pronouns “they/them”. Although they are generally white, Ren stated that they did grow up with some Italian and Polish culture references, especially when it comes to food and holidays. Officially diagnosed with Major Depressive Disorder as well as General Anxiety Disorder, Ren definitely believes and knows first hand that mental illnesses are real. In their case, they do not think that their disorders are trauma based.

Ren’s mental disorders severely affects their relationships, both platonic and romantic: “My anxiety will cause me to avoid social situations, jump to conclusions about others opinions of me, and shut down during difficult times. Depression helps me think the worst of every situation and keeps my self esteem very very low.” They have noticed that other people do not like, or respond very well, when a person does not have full confidence in themselves or in general. As noted, anxiety and depression are often diagnosed in the same person. It is not common that a person who has one of these diagnoses does not have the other. However, it is important to state that this does not mean they are diagnosed at the same time. In many cases, a client is more willing to accept one and will not report having symptoms of the other, especially if they are not necessarily familiar with symptoms of the other.

As one with a psychological disorder often does, Ren has heard of many stigmas when it comes to mental illnesses and is very aware that much of the public believe that mental illness is made up. They mention that their mother once parroted many familiar stigmatising phrases such as “oh, just don’t worry.” They also stated that before they personally experiences severe symptoms and working with a therapist, they also shared the same thinking. In many ways, this thinking is understandable. Mental illness is an abstract concept and is hard to grasp until it affects a person. Ren also discussed the stigma of taking medication in order to manage symptoms. These stigmas, unfortunately, also reach those who may benefit from taking medications.

When it came to the colour of their skin, Ren said this: “My skin color, because I'm in the majority in the US, hasn't affected my access to services. One thing I have noticed at the UK counseling center is that there are very few minorities there. And very few cis appearing males of any race.” It is not surprising that Ren’s skin colour has not affected their ability to access needed services. And while toxic masculinity is an entirely different and nuanced topic, it is also not entirely surprising that cis males of any race are even less likely to seek therapy.

The following respondent has asked that her name is changed, so I will refer to here as “Ellen” and she has also asked that I use her direct responses since she feels it is a more accurate take on her story (Ableist slurs have been censored):

Gender? Female

Race? Culture? (Did you grow up with your race’s culture?) white. I grew up in Alamo Heights, which is a wealthy suburb of San Antonio with its own classist racist sexist subculture. (Women take a year to make their debut, for example, and they have a coronation to crown the queen of fiesta in which they have women bow in 60 pound dresses until their noses touch the ground.) I got out of there as fast as I could! My home town culture is not my culture. It’s white but different from typical white culture.

Do you think MIs are real or made up? MI’s are real descriptions of symptoms. Some diagnoses are highly comorbid with trauma. Trauma can be more of a mental injury than a mental illness. A person is not disordered for having a trauma reaction to some situations any more than an arm is disordered for getting injured while lifting a car. I am a therapist and do not choose to take insurance in part because I do not agree to call appropriate reactions to stress an adjustment disorder, etc. That said, there is such a thing as mental illness, and certain diagnoses especially benefit from diagnosis, medications, and population-specific interventions.

Do you have an MI(officially diagnosed or self diagnosed)? Yes

If yes: Do you mind sharing what it is? PTSD

Was it trauma based? Yes. While I have some trauma from almost dying due to medical negligence while pregnant, most of my trauma is ongoing secondary complex medical trauma. My daughter is a wonderful human who has been through more terrifying medical procedures in 3.5 years than most people do in a lifetime. I cannot physically keep her safe, and some of what she has lived through has made me feel more helpless than a person is capable of feeling without breaking down.

Does it affect relationships? How so? I am not the same person. I had an experience that was so devastating that I felt like I died. I remember my old self but she isn’t me anymore. I have constructed a new self, lost friendships, gained same-experience friends as well as other new friends, and started a different life.

Does it affect your ability to function? How so? I have poor sleeping habits, gaps in my memory over the past few years, and flashbacks that make me wince. I sometimes get hypervigilant and can’t eat anything but puréed soups.

