DR. NICOLE CHRISTIAN-BRATHWAITE An African American psychiatrist shares her perspective on stigma, racial disparities and mental health, as we recognize National Minority Mental Health Month Like many of my patients, my path into psychiatry began with pain. My senior year of college, I contracted a severe case of tuberculosis and was isolated and hospitalized for more than two months. That experience changed my perspectives about medicine. It changed my understanding of being a physician and reinforced my commitment to becoming one.
But before I went to medical school, I spent a year teaching kids in a low-income neighborhood of Philadelphia. I learned something crucial. The kids who struggled the most at school were not the children who had significant physical or medical problems, but the children who were dealing with significant trauma. Those were the kids who were coming to the nurse’s office with physical complaints. Those were the children who were missing school and failing or acting out. Working with children that were often labeled as “difficult” or “oppositional,” but were actually experiencing significant emotional pain, made me realize I wanted to become a psychiatrist.
DR. NICOLE CHRISTIAN-BRATHWAITE
As an African American with parents who were active in our community, I was already keenly aware of the unmet needs in medically underserved low-income and minority communities. My mentors in medical school helped me explore opportunities to do trauma research in the community surrounding University of Pittsburgh as well as in Honduras, Mexico and Ghana. I was fortunate to be mentored during my residency and fellowship at Massachusetts General and McLean Hospital by Dr. David Henderson, now the chief of psychiatry at Boston Medical Center. Being one of the few African American residents at MGH/Mclean, it was vital to have guidance and support from mentors of color.
I went on to become the founder and CEO of Well Minds Consulting Co., which educates college and secondary school leaders about mental health and trauma, wellness and self-care, implicit bias, and understanding mental illness in children of color. I serve as a consultant to schools and universities including Mass College of Pharmacy, William James and Lesley University. I help the staff better understand the needs of the diverse student population and the impact trauma, race and culture have on mental health. I also see patients through my private practice and conduct telepsychiatry.
I believe appropriate mental health treatment can save lives. It saved my life.
My passion remains exploring trauma in kids, and the ethnic, racial and socioeconomic disparities that can contribute to trauma lasting into adulthood. My patient population ranges in age from 7 to 70s.
Hurdles to treatment
African Americans develop mental health conditions at a rate equal to everyone else, but studies have found that we have less access to health and mental health services, are less likely to seek care, and are more likely to receive poor quality care when treated. More than 37% of whites, but only 25% of African Americans, receive treatment for mental health or substance use. We are more likely to delay seeking mental health treatment, and more likely to end treatment prematurely.
Why?
We face implicit bias in medicine and mental health, limited treatment access in communities of color, and lack of cultural humility and understanding of clinicians. For example, some clinicians may be unaware that African Americans are more likely to manifest mental health symptoms and stress via physical signs than white patients are. Anxiety may be experienced with a racing heart, light-headedness, nausea or chronic headaches. African Americans often seek care from primary care providers well before seeking mental health care. If a primary care provider is not culturally aware of how African Americans present, they may misinterpret those signs, dismiss them and fail to make the appropriate referrals. That is deeply harmful. Studies have found rates of recovery of African Americans from PTSD and depression are significantly lower than the rates for white patients.
African Americans also may be dissuaded from expressing vulnerabilities or seeking treatment due to stigma around sharing “personal business” with people “outside the family.” We also face harmful stereotypes: for example, that Black men are hesitant to display emotion and reluctant to ask for or accept help, and that Black women never need help and do everything on their own. We can be made to feel we cannot reveal vulnerability or ask for help. I once said to a patient, “Oh, you’re so strong.” Her response resonated with me: “Yeah, but I’m tired of being so strong. I don’t want to have to be so strong.” We may assume that even if we are highly traumatized, we’re supposed to struggle because our parents struggled and our grandparents struggled. I know this first-hand. After the birth of my first child, I suffered from significant postpartum depression and was reluctant to seek treatment. I was afraid of the stigma. I was a psychiatrist preaching to others, yet for a long time, I would not reveal how much pain I was in. I allowed myself to suffer for months. Around three months postpartum, I finally realized that if I didn’t get treatment, I wasn’t going to survive this. Therapy and medication saved my life.
African American may also feel reluctant to pursue treatment for our children. There may be concern that if a child is tested or evaluated for a learning disability or a mental health issue, they will be “labeled.” I always tell families, it is better to know than not know. I remind parents: African American children are often disciplined for behaviors that white children will receive treatment for. If there are underlying concerns, it is far better they are identified early, so our children can receive the necessary supports. This myth that we can’t allow our children to be evaluated hurts our kids long-term. Lack of evaluation and treatment can lead to inappropriate labeling and harsh discipline rather than support.
It’s important to remember: There is no intrinsic difference between the psychological resilience of African Americans and white Americans. We unfortunately experience more stressors. Socioeconomic pressures, racism and microaggressions in the workplace are significant stressors that have been shown to increase the risk of mental illness in African Americans.
When to seek help
Seek help if you find that there are significant changes in your level of functioning or a decline in your ability to respond to stress.
One of the first places that we can identify emotional and mental health challenges in children is in school. Have their grades dropped suddenly? Are they significantly more irritable or angry? Are they isolating? Are they making statements like, “I don’t care what happens to me”? Do they look or feel hopeless? Are they having a hard time concentrating because their thoughts are racing or they’re having intrusive thoughts?
For adults: Is their work performance changing? Are they missing more work? Are they not able to complete tasks the way they normally would? Has their hygiene declined? Is their home suddenly in disarray? Has their appetite changed and have they lost or gained a significant amount of weight? Are they isolating? Are they using substances to manage the pain? Those are all concerning signs.
DR. PHILOMENA ASANTE
How do you find the right mental health provider?
It is important to be comfortable with your therapist or psychiatrist. Be an educated consumer. Learn about types of therapy. Ask questions. If you’re dealing with, for example, bipolar disorder or PTSD, ask what the therapist’s approach is.
If racism has been an issue in your life, and for over 95% of black people it has, ask the therapist: are you comfortable discussing race and my experiences with racism? It is important to be candid with your clinician.
There are resources to find therapists. An organization called Therapy for Black Girls consists of primarily Black female therapists who are interested in supporting and providing care for Black women. InnoPsych, a new website created by African American psychologist Dr. Charmain Jackman in Massachusetts, provides listings of therapists and psychiatrists of color nationwide. Many therapists and psychiatrist are listed in Psychology Today, which allows you to search based on gender, location, race, ethnicity, or sexual orientation. The Association of Black Psychologists also has a list of therapists. Families for Depression Awareness offers resources for family members of people with depression.