By Deborah L. Rouse
Monday, October 1, 2001
Many women of color suffer depression and stress brought on by persistent racism, gender bias, violence, poverty, big family size and social disadvantages. Yet therapy is rare, access to mental health services is poor and the quality is poor.
(WOMENSENEWS)--For many women of color, depression and stress are part of everyday life. Therapy is not.
"I think depression tends to be the dominant factor when it comes to the mental health issues that women of color face," said Surgeon General Dr. David Satcher, author of a recent report on mental health and the interplay of race, ethnicity and culture.
"Women of color have high rates of depression and depressive distress, and part of that probably comes from a lot of the life circumstances that these women experience, such as racism and discrimination, that culminate into stress and numerous other disorders," Satcher said in an interview.
He adds that out of all female ethnic groups in this country, Latino women are the ones least likely to be covered by insurance, followed by African American women. Native American women do have some mental health care services through the American Indian Health Service on their reservations, Satcher said.
"We don't know a lot about what happens to Native American women once they leave the reservation, because once they become part of the larger community, many of them don't identify themselves as Native Americans any longer."
The U.S. Surgeon General's recent report, "Mental Health: Culture, Race, and Ethnicity," addressed overall mental health issues of African Americans, Hispanics, Asian Americans and Native Americans; some sections briefly addressed women's concerns.
The report says much of the depression and stress women of color experience is a result of racism, gender bias, poverty, violence, large family size and social disadvantages.
The recent report and a 1999 general survey of Americans' mental health contained little statistical information, and even less about the four groups or women of color.
The reports estimated, however, that in a given year, 22 percent to 23 percent of the U.S. adult population--about 44 million people--has a diagnosable mental disorder. Anxiety disorders are the most common mental disorder in adults, affecting twice as many women as men, it said.
The report does say that older Asian American women have the highest suicide rate of all women over the age of 65 in the United States.
Some of the reasons for this dynamic may be attributed to the difficulties some Asian immigrants may encounter when attempting to adjust to American society. The prejudice and discrimination many of these women face in America, coupled with the angst they may feel over political upheaval in their homelands, are also factors, experts say.
The Surgeon General's report, however, did not provide further statistics or observations about either Asian American immigrant women or Asian American women who have lived in the United States for generations.
The report also said that Mexican American women, particularly those over the age of 40, were also likely to express emotional distress through physical rather than emotional symptoms.
Racial and ethnic minority women, the report said, also have less access to mental health services than white women. However, when minority women do have access, the services are likely to be of poor quality, and minority women are less likely than white women to use them.
This tendency may be related to access to income and availability of health insurance, but history and culture may play a role as well.
Dr. Vicki M. Mays, an African American professor of psychology at the University of California at Los Angeles, says that minority women tend to share a common theme when it comes to reasons for seeking therapy.
"Women who seek therapy do so because they find their level of functioning being less than optimal, they are concerned about a relationship, they have problems that have occurred relative to families and children. These issues bring them to a point of seeking care," she said.
However, Mays' greatest concern is not what brings these women to counseling, but what keeps them from using mental health services.
"The fact is, minority women don't seek mental health care as readily as white women. As women of color, we may be more likely to engage in other informal sources of help, such as prayer, or having 'sister support groups' where we sit around and talk with friends, hoping to gain what others often gain by having individual therapy."
Dr. Satcher says women of color may seek alternatives to formal therapy because of a profound lack of trust.
"I believe African American women, given the history they have with this country in terms of racism and discrimination, find it difficult to trust psychiatrists. I think women of color would feel better having a mental health care provider of their own race, but that is often difficult because there are not a lot of ethnic health care providers, and African American women are over-represented in areas where few ethnic providers choose to practice."
Dr. Yolanda Brooks, a Dallas, Texas-based psychologist, cites another reason for minority women's reluctance to seek counseling.
"Women of color tend to look at therapy as a sign of weakness," she says. "Black women tend to present themselves to society as strong, resilient human beings. In my opinion, you can trace this dynamic back to slavery, when a woman had to pretend she was okay when she was actually suffering inside. This characteristic has been deeply ingrained in the African American culture, to its detriment. I don't think pretending to be strong is always good."
Brooks says the stereotype is perpetuated in movies and literature, where mama keeps quiet about her suffering. "Nobody knows she is hurting," explains Brooks, "but when she gets alone behind the closed door, you see that she is physically sick."
Brooks also adds that for some women, black women in particular, admitting a need for therapy is a negative thing and reinforces all that is wrong in their lives.
"Once a black woman decides to seek counseling, she feels she is admitting she is not handling her problems well. She feels that seeing a therapist is validating what she sees as her lack of self-control. She feels she is giving away her power. As a culture, we don't disclose our hand because we don't want to be vulnerable," Brooks continues.
"So when you go and acknowledge to someone that you are vulnerable, you feel that they can use that against you. That's the mentality of many women in the African American culture."
Another reason women of color do not seek formal therapy is that, in their respective cultures, there are other ways of regaining a sense of peace and well-being. According to the report, Native American women and women of Alaskan descent often rely on traditional healers, who may work side by side with formal health providers in tribal mental health programs. African American women frequently rely on ministers, who may play various mental health roles as counselor, diagnostician or referral agent.
Explains Dr. Satcher, "I think many African American women go to family members or individuals in their churches instead of seeking conventional therapy because many churches now provide mental health services."
According to the report, almost 85 percent of African Americans as a whole have described themselves as "fairly religious" or very religious," and prayer is among their most common coping strategies.
Dr. Brooks, who facilitates self-help sessions in various churches, says she knows that black women tend to be very religious and tend to have faith in something or someone larger than themselves; that women of color often rely on that spiritual base in place of counseling.
"When a black women is suffering, she will more than likely pray about her problem before seeking a therapist," she said.
While Dr. Satcher feels that formal therapy is something that many minority women need and should have access to, he admits that having other human beings to bond with may sometimes be a good alternative to formal therapy. However, he also wants women to acknowledge the boundaries of such informal counseling.
"If a woman truly has clinical depression, she needs to seek care beyond what her friends or individuals at her church can provide, because oftentimes this level of depression frequently involves the need for medication."
But for the general malaise that all women feel once in a while, Dr. Satcher says nothing beats the steadfast ear of a good friend. "I certainly think having somebody that listens to you is good therapy for anybody."
Brooks says that community resources are rich with networks of support that can be good alternatives for women who are unable to afford therapy or do not have insurance coverage. These include nonprofit organizations, church-based groups, volunteer agencies and support groups.
"I have found that women often begin to feel better about themselves just making the effort to do so," Brooks explains. "The process of seeking knowledge and assistance can be, in and of itself, quite empowering. However, women need to know when more intensive intervention and assistance may be warranted.
"Just as you don't wait until you get a headache to go buy the aspirin, don't wait until you are completely overwhelmed to find out where or how to get help."
Deborah L. Rouse is a free-lance writer in Washington, D.C., regularly covering minority issues.
"Mental Health: Culture, Race, and Ethnicity," U.S. Department of Health and Human Services, 2001:
"Mental Health: A Report of the Surgeon General," U.S. Department of Health and Human Services, 1999:
National Women's Health Information Center:
National Black Women's Health Project:
National Asian Women's Health Organization: