Brought to you by the Depression Is Real Coalition, The Down & Up Show is dedicated to the reality of depression. Our hosts will talk with some of the world's top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects more than 15 million Americans every year. The other reality of depression is that there is hope.

Down & Up Show #07: Depression and the African American Community

MUSIC FADE UP

IAN VO DOWN & UP INTRO

The Down & Up Show on Depression Is Real.org. A talk show dedicated entirely to the subject of depression, and the reality that there is hope for people dealing with this disease. Now, your host, Dr. Ellen Frank.

DR. ELLEN FRANK INTROS DR. RAHN BAILEY

Welcome to the Down and Up Show on depressionisreal.org. Today we'll be discussing the serious issue of depression in the Black community. Joining us will be Dr. Rahn Bailey, Director of the National Medical Association's Psychiatry Section. The National Medical Association is the nation's oldest and largest organization representing the interest of more than 30,000 physicians of African decent.

DR. ELLEN FRANK / RAHN BAILEY, Director of the National Medical Association's Psychiatry Dept.

ELLEN FRANK INTRO:
Dr. Bailey is a general and forensic psychiatrist and currently serves as Director of the Program of Law and Psychiatry at the University of Texas at Houston Medical School. Dr. Bailey thanks for joining us today.

ELLEN FRANK QUESTION:
Can you discuss a little bit the study published recently in the Archives of General Psychiatry that found that depression in blacks seems to be more severe and more disabling than in non-Hispanic whites. What's your reaction to this study?

RAHN BAILEY ANSWER:
My reactionÉ isÉ similar to I think many professionals who I've spoken toÉ of thisÉ about this of late. I think that A it's consistent with my clinical experience, my research experience, I've been a psychiatrist since 1990, I guess almost two decades now. I think B maybe the reasons for why it might be more severe are probably attributable to the consideration that this stigma, thisÉ barrier against having mental illness or being treated for such, that is actually pervasive across our country, does seem to be more substantial and more severe and more impairing in the African-American community.

And third I think that many of theÉ additional, more physical barriers almost if you will, that come to play, families and churches and religion and many of the other cultural mores that theoretically should help one pursue and receive and obtain quality health care of any regard, unfortunately all too often tend to do just the opposite in the African-American community and that additionally leads to more impairment and more of an adverse outcome even when someone is identified and tries to get care.

ELLEN FRANK QUESTION:
Talk with me about this a little bit. Um, my experience, particularly with African American women has been that the stigma operates in a very particular way for them, and it has to do with their sense of self, that they ought to be able to take care of themselves. That they ought to be able to manage on their own, and that they've done that for generations, and, and that there's something actually shameful about asking for help, especially outside the community.

RAHN BAILEY ANSWER:
That's very consistent with my experience... there's aÉ I guess a myriad of phrases and comments that come to mind. The one that is most apropos is the comment that African-American women, i.e., mothers... raise their daughters but love their sons and theoretically that historically, allegedly implied that you raised your daughter to grow up and stand on her own two feet and be able to take care of herself just in case, maybe even expecting that there may not be a suitable mate that she would meet and marry and then who would take care of her in the age old sense of how a husband, not to be chauvinistic, "took care of his or her wife".

And very often it led toÉ the initial push to be strong, be successful, be academic, make great grades, and you end up blah, blah, blah with all the success and you're a medical doctor, et cetera, et cetera. But then very often you're without a partner and that leads to what type things you might do to remain independent. But at some point that person may become, mid to late 30s or pushing 40 years of age, particularly in the biological clock is ticking and all these struggles with not being a full and complete person, not having a baby, not having a spouse, not having a house with a picket fence and a traditional family will come into play.

These (unint.) who had tremendous success in several areas of life are feeling impaired or in deficit in this area of relationship. Clearly I think that there's something to be said for that, it's hard to prove, but it certainly is consistent with what my professional experience has shown me.

ELLEN FRANK QUESTION:
The study we were talking about earlier also found that in the United States about 57% of adults with major depressive disorder received treatment, but only about 48% of African Americans and 22% of Caribbean blacks with severe symptoms get any treatment. How much of this do you think is related to availability of treatment, and provision of adequate mental health care, versus stigma associated with having depression or seeking care?

