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Extrait :
ONE
The Silent Epidemic Among Black Men
When I first got the blues, they brought me over on a ship,
Men was standin' over me, and a lot more with a whip.
And ev'rybody wanna know why I sing the blues.
--B. B. King,
"Why I Sing the Blues"
Suppose black men were suffering through an epidemic. What if the disease struck as many as 20 percent of all African American men during their lives, and what if 15 percent of those with the most severe strain of the illness died? Imagine that the disease made men miss work, and made them less motivated and productive when they were on the job. Imagine further that even black men at the top of their professions were affected, rendered less decisive, their judgment impaired. And what if, in an effort to ease the pain of the disease, many African American men medicated themselves with addictive, deadly drugs? What if black families were being destroyed by this illness? What if many of the men suffering from this disease lost hope so completely that they placed little value on human life--theirs or anyone else's? And, finally, what if, while all this was happening, next to nothing was being done to get black men treatment and medications that are 80 percent effective against the disease?
I have no doubt about what would happen. African Americans would be in the streets, charging that black men were the victims of the most vicious form of racism. We would demand action. We would be outraged, and justifiably so.
Yet untreated depression is doing all these things to black men in America. In fact, it probably affects African American men more adversely than it does the general population. "Mental Health: Culture, Race and Ethnicity," the 2001 supplement to the Report on Mental Health by U.S. Surgeon General David Satcher, says that "racial and ethnic minorities collectively experience a greater disability burden from mental illness than do whites."
The release of Dr. Satcher's original Report on Mental Health in 1999 was a landmark moment for America. This was the first comprehensive report on the state of the nation's mental health issued by America's "physician-in-chief." It is both an inventory of the resources available to promote mental health and treat mental illness, and a call to action to use and improve those resources. It paints a portrait of mental illness, filling the canvas with the faces of America, revealing that the direct and indirect effects of mental illness cut across all the nation's dividing lines, whether race, religion, gender, economic level, or education.
But the supplemental report highlights the disparity that exists for black men in mental health as it does in relation to most health problems. For example, African American men are more likely to live with chronic illnesses--and studies show that living with chronic health problems increases the risk of suffering from depression. In its 2002 report, "The Burden of Chronic Diseases and Their Risk Factors," the federal Centers for Disease Control and Prevention points out that African American men have the highest rates of prostate cancer and hypertension in the world. The report also says black men are twice as likely as white men to develop diabetes, and suffer higher rates of heart disease and obesity. The American Cancer Society's 2003 "Cancer Facts and Figures" found that black men are more than twice as likely as white men to die from prostate cancer. We also are more likely than others to wait until an ailment reaches a serious stage before we seek treatment. According to a report issued by the Congressional Black Caucus Foundation in 2003, men in general are three times less likely than women to visit a doctor, and African American men specifically are less likely than white men to go to a doctor before they are in poor health. This is the case for physical ailments. Factor in the stigma attached to mental illness, and add other barriers that keep us from getting help, and it's easy to see why black men are even less likely to seek treatment for depression.
So, I maintain that what I described above--or worse--is happening to black men. But the nation, including the African American community, is silent. The silence on the subject among blacks is due, in part, to our lack of a vocabulary to talk about depression.
We call depression "the blues" in the black community. We're taught to shrug off this mental state. For many of us, it is not just a fact of life; it is a way of life. When bluesmen wail, "Every day I have the blues" or "It ain't nothing but the blues" or similar words from a thousand songs, they do more than mouth lyrics. They voice a cultural attitude. They state the accepted truth at the heart of their music: Having the blues goes along with being black in America.
In addition, from the time we are young boys, black males have ingrained into us an idea of manhood that requires a silence about feelings, a withholding of emotion, an ability to bear burdens alone, and a refusal to appear weak. The internal pressure to adhere to this concept of masculinity only increases as we confront a society that historically has sought to deny us our manhood.
The internal wall that keeps black men away from psychotherapy adjoins external barriers built just as high, if not higher. Mental health practitioners are overwhelmingly white, with the proportion of black psychiatrists, psychologists, and psychoanalysts estimated at less than 3 percent of the nation's total. This means that even if black men break through self-imposed barriers and seek professional help for mental problems, it may be difficult to find someone with whom they can build the rapport that allows a patient to reveal his most intimate secrets. As Dr. Richard Mouzon, a prominent black clinical psychologist in Atlanta, puts it, "We grow up knowing that it's dangerous to give up too much of yourself to the white man."
