Photo used for what depression looks like project
Depression is like our childhood fears, well the way we manage them anyway. We all had fears as a child that haunted us in the dead of night. From clowns to boogie men and all the things we thought lived under our beds. And for the most part we all handled it the same way – we buried our heads under our covers, squeezed our eyes shut and prayed we’d make it to morning. Because every child knows monsters cannot survive in the light of day. We treat mental illness the same way. We bury our heads in the sand, close our eyes tight and pray if we ignore it long enough or hard enough it’ll just go away. We pray that holding on tightly for one more day makes the difference in making our mental illness a figment, a nightmare. But unfortunately for us mental illnesses are not our childhood fear s- they do not fade under the light of a shining day, they don’t plague us only in the night.
Just as our culture influenced our childhood fears and the way we dealt with them, it also influences our mental health and our very acceptance of it.
Strength is a vital pillar of the black/minority community. A building block each parent takes as their duty to provide to their child. Black history is a difficult one. We were brought to this country as things to be bartered. We were stripped of our lives, our culture, often even our names – but we endured. That is the summary of black history, as I like to see it: we had the strength to endure every cruelty visited upon us and still stand strong. So strength is more than a pillar I should say, it’s our foundation. So it stands to reason that anything we perceive as weak is immediately rejected both consciously and subconsciously. And unfortunately that is what mental illness is portrayed as – a weakness. And we in the black community WILL NOT be labeled as weak. We will fight that label even if it costs us our lives. We will not endure the shame of being labeled depressed, anxious or bipolar.
Depression and mental illness are a weakness. That stigma is accepted as truth especially in the black community. In my family medicine clinic I had a young black female patient on follow up for weight loss. All her lab work thus far had been negative but in interview she was positive SIGECAPS. She had lost 15 lbs unintentionally, difficulty sleeping, difficulty concentrating. She endorsed feelings of guilt and hopelessness and passive suicidal ideation. When it got to the point in our conversation when I told her that her symptoms likely were due to depression she shut down. “No I’m not depressed.” she said, “I don’t do that depression and cutting stuff.” I spent over a half an hour in the room with the patient trying to educate her on depression and convince her talk to a counselor. My resident also spent considerable time doing the same but to no avail. I still think about her occasionally and wonder is she’s ok and if she ever sought help. Her case really solidified for me the need to change the conversation about mental health staring with education.
I was screening an older black female patient for depression when she asked what the questions were related to. When I explained she told me “Black people don’t get depressed.” I wish I could say this is the first time I had heard this but sadly I’ve lost count. African Americans and women in particular are a large percent of under diagnosed and under treated individuals with depression. My attending (a black woman herself) recently asked me about my specialty choice and when I told her she exclaimed, “Psychiatry! Girl you are black. You know black people don’t believe in psychiatry.” She went on to explain her struggles in getting her black pediatric patients into therapy when their parents refused to believe their diagnoses.
Black men experience depression at higher rates than their white counterparts. They also commit suicide at higher rates. I know countless black men who fight every day against the stereotype of the angry black man. But in that same accord those same black men cringe at the idea of being called sensitive or weak. Their masculinity in addition to their culture cannot abide weakness. They package their pain and the shame that comes with it and they bury it deep. They put on a brave face and pray no one sees through the cracks and exposes that lie that they’re “ok”. They will carry their pain as they march to their death as long as they can march strongly.
Speaking from personal experience I could not admit that I needed help. So I was “strong” and I endured. But the more I pressed down, the more I straightened my shoulders, and told myself to grin and bear it the worse it got. The harder I held on and gritted my teeth, the more rapidly I was losing control. And the loss of control was probably the most shaming of all. Because I should be stronger than this right? I should be able to control these feelings of depression but I just couldn’t. I remember talking to my oldest brother, finally admitting I was depressed and to my disappointment he reinforced what I thought. He told me “You’re not depressed, your Leslie. You’re stronger than all of us so you’ll be fine.” But I was. Both strong and depressed, the two do not cancel each other out. In retrospect it saddens me to see that I fell victim to that same subconscious association of depression with weakness and I suffered because of it. I have talked (bullied) friends into seeking treatment but somehow I failed myself.
We must start the conversation. We need to remove the taboo nature of mental health. We can begin this by simply starting the conversation – what is depression, anxiety bipolar disorder. I have been very open and forthcoming about my depression. I post about it on social media and have had numerous conversations with friends, classmates and families. The last time I was home catching up with friends a close friend of mine told me that she had been hospitalized for 2 weeks in undergrad and was so ashamed she made an elaborate story up about where she had gone. She has since started posting about her experiences as well and imploring others to get help.
We also must change attitudes towards mental health. I know first hand this is not an easy task because in doing so we must change our fundamental beliefs. Especially when it comes to suffering. Suffering is not a badge of honor. Suffering is not a badge of honor – this concept bears repeating. I grew up surrounded by people who took their pain and suffering and wore them as badges of honor. All of the things they suffered through silently in their lifetime they viewed as strengths. Suffering will never make us strong. Overcoming suffering is strength, fighting through suffering is strength but enduring is not. And enduring silently has dangerous consequences.
I occasionally saw frustration and weariness in the outpatient physicians when we had patients that were clearly suffering but refusing treatment. I hope that they stay the course because often they are not fighting a patient but a culture
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