Chil if I need to talk to someone about my troubles, I just call on the Lord.
and/or
What I need with some psychologist telling me what to do? I ain’t paying nobody to tell me something obvious.

These are some of the reasons I have heard over the years on why many African America people do not seek therapy. I’ll be the first to say that this attitude is slowly, ever so slowly changing. Now, that there are books published by African Americans about mental illnesses such as depression, there are more (usually younger adults) who acknowledge that we too, can become mentally ill.
I am diverging from the topic of Ruby a bit because this topic has been on my mind for quite some time and I wanted to blog about therapy and its role in helping individuals with their mental health issues. First, I wanted to speak on what it is NOT.

Many of us have watched t.v. shows such as Dr. Phil where the host presents individuals who are in a situation or have a mental health issue. The host usually chastises the individual depending on the situation such as situations of spousal abuse, the host quickly makes an assessment: “You need to leave” or for someone who is a drug addict: “You need to get help.”
I agree with the conclusions but not the process because everything has to be placed in context. Most shows are approximately 45-50 minutes (commercials cut into that hour slot) so we do not get to see how individuals evolve which is one of the major goals of therapy.

You cannot solve a mental health issue in 45-50 minutes and what we are watching is NOT therapy but entertainment with a slice of applied psychology. Therapy is the hard work of changing, adjusting, relearning and acceptance all of which can be difficult if not downright painful. Therapy is not the process of a therapist cosigning our perceptions about ourselves and our lives; especially if our assessments and behaviors undermine and cause harm. Our friends will say, “Uh-huh, you need to leave that alone.” Our pastors may say, “Pray about it.” Therapy challenges us with questions such as, “Why are you here and how does it benefit you?”

For many years, I wore a shroud of shame about my background because it remained visible yet silent. How could I explain her behavior when I didn’t understand what was going on? Nothing that she said or did could be attributed to alcohol or substance abuse. In fact, my mother was and continues to be vehemently against the use of street drugs and drinking. Other families whose parents had a substance abuse problem had a tangible thing that they could point to: “My mother/father is a drug addict/alcoholic” to explain their episodes of madness or neglect. Mental illness however, has no obvious causes even though it can be exasperated by stressors like experiencing and/or witnessing violence, death of a loved one, loss of a job and the most important of all- being African American in American society. It is not uncommon for an individual experiencing mental illness to abuse drugs or alcohol to alleviate or reduce the symptoms.
In the recent years, there has been more published in regards to African Americans and mental illness in media articles and books. I wanted to extend the conversation about mental illness from mood disorders such as depression to those whose mental illness diagnosis is categorized as a psychosis.
The Diagnostic and Statistical Manual of Mental Disorders 4th edition also known as the DSM-IV-TR is a manual used by mental health care counselors and other mental health workers to aid in the diagnosis of an individual. This text is used to diagnose both mood and psychotic disorders along with other mental health issues or abilities. Schizophrenia is categorized as one of many psychotic disorders with the following symptomology: distortions in thought content (delusions), perception (hallucinations), language and thought process (disorganized speech), and the lack of ability to self-monitor behaviors, disordered thinking, and emotional disconnection. Medication is prescribed for some disorders to either counter or balance the production of certain chemicals produced in the brain such as serotonin. In ideal instances, the medication aids in alleviating the symptoms while allowing the individual to live an active life.
NAMI (National Alliance of Mental Illness) found that Schizophrenia affects 2.5 million Americans. Although African Americans are only 12 percent of the American population, 25% have been diagnosed or treated for a mental illness with 3% diagnosed with schizophrenia or schizoaffective disorder. Further research has suggested that African Americans are oftentimes diagnosed with schizophrenia when in fact they may have other mental health issues.  This disease can have overwhelming implications for those who suffer from it as well as their families. In our family, my mother’s illness was never discussed. Instead, the episodes of giggling, audio and visual hallucinations, and delusions were referred to as “spells.”
 In discussing mental health issues with various people within the African American community, there is a misconception about an individual diagnosed with a mental illness versus someone who is developmentally delayed DD (formerly referred to as mentally retarded). One of the first steps in discussing the differences is defining each term.
What seems to occur in the discussions about mental illness versus someone who is developmentally delayed is a conflation of the two terms. In a conversation that I had with a health care worker in performing research for this text, she often said, “Well you know how child-like they are…” as a response to talking about mental illness. I often have to clarify that my mother is not developmentally delayed but even this term is complicated by the dual and recent diagnosis of dementia along with the Schizophrenia. What usually happens in these conversations is that I reemphasize the difference.
“Look,” I begin to explain. “My mother is a left brain thinker. She did calculus in high school—that stuff was fun to her. She taught me to read and write and to memorize my full name and address…”
Health Care Worker: “Oh, well…people with mental retardation can do that too?”
Me: “Even high functioning developmentally delayed people cannot do that.”
In short, her illness did not impact her cognitive ability but rather her perception of the world at large. It is not impossible for an individual to be developmentally delayed and diagnosed with a mental illness; rather, a mental illness does not necessarily mean that the individual is below average intelligence.
Secondly, the cause of developmental delay is usually attributed to genetic disorders or to factors that may have contributed to the development of the embryo in-utero such as substance abuse or birth defect amongst other factors. The range of ability for those who are developmentally delayed is described in three phases from Mild to Moderate to Severe Mental retardation. Individuals diagnosed as DD if mild, can acquire academic skills up to the sixth grade, learn basic vocational skills, and may be able to live independently with minimum guidance and supervision. Those who fall within the Moderate range demonstrate less ability to acquire academic skills up to the second grade, perform self-care, and learn basic vocational skills. DD individuals who are severe require assistance with personal care, have limited ability in acquiring basic academic skills and need full-time supervision. All levels may demonstrate an inability to socially interact with their peers but not always. Still, how can I describe the differences and why is it important to understand this?
In clarifying the differences, it is not my desire to place developmentally delayed individuals or their families under a shroud of shame. Each category deserves its distinctions and may require different treatment plans. It should be said that even within the range of people diagnosed with a mental illness, there are those whose diagnosis may have affected them so much that they need daily supervision and assistance in living their lives. I wish that my mother could have had this type of help so that she could have lived a productive life. She is an intelligent woman whose life was severely impacted by paranoid schizophrenia so much so that it cut off all avenues to a full life filled with family, friends, and achievements that she could proudly claim.
During the late sixties-early seventies when my mother was officially diagnosed, few people mentioned mental illness. It was not a mainstream topic nor one that took place within the community. This was also a period when mental institutions such as Camarillo Hospital had phased out permanent institutionalization of the severely mentally ill/disabled but offered no community support in its place. Most health insurance plans did not cover long-term mental health care treatment and many current insurance plans only offer limited if any mental health treatment.
Over the years, I have met other African Americans who have/had relatives diagnosed with a psychotic disorder. Our conversations tended to be closeted and it is only recently that a public dialogue on mental health has taken place in mainstream culture. In African American culture, mental illness is viewed from a myriad of perspectives, most of which is not helpful or useful in understanding our loved ones.    
Our family coped as most other families coped during that period.