RAHN BAILEY ANSWER:
I clearly think that it is a dual headed swordÉ if you will, that there is a stigma piece we've already addressed, it's very clear, but I think a pretty substantial component of the problem is about access. And access doesn't simply mean you all their services andÉ and do you have a public mental health system. I've worked in the outpatient and admission of an inpatient public mental health system settings where it proves in Texas and Alabama and Louisiana and the like, these services exist.

But many of the confounding components of how one can access the services, leads to the problem. For example, I've always been a person who's thought that it really made no sense at all that the psychiatric hospital or the psychiatric clinic very often is physically located at a different site then the general medical hospital or medical clinic. That makes the transportation issues and if finances are or indigency are in play, that may actually further impair somebody's ability to go to receive care.

In addition if the psych clinic is separate and isolated and it's on Sixth Street and that's all that's there and if you already have some trepidation for going cause you think that somebody's going to see you or criticize you or point fingers at you, it's that much more likely that you're not going to do it if it's separated, whereas were it to be on the third floor for example, of the major medical facility, you could go there, not feel afraid that somebody's going to out you if you will, if you're concerned about stigma and go ahead up under the auspices of going for medical care and get psych.

These are only two I think of several potentialities of the kinds of concerns that come into play. I think additionally impaired African-Americans because of these additional cultural mores, from pursuing psychiatric care and receiving it.

ELLEN FRANK QUESTION:
So, I know this is a really big issue, but, have you got thoughts about what we can do to close this accessibility gap to mental health care between blacks and whites?

RAHN BAILEY ANSWER:
Absolutely, I think it's a three-prong approach. Number one, I think we have to teach and educate across the board about psychology, psychiatry, whatever you want to call it, the way we would about general themes, sex education, if you will, in schools. Whether you want to start it in sixth grade or eighth grade or ninth grade, is fine with me. But so many persons in our society don't come into any concept of what is psychology or psychiatry until they already have a problem, until there's a relationship conflict, with some difficult on the job, if there's some problem that they have to try to fix or to face.

I think that a basic education, this is such a big issue that a basic exposure from an educational perspective, general information, early on, before a problem develops at some point in your life, would be helpful. I recommend that action take place in high school at least, maybe in the junior high school. Secondly I also think, as I said earlier, that we must integrate medical and psychiatric services in general, at least so I think a better overall systems of care approach, but particularly to provide care for those individuals who are less likely to pursue care if there's some consideration regarding stigma and we've already kind of been through that.

The third thing I simply say, it's very, very clear that we must have active and ongoing programs, be they educational, be they health fairs, be they just continued attempts in all venues to try de-stigmatize this adverse concept of what brain related illnesses and brain disease what they are, that they can be treated and that you can move forward. I'll finally just end by saying you know we do provide some assistance in these areas, but it's just not medical assistance. If you have academic trouble, we shovel you into the special education system, some educational reform system or put you in alternative school or residential care.

If you have a legal difficulty, everybody knows about the overused criminal justice system or individuals who veer off and have primary brain (unint.) disorders. We need to move toward a model with treating, diagnosing and treating, I think health care problems with health care solutions.

ELLEN FRANK QUESTION:
Let me ask you one final question. Do you think there's a role for the church in connecting African Americans with treatment for depression?

RAHN BAILEY ANSWER:
I doÉ we give short answers, but very often the answers could be longer and actually I'm remiss in leaving the church out. I referred a couple of times to what I call the cultural influences inÉ then a one coach with influences with what mom says at home. We have a two coach influence is what the preacher says at church on Sunday. And the reality is in settings where we've been to communicate with preachers of large congregations on something as simple as why don't you integrate something psychiatric into a basic health fair?

We've seenÉ we want to believe in psychiatry and African-American psychiatry, some pretty substantial gains. I'll just pause to comment, there's a guy named Kirby John Caldwell who's a big preacher in Houston with a big Methodist Church andÉ and they do health fairs regularly. Historically people would always come in for screening for blood pressure and screening for diabetes and the like, children with asthma concerns. Once they started screening for depression, it said a lot cause it theoretically was blessed if you will, by the preacher.

And it would allow individuals, even those who would not go to the screening table there in front of all the parishioners, maybe to think that it's some more mainstream type activity and a more mainstream type problem to have, then maybe that person may go to their primary doctor elsewhere. So that typeÉ acceptance if you will of brain related disorders can go a long way, in my opinion, to eliminating the stigma and eliminating these discrepancies in care.