There's no denying that access to mental health care is restricted for Americans in general. In private health insurance policies and government medical assistance programs, psychotherapy too often is considered a luxury rather than a medical necessity. It often has been said that in America the only people with a guaranteed right to health care are the inmates of our jails and prisons. That's even truer of mental health care. (Unfortunately, it is a right that is of marginal value; while many African American men receive their first and only treatment for mental illness behind bars, that treatment is apt to be directed at keeping them under control rather than alleviating the effects of their illness.)
Our health care system assures preventive measures and early intervention for mental health problems only to the privileged, just as it does for physical health problems. The disparity is so great in minority communities that, for many, mental illness receives attention only when it reaches a florid stage--in public hospitals' emergency rooms and psychiatric wards--or, worse, in its aftermath, when people with mental illness may end up behind bars and in morgues.
The consequences of untreated mental illness are dire. And the tragedy of the worst outcomes can be no greater than when the disorder is depression, one of the most common and treatable mental illnesses. The disease is painful, potentially fatal, but 80 percent of those who get treatment get better. Yet, quite sadly, only 25 percent of those who need help get it. African American men are especially prone to put ourselves in mortal danger because we readily embrace the belief that we can survive depression by riding out the illness, allowing it to run its course. The internal walls we build to keep out the world, and the walls society builds to isolate us, cut us off from the help we need. So we suffer, and we suffer needlessly.
I know that suffering firsthand. I dealt with untreated clinical depression for most of my life--into my forty-fifth year, in fact. Anyone looking at the outlines of my life probably would not believe that. They would say good fortune has followed me. I was born in the small town of Jackson, Georgia, which I remember as a good place to grow up, even in the era of segregation and overt racism. I had an older sister and three younger brothers. My mother raised us alone, having divorced my father when I was about four years old. She gave us so much of herself that I don't ever recall feeling deprived of a father. Her mantra was that all things are possible. She worked long hours as a beautician and pushed us to work hard in school to make sure we were prepared to take advantage of all of life's possibilities.
We lived in town, where we had armies of children our own ages as playmates and friends. Of course, we always had one another, despite the moments of sibling warfare in which opposing parties threatened to banish the other from the household by any means necessary. The summer was my favorite time. We spent much of it on my grandparents' farm. My grandmother showered me with love, and my grandfather taught me to work hard and take pride in even the most menial job.
We all did well at our studies, though one of my teachers early on wrote an evaluation of me that placed me in the category of borderline mentally retarded. She said I did not participate in class and, in fact, seemed unable to respond to simple questions. My mother refused to believe her. She argued that my "problems" were nothing more than shyness and a stammer that made speaking in front of others an embarrassing ordeal. She insisted that I not be held back or in any way separated from my peers as long as I was able to demonstrate adequate skills on paper--which I could.
When I reached the third grade and came under the tough-love tutelage of a teacher named Mrs. Doris Lummus, I began to blossom. I scored above grade level on the first standardized test I took. I gained confidence. The grades on my report card went from most...
Revue de presse :
The Silent Epidemic Among Black Men
When I first got the blues, they brought me over on a ship,
Men was standin' over me, and a lot more with a whip.
And ev'rybody wanna know why I sing the blues.
--B. B. King,
"Why I Sing the Blues"
Suppose black men were suffering through an epidemic. What if the disease struck as many as 20 percent of all African American men during their lives, and what if 15 percent of those with the most severe strain of the illness died? Imagine that the disease made men miss work, and made them less motivated and productive when they were on the job. Imagine further that even black men at the top of their professions were affected, rendered less decisive, their judgment impaired. And what if, in an effort to ease the pain of the disease, many African American men medicated themselves with addictive, deadly drugs? What if black families were being destroyed by this illness? What if many of the men suffering from this disease lost hope so completely that they placed little value on human life--theirs or anyone else's? And, finally, what if, while all this was happening, next to nothing was being done to get black men treatment and medications that are 80 percent effective against the disease?
I have no doubt about what would happen. African Americans would be in the streets, charging that black men were the victims of the most vicious form of racism. We would demand action. We would be outraged, and justifiably so.
Yet untreated depression is doing all these things to black men in America. In fact, it probably affects African American men more adversely than it does the general population. "Mental Health: Culture, Race and Ethnicity," the 2001 supplement to the Report on Mental Health by U.S. Surgeon General David Satcher, says that "racial and ethnic minorities collectively experience a greater disability burden from mental illness than do whites."
