A Guide to Contextualizing the Reality of Systemic Racism and Black Suicidology

These past months, I have been engulfed in a haze of 24/7 media coverage. It began with the COVID-19 pandemic, filling me with increasing anxiety. The mortality rate for COVID-19 has been disproportionately affecting the African American, Latinx, and Indigenous communities.¹ I worried about my family members whose positionality reflects comorbidities, older age, and minority populations. The hospitalization/death of family members and family friends has left me physically exhausted—experiencing insomnia and feeling mentally drained. I was still glued to the television when the recorded murder of George Floyd literally ignited America.

We Black professionals have learned how to master navigating through the murky waters of microaggressions and institutionalized oppression. Over a duration, I thought the clout of respectability politics – the discourse that professional minorities can rise above racism due to their professional status – would shield me from this. I was wrong. I have awakened, this week, with a complete comprehension of my positionality as a mental health professional, and a clear understanding of the context of suicide among Black Americans.

This article, the first in a series, is written with the objective of examining the social-political context of Black suicidology. We will examine the historical catalyst that has created the “perfect storm” of racial civil unrest and trauma within the Black community. The main goal is to understand how this impacts the growing trend of suicide among Black youth.²

Psychological Theories on Black Suicide

Postulated by Dr. Joy Degruy, the theory of Post-traumatic Slave Syndrome asserts that chattel slavery (which allowed people — considered legal property — to be bought, sold, and owned forever) left a legacy of intergenerational, psychological trauma on the descendants of enslaved Africans.³ It is represented in the current mental health crisis and racial disparities that we observe today. Another theorist, psychiatrist Dr. Alvin Poussaint, elaborates that the stigmatization of depression/suicide within the Black community, compounded with the minimalization of the mental health crisis by mental health professionals, constructs the current rise in suicide among Black boys and men.⁴ These scholars argue that suicide is a symptom of a larger trauma that Black people endure.

To enhance our comprehension of these theories, let us visualize the traumatic stress of the Black community in comparison to a rubber band. A moderate amount of stress, which is a natural reaction to stimuli within our environment, is intrinsically linked to our survival. Similarly, a rubber band is engineered to be elastic and handle a moderate amount of stress and tension. However, when too much force is exerted, without any release, the rubber band will snap.

In recent years, suicidal behavior among Black youth has significantly increased.⁵ As experts across a multitude of specialties continue to work in understanding the methodology behind this trend, we can look to previous and current events to paint a snapshot of what in the world is happening. In my opinion, the vicarious trauma experienced by the Black collective – because of repeated exposure to stress – has cultivated the internal and external stress that is currently present.

This stress is not random nor coincidental; it is systemic. African Americans have been funneled through imperialism, the trans-Atlantic slave trade, chattel slavery, Jim Crow, the Civil Rights Movement, and a “post-racial” America. In between these defining moments, space has not been created to holistically heal and breathe.

The COVID-19 pandemic, which disproportionately impacts African Americans, has increased these tensions. African Americans mostly reside in densely populated cities. Their homes are often intergenerational and contain extended family. They are more likely to lack medical/mental health resources, preventive care, are overrepresented in the prison system, are essential/critical workers, have little to no sick time, and work under horrible working conditions. ⁶

These stresses are heightened by the political racial divide that has resurfaced as a result of the killings of Ahmaud Aubrey, Breonna Taylor, and George Floyd. The global protest we are witnessing in this historical era is directed at police brutality. Within their lifetimes, Black boys and men are at the highest risk of being killed by police than any other racial group.⁷

The Role of Social Media

I think it is important to also understand the role social media plays in all of this. On one hand, it serves as a platform to facilitate the quick distribution of information to a large mass of individuals. This helps to circulate instances of police brutality and other discriminations to the masses, which helps mobilize movements within activism.

On the other hand, the lack of filtering violence has repeatedly exposed adolescents to images of brutalized Black bodies. You can easily find, as you scroll through your social media feed, at least one if not several uncensored videos or images of Black traumatization. For Generation Z, where technology and social media are embedded in their daily lives, these images may have adverse effects.

How does the repeated exposure to these images influence the psyche of Black youth? Does it correlate with or contribute to the increased suicidal behavior among Black youth? The present pandemic and police brutality together cultivate the conditions for a global protest and increase mental health dysfunctions that are currently apparent. Comparable to the upward trend of Black youth suicide, the disproportionate mortality rate of COVID-19 and police brutality may be linked to the systemic overlap of marginalization.

