Black Americans and mental health

• TYPE OF PSYCHOLOGY: Multicultural psychology; psychopathology; psychotherapy

The study of the mental health of Black Americans has frequently been influenced by negative and stereotypical views of this population. The diagnosis and treatment of mental health problems among Black Americans has evolved from practices based on dysfunctional and deficient models to ones based on an acceptance and understanding of this population’s cultural differences.

Introduction

Most Black people in the United States are descendants of formerly enslaved Africans. African Americans were actively oppressed and discriminated against for centuries, which affected the way mental health conditions in members of this group were viewed, diagnosed, and treated.

Enslaved Africans arrived in Virginia in 1619. As more Europeans settled in the colonies, the demand for a cheap labor force increased. From the mid-seventeenth through the eighteenth centuries, more than six million people were forcibly removed from Africa and enslaved. The slave trade was outlawed in the United States in 1808 but continued illegally. Although enslavement officially ended in 1865, Jim Crow laws in the South introduced de jure segregation in public facilities. Through the efforts of the twentieth-century civil rights movement, Jim Crow laws were gradually repealed. From 1965 to 1968, President Lyndon B. Johnson signed into law several bills, including the Civil Rights Act and the Voting Rights Act, that prohibited discrimination against African Americans in housing, education, employment, and voting.

An awareness of the legacy of discrimination and ongoing racism is critical to understanding African American mental health issues. The years of enslavement and discrimination, as well as continuing prejudice against people of color in American society, have had a lasting impact on the mental health of African Americans.

For much of American history, African Americans were referred to as “negroes” and “colored.” The Black community began to reject these terms during the civil rights movement. In the 1960s and 1970s, African Americans adopted terms including “Afro-American” and “Black” to describe themselves, in celebration of their rich heritage and to promote the idea that having Black skin was a positive rather than a negative characteristic. In the 1980s, many Black people began to embrace the term “African American.” The terms “Black” and “African American” have come to be used interchangeably. The evolution of this terminology is often viewed as evidence of the Black community’s embracing a positive racial identity. Racial identity refers to the recognition and acceptance of one’s self as a racial being in a society that often discriminates based on racial group membership. A positive Black racial identity has been found to protect individuals against some of the negative consequences of racism, and it is viewed as a positive indicator of mental health.

Historical Overview

Early models of mental health were not sensitive to cultural differences and often stereotyped Black people as being morally and intellectually inferior. Black people were seen as inherently dysfunctional. Later models saw Black people as culturally deficient, which suggested that acculturation to mainstream White culture would “cure” them. Modern models of mental health embrace the differences model, which promotes acceptance of cultural differences and seeks to incorporate a more culturally sensitive view in the diagnosis and treatment of mental health conditions. This model examines how social, cultural, political, and economic factors affect mental health conditions. This mental health model has ushered in psychology’s fourth force, multiculturalism.

Early examples of the “culturally deficient” model’s influence on mental health diagnoses include the psychological disorder drapetomania. This pseudoscientific disorder, which applied only to enslaved persons, was coined in 1851 by American physician Samuel Adolphus Cartwright, who defined the condition as “the disease causing Negroes to run away” from their owners. The treatment for this disorder, once it was determined that the disease had progressed to the stage of actually running away, as opposed to the mere desire to do so, was more frequent whipping. Further treatment guidelines included keeping enslaved people in a submissive state and treating them like children.

The study of African Americans’ mental health was often obscured by questionable methodology. For example, in a nineteenth-century study of Black rates of "insanity," the data were manipulated to demonstrate that Black people in the North had higher rates of insanity than Black people in the South. The conclusion was that freedom drove Black people crazy. Much of the early knowledge of Black people's mental health came from enslavers’ accounts. Early twentieth-century studies of mental health conditions among Black people relied on hospitalized patients with severe mental health conditions. Findings based on a limited number of hospitalized Black people were used to make broad generalizations about the entire population of African Americans. These studies were also used to support the view that mental health conditions occurred at higher rates among Black people than in the White population. At the time these studies were performed, the field of psychiatry had not developed a standardized method for diagnoses or specific diagnostic categories.