The release of Dr. Satcher's original Report on Mental Health in 1999 was a landmark moment for America. This was the first comprehensive report on the state of the nation's mental health issued by America's "physician-in-chief." It is both an inventory of the resources available to promote mental health and treat mental illness, and a call to action to use and improve those resources. It paints a portrait of mental illness, filling the canvas with the faces of America, revealing that the direct and indirect effects of mental illness cut across all the nation's dividing lines, whether race, religion, gender, economic level, or education.
But the supplemental report highlights the disparity that exists for black men in mental health as it does in relation to most health problems. For example, African American men are more likely to live with chronic illnesses--and studies show that living with chronic health problems increases the risk of suffering from depression. In its 2002 report, "The Burden of Chronic Diseases and Their Risk Factors," the federal Centers for Disease Control and Prevention points out that African American men have the highest rates of prostate cancer and hypertension in the world. The report also says black men are twice as likely as white men to develop diabetes, and suffer higher rates of heart disease and obesity. The American Cancer Society's 2003 "Cancer Facts and Figures" found that black men are more than twice as likely as white men to die from prostate cancer. We also are more likely than others to wait until an ailment reaches a serious stage before we seek treatment. According to a report issued by the Congressional Black Caucus Foundation in 2003, men in general are three times less likely than women to visit a doctor, and African American men specifically are less likely than white men to go to a doctor before they are in poor health. This is the case for physical ailments. Factor in the stigma attached to mental illness, and add other barriers that keep us from getting help, and it's easy to see why black men are even less likely to seek treatment for depression.
So, I maintain that what I described above--or worse--is happening to black men. But the nation, including the African American community, is silent. The silence on the subject among blacks is due, in part, to our lack of a vocabulary to talk about depression.
We call depression "the blues" in the black community. We're taught to shrug off this mental state. For many of us, it is not just a fact of life; it is a way of life. When bluesmen wail, "Every day I have the blues" or "It ain't nothing but the blues" or similar words from a thousand songs, they do more than mouth lyrics. They voice a cultural attitude. They state the accepted truth at the heart of their music: Having the blues goes along with being black in America.
In addition, from the time we are young boys, black males have ingrained into us an idea of manhood that requires a silence about feelings, a withholding of emotion, an ability to bear burdens alone, and a refusal to appear weak. The internal pressure to adhere to this concept of masculinity only increases as we confront a society that historically has sought to deny us our manhood.
The internal wall that keeps black men away from psychotherapy adjoins external barriers built just as high, if not higher. Mental health practitioners are overwhelmingly white, with the proportion of black psychiatrists, psychologists, and psychoanalysts estimated at less than 3 percent of the nation's total. This means that even if black men break through self-imposed barriers and seek professional help for mental problems, it may be difficult to find someone with whom they can build the rapport that allows a patient to reveal his most intimate secrets. As Dr. Richard Mouzon, a prominent black clinical psychologist in Atlanta, puts it, "We grow up knowing that it's dangerous to give up too much of yourself to the white man."
There's no denying that access to mental health care is restricted for Americans in general. In private health insurance policies and government medical assistance programs, psychotherapy too often is considered a luxury rather than a medical necessity. It often has been said that in America the only people with a guaranteed right to health care are the inmates of our jails and prisons. That's even truer of mental health care. (Unfortunately, it is a right that is of marginal value; while many African American men receive their first and only treatment for mental illness behind bars, that treatment is apt to be directed at keeping them under control rather than alleviating the effects of their illness.)
Our health care system assures preventive measures and early intervention for mental health problems only to the privileged, just as it does for physical health problems. The disparity is so great in minority communities that, for many, mental illness receives attention only when it reaches a florid stage--in public hospitals' emergency rooms and psychiatric wards--or, worse, in its aftermath, when people with mental illness may end up behind bars and in morgues.
The consequences of untreated mental illness are dire. And the tragedy of the worst outcomes can be no greater than when the disorder is depression, one of the most common and treatable mental illnesses. The disease is painful, potentially fatal, but 80 percent of those who get treatment get better. Yet, quite sadly, only 25 percent of those who need help get it. African American men are especially prone to put ourselves in mortal danger because we readily embrace the belief that we can survive depression by riding out the illness, allowing it to run its course. The internal walls we build to keep out the world, and the walls society builds to isolate us, cut us off from the help we need. So we suffer, and we suffer needlessly.
I know that suffering firsthand. I dealt with untreated clinical depression for most of my life--into my forty-fifth year, in fact. Anyone looking at the outlines of my life probably would not believe that. They would say good fortune has followed me. I was born in the small town of Jackson, Georgia, which I remember as a good place to grow up, even in the era of segregation and overt racism. I had an older sister and three younger brothers. My mother raised us alone, having divorced my father when I was about four years old. She gave us so much of herself that I don't ever recall feeling deprived of a father. Her mantra was that all things are possible. She worked long hours as a beautician and pushed us to work hard in school to make sure we were prepared to take advantage of all of life's possibilities.
