Michael Lindsey: When you look at the historical experience of African Americans in the United
States you'd have to start with the experience of slavery and the vestiges of slavery in
terms of the trauma associated with it.
And I think that blacks continue to experience trauma in certain ways and certainly with
respect to those who live in urban communities that are sort of infested with drugs or that
are particularly violent.
Those are traumatic situations that they experience on a daily basis.
Certainly, as we've seen in recent events, interactions with the police can be, again,
particularly traumatic.
So when you talk about mental illness in the black community I think you have to begin
with the experience of trauma and how trauma continues to abound in their experiences in
their daily lives.
I think that what happens for a lot of individuals is that they suffer in silence with respect
to having a mental illness.
And so what I mean by that in the greater society there's certainly a lot of stigma
associated with mental illness.
It's sort of antithetical to the American ethic, which is to be strong and courageous;
to pull yourself up by the bootstraps; to weather the storm, et cetera.
I think the second part of that point is what's happening at the community level or the society
level.
And I think what happens is that within the black community, I think that, again, that
ethic about what it means to be strong and courageous is particularly pronounced because
of trying to combat those forces like discrimination or racism and it just adds to the burden of
sort of what it means to survive.
And so then the person who's struggling with the mental illness is perhaps not embraced
or warmly accepted because of their struggles.
I remember as a young person growing up I used to hear about the person who was " sent
down south" and I used to wonder what that meant.
And it wasn't until I got older that I became more knowledgeable of the fact that that person
was struggling with a mental illness or perhaps substance abuse.
So from a historical perspective there's been a lot of emphasis in the black community particularly
in black families on keeping your problems close to the vest, in the home.
You don't share what's going on with outsiders.
No one can treat you as best as your family can.
You bring all your burdens and your problems to your family.
And if you do take it to any entity outside of your family it's the black church.
The church is really important in the black community.
Make no mistake about it.
It's a source of sort of salvation and healing.
And there's the whole collective support you get from your fellow churchgoers and that
sort of thing.
But I think also what has historically happened is that the church has been defined as the
place to sort of relieve your symptoms or to address your burdens and so it stops there.
And what I think needs to happen is that first of all I think pastors and lay ministers can
be more trained in the signs and presentations of mental illness, but I think that the church
can be sort of a triage unit if you will such that it identifies those who have needs and
it's that sort of first step in the sort of entrée into care, but it shouldn't stop there.
I believe that culturally competent care is critical to everything.
If patients perceive that providers are inauthentic and do not care about their unique circumstances
then they're likely to be turned off.
At a baseline providers should understand the history of their neighborhoods, for example,
or the history of the experience of African-Americans and Latinos such that they can put the clinical
presentation into context and understand what unique factors are in play with respect to
the clinical presentation and how that person is seeking to survive and live in the world
as an African-American or Latino.
And so I think that the onus is on the provider to understand that context and to understand
what it means for that person to live in that context.