Black Families and Mental Health

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0:04 Dr. Riana Anderson: Generally speaking, when we hold things in, we think that we're helping ourselves. Because talking about it is really scary and challenging and it can broach something that you've been trying to not think about for so long. As Michiganders, my hope would be that you understand that the word "pop" is really important to us. So if you think about a can of pop, and it's consistently being shaken, stirred, rolled around, dropped and not opened up, then you know what's next, right? You know that that can can either explode or when you do decide to open it up, it's gonna have some really forceful effects coming out.

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0:44 Narrator: While shaking a can of pop or soda provides a vivid picture, mental health is an immensely complicated and nuanced subject. And racial trauma and stigmas add additional layers of complexity for communities of color. This can add up to create a landscape that is difficult for black adults and children to navigate.

Hello, and welcome to Population Healthy. A podcast produced by the University of Michigan School of Public Health. In this season of population Healthy, we'll examine health inequities through the lens of race in America by talking to public health researchers, experts and others to learn more about what can be done to work toward health equity in our communities and across our country. This is population Healthy, Season 3: Race, Inequity and Closing the Health Gap.

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01:37 Narrator: Dr. Riana Anderson is an Assistant Professor of Health Behavior and Health Education at the University of Michigan School of Public Health. She studies racial discrimination and designs interventions to reduce racial trauma and stress for families.

01:51 Anderson: As a young Detroiter, I noticed that there were a lot of memorials, right? So there would be flowers, balloons, bears wrapped around a pole or post. And that often indicated the loss of someone. And I remember very clearly when there was a shooting in front of my house, one year, and we had this memorial in front of my house. It's this reminder of what's going on in the environment around you. So you're supposed to be commemorating this person. But for me as a young child, I just remember it being something that I now know as traumatizing or triggering. But at that point, I couldn't quite put my finger on it, like what is this feeling that I have every time I look at it. This feeling of dread or this feeling of anxiety around. What's gonna happen to me and what are the things that happen to folks that look like me.

02:39 Narrator: For Dr. Anderson, practicing public health provides an opportunity to positively impact her community in a way that's preventative, and not just reactionary. Especially when it comes to mental health.

02:50 Anderson: There was for a great number of years, this stigma around seeking mental health services airing out our dirty laundry, putting your family's business in the streets. Like we need to protect our own, so let's keep it in the house. Let's keep it in our own network was I think the way that a lot of people have been thinking about mental health for so long. I've actually seen a shift. So in the past two years or so, it's been really trendy for young people to be online and talk about their therapy, talk about depression and anxiety. There's clearly still some underlying stigma and there's differences with respect to age. But certainly, a new wave of young people who are absolute warriors for mental health treatment and reducing stigma. So I just wanna acknowledge that. But I do think that there is a shift happening, and I'm really excited to see it.

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03:44 Anderson: I've been talking about this a lot lately. And if you're listening, and it is outside of the year 2020, and you're wondering, "What the heck happened in 2020?" Well, there was a dual pandemic. So we had a pandemic that at first united all of us, and we really thought about the humanity of each person as something incredibly important, unique, special, and we wanted to save everyone's health and well-being.

And once those racial disparities started to emerge, and we saw the unraveling really of this united fabric, this idea that we are all together. When black and brown people were being impacted at greater rates than their counterparts, this is where we saw folks start to show that race is an important factor for them, and not caring about the well-being of black and brown folks. So I start with that because at the early pandemic quarter from, say, February to April, we were seeing rates of depression, anxiety and stress at three times that they normally would be. So say, for example, maybe one out of 10 people would be stressed, anxious or depressed in the black community. In January, we saw that it ticked up to about 40%, or four out of 10 people being stressed, anxious or depressed at the early point of the pandemic. So once those numbers started to come down a bit, because I think it was a shot perhaps at first like, "Oh my gosh, we don't really care about everybody." That message changed rapidly. Right?

0:05:14 Anderson: So after that changed and shifted a bit and people got more used to the normal kind of racial disparities, then in May, we witnessed very vividly someone being laid out on the ground and having his life snatched from him for 8 minutes and 46 seconds. So George Floyd became the literal face of the second pandemic within the pandemic which is to say more racial inequity. More racial discrimination emerged out of what we were already experiencing as a nation. And that's when you saw those numbers tick up even greater than they were just a few weeks before that. So you saw them exceed this 40% number of stress, anxiety, and depression.

So if all that taken together, is half of your population is experiencing any one of these psychological disorders or problems, then we are facing a true pandemic. Those are pandemic-leveled numbers, and it's not something that we should just be sweeping under the rug and saying, "Oh, this is a challenging time for people." This is impacting almost half of an entire population. So that's something that we should really be mindful of when we're talking about the state of mental health and the black community.

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06:22 Anderson: One of the ways that we talk about this is racial stress and trauma. I have colleagues who are working on this idea that from a clinical diagnostic perspective, racial trauma, which we often see and more frequently are seeing as a result of watching people that look like you being killed on very national platforms time and time and time again, even when they've done nothing wrong. These people are older, younger, these people are lighter skin, darker skin, these people are identifying as male and female, it really goes across the spectrum.