We lived in town, where we had armies of children our own ages as playmates and friends. Of course, we always had one another, despite the moments of sibling warfare in which opposing parties threatened to banish the other from the household by any means necessary. The summer was my favorite time. We spent much of it on my grandparents' farm. My grandmother showered me with love, and my grandfather taught me to work hard and take pride in even the most menial job.
We all did well at our studies, though one of my teachers early on wrote an evaluation of me that placed me in the category of borderline mentally retarded. She said I did not participate in class and, in fact, seemed unable to respond to simple questions. My mother refused to believe her. She argued that my "problems" were nothing more than shyness and a stammer that made speaking in front of others an embarrassing ordeal. She insisted that I not be held back or in any way separated from my peers as long as I was able to demonstrate adequate skills on paper--which I could.
When I reached the third grade and came under the tough-love tutelage of a teacher named Mrs. Doris Lummus, I began to blossom. I scored above grade level on the first standardized test I took. I gained confidence. The grades on my report card went from most...
"Standing in the Shadows is a brave, unblinking look at what it is like to be an African American man with depression. John Head's insightful analysis of the connection between racism and this illness should be required reading for everyone who cares that African American men are often absent from their families, are in jails and prisons in disproportionate numbers, and die at an alarming rates from suicide.”
—Cynthia Wainscott, Chair, National Mental Health Association
"John Head deftly takes us on a personal and cultural journey into the nature of depression and the social stigmas that surround it. Standing in the Shadows is an insightful, compelling, and practical guide."
—Lawrence Kutner, Ph.D., co-director, Harvard Medical School Center for Mental Health and Media.
"This book does not haggle with statistics and scientific discoveries . . . .it literally keeps the topic of depression and black men honest by taking us through a progressive journey that helps us understand the real hurdles. Before you delve into any medical journal . . . read this book first so that you will have a deeper understanding of the topic and develop a good foundation."
—Donna Holland Barnes, Ph.D, resident and co-founder of the National Organization for People of Color Against Suicide and assistant professor in
the department of psychiatry at Howard University.
"Neither a polemic nor a weepy tell-all, Standing in the Shadows is a sobering look at what the world's most common mental illness is doing to a big chunk of our population—with well-researched words of hope and help for those men and the people who love them."
—Tracy Thompson, author of The Beast: A Reckoning with Depression
“John Head's Standing in the Shadows is a "must read" for the black man suffering from the lingering, tormenting blues and for anyone who knows him. Head makes the experience of depression real in heartfelt, well-crafted vignettes that give substance to his demand that we acknowledge, name, understand, and do something to ease the psychic pain that many black men suffer in relative silence.”
—Sandra C. Walker, MD, psychiatrist and psychoanalyst
—Cynthia Wainscott, Chair, National Mental Health Association
"John Head deftly takes us on a personal and cultural journey into the nature of depression and the social stigmas that surround it. Standing in the Shadows is an insightful, compelling, and practical guide."
—Lawrence Kutner, Ph.D., co-director, Harvard Medical School Center for Mental Health and Media.
"This book does not haggle with statistics and scientific discoveries . . . .it literally keeps the topic of depression and black men honest by taking us through a progressive journey that helps us understand the real hurdles. Before you delve into any medical journal . . . read this book first so that you will have a deeper understanding of the topic and develop a good foundation."
—Donna Holland Barnes, Ph.D, resident and co-founder of the National Organization for People of Color Against Suicide and assistant professor in
the department of psychiatry at Howard University.
"Neither a polemic nor a weepy tell-all, Standing in the Shadows is a sobering look at what the world's most common mental illness is doing to a big chunk of our population—with well-researched words of hope and help for those men and the people who love them."
—Tracy Thompson, author of The Beast: A Reckoning with Depression
“John Head's Standing in the Shadows is a "must read" for the black man suffering from the lingering, tormenting blues and for anyone who knows him. Head makes the experience of depression real in heartfelt, well-crafted vignettes that give substance to his demand that we acknowledge, name, understand, and do something to ease the psychic pain that many black men suffer in relative silence.”
—Sandra C. Walker, MD, psychiatrist and psychoanalyst
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- ÉditeurBroadway Books
- Date d'édition2004
- ISBN 10 0767913531
- ISBN 13 9780767913539
- ReliureRelié
- Nombre de pages209
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