They’re crying out for help. But will anyone listen?
They are African-American men, struggling with mental illness and post-traumatic stress disorder—many are veterans, but many more are civilians struggling in secret, ashamed.
These are men like 26-year-old James Brown. Brown served two tours in Iraq. When he returned home he was diagnosed with PTSD. He ended up going to jail for a court-appointed sentence in 2012 in El Paso, Texas. That’s where several guards reportedly detained him in riot gear and forced him to the ground. He began bleeding through the ears, nose and mouth and his kidneys shut down. According to media reports, the guards did not order medical attention for him. He went into the jail on a Friday. By Sunday, he was dead.
Brown’s case, which is still pending investigation, points to many issues surrounding PTSD, the criminalization of mental health as it relates to black communities and disparities in treatment. PTSD severely affects people’s chances of gaining and maintaining steady employment. According to the National Coalition of Homeless Veterans, on any given night, nearly 50,000 veterans are homeless and roughly 40 percent of those homeless veterans are African American or Hispanic.
“It wasn’t until 1979, that PTSD became a legitimate mental health diagnosis,” Ron Armstead tells The Root. Armstead works with the Black Caucus Veterans Brain Trust to level disparities for black veterans. “Prior to 1979, there were problems targeting PTSD as a legitimate diagnosis. There still isn’t a silver bullet treatment for it. But there are a variety of treatment modalities that people are using.”
The issues surrounding PTSD and diagnosis are compounded by health disparities in African-American communities. Many African-American men are reluctant to go to the doctor because of misdiagnosis or mistreatment. There is also the perceived weakness surrounding asking for help for men. Armstead says many men may not see PTSD as something for which one even go to the doctor.
According to Dr. Annelle Primm, who has worked in the area of health disparities as it relates to African Americans for decades, co-founding a treatment program which provided in-home mental health treatment to patients, a PTSD diagnosis is more common in women than men, and that disparity holds true in African-American communities. Black men are less likely to receive a diagnosis of PTSD. The idea that coming forward for help is seen as a weakness, Primm says, is directly related to stereotypes that people hold of individuals with mental illness—that mental illness is laziness or a character flaw rather than a disease.
“Some black men, because of how they are socialized, think that people with mental health problems should snap out of it and literally pull themselves up by their bootstraps,” says Primm. “This attitude is particularly pronounced in military cultures.”
Dr. William Lawson, chair of the department of Howard University’s Department of Psychiatry and Behavioral Sciences, says that black veterans are more likely to experience PTSD because they are often on the front lines of battle and more likely to have experienced previous traumatic experiences. Lawson remembers a patient who kept seeing body parts floating in the air. The patient had been in a foxhole during Vietnam and a grenade fell down the hole and blew up everyone in it. He kept seeing visions of that happening.
Lawson says in many cases, like this patient, he found that doctors were misdiagnosing them as schizophrenic. PTSD, an anxiety disorder characterized by symptoms of flashbacks, nightmares, hypervigilance, being hyperreactive, and withdrawal, among other symptoms, is a diagnosis where veterans are given financial relief, whereas schizophrenia isn’t a diagnosis eligible for financial aid.
“We did testing and many people didn’t see PTSD as a black person’s disease because of racist notions,” Lawson said. “PTSD assumes that a person has insight and sensitivity. People assume that black people are invulnerable, that we do not have a functional apparatus to experience any kind of mood complexity.”
Outside the veterans’ system of support, there isn’t a lot of support for black men and PTSD. Thomas Mellman, a professor of psychiatry and director of the Center for Clinical and Translational Research and Stress/Sleep Studies Program at Howard’s College of Medicine, has been working on studies on black veterans and sleep disorders, but also of 18- to 35-year-olds and sleep disorders in inner-city areas in Washington, D.C., where violence and trauma have occurred. Mellman has found that talk therapy can be a healthy form of treatment and that having people write about their traumatic experiences went a long way toward relieving distress.
Dr. Tanya Alim, a Washington, D.C.-based psychiatrist, found during her studies that 50 percent of patients who had been exposed to trauma developed PTSD, but only 17 percent had been recognized and entered into treatment.
Armstead, who has been advocating for black veterans to elected officials for over 20 years, has found that a variety of treatment works to alleviate PTSD for African-American men who are skeptical about traditional treatment modalities.
“I never told them that they were in treatment or in therapy. They would come to me and say, ‘I just enjoy rapping with you.’ I never said to a veteran he was a patient or a client; he was a veteran and we talked like equals,” says Armstead. “For group therapy, we had ‘rap groups,’ instead of labeling it as therapeutic intervention.”
But first, it’s important for black men to seek treatment.
“There is a stigma associated with going to get help,” says Armstead. “Brothers won’t go in to a doctor until they see some blood.”