So how does that impact you? That's a state of racial terror or racial trauma that's hard to run away from. In the School of Public Health, we might talk about life expectancy, and we talk about these numbers differing between the suburbs and the inner city, a 15 or 20 year difference, in some cities 30 year differences, but that doesn't give the story of, okay, beyond my heart, going out early or beyond not having a house that's gonna insulate me properly and that's gonna lead to disease and demise over time.

07:31 Anderson: That quality of my lived experience, living in a state of racial terror and fear all the time is incredibly traumatic, so you're hyper-vigilant, you're looking around, you're waiting for something to happen. You are ruminating on this thing that happened. You are grieving uncontrollably for people you may not have known or people that you do know. As I've tried to explain it lately, it's not something that you just check mark and say, oh, that person has this. It's an experience, it's a process, it is something that nips at the individual day in and day out, and not just the individual, so the work that I do is talks about the family.

So if my parent is impacted by something, I, as a child, and I'm gonna be impacted. If we are going through something in one year it's going to relate to something that happens to me as a child several years later. It's a longitudinal developmental and symbiotic process. It's not just a one-and-done deal. It's people who are experiencing this day in and day out, and it's pervasive throughout the entire family and community as well. If you think about what a can or a bottle of pop can do when you just start to open it just a little bit, and you hear that fizz out, you hear that expression of air, of breath, just come out very slowly in that moment, that's kind of what we're talking about when we encourage families to talk. You wanna get some of that air out and you wanna let each other know that you are a sounding board that you can support each other in some of these more challenging conversations and some of that requires actually talking on our own and practicing for ourselves. So I actually recommend, especially to parents, have you talked in the mirror to yourself?

09:06 Anderson: That's something that we do if we're doing a job interview or if we have a tough conversation we need to have with a friend or something. You might do a voice note on your phone, you might talk to yourself in the mirror but it's not enough is to just say, "Well, I don't know what to say." Okay, well, get to saying something and practice what that might be, right. Talk to your partner, talk to your friends, talk to your parents, and kinda unpack some of the things that you may have had growing up. So it does take self-work and I'm really clear on that with parents, you've gotta do some work before you talk to your kids because you are human too. You're not just a parent, that's not your only identity. You have been saddled with decades of racial stress and trauma yourself. You may not have gotten something as a child that you need desperately in order to help your kid to be the best person that they can be. So talk first, get your own can open first, and then talk to your kids using things like the media, so whatever is on TV, you can use that as fodder.

And you can simply ask the question, What does it feel like to blah, blah, blah? What is that like for you? What is it like to watch this, how are you feeling ? That question opens up an entire world of conversation so start there, and if you're not getting the type of media that is eliciting those questions there are tons of resources, tons of books, tons of movies, tons of question guides that are online, freely available. I'm of the no excuse variety, open up your mouth. Pop the pop, get those conversations going.

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10:38 Narrator: Although Black Americans share a history of racial trauma and are actively fighting against systemic and individualized racism, they are not a monolith. Within this group, there are myriad experiences that occur based on gender, sexuality and ethnic background among others. For Gabriel Johnson, a Ph. D. Student in the Department of Health Behavior and Health Education, exploring mental health in black man themes of masculinity, LGBT+ Health and intersectionality gives additional insight into mental health in the black community.

11:09 Gabriel Johnson: I've been at the University of Michigan for... This would be my fourth year. I came to get my Master's in Public Health, initially focusing on Black women's health, which shapes the things I say now. And through a myriad of different experiences and reflecting on my past, I applied to come here for my PhD., I got admitted, and I focused now on black men and black masculine of centered individuals, meaning people who may not necessarily identify as men who identify more masculine of center. So we understand that presentation is on a spectrum and gender presentation is on a spectrum, so people who identify more masculine of center.

So there's transmasculine folks, there are people who identify as women but identify as more masculine, and looking at those people and black men and how their perceptions of masculinity and how general perceptions of masculinity, and cultural differences in masculinity, and the negotiation of those different types of masculinities impact and influence mental health and Hopefully, if my career is long and strong, I'm looking at how potentially those may also influence physical health outcomes. I was blessed enough to get an opportunity to teach seventh grade math. I loved it, it was amazing, but I had a lot of experiences with a lot of my seventh grade students having suicidal ideation, self-harm, depression, as well as some suicide attempts.

And the solutions that I was trying to seek in the school, they didn't seem sufficient to address what was happening. And particularly in my experience, a lot students that were coming to me were black and particularly identified or were exploring their sexuality.

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12:50 Johnson: There's this conversation about different types of masculinity, right? There's what is probably commonly referred to as a hegemonic masculinity, or like a dominant masculinity that people often attribute to 'Toxic masculinity' which comprises of a social presentation, risk taking, emotional restraint, the power over women, dominance, self-reliance and things like that. But there's also a different cultural masculinity, that I think get missed in the conversation. When we talk about this in regards to black men, we have to recognize that black men are marginalized, we experience racism brought out in different ways. And because we're black men and we may exhibit some of these typical Hege-like masculine traits such as risk-taking, dominance, some of those things may put us in danger, because we are aware of our history and how that influences us being exposed to opportunities where we are not able to make money, but also being in spaces where there's incredibly high amounts of stress.

