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Mental Note

Episode 39 - Black Mental Health, Part 1

By Mazella Fuller, PhD, MSW, LCSW, CEDS & Charlynn Small Ph.D

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How does the history of race impact your mental health?

To get a better idea, we’re spending the next two episodes with Dr. Mazella Fuller and Dr. Charlynn Small - two leading thinkers on Black mental health.

Today’s show is all about the history and definitions of Black mental health. Part 2 will focus on how to make change happen - whether you’re part of the Black community or not. It will feature practical tools to evolve the mental health community by making it more equitable and inclusive.

 

Transcript

Ellie Pike:
Most of the time, our podcast episodes revolve around the recovery stories of individuals, or at most, families. But what happens when history, culture, and science have treated you and everyone who looks like you so differently for so long that your mental health journey can no longer be fully understood on its own?

Dr. Charlynn Small:
Some persons have said that black persons are immune to mental illness. This is according to John Galt in 1848. He said that we were immune to mental illness because we hadn't been exposed to the daily mental excitement of the free population. Okay, two years later, physician Samuel Cartwright decided that we were not immune to mental illness, because he determined that any slave that wanted to run away from slavery wanted to run away from being beaten and raped and sold. They must have been out of their cotton-picking minds to want to run away from the plantation. He called this drapetomania.

Ellie Pike:
To get a better idea of how race affects mental well-being, we're spending the next two episodes with Dr. Mazella Fuller, and Dr. Charlynn Small, two leading thinkers on black mental health. I cannot overstate how qualified doctors, Small and Fuller are to guide us over the next two episodes. In my conversation with them, it took over seven minutes, just to list the various accomplishments, institutions, and programs they're a part of. And those were only the ones that were top of mind. In the interest of time, here are a few highlights, I think are worth noting. Dr. Charlynn Small is a frequent speaker who advocates for the awareness of eating disorders affecting black women, persons of color, and other underrepresented groups. She's a licensed clinical psychologist at University of Richmond, and on the board for the International Association of Eating Disorder Professionals, IAEDP, for short. Her doctorate is from Howard University in Washington, D.C.

Ellie Pike:
Dr. Mazella Fuller has worked in education for many years as a high school teacher, adjunct instructor, consultant, and clinician. She received her education from Smith College, and the University of Massachusetts Amherst. She now serves as a clinical associate on staff at Duke University Counseling and Psychological Services.

Ellie Pike:
Both doctors, Small and Fuller co-founded the Institute for Antiracism and Equity in Mental Health, as well as IAEDP's African-American Eating Disorders Professionals committee. In addition, they co-edited the book, Treating Black Women with Eating Disorders: A Clinician's Guide. On top of all that, these women like to have fun.

Dr. Mazella Fuller:
Pandemic or no pandemics, unrest or no unrest, I'm going to get my nails done, massage and spa, to care work, makeup, hair. And so, I am a big, big proponent of self-care, and especially as a black woman, because nobody thinks I should be taken care of.

Ellie Pike:
The three of us are going to explore the story of mental health in the black community by discussing its definition, history, status, and what needs to happen to open up treatment and research to people who often feel like they're left on the outside. There's a lot to digest, from viewing structural racism as a public health emergency, to examining not only the cultural backgrounds of patients, but also clinicians. You might want to return to these episodes from time to time. But for today's episode, we're focusing on the history of black mental health. You're listening to Mental Note podcast. I am Ellie Pike.

Ellie Pike:
Today, we're talking about black mental health and what that looks like now, and also throughout history. And then we'll have a sequel to this episode of really talking about how to equip our community, our mental health community to better serve the black community. This is a really basic question that many of us don't ask or talk about, but we just talk about mental health, but I don't know if we always say what mental health means to us or what it really is. Can we start there? And just, I'm curious what that means to you, maybe personally, or why you do this work, or a more scientific definition, if you would like.

Dr. Mazella Fuller:
I'll kind of take it from a two-pronged approach. One, from being a social worker, because social worker, the ethics and part of our just mission, and of course, ethical practice is to address the whole person, but holistically, mind, body, and spirit, or mind, body, and soul. That is the essence of my clinical practice, and especially if I'm working in a black community, because 85%, I think through SAMHSA, of us as black people use some sort of religion as a coping mechanism.

