Racism and discrimination place innumerable barriers, visible and invisible, on people who experience it. Those barriers impact myriad aspects of an individual’s life, not the least of which is their access to mental health treatment. The tragic irony of this reality is that those who face racism and other forms of discrimination are often those who are the most in need of mental health treatment. Two of the most common types of discrimination, racial and economic, can trigger mental health problems as well as prevent those individuals from getting the help they need to cope.
Depression Is Colorblind, the World Is Not
In his brilliant book on depression, The Noonday Demon, Andrew Solomon interviews Dièry Prudent, an African-American man of Haitian descent who grew up in an impoverished neighborhood in Brooklyn. He was bullied as a youth due to his Haitian family and their religious beliefs — the family was Seventh-day Adventists. This bullying and ostracism enraged Prudent and he channeled his rage into working out and reading, hoping to forget the pain he was living with. On a semester abroad in Paris, Prudent was repeatedly subjected to racial profiling by police, culminating in an incident in which he was violently beaten and publicly arrested. Solomon writes that at this point, “Dièry’s hidden rage blossomed into symptoms of acute depression. He continued to function but there was ‘a heavy weight on me.’” Solomon, who is friends with Prudent, writes, “Dièry is the object of constant racism, which is exacerbated by his intimidating size and physique. I have been on street corners with him in New York where he was trying to hail a cab for fifteen minutes and none would stop for him; when I raised my hand [Solomon is white] we have one in 10 seconds flat.” These indignities would rightfully make anyone angry and upset but for someone who already struggles with depression, discrimination exacerbates the condition.
Prudent is well aware of the way that his depression is both universal to everyone who struggles with the condition and also connected to being a black man. In his interview with Solomon, he says, “The depression itself is colorblind … when I’m down I see happy people of every hue and every shape and size around me, and I feel like God, I’m the only one on this planet who’s this depressed.” Anyone who has struggled with depression or mental health issues is familiar with this sense of isolation. In Dièry’s case, and the case of other folks who face discrimination, the results of that discrimination compounded his depression. Prudent continues, “Then the race card does come into play. You feel like the world is just hoping to pull you down. I’m a big, strong black man and no one is going to waste time feeling sorry for me.”
Discrimination Changes the Brain
Prudent’s experience is supported by clinical evidence. In 2015, researchers performed an analysis drawing from roughly 300 studies conducted around the world over the last three decades. The meta-analysis revealed that self-reported racial discrimination is consistently related to poor mental health. Gilbert Gee, professor in the Fielding School’s Department of Community Health Sciences, elaborated on the link between mental health and discrimination. “There are so many different [ways discrimination is experienced], some of them direct and some of them indirect,” Gee explained. The data, however, is conclusive. Even when the researchers accounted for other stress factors, the link between discrimination and mental health disorders was clear.
UCLA Fielding School of Public Health professor Vickie Mays, one of Gee’s colleagues, has collaborated on a study showing that experiencing discrimination over time can interfere with the way the brain processes information. The areas of the brain that are impacted relate to planning and decision-making. Mays elaborated: “When we’ve had these experiences and anticipate that other incidents might lead us to be discriminated against, it can interfere with our ability to cognitively function at our best.”
What Can Be Done
With discrimination so pervasive and manifesting in so many different ways, it can be hard to develop a strategy to help those whose mental health has been affected by it. One of the things that’s needed, Mays says, is including that relevant information in patients’ medical profiles. “We screen for mental health disorders when we are putting together an individual’s electronic health record, but maybe we also need to ask about their experiences with discrimination, which would identify people at risk who could benefit from prevention efforts.” Once those elements have been identified, practitioners can then address those issues.
Of course, one of the hardest issues to solve is that of insurance. Those who face discrimination are likely to have the most trouble getting help for mental health issues. The Atlantic cited a report from the Journal of Health and Social Behavior that suggests “psychotherapists are more likely to offer appointments to middle class white people than to middle class African-Americans or to working class people of any race.” Discrimination, it seems, isn’t limited to those outside the mental health profession.
It’s difficult to come up with a solution for such complex barriers but talking openly about these issues is a good place to start. Gee believes legislation around these issues is an important component. “Policies that promote human rights can not only buttress the foundations of a civil society,” Gee said, “but they can also make for a healthier one.”