Writer's 20-year struggle with depression a window on a world where black men go untreated
By VIRGINIA ANDERSON
The Atlanta Journal-Constitution
Published on: 02/25/05 John Head — father of three healthy sons, winner of professional awards and husband to a prominent physician — looked at himself one day and reached a conclusion about his life and all the things that he had worked so hard to achieve.
It was time to kill himself.
No matter the distance he had traveled from the days as a boy growing up in Butts County: Feelings of worthlessness, sadness and hopelessness clogged his brain.
In comparison, death seemed soothing.
"I had this railing in my apartment, and I took the rope that I'd saved from my move," Head recalled last week. "I measured the rope and the distance from the railing, where I'd hang the rope, to a chair. I measured how long the rope would need to be. And I rehearsed it."
During his death rehearsal that day in 1996, he suddenly realized he'd be repeating the cycle, burdening his sons with the same loneliness he had endured as a black boy who didn't know his father.
Worse, his boys would grow up with the knowledge that their father had taken his life. It was at that moment that Head accepted, after 20 years, that he had a mental illness, depression.
"That was when I really knew that what I was going through was not only painful but deadly," said Head, 53." That was when I really opened up to the idea of getting treatment."
Head's experience led him to write "Standing in the Shadows: Understanding and Overcoming Depression in Black Men" ($22.95, Broadway Books), published last fall.
Mental health officials have hailed the book as a brave, personal story of how paralyzing depression can be to African-American men.
Beneath the personal poignancy, however, lies a disturbing undercurrent, said many mental health experts: If an accomplished, highly informed black man refused for 20 years to seek treatment for depression, how difficult is it for uneducated or poor black men to seek help?
As Black History Month winds down, some mental health experts who work with black males suggest that these questions deserve greater study and discussion.
They believe that depression is likely a key factor in a 233 percent increase in suicide in black males aged 10-14 from 1980 to 1995.
"Black men feel that they have to be twice as good as other people, that you can't be weak because other people will take advantage of you," said Dr. David Satcher, former U.S. surgeon general who oversaw the 1999 surgeon general's report on mental health in the United States. "Those [pressures] work powerfully against a black male seeking treatment for depression and other mental illnesses."
Studies suggest that an equal percentage — 12 percent — of black males and white males suffer from depression.
Fewer black men are treated for it, however. While only one-third of all Americans with a mental illness receive care, less than half that number of African-Americans receive mental health treatment, according to Satcher's 1999 report.
And about one in four African-Americans is uninsured, compared with about 16 percent of the U.S. population overall. African-Americans are less likely to receive antidepressants, and when they do, they are more likely than whites to stop taking them.
Particularly troubling to those who study and treat mental illness in black men is their disproportionately higher rates of incarceration than other racial groups. Nearly half the male U.S. prison population is black, and about 40 percent of those in the juvenile justice system are black. About 12 percent of the U.S. population is black.
Untreated depression and other mental illness in black men is a contributing factor, mental health experts believe.
"It's a very difficult and very serious situation for these young men and for society," said Dr. Alvin Pouissant, professor of psychiatry at Harvard Medical School and co-author of "Lay My Burden Down," which examines the escalating suicide rates of young black males.
Closer to home, psychiatrists who work with Atlanta's homeless and black youth said they see dozens of black males each year head to jail or juvenile justice when they should be in treatment centers.
"It happens all the time, and it's very alarming," said Dr. Raymond J. Kotwicki, medical director of community outreach programs, Department of Psychiatry and Behavioral Sciences, at Emory University School of Medicine.
While all mental illnesses come wrapped in stigma, mental illnesses in black men are even more entangled. Historical racism and current cultural biases and expectations all play a part, mental health advocates said.
Nearly two-thirds of African-Americans believe mental illness is a shortcoming that can be overcome through prayer and faith, according to a study by the National Alliance for the Mentally Ill.
In Head's case, his wife, a physician who is a researcher with the Atlanta-based Centers for Disease Control and Prevention, kept gently telling him that he was ill.
His own mind told him, though, that he was worthless.
He lived off and on with that feeling and an array of other negative emotions for years.
Head, former Atlanta Journal-Constitution reporter and editorial board member, had served as press secretary for former Mayor Maynard Jackson.
He had felt for years that he was a failure who would be exposed any day as a phony.
To admit that he had depression would be to advertise to the world that "one more black man was a failure," Head thought.
"There's this idea that your manhood is something the rest of the world is trying to deny," Head said. "So we learn as young boys not to be weak, not to show our shortcomings."
Head found a therapist he trusted. While he balked initially at the thought of taking medication, his doctor convinced him he needed it. It took a while to find the right antidepressant, but they finally did. Head continued with psychotherapy for several years but now goes in only occasionally.
Head considers himself fortunate. His wife, Dr. Claire Broome, stood by him throughout. His employer was understanding. He had insurance and a good income. He can't begin to imagine the difficulties that less fortunate black men face.
"It's almost impossible," Head said. "In those cases, access to mental health care is in an emergency room or behind bars."