Dr. Charlynn Small:
Well, we have similar philosophies in that respect. I am trained as a school psychologist. That is what my doctorate is in. And as such, when working with persons from K through 12, the focus indeed is on the whole human being, the effect, the physical, and the cognitive. If any one of those areas is not doing well, well, that affects everything, because the emotional, the physical, the social well-being affects how we think and how we feel and how we act toward others, how we engage with others, how we handle stressors and so forth. So indeed, we have to address the entire person.

Dr. Charlynn Small:
I did an interview recently with Brian Pollack. He is a young person who has an outlet called Minding Men, and he addresses, on a monthly basis, issues affecting men. And I talked with him last month about black men, and whether or not there in fact is a health crisis. And before I did the interview, naturally, I did my own little independent survey of black men, and whether or not they thought that there was indeed a mental health crisis. And they all said, "Yes, indeed, we are in a crisis." How can you not be when you turn on the TV, and there's some black male that has been murdered, harmed in some kind of way? And all of these things have a ripple effect. Those of us who are remaining are left to think, "Am I next?" It really is a problem for us.

Dr. Charlynn Small:
When I was talking to my son about it, I said it, "Oh, are you in a crisis, you guys, black men?" And he said, "Well, yeah, you know, it's kind of hard that we're supposed to be all things to everybody, and they're looking for us to be perfect. And when we fall short, that's a problem, and we feel badly about it." So there's some issues in terms of how we define mental health and where we are right now.

Ellie Pike:
Thank you so much. And that was a perfect lead-in to my next conversation topic, which was, really in general, what are the influencers to mental health? And, I think many of us can easily answer, stress, trauma, intergenerational stress, like what we've experienced from-

Dr. Charlynn Small:
Whoo! Oh, boy. Yeah.

Ellie Pike:
... one generation to the next. And then I know that there are specific influences to the black community, just like what you're talking about.

Dr. Mazella Fuller:
Ellie, the most important thing is we have to look at the historical implications, from slavery, Jim Crow, to current day, in pipeline to prison. You know, we represent 13% of the population. It's about 46 million, I guess, but we're 40% black people in the... Mostly black men in the prisons. And because I'm an economist, too, I went to school to have a... I have a econ degree. And so, I look at everything in terms of dollars. And so, economically speaking, black people are still at the bottom. Even with PhDs or MDs, we still don't make the same amount of money as our white counterparts or other counterparts.

Dr. Mazella Fuller:
Until we address the slavery, reckon with the implications of slavery, and give people a leg up in terms of the social piece, the social piece of, if we want to say, what does that look like? Interpersonal racism at work, not giving people promotions, institutional policies that does not promote fairness, or just societal things. I guess that's where I want to land, a little bit around the economic piece and the historical impact of slavery that we're still struggling with in 2021.

Dr. Charlynn Small:
You're exactly right. In terms of the intergenerational piece that you mentioned, Ellie, 50 years ago, when my father taught my oldest brother how to drive, he said, "If you get stopped by the police, put your hands in plain sight, don't make any sudden moves, okay?" 12 years after that, when he taught my other brother and I how to drive, we were admonished similarly, "You get stopped by the police, you don't make any sudden moves. You put your hands in plain sight." My children are 17 and 19, they're new drivers. I had to give them the exact same caution. And rest assured, if my children have children, they will have to tell their children the same things.

Ellie Pike:
I want to emphasize the toll that hypervigilance takes on an individual's mental health, especially when it's compounded over time through multiple generations. Charlynn's family isn't the only one that has to view every car ride as a potential for a deadly interaction with law enforcement. I have friends and family who must teach their kids the exact same thing. Yet, for me and my parents and their parents before them, we never had to learn to drive that way. It may sound small, but it's one of the many ways white privilege creates an experiential divide. Something normal for me, like driving, which takes a very small psychological toll, may be an anxiety-producing daily routine that takes an enormous psychological toll for someone else.

Dr. Charlynn Small:
These are our daily lived experiences. And, Mazella talked about not getting the accolades or the promotions and so forth. That resonates with me that that's a big thing. We have to be as sharp. Excellence must be the order of the day for us. And then, still, when we don't get that raise, when we know that we have done work that is as good as anyone else, and we still don't get that promotion, or we still don't make the same amount of money as our counterparts, these kind of things weigh on us all the time, and we're constantly asking why.

Ellie Pike:
When I hear you both talk, I hear two pieces that are so intertwined. It's the hundreds of years of intergenerational trauma and survival, the fight for survival, and then the daily stressors and the constant anxiety that you feel, which is also another fight for survival. And one thing that stood out for me when I was reading your book was talking about the distrust of the healthcare system and the history there. And I remember reading The Immortal Life of Henrietta Lacks, and being so surprised that this was as recent as it was. [crosstalk 00:13:23].

