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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.
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A new Harvard study finds that the language you use affects patient outcome.
- A study at Harvard's McLean Hospital claims that using the language of chemical imbalances worsens patient outcomes.
- Though psychiatry has largely abandoned DSM categories, professor Joseph E Davis writes that the field continues to strive for a "brain-based diagnostic system."
- Chemical explanations of mental health appear to benefit pharmaceutical companies far more than patients.
Challenging the Chemical Imbalance Theory of Mental Disorders: Robert Whitaker, Journalist<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="41699c8c2cb2aee9271a36646e0bee7d"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/-8BDC7i8Yyw?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>This is a far cry from Howard Rusk's 1947 NY Times editorial calling for mental healt</p><p>h disorders to be treated similarly to physical disease (such as diabetes and cancer). This mindset—not attributable to Rusk alone; he was merely relaying the psychiatric currency of the time—has dominated the field for decades: mental anguish is a genetic and/or chemical-deficiency disorder that must be treated pharmacologically.</p><p>Even as psychiatry untethered from DSM categories, the field still used chemistry to validate its existence. Psychotherapy, arguably the most efficient means for managing much of our anxiety and depression, is time- and labor-intensive. Counseling requires an empathetic and wizened ear to guide the patient to do the work. Ingesting a pill to do that work for you is more seductive, and easier. As Davis writes, even though the industry abandoned the DSM, it continues to strive for a "brain-based diagnostic system." </p><p>That language has infiltrated public consciousness. The team at McLean surveyed 279 patients seeking acute treatment for depression. As they note, the causes of psychological distress have constantly shifted over the millennia: humoral imbalance in the ancient world; spiritual possession in medieval times; early childhood experiences around the time of Freud; maladaptive thought patterns dominant in the latter half of last century. While the team found that psychosocial explanations remain popular, biogenetic explanations (such as the chemical imbalance theory) are becoming more prominent. </p><p>Interestingly, the 80 people Davis interviewed for his book predominantly relied on biogenetic explanations. Instead of doctors diagnosing patients, as you might expect, they increasingly serve to confirm what patients come in suspecting. Patients arrive at medical offices confident in their self-diagnoses. They believe a pill is the best course of treatment, largely because they saw an advertisement or listened to a friend. Doctors too often oblige without further curiosity as to the reasons for their distress. </p>
Image: Illustration Forest / Shutterstock<p>While medicalizing mental health softens the stigma of depression—if a disorder is inheritable, it was never really your fault—it also disempowers the patient. The team at McLean writes,</p><p style="margin-left: 20px;">"More recent studies indicate that participants who are told that their depression is caused by a chemical imbalance or genetic abnormality expect to have depression for a longer period, report more depressive symptoms, and feel they have less control over their negative emotions."</p><p>Davis points out the language used by direct-to-consumer advertising prevalent in America. Doctors, media, and advertising agencies converge around common messages, such as everyday blues is a "real medical condition," everyone is susceptible to clinical depression, and drugs correct underlying somatic conditions that you never consciously control. He continues,</p><p style="margin-left: 20px;">"Your inner life and evaluative stance are of marginal, if any, relevance; counseling or psychotherapy aimed at self-insight would serve little purpose." </p><p>The McLean team discovered a similar phenomenon: patients expect little from psychotherapy and a lot from pills. When depression is treated as the result of an internal and immutable essence instead of environmental conditions, behavioral changes are not expected to make much difference. Chemistry rules the popular imagination.</p>
Why Depression Isn't Just a Chemical Imbalance<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="fbc027c9358dad4a6d9e2704fc9ddb04"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/GAC9ODvSxh0?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Many years ago, my best friend tried to quit smoking. He asked for help. While I'm no addiction expert, I offered what I knew from my fitness toolkit: breathing exercises and cardiovascular training, methods for strengthening his body and mind that could, I hoped, inspire him to take better care of himself in general. He replied, "No, I meant something like a pill."</p><p>A few years later, he quit for good. After failing the cold turkey method a number of times, it finally stuck. Maybe it was watching his children grow up—the reason my parents quit when I was young. This method is not easy, however. It challenges you; it forces you to confront your demons; it drastically affects your brain chemistry. Yet, in the long run, it sometimes works. </p><p>Sometimes pills work, too. But often they do not. The journalist Robert Whitaker, author of "Anatomy of an Epidemic," discussed the clinical trial process <a href="https://bigthink.com/mind-brain/antidepressants-dangers" target="_self">during our recent conversation</a>. While the FDA process appears thorough from the outside, pharmaceutical companies only need to prove that a drug works better than placebo, not that it works for the most amount of people. He continues, </p><p style="margin-left: 20px;">"Let's say you have a drug that provides a relief of symptoms in 20 percent of people. In placebo, it's 10 percent. How many people in that study do not benefit from the drug? Nine out of 10. How many people are exposed to the adverse effects of the drug? 100 percent."</p><p>Even though some pharmacological interventions show little efficacy, and even though Xanax, an addictive and destructive benzodiazepine that only showed <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/" target="_blank">short-term (four weeks) efficacy</a> in clinical trials, is being prescribed for many months and years, doctors continue to use the language of clinical neuroscience to describe mental health issues. If chemistry is the problem, people will turn to chemistry for the solution. </p><p>Perhaps we should, as psychiatrist Dean Schuyler <a href="https://bigthink.com/surprising-science/antidepressant-effects" target="_self">writes</a> in a 1974 book, recognize that most depressive episodes "will run their course and terminate with virtually complete recovery without specific intervention." The problem is that idea isn't profitable. As long as the gatekeepers continue to use the language of chemical imbalances to describe what for many is just an episodic case of the "blahs," we'll continue creating more problems than we solve.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
SEAL training is the ultimate test of both mental and physical strength.
