When Terrie Williams, an African-American writer, speaker, and public-relations consultant, wrote about her experience with depression in a 2006 article in Essence, a magazine aimed at black women, she and her editors reaped a response they had not counted on.

"I was stunned," she told Psychiatric News, by the number of readers who wrote to the magazine to share their stories of often untreated emotional suffering. "It was overwhelming. I wasn't prepared for the depth of pain and gut-wrenching stories from people who just finally have an opportunity to pour out their childhood wounds.

"There was something sobering about receiving so many letters and seeing them in print [and] about the fact that I was the only person they had ever told," said Williams.

The flood prompted her to write a book, Black Pain: It Just Looks Like We're Not Hurting, published this year by Scribner. Part confession, part advocacy, part history lesson, and part resource guide to finding treatment and support, the book is a frontal assault on what Williams calls the silence that surrounds depression and other mental illnesses in the black community.

"I wanted the book to be accessible and in your face about why we as individuals and a community are dying," she said in an interview.

In October Williams brought her message to a special" Conversations" event sponsored by the American Psychiatric Foundation at the APA Institute on Psychiatric Services, where she spoke before an audience with psychiatrist Altha Stewart, M.D.FIG1

Her book has garnered praise from many quarters, including from APA Director of Minority and National Affairs Annelle Primm, M.D., and Chicago-based community psychiatrist Carl Bell, M.D. In a lengthy quote prefacing the book, Primm wrote that Williams "lifts the veil on Black trauma, loss, and victimization, validating our daily strife and lifelong struggles."

Primm added, "Terrie explains the source and impact of Black psychological wounds and demoralization. She gently removes the armor, looks behind it, and helps us realize that this is shared pain and we are not alone. The book reminds us that the strength and resources of the village must be brought to bear to open the door to break the silence, neutralize the pain, harness hope, and set free our collective spirit."

Williams is also president and founder of the Stay Strong Foundation, which works to "support, educate, and inspire America's youth through a series of programs and events that are designed to raise awareness of teen issues, promote the personal well-being of young people, and enhance their educational and professional development."

Williams is especially passionate about the value of psychotherapy and the need to make it accessible and acceptable to African-American communities.

"I think it's necessary to breathe, to really live," she said." But as a community [African Americans] are not familiar with therapy and don't feel entitled to the therapeutic community as a whole. It's just not thought of as an option."

But there are exceptions. In the chapter "I Wish It Would Rain," in which she focuses on the legacy of anguish borne by black men, Williams describes t he experience of one psychiatrist, Denese Shervington, M.D., M.P.H., a professor of clinical psychiatry at Columbia University Medical Center, who successfully used psychotherapy as an adjunct to a traditional drug-treatment program for cocaine-addicted black men.

"Not only did the black men come to therapy, they came on time, looked forward to their sessions, and were eager to be heard," Williams wrote in her book.

Williams also wrote that African Americans would "be more receptive to therapy if we could see racially sensitive therapists at rates that were affordable to us."

In an interview with Psychiatric News, she said that being racially sensitive doesn't necessarily require that a therapist be of the same race or ethnicity as the patient. Williams calls it a matter of professionalism.

"When I take on a project, I have to identify the different audiences I am trying to address and tailor the message accordingly," she said." So when you are going to take on a particular patient, if you are really good at what you do, you make it your business to do a little research."

Williams described vignettes of the nuanced social and psychological adjustments black men and women are required to make on a daily basis, accommodations to social conditioning that go largely unnoticed by others: tall, strong, black men who walk or hold themselves differently so as to not to appear intimidating, for example, or the heightened fear some very dark-skinned black men have learned to expect from others.

"Or what happens to your spirit when a white woman clutches her bag in an elevator or on the street [in the presence of a black man] just because it's second nature," Williams said. "It's not just rolling off your back; it's having an effect on you."

Too often, she said, these ingrained responses play out in pathologies with larger, socially tragic consequences. "In the streets every single day, we are taking each other out. We are in pain, and we haven't even named it."

Her book also takes on the subject of spirituality—the need for it in any healing and the importance of Christian spirituality throughout African-American history—but also the resistance some black clergy and churchgoers may have to viewing emotional suffering through the lens of mental health and illness.

"We have a long way to go," Williams told Psychiatric News. "There are a lot of people who believe depression is the devil, who believe that you pray it away and that anything other than prayer is a betrayal of God."

She recalled speaking to a church congregation. "The minister stood up and started by saying he had never spoken about this publicly," Williams recalled. "He said that when he was 2 years old, he was told his mother was dead." In fact, it turned out she was in a psychiatric hospital.

But there is evidence that the tide is turning. In this fall's edition of the magazine Real Health: The Guide to Black Wellness, the featured article is titled "Take Off the Mask: Understand Depression and Take Control of Your Life."

The article recounted the story of a black teenager who jumped from the window of his parents' apartment. He survived with shattered leg, broken pelvis and jaw, and a fractured wrist. Several months later he was sitting in a wheelchair sharing his story at a congressional briefing on the stigma of mental illness.

"Parents and young adults should know the symptoms and should know where or how to get help," the youngster is quoted as saying. "And if telling my story saves a life, then I know why God saved me and why I have the integrity to tell my story."

Information about the Stay Strong Foundation, including how to volunteer, is posted at<www.thestaystrongfoundation.org>.▪