ELLEN FRANK QUESTION:
Rahn, thank you so much for talking with us today. I've found what you had to say just fascinating. And, I think again, it's, it's a wonderful message of help and hope um, with respect to depression.

RAHN BAILEY ANSWER:
Thanks for having me.

ELLEN FRANK EXTROS RAHN BAILEY & INTROS TERRIE WILLIAMS:
We have Terrie Williams back on the show today, to discuss another issue. We had an opportunity to speak with Dr. Rahn Bailey, Director of the National Medical Association's Psychiatry Section on this topic, and you've spoken about how hard it is for African Americans to talk about depression. Would you say a little bit more about that?

TERRIE WILLIAMS ANSWER:
Well, I think that there are a lot of factors that affect African Americans. Obviously, you know, we've talked about this as a universal issue but there are another set of factors that, you know, affect African Americans. And one just has to do with just being African American in this country and what that means.

And there are great difficulties just inherent in that. For usÉ I mean, for most people it's a stigma, but for African Americans I think many would rather tell someone that they have a relative in jail or on drugs before they will ever mention mental illness.

And part of it has to do with the fact that you have no control or that people will look at you and think that you're crazy, whateverÑyou know, whatever that means. But it'sÉ I think on a lot of levels depression isÑisÑis very political for African Americans.

I read an article in Associated Press last year. It was a fascinating article where several men in all walks of life, but a lot of corporate men, talked about how they had to regularly combat stereotypes. That if it was a big, tall, black man in corporate America, that he would adjust his stance, his voice level so that he does not appear intimidating.

And I spoke with a friend who works at the New York Times who said to me that when he is walking down the street... Now here's a black guy. If he's walking down the street with his yoga mat, he feels really comfortable with that because he thinks that that makes a statement like "I'm an okay black man".

And so these kinds of nuances, in what can be a very racist country in terms of how people of color are dealt with, have a profound impact on your psyche if you have to move through life and adjust everything that you do.

ELLEN FRANK QUESTION:
Do you think there are special issues for African American women in accepting that they have depression?

TERRIE WILLIAMS ANSWER:
Well, yes, beÉ And, you know, good question. So much of it has to do with the fact that you're the strong one. You're the one that everyone goes to. You are supposed to handle everything all the time. And I think a lot of that has to do with just, you know, there is intergenerational residuals from slavery that have had quite an impact.

But you are justÉ Whatever happens to you, you are supposed to handle, no ifs, ands or buts. And so part of being inÑbeing on the planet means that you have to deal with all this stuff. So you just think if you're accustomed to feeling bad, you feel like that's how you're supposed to feel all the time.

But there's a better way. Just becauseÉ That's why, you know, for a long time when I was waking up the way I did, okay, I got used to feeling bad. That's just the way I'm feeling. And then one day, you know, God said, "No, no, no. You don't have to feel like that". But there are important things that we have to take note of and one has to do with, you know, putting the oxygen mask over your own mouth first.

You know, like when there'sÑifÑwhen you're on a plane and then they tell you that if there'sÑyou know, if you have a small child sitting next to you or somebody acting like a small child, then you can secure that person's mask after you have secured your own. And it's so very, very symbolic about life.

That you can't really do anything for anybody else unless you are taking care of you. When we snap at people, childrenÉ I've seen parents snapping at their kids. SometimesÉ And it always (unint.) me. And I know it's not the kid's fault but it's something that's inside of you that is unresolved.

You maybe need a massage. Maybe you need somebody to talk to. And if you don't have those outlets, it becomes very challenging.

ELLEN FRANK QUESTION:
You know, Dr. Bailey spoke with us about the important role churches play in African American life in this country, and you've spoken freely about your faith. Tell us about the role your faith has played in your life and in battling your depression.

TERRIE WILLIAMS ANSWER:
Well, I clearly am still standing because of my faith. There were just many days and times when I just thought I wouldn't be here. In my darkest days, Ellen, I was never suicidal but there were just times when I wouldÉ I travel a lot so I wouldÑI would say, you know, that if this plane goes down, I'm okay with that.

