But change comes slowly.
“There’s some shame and embarrassment,” said Damian Waters, a marriage and family therapist whose clients at his practice in Upper Marlboro are predominantly African American. “You’ll tell someone that you went to the doctor, but you won’t tell that you went to the counselor or psychiatrist. Also, there is the idea that their faith should carry them through, though often their problems are larger than that.”
Self-reliance and distrust
The notion, dating back to slavery, that one should endure life’s difficulties without complaint or appearing weak runs deep in African American culture.
“People kind of expect, ‘Gee, you should pull yourself up by your bootstraps, get yourself together, there’s nothing wrong with you,’ ” said Annelle Primm, deputy medical director of the American Psychiatric Association and director of its office of minority and national affairs. “We were always taught: ‘Don’t put your business in the street. Don’t put your family’s issues out in front of strangers.’ ”
As a result, “many African Americans have gone without needed care, and when they have sought care it has been at the crisis stage, which is not optimal,” she said.
African Americans have also tended to distrust the medical professions, Waters said, especially after the Tuskegee experiment in which the U.S. Public Health Service knowingly withheld syphilis treatment from black men to watch the disease run its course.
The dismal state of black hospitals during segregation fueled their suspicion, as did African Americans’ high rate of involuntary commitment into institutions. While they are underrepresented in outpatient therapy, they are committed to inpatient care at twice the rate of whites, sometimes against their will, Waters said.
“It’s been documented, the amount of distrust many African Americans have toward the health professions,” Primm said. Especially if the provider is of a different racial and cultural background, “they may have expectations that they’re not going to be treated well.”
Part of this has to do with communication styles, she said, adding that standard approaches to therapy, in which the provider stays quiet and listens, can be off-putting to African Americans.