Sir Francis Galton was a nineteenth-century psychometrician and eugenicist. He studied racial differences on intelligence tests. In Galton’s time, psychometrics was the field concerned with developing tests to measure personality traits, intellectual ability, and psychological attitudes. Eugenicists believed that the lighter-skinned White race was genetically, intellectually, and morally superior to darker-skinned races. Galton claimed that those with African ancestry were significantly below Anglo-Saxons in the normal frequency distribution of general mental ability. Early proponents of eugenics supported sterilization and selective breeding to decrease and control the Black population. The thinking was that through selective breeding, eugenicists could reduce the intellectual inferiority of Black people, which was thought to contribute to immoral behavior, and that sterilization would prevent any increase in the number of Black people in the population, which would weaken the national gene pool. Eugenics was often used as an attempt to defend racism on the basis of science. Racial differences on tests of intelligence were often used to justify the disproportional placement of Black children in special education courses. Although ethnic differences on tests of intelligence continue to be controversial areas of study, it is generally accepted that racial or ethnic performance differences on tests of intelligence are caused by environmental factors such as nutrition, access to quality education, richness of the early home environment, and other environmental factors.

By the mid-1970s, diagnostic criteria for mental disorders had been established and helped scientists develop more objective research methodologies. The National Institute of Mental Health conducted the Epidemiologic Catchment Area (ECA) program (1980–85), the largest study of mental health conditions of its kind at the time. The program examined the incidence and prevalence of various types of mental health conditions among different populations. The study found little variation in psychological disorders and rates of substance abuse by race. These findings have been replicated multiple times.

Contributing Socioeconomic Factors

Various social, political, and economic factors significantly affect what types of mental distress are experienced by African Americans. Although the majority of African Americans are not low-income individuals, a significant number fall below the government’s official poverty line. In 2021, some 19.5 percent of African American families lived in poverty, compared with 11.3 percent of families in the United States as a whole, and 8.2 percent of non-Hispanic White Americans. In 2022, the rate of poverty in the African American community fell to an all-time low of 17.1 percent, but the inequality remained evident, with the overall percentage of all races remaining at 11.3 percent. Rates of unemployment are also higher among African Americans than among White individuals. Higher rates of mental health conditions are correlated with lower socioeconomic status, higher rates of violence, and lower attention paid to mental health treatment. Black people have higher rates of divorce, separation, and never-married status when compared with other ethnic groups. Black children are more likely to live in households headed by women, which are more likely to be low-income or experience continual economic hardship. African American adults are also less likely to have access to quality healthcare or affordable health insurance. Black men have higher incarceration rates than any other ethnic group, and African Americans are disproportionately represented among the unhoused population. These demographic conditions significantly affect rates of mental health conditions within the population.

African Americans underutilize mental health services. Only about one-third of African Americans with mental health conditions get care. The percentage of African Americans receiving care is half that of non-Hispanic White individuals. Because of the historic negative treatment of Black people by medical and mental health professionals, many African Americans are reluctant to seek professional treatment for mental health conditions. African Americans are more likely to use emergency services or seek services from their primary care physicians than from a mental health professional, and they typically seek care after the mental health condition has reached a crisis point. An increase in the number of African American mental health professionals could positively affect the scientific study of this group, its utilization rates of existing mental health services, and how this population deals with mental health issues.

Rates of Mental Health Conditions

Rates of mental health conditions among African Americans are similar to those among White individuals; however, differences exist for specific mental health conditions. For example, African Americans are less likely than other races to suffer from depression and have lower rates of suicide, except for young Black men (ages thirteen to twenty-four), among whom suicide rates are rising. Simple phobias and somatization are more common in Black women than in White women. Compared with the general population, African Americans are more likely to be exposed to violence, which affects the rates at which they are affected by post-traumatic stress disorder, anxiety, and depression.

African American youths have lower rates of tobacco, alcohol, and other illicit drug use than their White or Hispanic peers. However, when African American youths abuse substances, they are more likely to suffer negative social consequences (such as expulsion from school) than members of other ethnic groups.

Biases and Disparities

When compared with White individuals who exhibit the same symptoms, African Americans are more likely to be diagnosed with schizophrenia. Black people are also more likely than White individuals to be improperly diagnosed when suffering from affective disorders such as depression.

African Americans have higher rates of diabetes, stroke, obesity, and cardiac disease than other ethnic groups. These medical conditions have been linked to genetic factors as well as the high levels of stress often experienced by this population. African Americans also have a lower life expectancy (70.8 years in 2021) when compared with White Americans (76.4 years). In 2022, suicide was the third leading cause of death of Black youth between ten and twenty-three.

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