ButÉ And I also used to wonder when people would say that God told them to do something. And, even though I believe in God, I just never really understood that. But I know very clearly that He does communicate to us, that little voice that we hear. When He said to me that it was time to share my story and I did, and what I callÉ

A lot of times in the African American community we talk about putting our business out on the street. I know I would not have done that had I not been so directed. And it has strengthened me in all ways when I do have difficult moments. And part of sharing my story has meant that I didn't have to make excuses or lie like I did before because you can't just walk around saying, "Well... Oh, I couldn't get up this morning".

You know, that's a real challenge for people. But it was hearing that voice and it's my constantly praying, you know, throughout the day that if I've had a difficult moment and it passes, "Thank you, God". You know? So I rely on my faith to keep me going.

ELLEN FRANK QUESTION:
How do you put together the piece of your overcoming depression that comes from your faith with the piece that comes from taking a medication?

TERRIE WILLIAMS ANSWER:
Well, you know, it's funny because a lot of times in theÑin the African American community, in the church, there are people who will say, you know, "Don't put your business out in the street". They will say, "That's just the devil in you and you can pray it away".

But what I believe is that God puts the right people and the right factors in your life that will help you to overcome depression. And I think it's very individual and I think that the church has to be more aggressive, more assertive about keeping options open and to not discourage people about seeking help.

There isÉ There's nothing that anyone could say to me that would make me not say that if you had the means to talk to a therapist, because there's that stuff inside you from childhood and day to day that you don't deal with that can be causing you a lot of pain. So I'm of the belief that it's God who puts the right people in the right place.

ELLEN FRANK QUESTION:
Tell us a little bit about your upcoming book, ÒIt Just Looks Like We're Not HurtingÓ.

TERRIE WILLIAMS ANSWER:
Well, I'm very, very excited about it. It's a very accessible kind of read, which is a look at how it affects us. It's out there everyday. I think that a lot of timesÉ And I'm justÑI'm so passionate about this. I really am like a woman on fire because what I know is that we don't even know what the symptoms are.

Okay? So if you're not aware, if you don't know what the symptoms are, you can't even begin to name what it is that's ailing you. So this is a highly accessible read to tell you what it looks like and what it feels like, because it's everywhere you turn. You know, if you look at the screening headlines, what hasÑthe violence that we hear about everyday, people are the walking wounded.

So it's clearly explaining what it looks like. I'm taking a look at men, women, youth, what the black church does in regard to mental health, how to heal in your own time, because a lot of times people will tell you to snap out of it. They don't understand what you're going through and whatever it is that you're going through shouldn't take you this long to get over it.

So it's aÑit's a look at that and the different types of ways that you canÑyou know, can get healing. So I'm really, really excited about it. I have a lot of well-known people and average people who are sharing their stories for the very first time. Because what I know is that we will never ever begin to heal unless we share our stories with each other.

And you definitely, definitely find out once you either go to therapy or you are a part of a group where there's a forum for us to share.

ELLEN FRANK QUESTION:
Any other thoughts you'd like to share with us?

TERRIE WILLIAMS ANSWER:
Just that there's lightÉ Just wanting to encourage people that there is light at the end of the tunnel. You know? I think that that's what I would really most wanna communicate, that there's light at the end of the tunnel.

ELLEN FRANK CLOSE:
Terrie, thank you so much for your time. You truly have an inspirational story that I think many, many people in our audience can learn from. The work you're doing, speaking out about depression and educating people to recognize depression and to seek help, is so important in helping people to learn to take care of themselves and to understand that they don't need to hide behind their wealth or success or drugs or alcohol. Thanks again.

As we continue to learn more about depression and the Black community we hope you'll be able to come back to provide us with additional insights. It's important that everyone and every community knows that there is help and hope when it comes to depression. Please visit depressionisreal.org for more information and tell us what you think, send us an e-mail by logging onto to depressionisreal.org or call us at 1-888-973-HOPE. That's 1-888-973-HOPE. We want to hear from you.

DR. ELLEN FRANK OUTRO (Music up half way through)

For the Depression is Real Coalition, I'm Ellen Frank. Join us next time for another episode of the Down & Up Show on depressionisreal.org. [music]

IAN VO CLOSE

Thanks for listening to the Down and Up Show. For more information, log onto www.depressionisreal.org. You can find us there and at iTunes. And remember stay subscribed.