Deep-seated racism in the United States sets in motion a "vicious
cycle" whose psychological and biological consequences have a crushing
impact on health status. Depression and all its sequelae are an inevitable and
particularly devastating part of this cycle, Annelle Primm, M.D., told a
special meeting of the Congressional Black Caucus in September.
Carl Bell, M.D.: Caucus members should take steps to ensure that"
the underserved get the benefit" of new technology to identify
people at risk of developing serious mental health problems.
Annelle Primm, M.D.: African Americans "receive inferior or
inadequate treatment, or, worse, our symptoms are misunderstood, and we are
diagnosed with schizophrenia."
Primm is director of the APA Office of Minority and National Affairs and
was part of a panel that addressed the impact of racism on behavior and
Also on the panel was psychiatrist Carl Bell, M.D., president and CEO of
the Community Mental Health Council in Chicago and a professor of psychiatry
and public health at the University of Illinois at Chicago.
Describing for the caucus members what she meant by the vicious cycle set
into motion by racism, Primm said, "When we have a mental illness like
depression, we are very likely not aware that we are ill, we tend to stay away
from psychiatrists and mental health professionals because of the stigma, we
may stay away from physicians... because we are uninsured, but even if we
happen to get in the door of some health provider, we are less likely to be
diagnosed at all, we receive inferior or inadequate treatment, or, worse, our
symptoms are misunderstood, and we are diagnosed with
She emphasized that when quality medical care, including that for
depression, is unavailable or unaccessed, as in so many minority communities,
physical illnesses such as diabetes and heart disease spiral out of control.
And filling the void where medical care should be are alcohol and drugs, which"
are available 24-7, and 365. This kicks the vicious cycle into
overdrive," she said.
"The double whammy" of untreated mental illness and substance
abuse, with the impaired judgment they often bring, then propels people"
down a path of destruction—violence, homicide, suicide,
incarceration, [and] exposure to diseases like HIV/AIDS."
Bell's message was that "when you consider the socioeconomic
conditions that African Americans face, and the inherent toxicity of
underserved and unresourced environments—created by a system of racism
that goes back to slavery—and you consider the levels of adverse
childhood experiences, it is little wonder that African Americans have greater
rates" of the most serious physical illnesses.
He also wanted caucus members to understand that "there is a huge
paradigm shift coming in mental health in which psychiatrists will be able to
identify people at risk of developing serious mental health problems,"
and he hoped they would take steps to ensure that "the underserved get
the benefit of this new technology that is on the horizon."
Primm told caucus members that despite the bleak picture she painted of the
health consequences that stem from centuries of racism, she wanted her talk to
end with some hope.
For her part, she said, "Even if it takes me 10 years, I want to tour
the country in areas where there are high concentrations of people of African
descent and other marginalized populations" to help those who can make a
difference "understand the impact of mental health disparities on
overall health, to increase diversity in the health and mental health
professions, to share models that work, to educate the public about mental
health in a culturally tailored way,... and to stop the vicious cycle."▪