Ellie Pike:
Let me explain a little more about Henrietta Lacks. She was a black woman with cervical cancer who sought treatment in 1951 from Johns Hopkins Hospital. The healthcare system harvested her cancer cells, cloned them, and sold them, all without her permission. Her cells lived for many years as tools for research, but she and her family were only recently given acknowledgment and scientific papers in 2013. Okay, back to the interview. Maybe you all can share a couple of those defining moments in history, in healthcare that have really caused distrust for the black community.

Dr. Charlynn Small:
We can take you back, way on back. I can talk about Dr. Walter Plecker. He was director of Virginia's Bureau of Vital Statistics. And this person said that there was no way a black man could be remotely similar to a white man, mentally or morally. And if you talk in terms of stereotypes, you have to say that these things have some longevity. For instance, the CEO of Wells Fargo said something similar. These things just, they persist and they hurt. And professionals see members of these groups as worthless sometimes. How well motivated will you be if this is what you're up against? Some persons have said that black persons are immune to mental illness. This according to John Galt in 1848, whoever he was, he said that we were immune to mental illness because we hadn't been exposed to the daily mental excitement of the free population.

Dr. Charlynn Small:
Okay, two years later, physician podcast, in 1851, decided that we were not immune to mental illness, because he determined that any slave that wanted to run away from slavery wanted to run away from being beaten and raped and sold and having their babies snatched out of their arms and sold. And these people who work from can't see in the morning to can't see at night, they must have been out of their cotton-picking minds to want to run away from the plantation. He called this drapetomania.

Dr. Charlynn Small:
Black men who demonstrated for civil rights in the 60s and so forth, they were called schizophrenic. If they developed these hostile and aggressive feelings, they were somehow mentally ill. White persons, Jewish persons who are survivors of the Holocaust, and their descendants, they can qualify for a diagnosis of PTSD, and perhaps they should. However, black persons who are descendants of slavery, we don't qualify for a diagnosis of PTSD.

Dr. Mazella Fuller:
If you don't have the resources, Ellie, whether is environmental stressors, acculturative stress is everywhere. And the thing is, why wouldn't people be skeptical about going to... You get misdiagnosis, poor quality treatment. People aren't competent enough. They don't understand your culture, because you have to understand a person's culture before you can serve them and before they can trust you. We can lead right into, we are indeed dealing with a public health crisis with the coronavirus and the pandemic, so we already know that when you shake this up, 55% of blacks live in places where there is no health care, they've shut down all the hospitals. This is real stuff. We talking policy.

Dr. Charlynn Small:
And it's more than medical deserts. Sometimes, you can't even purchase good medical care when you're right among the best, I'm thinking of Serena.

Ellie Pike:
I'm going to quickly interject for those of you who aren't immediately aware that Dr. Small is talking about tennis superstar, Serena Williams. She endured a life-threatening hospital visit for the delivery of her baby that was made far worse because nobody took her seriously, a situation all too familiar for black women. In fact, the Centers for Disease Control and Prevention report that black women in the United States are over three times more likely to die from pregnancy or childbirth related causes.

Dr. Charlynn Small:
All right, come on now. Serena, when she was having that baby, she told people, "Look, this isn't right." Because, you know, she had all kinds of problems with the blood clots, and she told people, "Listen, I feel like I did when I was having these blood clots." That almost took her away, but her nurses told her, "Oh, you know, it's just the medication that you're taking is making you feel this way." No one would believe her. She said, "Listen, I need to have a CAT scan, and I need to start my drip." Ultimately, she continued to advocate for herself, and they did an MRI or something, but it wasn't what she asked to have done.

Dr. Charlynn Small:
And those things turned out to be within normal limits. And subsequently, she finally did get the scan that she requested. And she, once again was, her lungs were full of clots. And this led to six additional surgeries, while she was in the hospital trying to have this one little baby. So in addition to the medical deserts, you have people that somehow think that we don't know anything about ourselves. We have lived in our bodies for all of these years, but we're not taken seriously when we say there's something wrong, and there's something wrong with that.

Ellie Pike:
Something wrong, indeed, because it's not just Serena Williams, and it's not just medical deserts. These are only a few examples of why the black community distrust the healthcare system. So when a crisis actually does arise and quality health care is needed, that justifiable distrust only inhibits the access to care. There's absolutely something wrong with that. And you both did such an incredible job sharing about the history, and just this long running history of denying mental health to the black community, and really creating distress within the healthcare system and medical deserts. How far actually have we come? When you think about where we are today, are there any successes along the road?