Have you heard of any of the stigmas surrounding MIs? I hate how other therapists talk about patients with Axis II disorders. It really angers me. I also hate it when people question whether DID is real. In general, I hate it when unappreciated behavior is labeled as crazy. Some people are shamed for taking medication—this is also unacceptable. Meds are like a life jacket. Therapy is like swimming lessons. If the undertow is strong enough, you need to wear a life jacket. It’s easier to move around emotionally without a life jacket, so if you don’t get overwhelmed by MI symptoms, it can be more advantageous to learn to swim instead.

Do they affect you personally? Yes

If yes: how so? I sometimes feel judged by other therapists for working with a subject that is so close to my personal life.

If no: do you agree with the stigmas? No

If you grew up with culture, does your culture affect how MIs are perceived? My home town has not influenced my perspective more than to confirm that my values are not that.

Do you think your skin colour affects your access to services? No

Have you attempted suicide due to your MI? No

Have you considered/seriously thought of it? Only as a preteen

Do you think your gender affects how your MI is seen? Hypervigilance in mothers of medically complex children gets patronized like cr*zy. Concerns that aren’t pitched appropriately are dismissed. If my husband says the same thing, he is seen as insightful. Trauma is ignored in cognitively disabled kids and their parents, and no one suggests treatment or support. My child had brain surgery, and no one mentioned trauma concerns for me or my toddler—that makes no logical sense. There aren’t many professionals in the system who do more than observe PTSD symptoms in parents of medically complex kids while they simultaneously expect them to overfunction. My personal goal is to get moms more access to care so they can have the capacity to offer their kids healthy attachment.

The third respondent, Emily, has also asked that her questions be quoted verbatim:

Gender? Female

Race? Culture? (Did you grow up with your race’s culture?) yes, white American (as much as white culture can exist), Italian?

Do you think MIs are real or made up? Very, very real.

Do you have an MI(officially diagnosed or self diagnosed)? Yes, officially diagnosed.

If yes: Do you mind sharing what it is? Depression, anxiety, OCD.

Was it trauma based? No.

Does it affect relationships? How so? Yes, a serious boyfriend left me because of a “funk” I got into because of depression.

Does it affect your ability to function? How so? Yes, there are many days I cannot physically get out of bed. It is hard to work; in fact, I am currently taking a leave of absence from work due to anxiety from finishing up my last college course ever. I have failed courses in the past because of this—I just stop doing the work because I get behind, get overwhelmed, then get embarrassed to reach out to my professors. Thankfully, once I finally did, I have found they are very accommodating.

Have you heard of any of the stigmas surrounding MIs? Many! “You're just lazy, get over it, think positively, exercise more, eat right!” The list is unending.

Do they affect you personally? If yes: how so? Yes, pretty much everyone I know has given one of the responses listed above—except people who have experienced mental illness, as well as those who have taken the time to try to understand it.

Do they affect someone you know? If yes: how so? Yes, multiple family members well as my best friend.

If you grew up with culture, does your culture affect how MIs are perceived? I think American culture does, but it really depends on the family. My family didn't really understand it, nor did they take the time to understand it, in the past. I really do think recent changes on how mental illness is brought up in our society has changed this for the better.

Do you think your skin colour affects your access to services? Yes, in a good way… all services, really. White privilege.

Have you attempted suicide due to your MI? No, but used to cut.

Have you considered/seriously thought of it? Yes.

Do you think your gender affects how your MI is seen? Yes, I think women are affected by illness blindness from doctors in general, but especially from mental illness because women are supposed to handle those kind of problems better than men. However, I just did a quick search about PTSD diagnosis (what's the plural of that?) in me vs women, and women are actually diagnosed more often. But I suspect that more women seek treatment since me are viewed as weak for seeking treatment. I guess I don't know! Maybe it depends on the mental illness itself. That's a tough one. One thing to mention—not sure if it's because of prescription restrictions or not—but I have been seeing my therapist for about six years and she has only in the past few months prescribed me Ativan for anxiety. Since then, I have told her twice it doesn't work, and she has not moved me to a new prescription. Guess that'll take another six years.

Limitations

For this research, there were a few limitations. It was not entirely surprisingly difficult to find women, or even nonbinary folks who were willing to share their stories. Many are not willing to advertise their lives and struggles. I also failed to reach out to a couple women of colour due to struggling with my own depression and anxiety. Also, looking back, there were not enough respondents who had trauma based disorders. The same with nonbinary or trans identifying people: how does their gender identity or lack of play into their struggles with mental illness and how it is treated?

