Matters of the Mind

By Katrice Mines

“When I finally realized what was going on, I had been a journalist for 15 years; working for newspapers in Detroit and Atlanta. I worked for the USA Today and had been press secretary to Maynard Jackson during his first term. I had a lot of things to be happy about. But I wasn’t getting any enjoyment out of life. It actually went beyond that … I was really struggling.

It would vary. Generally, it was a matter of everything being normal as far as coping with problems, but then I would slip into this depression. Sometimes there might be an event that would trigger it. Something would happen that anyone would get upset about, but my sadness tended to be out of proportion to what happened. Something that somebody else might bounce back from in a day or two, I would be down about four weeks. And, sometimes there weren’t triggering events; I would just find myself down in a deep hole. Eventually after a few weeks, I would start going back up again — either as the result of something positive happening or just out of the blue. And that kind of cycle of being on an even keel and then way down continued for years.”

Two decades later, John Head, an author and mental health activist, can comfortably recant the tumultuous time in his life prior to being diagnosed with clinical depression because he understands and unabashedly accepts it.

Head would be the first to tell you that you may have known him and not recognized the dilemma that plagued him for 25 years. You actually may even have a friend or relative who is suffering and not know; especially in the African-American community in general and amongst ambitious black executives specifically. Why? Because they are a part of a unique paradox: Enviably successful by most measures, but agonized in private.

The reality, experts agree, is that African Americans still grapple with ignorance and shame about mental illness.

Indeed, Head, a former editorial board member of the Atlanta Journal Constitution and the author of “Standing in the Shadows: Understanding and Overcoming Depression in Black Men,” is not an anomaly. Every year, more than 19 million Americans suffer from some type of depressive illness. According to a U.S. Surgeon General report, African Americans are over-represented in populations that are particularly at risk for mental illness. The issue is that depression remains taboo in the African-American community. For many, the symptoms that indicate its onset seem inconsequential. And black men, particularly, are likely to ignore the warning signs, while black women struggle to maintain.

The common thread is a feeling of guilt that layers their despair. The result is a vicious cycle that eventually worsens without intervention.

Major depressive disorder, commonly known as clinical depression, is the leading cause of disability in the United States for individuals age 15-44.

Widely misunderstood, the disease calls attention to itself in subtle ways — some symptoms easy to overlook. Warning signals could be a prolonged loss of energy; changes in sleep patterns and appetite; headaches; restlessness and sadness. Yet, others even more obscure, such as a diminished interest in work; excessive guilt; memory lapses and a tendency toward certain thoughts that are obsessive, may go unrecognized all together — presenting a special challenge.

Over the course of an African-American’s lifetime, mental health care needs change according to an individual’s unique interactions with his or her environment, according to “Mental Health Care in the African- American Community,” a comprehensive text providing new ways of approaching mental health needs of the black community.

Research clearly states that there is a difference in the manifestation of depressive symptoms when you bring in the cultural aspect, explains Dr. Jo-Ann Lipford Sanders, director of the Graduate Studies in Counseling Program at Heidelberg College, and a contributor to “Mental Health Care in the African-American Community.”

“One of the primary issues is in how one has developed coping mechanisms to handle this depression and the severity of it,” she says. “Take for instance someone who has a great deal of stress on their job. Normally, they can handle this stress but it might manifest itself in their being tired all the time, overeating or being mean spirited … but they are functional.”

“Now take this same person with all of their ‘manageable stress’ and allow something major to happen, [causing them to] become overwhelmed. It is like a bottle of soda that when settled is okay, but if shaken and opened will explode,” Lipford Sanders continues.

High achieving African-American executives often fall into this segment. Yet, even mired in their angst, studies show that a driven professional can operate as well at 30 percent of their capacity as others at 100 percent. Both the pressures of race and a competitive society require it. The age-old axiom, “to whom much is given, much is expected” applies.

“There is an increased amount of stress being a professional person in a white-dominated environment,” contends Dr. Darryl L. Townes, psychologist and the head of Townes Consulting and Psychological Services LLC. “Black-owned businesses still operate in the context of a white-dominated society, and that comes with increased pressure in terms of our performance, ability to get ahead and having to work twice as hard to get half as far. These things increase the amount of anxiety that we experience as black people. Someone once said, ‘more money, more problems.’ And that [notion] has a tendency to really complicate our issues because as we pursue more education and more status, we encounter more resistance from mainstream society than people who don’t do so. We still kind of measure ourselves against the standard of ‘the American dream’ [ideology].”

Townes notes a familiar outgrowth amongst his patients who have achieved upward mobility in demanding careers — a “negative thinking pattern.”

“You get so much negativity from the world that it’s really hard to maintain a positive outlook on life,” he believes. “It’s like we know that others may have it easier and that becomes very disheartening to us.

A lot of my patients have a hard time maintaining the pace … even if things aren’t directly happening in their companies, just hearing about the economy and other things makes them wonder, ‘when is this going to hit me? When am I going to be impacted by this?’ It’s like they’re constantly on edge thinking the other shoe is going to drop soon.”

Knowing is half the battle of coping, suggests Dr. Aaron Turpeau, who deems clear-headedness and preparation necessary for high achievers to handle the demands of success.