Dr. Mazella Fuller:
We have a long way to go, Ellie, no doubt. But I think we've come a long way, too. I really do. And for example, because you have to think about how many providers, or like, I'm just going to speak for about black providers, whether they're psychiatry, psychology, or social work, or other mental MHPs, mental health professionals. And the percentage is very, very low. So the hope is, I think, and where we've come is that the people who are hold the majority of these positions, because it's, no matter what you say, in the majority of mental health positions are white men that hold the executive offices.

Dr. Mazella Fuller:
So the decision makers, Ellie, will have to share power. You will have to bring on more staff of people of color, and people who are willing to advance the equity, not... We can sometimes have people of color, and there, no one is monolithic. So the people that you hired need to be aligned with the values that you're looking for, if you're advancing more or less for... Speak it like, "Okay, we want more therapists on staff. We want more directors of our businesses." Or, "We want an advisory board." If you don't want to hire anyone, then get the cheaper ways to get you an advisory board that represent the people you're trying to access.

Ellie Pike:
You know, kind of honing it back in to the black community, I'm curious what the conversations are within the black community about mental health and mental health services, too.

Dr. Mazella Fuller:
Well, it's a lot of talk, I can tell you that, from stigma, paranoia, healthy paranoia now, not schizophrenic kind, and trust. So that's what everybody's talking about in the black community. And I'm telling you, you can look at Black Girls Therapy. And, I mean, you can just kind of Google up now a lot, and you see more... I've seen more now than I've seen in my 25 or 30-year history of, people are taking it and don't create [inaudible 00:23:04]. They have their own... Like, all my doctors, all my physicians are black. It's not like they're running away, but they are still dealing with some of the misconceptions, and they're still like Serena, or Beyonce, or Jay. They don't have to be icons, they can be everyday women. I have a very friend who is a PhD therapist, black daughter lost her baby with all the stressors. So this stuff is real in our real community. We want to be well.

Dr. Charlynn Small:
We absolutely do. And if we can't have people that look like us, I have a cousin in Staten Island, New York, he's two years older than me. He's 62. He told me that he has never in his life had a black physician, not a dentist, not nothing, living in Staten Island. I have had mostly black doctors, but then, I've had white ones that were really good, but you got to want to be an ally. You got to want to help these people. And, unfortunately, everybody doesn't.

Ellie Pike:
Thank you for listening to part one of our two-part conversation with Dr. Mazella Fuller, and Dr. Charlynn Small about the story of mental health in the black community. These episodes only scratch the surface of the work that they've done to share this story with the world. I highly encourage you, especially if you're a clinician to pick up a copy of their book, Treating Black Women with Eating Disorders: A Clinician's Guide. We'll link to it, as well as some of their historical sources in our show notes. Join us for our next episode when our guests provide practical tools for both clinicians and the rest of us to become more inclusive and equitable in supporting mental health.

Ellie Pike:
Mental Note podcast is brought to you by Eating Recovery Center & Pathlight Mood & Anxiety Center. If you'd like to talk to a trained therapist to see if treatment is right for you, please call them at 877-411-9578. They also provide a support group for the BiPAP community on Monday evenings. Check it out, and join at eatingrecovery.com, or pathlightbh.com. Speaking of our sponsor, I'd love to invite you to an inspiring event they're hosting this coming March 4, with activist, Sonya Renee Taylor, author of the bestselling book, The Body Is Not an Apology: The Power of Radical Self-Love.

Ellie Pike:
Sonya is a leader in the body positivity movement, and is recognized around the world for helping people see themselves and others with fierce appreciation. Register for free at eatingrecovery.com/events. You can sign up for our E-newsletter, and learn more about the people we interview at mentalnotepodcast.com. We'd also love it if you left us a review on iTunes, it helps others find our podcast. Mental Note is produced and hosted by me, Ellie Pike, and directed by Sam Pike. Till next time.

Presented by

Mazella Fuller, PhD, MSW, LCSW, CEDS

I am a staff social worker at CAPS and Clinical Associate in the Department of Psychiatry and Behavioral Sciences. I graduated from Smith College School for Social Work and completed my c...
Presented by

Charlynn Small Ph.D

Dr. Small began working at CAPS in 2004 as a post-doctoral intern. She serves as chairperson of the University’s Eating and Body Image Concerns (EBIC) team. She is a frequent speaker a...

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