Connecting Systemic Racism to Black Youth Suicide

What does this all have to do with Black youth suicide? Black suicidology does not exist within a vacuum. It is situational and framed by a multitude of factors. Therefore, it is important to contextualize the collective experience. And in a society with a history of racial division, we cannot separate the system from the context. The growing trend of suicide among Black youth is a symptom of systemic racism and the systematic marginalization of Black experiences.

For example, a recent study documented that several White doctors hold racial beliefs that “Black people have physically tougher skin” and “have a higher pain threshold than White patients”.⁷ Perceived racial biases such as these contribute to the systematic mistreatment of Black people by the medical field. Black women have a maternal mortality rate that is three times higher than White women. ADHD Black youth are often underdiagnosed or misdiagnosed with Oppositional Defiant Disorder (ODD).⁹

Although Black youth are the fastest growing group within adolescents for suicidal behavior, Black people are underrepresented in suicide-related research and treatment, and as mental health professionals. The patterns that we are observing are conditioned upon institutionalized racism. How do we address Black suicide without acknowledging the whole system?

It is like a hive of hornets have built a nest in your attic, and instead of removing the whole nest, you spend your days and nights shooing away the hornets around you. The underlying causes of the problem persist.

The Role of Mental Health Professionals

The Black mental health crisis is a residual effect of a system that needs reforming. This state of emergency has been afire for over four-hundred years. What steps can we in the mental health field take to increase the efficacy of treatment for Black suicidal behavior?

When we address Black suicidology, it is essential to address the impact of racism on our clients’ experiences. It is essential to evaluate institutionalized oppression holistically – meaning, examine how housing, financial, economic, environmental, and other social factors directly impact your client. As we address and acknowledge systemic oppression, we as mental health professionals must strive to understand the whole picture.

I think that as mental health professionals it is our responsibility to acknowledge and strive to understand and act upon the uniqueness of the Black life experience. I conclude that there are five main components in reforming the ways we deal with racial disparities within Black suicidology.

1. Provide more inclusive research. As with research in general, the general body of suicide research currently focuses on Whiteness. We need to fund more research tailored to addressing the unique experiences of Black people. We cannot be under the assumption that research impacts people of color similarly to Whites. It is essential to acknowledge and address how cultural/social differences should effect specialized nuances in assessment and treatment methodology.
2. Integrate the community. The survival of Black America is built on community, family structure, and the church. To address suicide, we must meet clients where they are. As CAMS and other effective treatments understand, the individual is the expert on their own experience. People know what they need, and it is our objective to provide them with the tools and terminology for their mental health. For example, many in the Black community may describe suicidal behavior as a manifestation of physical pain (ex., “I’m feeling pain in my stomach” or “my head hurts”) or as a symptom of “strange” behavior (i.e., “my child is being lazy” or “her behavior has been changed”). Mental health professionals not versed in these cultural differences may dismiss, overlook, and misdiagnose their clients.
3. Introduce accessible mental health services. Accessibility refers to providing services in communities of color and services that are affordable. We have discussed the political and social disparities that make accessible mental health services difficult. Accessibility is crucial in the struggle to combat suicide in the Black community.
4. Fund evidence-based treatments that support multicultural therapy. There is limited research on the efficacy of treatments/therapies directed specifically towards Black trauma and suicide. We are not fully adept at understanding what works; however, of the literature available, treatments that are multicultural in nature are most effective with this community. Multicultural treatments integrate a collaborative (client-led) and community-centered approach.
5. Educate and hire more Black mental health providers. Due to a history of medical/mental health racism, there is distrust of the mental health field by Black people.¹¹ Is it fair to expect marginalized people to freely interact with a system they perceive to be oppressive? Instead, it is more beneficial to validate and empathize with our clients, and Black mental health providers are most inherently suited for this. Therefore, we need more Black mental health professionals who more likely possess an acute understanding of the lived experiences of those they are treating.

Next Steps

We are experiencing a shift in the American conscious. As Black Americans continue to deal with stressors of racism, mental health services are a necessity.

What is our responsibility in providing preventive measures and intervention to this community during these extraordinary times? How do we continue to address the growing trend of suicidal behavior among Black youth? What is our responsibility as mental health providers in comprehending the pain of our clients, colleagues, and students?

These questions form the basis of conversations that need to happen in our field, but it starts with acknowledging the reality of systemic racism, the impact of institutionalized marginalization and racial disparities, and the psychological toll it takes to survive.

References:

1. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
2. Degruy, Joy. (2005). Post traumatic slave syndrome: America’s legacy of enduring injury and healing. Milwaukie, Oregon: Upton Press.
3. https://www.npr.org/templates/story/story.php?storyId=5070636
4. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
5. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/racial-ethnic-minorities.html
6. https://www.pnas.org/content/116/34/16793
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/