- The fact that U.S. Navy SEALs endure very rigorous training before entering the field is common knowledge, but just what happens at those facilities is less often discussed. In this video, former SEALs Brent Gleeson, David Goggins, and Eric Greitens (as well as authors Jesse Itzler and Jamie Wheal) talk about how the 18-month program is designed to build elite, disciplined operatives with immense mental toughness and resilience.
- Wheal dives into the cutting-edge technology and science that the navy uses to prepare these individuals. Itzler shares his experience meeting and briefly living with Goggins (who was also an Army Ranger) and the things he learned about pushing past perceived limits.
- Goggins dives into why you should leave your comfort zone, introduces the 40 percent rule, and explains why the biggest battle we all face is the one in our own minds. "Usually whatever's in front of you isn't as big as you make it out to be," says the SEAL turned motivational speaker. "We start to make these very small things enormous because we allow our minds to take control and go away from us. We have to regain control of our mind."
Here's why you might eat greenhouse gases in the future.
- The company's protein powder, "Solein," is similar in form and taste to wheat flour.
- Based on a concept developed by NASA, the product has wide potential as a carbon-neutral source of protein.
- The man-made "meat" industry just got even more interesting.
Seriously sustainable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDIzNS9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTYyMjM4NTMzMX0.BCEfYnn6C3z1zUHIS38xOWjXktgamNBi5iyqklSMYK8/img.png?width=980" id="ea524" class="rm-shortcode" data-rm-shortcode-id="50533380eeb18eb5833b6b6aa3abec38" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>Solar Foods makes Solein by extracting CO₂ from air using <a href="https://www.fastcompany.com/90356326/we-have-the-tech-to-suck-co2-from-the-air-but-can-it-suck-enough-to-make-a-difference" target="_blank">carbon-capture technology</a>, and then combines it with water, nutrients and vitamins, using 100 percent renewable solar energy from partner <a href="https://www.fortum.com" target="_blank">Fortum</a> to promote a natural fermentation process similar to the one that produces yeast and lactic acid bacteria.</p><p>When the company claims its single-celled protein is "free from agricultural limitations," they're not kidding. Being produced indoors means Solar Foods is not dependent on arable land, water (i.e., rain), or favorable weather.</p><p>The company is already working with the European Space Agency to develop foods for off-planet production and consumption. (The idea for Solein actually began at NASA.) They also see potential in bringing protein production to areas whose climate or ground conditions make conventional agriculture impossible.</p><p>And let's not forget all those <a href="https://www.bk.com/menu-item/impossible-whopper" target="_blank">beef-free burgers</a> based on pea and soy proteins currently gaining popularity. The environmental challenge of scaling up the supply of those plants to meet their high demand may provide an opening for the completely renewable Solein — the company could provide companies that produce animal-free "meats," such as <a href="https://www.beyondmeat.com/products/" target="_blank">Beyond Meat</a> and <a href="https://impossiblefoods.com" target="_blank">Impossible Foods</a>, a way to further reduce their environmental impact.</p>
The larger promise<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MDI0MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NjU4MTg2OX0.7dZZYT5WEV_EupBuLVFwHynarTiz8RYR9aJtC6Ts2C4/img.jpg?width=980" id="3415d" class="rm-shortcode" data-rm-shortcode-id="2e6eebe06d795f844752f9e9d30040d7" data-rm-shortcode-name="rebelmouse-image" />
Image source: Solar Foods<p>The impact of the beef — and for that matter, poultry, pork, and fish — industries on our planet is widely recognized as one of the main drivers behind climate change, pollution, habitat loss, and antibiotic-resistant illness. From the cutting down of rainforests for cattle-grazing land, to runoff from factory farming of livestock and plants, to the disruption of the marine food chain, to the overuse of antibiotics in food animals, it's been disastrous.</p><p>The advent of a promising source of protein derived from two of the most renewable things we have, CO₂ and sunlight, <a href="https://solarfoods.fi/environmental-impact/" target="_blank">gets us out of the planet-destruction business</a> at the same time as it offers the promise of a stable, long-term solution to one of the world's most fundamental nutritional needs.</p>
Solar Foods' timetable<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xOTk0MTEzMS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTU5OTU1OTMwMn0.wnXh56iO_77x2XKV2uIPf78BKw4AJLUpmiyq_JBVGvo/img.jpg?width=1245&coordinates=172%2C146%2C62%2C135&height=700" id="0297c" class="rm-shortcode" data-rm-shortcode-id="125c9a98ec818f5c241fa28ef1423e67" data-rm-shortcode-name="rebelmouse-image" />
Image source: Lubsan / Shutterstock / Big Think<p>While company plans are always moderated by unforeseen events — including the availability of sufficient funding — Solar Foods plans a global commercial rollout for Solein in 2021 and to be producing two million meals annually, with a revenue of $800 million to $1.2 billion by 2023. By 2050, they hope to be providing sustenance to 9 billion people as part of a $500 billion protein market.</p><p>The project began in 2018, and this year, they anticipate achieving three things: Launching Solein (check), beginning the approval process certifying its safety as a Novel Food in the EU, and publishing plans for a 1,000-metric ton-per-year factory capable of producing 500 million meals annually.</p>
The protein powder Solein. Image source: SOLAR FOODS
Is focusing solely on body mass index the best way for doctor to frame obesity?
- New guidelines published in the Canadian Medical Association Journal argue that obesity should be defined as a condition that involves high body mass index along with a corresponding physical or mental health condition.
- The guidelines note that classifying obesity by body mass index alone may lead to fat shaming or non-optimal treatments.
- The guidelines offer five steps for reframing the way doctors treat obesity.