The Washingtonian’s View

In the United States, an estimated almost 3 million people have bipolar disorder.  The disorder is commonly referred to as manic-depressive illness. An individual who suffers day to day with bipolar disorder can go from feeling very, very high (called mania) to feeling very, very low (depression).

Overall, only one-third of Americans with a mental illness or a mental health problem get care. Yet, the percentage of African-Americans receiving needed care is only half that of non-Hispanic whites. One study reported that nearly 60% of older African American adults were not receiving needed services.

With proper treatment (a combination of medication and proper cognitive behavioural therapy), people can control these mood swings and lead successfully fulfilling lives. The rate of those with bipolar disorder is about the same between African-Americans and other Americans.  Unfortunately, African-Americans are less likely to receive a diagnosis and, therefore, treatment for this illness.

Education is lacking overall, in making people aware of various mental health disorders.   But sadly minorities are less educated about mental disorders in general.  Without proper education and training, one never knows what to look for with the disorder.

There are several reasons that have contributed to African-Americans not receiving help for bipolar disorder and other mental illnesses.

In the African-American community there is often a general mistrust of health professionals.  This is based in part on historically higher-than-average institutionalization of African Americans with mental illness (which some agencies look at as a form of racism).  Other African-Americans have a mistrust based on previous mistreatments, like such tragic events as the Tuskegee syphilis study.

Another reason is the cultural barriers between many doctors and their patients.  Many of the patients come from other lands where there ideas of mental illnesses are connected to witchcraft or mystical ideas. 

Also in the African-American community there is a stronger belief in family and religion than mental health professionals.  In moments of emotional distress, African-Americans have been noted as saying, “God, please help me in this time of trouble” or “God!  Satan is trying to get a hold of me!  Please help!”   

African-Americans, minorities in general rather, tend to focus on physical problems, rather than mental symptoms.  Most commonly, when they are going through an episode, they may be more prone to masking the symptoms by taking drugs and alcohol.  Sometimes even with other medical conditions.

Another area is the socioeconomic factors which can limit access to medical and mental health care.  In this case, most African-Americans (those in a more urban setting) get their care from medical trucks that come into the neighbourhood every-so-often.  Unsurprisingly, about 25 percent of African-Americans do not have health insurance, and consider their care coming from these medical trucks or hospital emergency rooms. 

Nearly 1 in 4 African Americans is uninsured, compared to 16% of the U.S. population. Rates of employer-based health coverage are just over 50% for employed African Americans, compared to over 70% for employed non-Hispanic whites. Medicaid covers nearly 21% of African Americans.

The public mental health safety net of hospitals, community health centers, and local health departments are vital to many African Americans, especially to those in high-need populations. African Americans account for only 2% of psychiatrists, 2% of psychologists, and 4% of social workers in the United States.

The biggest thing probably has to be the continued misunderstanding and stigma about mental illness.  African-Americans will equate the person who has a mental defect as socially unacceptable.  They will also attempt to ‘hide’ the person.  Society says this person is unwell and thus, they aren’t socially fit to be part of the collective.

While few clinical trials have evaluated the response of African Americans to evidence-based treatment, the limited data available suggest that, for the most part, African Americans respond favorably to treatment. However, there is cause for concern about the appropriateness of some diagnostic and treatment procedures. For example, when compared to whites who exhibit the same symptoms, African Americans tend to be diagnosed more frequently with schizophrenia and less frequently with affective disorders.

You have to watch for the signs of bipolar disorder.  Mental Health America, a nonprofit, gives a good list of things one should look out for. 

Bipolar disorder often rears its ugly head in the teen years.  In fact, African-Americans of all ages are under represented in outpatient treatment but overrepresented in inpatient treatment.   Although the disorder in a majority of cases forms during the teenage years, it sometimes doesn’t become noticeable until years afterwards.  The disorder is a potentially life-threatening illness (if it goes untreated).  An individual who suffers from bipolar disorder needs a good support system.  Like many things, success is only possible if a person is willing to work on it.  NOTE:  Tragically, one of five people with bipolar disorder commits suicide.

Studies have shown that blacks metabolize psychiatric medications more slowly than whites.  With this information, it is believed that blacks often receive higher dosages than do whites.  This can lead to more severe side effects. As a result, they may stop taking medications at a greater rate than whites with similar diagnoses.

 The signs of bipolar disorder include:

Mania

·       Excessive energy, restlessness, racing thoughts and rapid talking

·       Denial that anything is wrong

·       Extremely happy feelings

·       Easily irritated

·       Needing little sleep

·       Unrealistic belief in one’s ability

·       Poor judgment

·       Sustained, unusual behavior

·       Increased sex drive

·       Substance abuse

·       Aggressive behavior

·       Paranoia

Depression

·       Poor appetite or eating too much

·       Trouble sleeping or sleeping too much

·       Nervousness and worry

·       Loss of interest in and withdrawal from usual activities

·       Feelings of sadness that don’t go away

·       Irritability or restlessness

·       Lack of energy

·       Feelings of sadness, worthlessness or guilt

·       Inability to think or concentrate

·       Repeated thoughts of death or suicide

·       Chronic pain or other physical problems that don’t respond to treatment

·       High risk-taking behavior, including reckless driving or substance abuse

There is no clear sign of what exactly causes bipolar disorder.  Thankfully scientists who have devoted years upon years of research in the field, have concluded:

Brain chemistry – There are chemical changes or imbalances in the brain during both extremes of behavior (mania and depression).

Genetics – Close relatives of people with bipolar disorder are 10 to 20 times more likely to get depression or bipolar disorder than other people.

Drug and alcohol abuse – More than half of the people diagnosed with bipolar disorder have histories of substance abuse. In some cases, substance abuse precedes the development of the problem; in others, alcohol or other drugs may be used as a form of self-medication.

Stressful or disturbing events – Both can cause mood swings

There is hope. People with bipolar disorder can be helped by treatment. Treatment can include:

Medication – one or more medicines may be requested by doctor.   

Counseling – psychotherapy or other forms of counseling.   

Peer Support – advice of others with bipolar disorder can aid recovery.

Complementary Care – exercise and distressing activities.   

ECT, or electroconvulsive therapy – This is used as a last resort to treat severe bouts of depression and suicidal thoughts. It’s only considered when medication and therapy haven’t worked.

Resources

National Medical Association
(for a list of African American doctors)
(888) 662-7497
www.nmanet.org

Black Psychiatrists of America
(510) 834-7103

American Association of Pastoral Counselors
www.aapc.org

Depression and Bipolar Support Alliance (DBSA)
Website URL: www.dbsalliance.org

American Psychiatric Association
Email Address: apa@psych.org
Website URL: www.psych.org