13:45 Johnson: When we think about gangs and gang affiliations, when we think about being in high poverty areas, when we think about being in places that potentially are exposed to high violence or lack of support for whatever reason, a lot of these masculine traits can be protective in some way as I said before, to protect oneself from being hurt, to show other people that, Please don't mess with me, and sort of protecting one's physical well-being, but then also for mental well-being, showing emotional restraint can be protective, right. 'Cause sometimes showing emotion in certain situations can be damaging, a good example is when interacting with police and showing emotional restraint, not getting angry, not getting frustrated, not getting 'Extremely emotional' can save one's life. The issue with masculinity is constantly needing to be proven, and with all masculinity, we have black men being masculine, right. Often, many of us have been subjugated by the structural forces that be, by messages that say, We aren't good enough, for me, that says black men are not great fathers or they're absent, even though I have a child ground me all the time and constantly take care of that child. These messages, these processions, these beliefs really make masculinity quite fragile.

14:55 Johnson: And even more so when you think about day-to-day interpersonal interactions, there's this almost a vigilance to constantly prove to yourself and to others around you that they are men through these measures of masculinity whether that be presenting as more heterosexual when you don't need to, black men who are gay, bi, and our black men who have assexuations with men who end up showing themselves to be more 'Heterosexual' presenting, even though it's not how they present. As well as also, we think of violence as a common way that it's a very good example of how precarious masculinity is particularly on black men, when you think about in schools, when you think about intimate partner violence. And some of those instances are large because there's an experience or something that happens, something that said that threatens a man's sense of masculinity and who he is. It's a very complicated picture, but I don't wanna over-simplify it.

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15:50 Johnson: When you think about the language that has presented to discuss sexuality, and romantic relationships, often this dynamic world of sexuality, sexual relationships and romantic relationships isn't really totally captured, which is a lifetime's work. But I think a decent number of black men would not identify as either heterosexual or gay or bisexual, but as something in between. The language that we kinda impose doesn't really provide space and is an additional layer of restriction, which when we think about this really influences mental health, right. When you are constantly told either actively or passively, that you cannot be yourself in so many words, that really influences the relationships you can actually have, and also who you can talk to for support in case of serious situations.

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16:39 Johnson: I do think this conversation often lacks nuance when we talk about black men sexuality, relationships and relationships as a whole. When we think about family, when we think about parenting and things like that, so because we are often assigning this broad general idea of what masculinity is, and placing it upon a group who has a unique history within the United States and within their own cultures. And that's not even accounting for geographical differences or ethnic differences within the diaspora. When you think about Caribbean, people who are first, second generation African immigrants, Afro-Latinos and etcetera. There's a lot of dialogue in more smaller critical circles about men and black men, and I think it's important to have that conversation. I think there's two sides of that coin, I think it's similar to the conversation had being heard about our race and racism. I think there's a place for black men to sit back and listen and taking those perspectives, but I think it's also a space for black men to kinda act in unique ways that they have not acted in before. There's ways to build power and an emotional restraint is not one of them. I think it's a time for black men to really love other folks in ways that are really powerful, and to demonstrate their commitment through unique ways of loving.

17:54 Narrator: There are a myriad of mental health challenges for black Americans, but also a number of resources to help people cope, communicate and deal with personal challenges. There are no easy solutions to complex challenges, but new avenues will continue to emerge with an increased willingness to discuss mental health.

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18:18 Narrator: On the next edition of population Healthy.

18:21 Speaker: I think the reality is, is that the Academy and the research apparatus just isn't infused with enough communities of color for it to be a reality for us to say that all of the research that's done in communities of color need to be led by practitioners or researchers who are also of color or who have that same identity match. That is something we should be aspiring to.

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18:54 Narrator: Thanks for listening to this episode of Population Healthy: Race, Inequity, and Closing the Health Gap from the University of Michigan School of Public Health. We hope you learned something that'll help you make the world a healthier place. Please subscribe or follow our podcast on Apple Podcasts, Google Play, Stitcher or Spotify or wherever you listen to podcasts. Interested in studying public health with us, join our interest list by going to our home page publichealth.umich.edu and check out our programs and degrees and other helpful resources across our website. Be sure to follow us, @umichsph on Twitter, Instagram and Facebook to join the conversation, learn more from Michigan public health experts, and share episodes of the podcast with your friends and followers. You can also check out the show notes on our website, publichealth.umich.edu/podcast for more resources about the topics discussed in this episode. If you wanna stay up-to-date with the latest research and expertise from Michigan Public Health subscribe to our weekly newsletter population Healthy, head of publichealth.umich.edu/news/newsletter to sign up and be sure to join us next time. Thanks for listening and doing your part to make the world a healthier place for all.

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