Under the Microscope

Member of Congress Jesse Jackson, Jr. has been in the news recently as he continues his month-long leave of absence from the House of Representatives and receives care for a “mood disorder” at an undisclosed in-patient treatment facility.

That this man-gets-sick-man-gets-treatment story is getting more attention than it might otherwise merit is because the “man” is a Member of Congress and son of a famous leader in the Civil Rights movement and because, in an effort to recover away from the spotlight, decisions have been made to keep some aspects of his illness confidential—fewer, one might argue, than most of us would be comfortable with. 

In the absence of actual facts, we have speculation and an apparent green light to make an arm’s length diagnosis about the man and his mental health.  The echoes with last year’s open season on Charlie Sheen are unavoidable.

A Google search on Rep. Jackson and “mood disorder” or “mental health” will bring up plenty of hits.  Some will focus on the political implications (Mr. Jackson is up for re-election in November), some the mental health implications, some will talk about mental health disparities between African-Americans and the general population.  Should he resign his seat?  Why don’t they tell us where he is being treated and for what?  Shouldn’t his doctor be forced to release Jackson’s medical records?

As it happens, July is Minority Mental Health Awareness Month which means that irrespective of whether Mr. Jackson’s actions are consistent with our attitudes towards mental health, we have an opportunity to consider questions of mental health and mental illness from a more culturally appropriate perspective.

While different segments of the U.S. population as a whole appear to experience mental health conditions at similar rates (20-25%), treatment-seeking behavior varies significantly across cultural and ethnic groups.  For example, from the website of the American Psychiatric Association, we are told that “one out of three African Americans who need mental health care receives it.”

It is interesting to note that one study recently reported that Hispanic immigrants who have lived in the United States for an extended period of time, who have been “acculturated,” experience depression at significantly higher rates than do newly arrived immigrants.  The study’s authors suggest that the newly-arrived are sustained by their ties to their country of origin, their language, culture and family.  As the length of stay increases, those connections, that “social network”, begins to erode and the resulting isolation can impact the immigrant’s mental health.

The model of independence and self-sufficiency that informs the American character and the dominant culture’s attitudes towards healthcare runs counter to the cultural norms of many minority groups.

Diane Woods, founding president of the California-based African American Health Institute of San Bernardino County and author of a recently-released study of ways to reduce disparities in mental health care for black Californians, said in a recent interview:

We congregate together as groups and we like to be in groups. We like to interact with other people of like-mind and of like-thought,” Woods said. “The concept that even though you are not biologically related to an individual, because of our culture, and you come from African heritage, you come from a larger family. So you hear the terms, ‘brother, sister.’

When taken together with the central role that religion plays in many African-American communities it is easy to understand why persons experiencing a mental health condition might first go to their pastor or other member of their faith community before seeking a conventional behavioral health intervention.

It is also important to recognize that minority and immigrant communities experience higher rates of unemployment and poverty which also limit access to healthcare of any kind.

There are also historical biases to consider when trying to impact mental health in minority communities.  To be a member of any minority group is to be sensitive to the labels assigned by the dominant culture and this can extend from language-based misunderstandings to pejoratives like “snowback” and a diagnosis like “schizophrenic”:  each further marginalize and segregate. 

Proper diagnosis and treatment depend on a trust-based relationship between the patient and the provider of mental health services.  Absent reliable scientific tests to determine the state of the client’s mental health, the provider must make a determination based on interviews and, for populations that are too-often judged and found lacking, the disclosure of symptoms that suggest less than perfect mental health can be an impossible disclosure to make.

Rep. Jackson is in a tough spot that can make any recovery that much more difficult. 

Being an African-America public figure from a famous family means that there is no shortage of people watching his every action.  And, regardless of your culture of origin, one thing you can’t see under a microscope is recovery.

--Paddy Kutz

Executive Director