Black Mental Health Isn't the Same as White Mental Health
Dr. Michael Lindsey of NYU's Silver School of Social Work shares his views on the state of mental health within the African-American community.
Dr. Michael A. Lindsey is an associate professor at the Silver School of Social Work. Dr. Lindsey is a child and adolescent mental health services researcher, and is particularly interested in the prohibitive factors that lead to unmet mental health need among vulnerable youth with serious psychiatric illnesses, including depression. Dr. Lindsey has received research support from the National Institute of Mental Health (NIMH) to examine the social network influences on perceptual and actual barriers to mental health care among African American adolescent males with depression. Dr. Lindsey’s current research, funded by NIMH and the Annie E. Casey Foundation, involves the development and test of a treatment engagement intervention that promotes access to and use of mental health services among depressed adolescents in school- and community-based treatment. Dr. Lindsey is a member of the Ford Foundation Scholars Network on Masculinity and the Wellbeing of African American Males; the Emerging Scholars Interdisciplinary Network; and the Mental Health Education Integration Consortium. His published research has appeared in the American Journal of Men’s Health, Journal of Adolescent Health, Clinical Child and Family Psychology Review, Journal Clinical Child & Adolescent Psychology, Journal of Black Psychology, General Hospital Psychiatry, Prevention Science, Psychiatric Services, and in the journal Social Work. Dr. Lindsey is currently a standing member of the NIMH Services Research Committee, and a board member-at-large for the Society for Social Work and Research.
Dr. Lindsey holds a PhD in social work and MPH from the University of Pittsburgh; an MSW from Howard University; and a BA in sociology from Morehouse College. He also completed a two-year postdoctoral fellowship in public health at the Bloomberg School of Public Health, Johns Hopkins University.
Michael Lindsey: When you look at the historical experience of African-Americans in the United States, you'd have to start with the experience of slavery and the vestiges of slavery in terms of the trauma associated with it. And I think that blacks continue to experience trauma in certain ways and certainly with respect to those who live in urban communities that are sort of infested with drugs or that are particularly violent. Those are traumatic situations that they experience on a daily basis. Certainly, as we've seen in recent events, interactions with the police can be, again, particularly traumatic. So when you talk about mental illness in the black community, I think you have to begin with the experience of trauma and how trauma continues to abound in their experiences, in their daily lives.
I think that what happens for a lot of individuals is that they suffer in silence with respect to having a mental illness. And so what I mean by that — in the greater society there's certainly a lot of stigma associated with mental illness. It's sort of antithetical to the American ethic, which is to be strong and courageous; to pull yourself up by the bootstraps; to weather the storm, et cetera.
I think the second part of that point is what's happening at the community level or the society level. And I think what happens is that within the black community, I think that, again, that ethic about what it means to be strong and courageous is particularly pronounced because of trying to combat those forces like discrimination or racism and it just adds to the burden of sort of what it means to survive. And so then the person who's struggling with the mental illness is perhaps not embraced or warmly accepted because of their struggles.
I remember, as a young person growing up, I used to hear about the person who was "sent down south" and I used to wonder what that meant. And it wasn't until I got older that I became more knowledgeable of the fact that that person was struggling with a mental illness or perhaps substance abuse.
So from a historical perspective there's been a lot of emphasis in the black community particularly in black families on keeping your problems close to the vest, in the home. You don't share what's going on with outsiders. No one can treat you as best as your family can. You bring all your burdens and your problems to your family. And if you do take it to any entity outside of your family, it's the black church.
The church is really important in the black community. Make no mistake about it. It's a source of sort of salvation and healing. And there's the whole collective support you get from your fellow churchgoers and that sort of thing. But I think also what has historically happened is that the church has been defined as the place to sort of relieve your symptoms or to address your burdens and so it stops there. And what I think needs to happen is that first of all I think pastors and lay ministers can be more trained in the signs and presentations of mental illness, but I think that the church can be sort of a triage unit, if you will, such that it identifies those who have needs and it's that sort of first step in the sort of entrée into care, but it shouldn't stop there.
I believe that culturally competent care is critical to everything. If patients perceive that providers are inauthentic and do not care about their unique circumstances, then they're likely to be turned off. At a baseline, providers should understand the history of their neighborhoods, for example, or the history of the experience of African-Americans and Latinos such that they can put the clinical presentation into context and understand what unique factors are in play with respect to the clinical presentation and how that person is seeking to survive and live in the world as an African-American or Latino. And so I think that the onus is on the provider to understand that context and to understand what it means for that person to live in that context.
Big Think and the Mental Health Channel are proud to present Big Thinkers on Mental Health, a new series dedicated to open discussion of anxiety, depression, and the many other psychological disorders that affect millions worldwide.
You can't have a frank discussion about mental health within the African-American community without confronting issues related to social trauma. Uncomfortable (and sometimes dangerous) encounters with a distrusted police force. Drugs and crime infesting a neighborhood. The institutional scars of slavery and segregation. These are all issues our contemporary black population must deal with each and every day.
Dr. Michael Lindsey of NYU's Silver School of Social Work sees signs of debilitating trauma throughout black America. He points to two key reasons for this. First, mental illness is unfairly stigmatized in these communities, just as it is throughout American culture. Second, cultural definitions of strength and courage are dictated by efforts to work against institutional ills such as discrimination. How one reacts to these ills, coupled with the community's response to said reaction, adds a lot of tension other Americans don't necessarily have to deal with.
Finally, Lindsey speaks to the value placed on authenticity, a major reason why many sufferers in the black community internalize their strife rather than share it with the outside world.
A plan to forgive almost a trillion dollars in debt would solve the student loan debt crisis, but can it work?