Conclusion

Everyday, the stigmas around mental illness hurt those who suffer from them. By breaking the stigmas around mental illness, those who suffer from them will be more likely to come forward and get help. Breaking the stigmas will also lower the amount of discrimination mentally ill people face on a fairly regular basis. It is important to realize that public stigmatization of mental health can lead to self stigmatization which can have negative outcomes. Instead of promoting stigmas and believing the negative stereotypes that surround mental health and mental health treatment, the public should be encouraged to help make life a little better more accessible to those who need extra help—especially women who fall into racial minority groups.

This research is very important. It is important to realize that while as a society we have come a long way in accepting mental illnesses as real diseases, there is still a long way to go. Stigmas make it that much harder for those who suffer from these mental diseases to reach out for help. It is crucial to start teaching the public that those who are mentally ill should not be social outcasts. Racial minorities need to be able to access services that not only address mental disorders but also take into account language and cultural barriers.

References

Fawcett, Kristin. “How Mental Illness is Misrepresented in the Media.” U.S News, 16 Apr. 2015, 10:51am, health.usnews.com/health-news/health-wellness/articles/2015/04/16/how-mental-illness-is-misrepresented-in-the-media.

Parcesepe, Angela M., and Leopoldo J. Cabassa. 2013. "Public stigma of mental illness in the United States: A systematic literature review." 40(5). Retrieved February 21, 2017 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835659/).

Chang, Edward C. “Relationship between loneliness and symptoms of anxiety and depression in African American men and women: Evidence for gender as a moderator.” Personality and Individual Differences, vol. 120, 1 Jan. 2018, pp. 138–143., doi:http://www.sciencedirect.com/science/article/pii/S0191886917305378?via%3Dihub.

Ruglass, Lesia M, et al. “Racial/Ethnic match and treatment outcomes for women with PTSD and substance use disorders receiving community-Based treatment.” Community Mental Health , 2014, pp. 811–822., doi:https://search-proquest-com.ezproxy.uky.edu/docview/1564091503?OpenUrlRefId=info:xri/sid:primo&accountid=11836#.

Sue, Stanley, et al. “Asian American Mental Health: A Call to Action.” American Psychologist, vol. 67, no. 7, Oct. 2012, pp. 532–544., doi:http://psycnet.apa.org.ezproxy.uky.edu/record/2012-27130-003?doi=1.

Nadeem, Erum, et al. “Does Stigma Keep Poor Young Immigrant and U.S.-Born Black and Latina Women From Seeking Mental Health Care?” Psychiatric Services, vol. 58, no. 12, 1 Dec. 2007, pp. 1547–1554., doi:http://ps.psychiatryonline.org/doi/full/10.1176/ps.2007.58.12.1547.

Alvidrez, Jennifer. “Ethnic Variations in Mental Health Attitudes and Service Use Among Low-Income African American, Latina, and European American Young Women.” Community Mental Health Journal, vol. 35, no. 6, Dec. 1999, doi:https://link-springer-com.ezproxy.uky.edu/article/10.1023%2FA%3A1018759201290.

Chang, Jen Jen, et al. “Racial/Ethnic Differences in the Correlates of Mental Health Services Use among Pregnant Women with Depressive Symptoms.” Maternal Mental Health Journal, Apr. 2016, doi:http://web.a.ebscohost.com.ezproxy.uky.edu/ehost/pdfviewer/pdfviewer?vid=1&sid=7b324585-4459-4576-adfb-4eee17488435%40sessionmgr4006.

Erum Nadeen, et al. “Mental health care preferences among low-Income and minority women.” Archives of Women's Mental Health, June 2008, pp. 93–104.,doi:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2689381/.

Narikiyo, Trudy A, and Velma A Kameoka. “Attributions of Mental Illness and Judgments About Help Seeking Among Japanese-American and White American Students.” Journal of Counseling Psychology, vol. 39, no. 3, pp. 363–369., doi:http://psycnet.apa.org.ezproxy.uky.edu/record/1992-40455-001?doi=1.