By Janet Singleton

It can take your money, your health, and even your life. Yet in the black community mental illness is not taken seriously, says Denver clinical psychologist Robert Atwell, PsyD. “Depression, anxiety, and severe emotional distress just are not given that much weight. Problems do not get attention until they have grown so severe that people cannot function.”

“We don’t say it’s depression,” says Carl Bell, MD, an outspoken Chicago psychiatrist. “We just say, ‘Bubba’s lazy.’”

What hurts the mind attacks the body.

Yet emotional disturbances kill people, clinicians say. Conditions that are brought on or made worse through depression and/or anxiety include high blood pressure, diabetes, dementia, obesity, and heart disease—all prevalent in the black community.

“If you are depressed or anxious you are at greater risk to do things to escape your discomfort,” Bell says. “(Affected people) use drugs, drink, smoke, eat to obesity, trade sex for affection and risk HIV infections; so all of this has huge physical health consequences that can lead to disease and early death—far more than suicide from depression.”

“Our people suffer more from depression and anxiety because we get dinged all the time,” says Atwell, former president of the Association of Black Psychologists (2005-2007). Each day black people are pelted with what he calls “micro insults” to their self-esteem and security. “And these emotional issues are killing us.”

Do antidepressants really work?

Antidepressants are important weapons in the fight to control such issues, according to many clinicians, including Bell. Yet in 2002 Irving Kirsch, researcher at the University of Connecticut, and colleagues looked at previously unreleased studies of Prozac, Paxil, Zoloft, Effexor, Serzone, and Celexa—experiments conducted by the companies that manufacture the drugs—and found dummy pills to be almost as effective.

Much of the research fails to distinguish people with severe depression from those with mild cases, counters Bernadette Cullen, MRCPsych, head of the Community Psychiatry Program at Johns Hopkins in Baltimore, MD. “If someone is extremely depressed, talk therapy alone is not going to get them out of that.”

Can mental illness make you poor?

If patients do not have access to sliding-scale community programs like Cullen’s, they may not be able to afford treatment, whether with pills, talk, or a combination. The nation’s lack of affordable mental health care is “scandalous,” says Andrew Solomon, author of The Noonday Demon: An Atlas of Depression.

And a cruel accessibility-verses-need paradox exists. “Across cultures people who are economically disadvantaged are more likely to suffer mental illness,” says Solomon.

Poverty leads to emotional problems, and emotional problems may lead to poverty. Nonprofit research group RAND followed families for over 40 years and concluded that mental health problems caused a 20 percent decrease in adult income. Even within families, psychologically plagued siblings made an average of $10, 400 less compared to their healthier brothers and sisters.

The psych ceiling: mental illness as a barrier to advancement.

The study indicates that lost days at work account for much of the income disparity. Atwell says emotional distress affects the quality of performance as severely as it does the quantity. Coping mechanisms, positive and negative, from church attendance to substance abuse, allow emotionally distraught black people to function normally, hold down jobs, and deny they have a problem, he says. However, their effectiveness at work is impaired.

“We may be functioning with a low level of depression. One reason is that we know we aren’t compensated for our work to the degree that whites are for theirs. So we may be working harder but less efficiently. Depression costs us our creativity, spontaneity, and stamina. That would logically lead to less progress in the workplace and reinforce stereotypical expectations.”

The best things in life are free.

Yet numerous paths to feeling better exist and bear no or low admission fees. Denver psychologist Ralph Jones, EdD, suggests looking into church-based programs. Exercise; self-help books; volunteer work; sunlight; supplements like St John’s Wort or SAMe pop up repeatedly as the approaches experts recommend in the push against depression and anxiety. “Make it a point every day to talk to someone who really likes you and offers nurturing support and affection,” Atwell says.

Another mental health booster is nutrition, Jones says. “I’m afraid the black community is not making the connection.” What we’re eating and how we’re sleeping is essential to how happy we are, says the psychologist, who believes in yoga and meditation.

“One more stick to beat you with.”

A seemingly impenetrable brick wall can stand in the way of recognition and treatment—stigma. “Because of our history of exploitation we don’t want to acknowledge weaknesses,” Atwell says. “You don’t give somebody just one more stick to beat you with.”

Prejudice is wrapped up in the ball of confusion about what depression actually is. But the medical community now widely agrees that clinical depression is not a willful condition. You do not choose it; it chooses you.

“There is no question that these are brain disorders,” says Solomon. He interviewed depressed people from an array of races, classes, and cultures while researching his book. A sufferer, himself, he interrupted the writing of his tome, which won the 2002 National Book Award, to recover from a breakdown.

Living becomes less brutal.

Son of corporate mogul Howard Solomon, the writer’s privileged background and wide research gave him a look at both sides of the class line. “The difference is that if you live in a world where everything seems perfect yet you are depressed, you know there is a problem and you seek help. But if you are struggling through life all the time, you think, ‘I am struggling all the time; of course I’m depressed.’”

What people don’t realize is that their depression, not just class or race, is making life more difficult, he says. “Once the depression is under control, living becomes less brutal.”

Therapy is the answer, Atwell adds. “Professionals can help people develop insights and develop prescriptions for achieving better behavior.” Without treatment, psychological problems will rear their hungry heads and feast. “There is always some way in which emotional pain will manifest itself.”

FIVE MYTHS WE TEND to BELIEVE about MENTAL ILLNESS

Mentally ill equals “crazy.”

People walking downtown talking to themselves represent only a small portion of the mentally ill. And not being at the point of hearing voices or ranting in the street does not certify your psychological health. “Most people suffering from mental illnesses are in touch with reality,” says a statement by NAMI.

Antidepressants make people high.

“This is simply not true,” Bell says. “Antidepressants are indicated to treat depression. There is no ‘happy pill.’ Uppers are drugs; antidepressants are medications. Antidepressants are not habit forming. This is more ignorance and anti-psychiatry propaganda and misinformation.”

What doesn’t kill you makes you stronger.

Actually the opposite is true. Patients with chronic stress exhibit immune disorders that can make them weaker in the face of diseases and the daily pressures of life. And harsh events, from interpersonal violence to battlefield experiences, can lead to post traumatic stress disorder.

Only weak people suffer from depression and emotional problems.

“Mental illness is not anyone’s fault, anymore than heart disease or diabetes is a person’s fault,” says NAMI. “According to the Surgeon General’s report: ‘Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof), associated with distress and/ or impaired functioning.’”

I can pray this away.

“I have no doubt prayer is helpful,” Atwell says. “But it is not an effective way to completely address the problem.”

Janet Singleton is an award-winning novelist and journalist