Special Health Bulletin: “Black and Blue: Depression in the African American Community”

In 1929 Louis Armstrong, arguably the greatest of all American Jazz artists, performed a song written by prolific lyricist Andy Razaf, that exemplifies a sometimes hidden phenomenon in the African American community-the proverbial “blues”. In his characteristic gritty voice he intones, “How will it end? I ain’t got a friend. My only sin is my skin. What did I do to be so black and blue?” While it is obvious that feelings of sadness and depression are not privy to people of color, we do know that mental illnesses, including depression, are often under-diagnosed, misdiagnosed and poorly managed among blacks, especially young men. Yes, being black, young, and “blue” proves a unique, and sometimes debilitating, condition indeed.

“J.W. is a very motivated 27 year old New Orleans native who immigrated to Los Angeles to live with his mother’s family following Hurricane Katrina. The economic downturn last year resulted in him losing his lucrative California based job. Despite his best efforts, he simply cannot find a job, and is unable to move into his own apartment. Auntie M. has given him two more weeks to find somewhere to live. K.G., his longtime girlfriend, and mother of his only son, relocated to Houston to marry her college sweetheart. Crushed, J.W. began bible study faithfully, but now finds himself feeling angry and alone. He feels guilty that he is unable to consistently send his son money or help his aunt with the bills. In the quiet of his aunt’s living room, he tearfully fingers a small handgun, imaging this crazy world without him.

“L.P. is a beautiful 22 year old who despite physical and emotional abuse as a child, has excelled as a runway model. At age seven she was placed in foster care, where she remained until age 18. L.P. has worked very hard as a model, is described by her friends as a ‘social butterfly”, but finds herself unable to leave her loft apartment for the past eight days. She will not answer her home or cell phone, even when her agent calls. Despite spending the entire day in bed, she can’t sleep longer than a couple of hours at a time, has no appetite for food and feels sad to the point that she is “numb”. She doesn’t even flinch when the shiny, new kitchen knife draws blood from her wrist.

While individuals must refrain from self-diagnosis, it is important to be familiar with the symptoms associated with depression in order to know when to seek help. Many people experience periods of sadness described as situational depression. These include bereavement associated with the loss of a loved one, post partum depression, seasonal affective disorder (SAD), premenopausal syndrome (PMS) as well as depressed mood associated with alcohol and drug intoxication or withdrawal. Certain medical conditions including thyroid disease, heart attack, stroke, diabetes mellitus, and Human Immunodeficiency Virus (HIV) can be associated with depression. Major Depression is classically characterized by the presence of at least two of the following symptoms, most of the time, every day for at least two weeks: depressed, irritable, or cranky mood most of the time nearly every day; greatly reduced interest in previously pleasurable activities; changes in appetite resulting in weight loss and less commonly weight gain; sleep disturbance including insomnia and excessive sleep; feelings of agitation or slowing down; fatigue or lack of energy; pervasive feelings of guilt; feelings of decreased self worth; decreased concentration and inability to make decisions. Short-term sadness involving job loss, loneliness, marital strife or other life stresses is normal, however, prolonged failure to “get over” the situation may reflect a more serious issue.

The etiology, or underlying cause, of depression is an active area of study. Many factors are thought to be involved including, but not limited to genetic predisposition, chemical and hormonal imbalances, guilt associated with prior physical, emotional or sexual abuse, as well as unresolved issues from childhood. Christian counselor and Professor of Psychology at Bethel College, St. Paul, MN, Andy J. Johnson, Ph.D., describes depression as a “melding together of sadness over losses and unresolved anger in such a way that neither emotion can be fully experienced and resolved.” Many black youths are confronted during their formative years with the mandate to trade outward emotional expression for a survivalist’s bravado that can negatively affect them well into adulthood. In his book “Standing in the Shadows: Understanding and Overcoming Depression in Black Men”, journalist and victim of depression John Head explains: “[F] rom the time we are young boys, black males have ingrained into us an idea of manhood that requires a silence about feelings, a withholding of emotion, an ability to bear burdens alone, and a refusal to appear weak.” He continues, “[t] he interval pressure to adhere to this concept of masculinity only increases as we confront a society that historically has sought to deny us our manhood.” Additionally, perceived victimization by educators, employees, police, landlords, as well as the criminal justice and social welfare systems places great strain on these vulnerable members of our community. Subsequently, many black youths, especially males, are prone to suffering situational and or clinical depression and the associated increased risk of suicide death. Data gathered between 1988 and 1995, reflects a 146% increase in suicide death among African American males ages 15-19. According to reports released by the Centers for Disease Control and Prevention (CDC) in 2000, while white males account for the majority of suicide death, the suicide rate has been rapidly increasing among African American males ages 10-19 and had in fact doubled over the preceding decade. In 2007, the CDC proclaims suicide as the second leading cause of death among 25-34 year olds and the third leading cause of death among 15-24 year olds.

As bible believers, we know that the “thief comes to steal and kill and destroy, but [that Jesus] came to give life.” (John 10:10 New Century Version) If you or someone you know suffer from symptoms of depression, prayerfully consider seeking professional counseling and or psychiatric help. Though there remains a disparity in the number of African American mental health care providers, it is quite possible to identify a provider that practices with respect and cultural competence. Choose someone with whom you feel safe from bias, judgment, anger and criticism. Ask about licensure, area of specialty, and educational background. Don’t be afraid to ask early on about the treatment plan. Treatment regimens may include customized individual or family therapy, as well as medications including SSRIs (serotonin re-uptake inhibitors), TCAs (tricyclics), atypical antidepressants and MAOIs (monoamine oxidase inhibitors).

Dealing effectively with sadness or a true subtype of depression can be challenging, but you are up to it! Maintain open lines of communication with your medical doctor, therapist, minister and other support persons. Be patient with your progress, and open to God using multiple people and methods to facilitate your healing. Free yourself of unfounded feelings of guilt. As a Christian, you are free to ask forgiveness for any sins you’ve ever committed. Romans 8:1 declares, “Therefore, there is now no condemnation for those who are in Christ Jesus.” Know that the guilt most often associated with depression is not your own, but is a symptom of the disease process. As a community, we must fight to end the stigma associated with mental illnesses including depression. We must not be judgmental, but prayerfully supportive of one another. We must educate ourselves with regard to available community resources, and be prepared to direct those in need of mental health services in the right direction. Remember, asking for help is not an admission of weakness, lack of faith or decreased value to God. Doing so marks the first step to ones divinely created best self! Physically, spiritually and mentally sound individuals are the very fabric of a vibrant, progressive community capable of facing the toughest of challenges, even that of being black while sometimes blue.

Community Resources: Note! If someone shares with you a plan to hurt themselves, CALL 911 or provide transport to a nearby emergency department. If you have thoughts of suicide, seek help. DO NOT DELAY!

1-800-SUICIDE (Help line. US Department of Health and Human Services Substance Abuse and Mental Health Services Administration)