“I always ask new clients to outline for themselves the goals in life they consider most important,” he shares. “If making money and accumulating wealth rates at the top of their lists of priorities, then some family neglect and sacrifice of health may be a price they accept. But if the person tells me the health and happiness of their spouse and family rate at the top of the list, clearly, adjustments need to be made, and priorities sorted out to make his or her achievement worthwhile. That’s the course we then follow in counseling sessions.”

Adds Turpeau, “It seems fairly logical to organize your life in a sensible way, but we Americans seldom use that approach. As the Swiss psychiatrist Carl Jung once said, ‘the West rewards deformed personalities.’”

“Well-rounded holistic people [are not] rewarded financially as well as people who completely dedicate themselves to the development of a certain knowledge and skill to the point where they are better than everyone else,” Turpeau argues.

Though an overwhelming factor of American culture, its ramifications have not gone unnoticed. In an unparalleled endeavor, Dr. David Satcher, director of the Center of Excellence on Health Disparities and the Satcher Health Leadership Institute at Morehouse School of Medicine, made a pivotal step toward educating Americans about mental health challenges among minorities during his tenure as the 16th Surgeon General of the United States. In 1999, he released a 487-page report that he hoped would “change the environment” around depression and essentially de-stigmatize mental illness in general. It was the first surgeon general’s report on mental illness in history.

“Despite unprecedented knowledge gained in just the past three decades about the brain and human behavior, mental health is often an afterthought,” he noted.

Satcher later observed, “Multigenerational poverty and traumatic experiences put a higher burden on African Americans and Hispanics who need mental health services but might feel stigmatized if they seek them. And particular tendencies of ethnic groups to view mental illness as a character weakness or failure of their spiritual faith can play a major role in whether an individual will seek care. For example, Asian Americans have difficulty accepting the notion of mental health services, and are 25 percent as likely as whites to seek care, while African Americans are 50 percent as likely to seek care.”

Head, who thought in hindsight he saw signs of depression when he was just 9 years old and failed to make a baseball team, was amongst the 50th percentile that escaped the cycling, but not before his situation nearly consumed him.

The longer I went without doing anything about [my depression] the shorter those periods when I was up and the longer and deeper those periods when I was down became. It reached the point when I was on those down cycles and would struggle just to be able to function. You can imagine someone who worked in a newspaper but didn’t want to have contact with anybody and wouldn’t return phone calls … who didn’t like to go out and interview face-to-face … the guy who made excuses for not getting work in on time.

I was not as productive as I should have been and sometimes the quality of the work was not what it should have been, and so it was not only affecting my day-to-day job but my career. If someone gave me a compliment for doing a good job on an editorial or column, I would think, ‘they’re just saying that to be nice … they don’t really know how bad I am as a writer.’ I really had a negative outlook on everything. That’s a very bad place to be for a black man or anyone black.

Head’s breaking point came when he decided that his family, including three sons, would be better off without him living in the home. Suddenly, he realized that he was replicating the scenario that marked his own childhood. Head was abandoning his children; something he vowed never to do.

I thought they’d be better without having this constant negative storm cloud in the house … I didn’t do it to make myself happier, and it didn’t make me happier. It put all of the sadness on me and I finally reached the point where I was suicidal; I had suicidal ideation and was doing things to prepare for that. But, I pulled back at the thought of my sons and what it would be like for them … for me not only to leave them but to leave them in the way that I was planning to, and the kind of burden [my death] would place on them. I knew they wouldn’t understand and may even think that it was their fault.

The veteran journalist was at his lowest, but for the first time, he essentially distinguished that his state was, in fact, more than just a “weakness or a character flaw;” or that “he should just be able to pull himself together.”

Since undergoing treatment, Head’s revelation of wellness has transformed his career. Currently a writer for Health Net, his advocacy is a grassroots contribution to Satcher’s administrative appeal for increased awareness and acceptance of mental illness as a physical condition that can be treated.

The National Institute of Mental Health reveals that of those who suffer with depression every year, less than 20 percent seek treatment.

Encouragingly, however, Mental Health America reports that 80 percent of people with clinical depression can be treated successfully. It’s good news in the uphill battle to change societal perceptions.

In the meantime, one influential institution of black communities — the church — is becoming a strengthened proponent for heightened attention to issues of mental and emotional wellness, particularly with respect to treatment for depression.

Margaret Sims, a trained counselor who runs the mental health ministry at the Hillcrest Church of Christ in Decatur, Ga., notes an influx of people asking for help. Echoing what many other specialists in the field suggest, Sims urges “the most important thing for us to do is get people assessed as to their problems and then get them the assistance they require.”

Dr. Gerald L. Durley, psychologist and senior pastor of Providence Missionary Baptist Church in Atlanta, agrees also noticing in his ministry a growing willingness of people to become more open to aid in coping with depression.

“A factor in getting people to open up,” says Durley, “is [helping them] understand [that] the problem does not indicate personal failure or weakness, but instead is an illness — and can bring anybody to crisis.”

Originally published the Atlanta Tribune: The Magazine in October 2008.