The psychotherapeutic community attempts to cater to the needs of all people suffering from mental health disorders, regardless of sex, race, ethnicity, socio-economic background or personal life history. But this strategy of inclusivity has in many respects been a failure, especially for individuals of color. While only one-third of those victimized by mental disorders will ever seek counseling and treatment to help them cope with their conditions, the percentage of African Americans experiencing mental illness who choose to enter therapy\u2014or are able to gain access to therapy\u2014is only half as high as the rate for non-Hispanic whites. The situation with African American men is especially troubling. Mental health experts estimate that at least 7 percent of African American men will develop depression, the most common form of mental illness, at some point in their lifetimes. But only a small number will ever seek treatment for their condition, which makes African American males the most underserved segment of the population among those who suffer from this debilitating illness. The price of this neglect is steep. According to the Centers for Disease Control, suicide is now the third-largest killer of young African American men between the ages of 15 and 24, and suicide rates have skyrocketed over the last 30 years for African American youth in the 10 to 14 age group. Few doubt that high levels of untreated depression have driven these numbers skyward, and mental health professionals also know that men who fail to get the treatment they need for depression will often self-medicate to help them deal with feelings they cannot control\u2014in other words, they will turn to drugs and alcohol to escape from their feelings of emptiness and meaninglessness.\r\nA Culture of Denial\r\nIn an effort to explain the lack of African American males who seek treatment for depression and other mental health issues, observers point to a hyper-masculine tradition in the African American community that tends to identify feelings of helplessness or disempowerment as a sign of personal weakness. In general, women in all racial and ethnic groups are far more likely to seek help for mental health issues than men, and it has long been believed that the reluctance of men to ask for help when they are depressed or otherwise struggling to cope with the challenges of daily life is based on a concept of masculinity that stresses the value of self-help and self-reliance in all circumstances. Sadly old cultural habits die hard, and even in this supposedly liberated age, millions of men\u2014including large numbers of African American men\u2014are still putting themselves through unnecessary torture because of an outdated mode of thinking that makes it difficult for them to admit to feeling overwhelmed by the events and circumstances of their lives. All too often, African American media commentators, writers, academics and cultural arbiters say African American men are conditioned to believe that strong men\u2014real men\u2014deny their troubles, or hide them behind a mask of fearlessness, defiance and bravado. This is what is necessary to survive in a hostile world, they are taught (or conclude on their own), and at a subconscious level they become convinced that if they show weakness or vulnerability they will be taken advantage of by their enemies and mocked or rejected by their peers.\r\nThe Deeper Context\r\nMisguided machismo has undoubtedly prevented men of all races and colors from facing the truth about their depression. But in the case of African American men and depression there is more going on than just this particular cultural dynamic. Here are some other important factors that must be acknowledged and considered:\r\n\r\n \tAccessibility and affordability are often foreign concepts in America\u2019s health care system, and because poverty affects African-Americans disproportionally, many men who might be willing to enter therapy for depression may not have the financial resources or the health insurance that would allow them to do so.\r\n \tReligious belief appears to be preventing many African American Americans from asking for mental health care. According to the National Alliance for the Mentally Ill, two-thirds of African Americans believe mental disorders like depression can be overcome by faith and prayer alone.\r\n \tAfrican American men suffer from serious chronic illnesses such as diabetes and cancer at much higher rates than white men, and these diseases and disorders are known to be significant risk factors for depression.\r\n \tWhile unemployed African Americans suffer from high rates of depression, research reveals that African American men who make more than $80,000 per year become victims of depression more often than those who make less than $17,000 annually. Many successful African American men who work in integrated environments report being surrounded by a subtle but pervasive racism that leaves them feeling as if they must work twice as hard to prove they belong. Not surprisingly, this situation often causes great stress and anxiety (the primary precursors of depression).\r\n \tIncarceration is a poor substitute for mental health treatment: young African American males are sent to jail for their crimes much more frequently than Caucasian youth who are guilty of the same or similar offenses, and these discriminatory incarceration patterns prevent many troubled young African Americans from getting the type of counseling and intervention they need to help them cope with their personal issues and turn their lives around.\r\n \tWhites dominate the psychological and psychiatric professions, as only 2 percent of licensed mental health professionals are African American (and about three-fourths of these are women). Many African American men feel uncomfortable revealing their deepest secrets and feelings to people who do not share their cultural background, and a shortage of African American male therapists also means a lack of role models for future scholars who might be searching for a way to give back to their communities.\r\n \tIn general, there is a long-standing mistrust of the medical profession among African Americans. Many trace feelings to the infamous Tuskegee experiments, when African American medical patients were betrayed in the worst way imaginable by professionals who were supposed to be looking out for their health and welfare (this barbaric program was still ongoing as recently as the 1970s).\r\n\r\nWaking Up to a Better Morning\r\nBlaming everything on an excess of machismo and old-fashioned attitudes about manliness grossly oversimplifies a complex issue. Many African American men suffering from depression, and who are aware they have this problem, undoubtedly feel that the mental health profession is not really interested in them, has few therapists who are capable of understanding them and cannot be trusted to do the right thing by patients of color. If fully supported by influential community organizations and African American members of the mental health profession, a specialized public relations effort targeted specifically at African American men, perhaps similar to the National Institute of Mental Health\u2019s \u201cReal Men, Real Depression\u201d campaign, could make a positive impact. But regardless of the cultural or social context, respected African American leaders, messengers and teachers need to begin speaking openly and honestly about depression. Additionally, promising African American students should be encouraged to pursue careers in the mental health professions, where their talents and skills are sorely needed. There are no quick fixes to the problem of untreated and unacknowledged depression in African American men. But even the longest journeys are completed one step at a time, and modest efforts to begin a serious discussion about this issue now could conceivably yield big dividends in the future. Unfortunately, millions of African American men are currently suffering from depression in silence, and the only way to expose the truth about this tragic situation is for those who know and understand to begin raising their voices and demanding to be heard, until everyone in the African American community is awake, aware and listening.