- Sen. Elizabeth Warren has just proposed a bold education reform plan that would forgive billions in student debt.
- The plan would forgive the debt held by more than 30 million Americans.
- The debt forgiveness program is one part of a larger program to make higher education more accessible.
Researchers hope the technology will further our understanding of the brain, but lawmakers may not be ready for the ethical challenges.
- Researchers at the Yale School of Medicine successfully restored some functions to pig brains that had been dead for hours.
- They hope the technology will advance our understanding of the brain, potentially developing new treatments for debilitating diseases and disorders.
- The research raises many ethical questions and puts to the test our current understanding of death.
The image of an undead brain coming back to live again is the stuff of science fiction. Not just any science fiction, specifically B-grade sci fi. What instantly springs to mind is the black-and-white horrors of films like Fiend Without a Face. Bad acting. Plastic monstrosities. Visible strings. And a spinal cord that, for some reason, is also a tentacle?
But like any good science fiction, it's only a matter of time before some manner of it seeps into our reality. This week's Nature published the findings of researchers who managed to restore function to pigs' brains that were clinically dead. At least, what we once thought of as dead.
What's dead may never die, it seems
The researchers did not hail from House Greyjoy — "What is dead may never die" — but came largely from the Yale School of Medicine. They connected 32 pig brains to a system called BrainEx. BrainEx is an artificial perfusion system — that is, a system that takes over the functions normally regulated by the organ. The pigs had been killed four hours earlier at a U.S. Department of Agriculture slaughterhouse; their brains completely removed from the skulls.
BrainEx pumped an experiment solution into the brain that essentially mimic blood flow. It brought oxygen and nutrients to the tissues, giving brain cells the resources to begin many normal functions. The cells began consuming and metabolizing sugars. The brains' immune systems kicked in. Neuron samples could carry an electrical signal. Some brain cells even responded to drugs.
The researchers have managed to keep some brains alive for up to 36 hours, and currently do not know if BrainEx can have sustained the brains longer. "It is conceivable we are just preventing the inevitable, and the brain won't be able to recover," said Nenad Sestan, Yale neuroscientist and the lead researcher.
As a control, other brains received either a fake solution or no solution at all. None revived brain activity and deteriorated as normal.
The researchers hope the technology can enhance our ability to study the brain and its cellular functions. One of the main avenues of such studies would be brain disorders and diseases. This could point the way to developing new of treatments for the likes of brain injuries, Alzheimer's, Huntington's, and neurodegenerative conditions.
"This is an extraordinary and very promising breakthrough for neuroscience. It immediately offers a much better model for studying the human brain, which is extraordinarily important, given the vast amount of human suffering from diseases of the mind [and] brain," Nita Farahany, the bioethicists at the Duke University School of Law who wrote the study's commentary, told National Geographic.
An ethical gray matter
Before anyone gets an Island of Dr. Moreau vibe, it's worth noting that the brains did not approach neural activity anywhere near consciousness.
The BrainEx solution contained chemicals that prevented neurons from firing. To be extra cautious, the researchers also monitored the brains for any such activity and were prepared to administer an anesthetic should they have seen signs of consciousness.
Even so, the research signals a massive debate to come regarding medical ethics and our definition of death.
Most countries define death, clinically speaking, as the irreversible loss of brain or circulatory function. This definition was already at odds with some folk- and value-centric understandings, but where do we go if it becomes possible to reverse clinical death with artificial perfusion?
"This is wild," Jonathan Moreno, a bioethicist at the University of Pennsylvania, told the New York Times. "If ever there was an issue that merited big public deliberation on the ethics of science and medicine, this is one."
One possible consequence involves organ donations. Some European countries require emergency responders to use a process that preserves organs when they cannot resuscitate a person. They continue to pump blood throughout the body, but use a "thoracic aortic occlusion balloon" to prevent that blood from reaching the brain.
The system is already controversial because it raises concerns about what caused the patient's death. But what happens when brain death becomes readily reversible? Stuart Younger, a bioethicist at Case Western Reserve University, told Nature that if BrainEx were to become widely available, it could shrink the pool of eligible donors.
"There's a potential conflict here between the interests of potential donors — who might not even be donors — and people who are waiting for organs," he said.
It will be a while before such experiments go anywhere near human subjects. A more immediate ethical question relates to how such experiments harm animal subjects.
Ethical review boards evaluate research protocols and can reject any that causes undue pain, suffering, or distress. Since dead animals feel no pain, suffer no trauma, they are typically approved as subjects. But how do such boards make a judgement regarding the suffering of a "cellularly active" brain? The distress of a partially alive brain?
The dilemma is unprecedented.
Setting new boundaries
Another science fiction story that comes to mind when discussing this story is, of course, Frankenstein. As Farahany told National Geographic: "It is definitely has [sic] a good science-fiction element to it, and it is restoring cellular function where we previously thought impossible. But to have Frankenstein, you need some degree of consciousness, some 'there' there. [The researchers] did not recover any form of consciousness in this study, and it is still unclear if we ever could. But we are one step closer to that possibility."
She's right. The researchers undertook their research for the betterment of humanity, and we may one day reap some unimaginable medical benefits from it. The ethical questions, however, remain as unsettling as the stories they remind us of.
In most states, LGBTQ Americans have no legal protections against discrimination in the workplace.
- The Supreme Court will decide whether the Civil Rights Act of 1964 also applies to gay and transgender people.
- The court, which currently has a probable conservative majority, will likely decide on the cases in 2020.
- Only 21 states and the District of Columbia have passed laws effectively extending the Civil Rights of 1964 to gay and transgender people.
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