The Concept of Mental Health in Communities of African Descent: The Need for Culturally Inclusive Practice
Conference held at Belmont Center for Comprehensive Treatment on October 6, 2004
New Directions in Geriatric Behavioral Health: Serving Older Persons of Different Cultures The Mental Health Association of Southeastern Pennsylvania
Dr. Norma D. Thomas
People of African descent are strong, resilient, spiritual people, with values rooted in affiliation, collectivity, sharing, spirituality, acceptance of fate, past-time and veneration of the elderly, as compared to United States values of individualism, ownership, autonomy, independence, mastery of the environment, the future, youth, progress, achievement, power, perfection, planning and efficiency (Pinderhughes, 1982 Randall-David, 1989). The cultural value of universal charity gives dignity to people regardless of their station in life. In many of the different languages from the continent of Africa, there is no word for aloneness. The collective approach to human behavior emphasizes collective responsibility, shared concern and a commitment to common cause, family and is community centered (Schiele, 2000).
Even though there are Africans in America whose families have resided in this country for over four hundred years, their ancestors did not willingly arrive on this shore. Therefore, given the fact that time for people of African descent is circular and not linear, the assault of slavery is still as relevant today as it ever was. The theoretical framework of MAAFA which is a Swahili word meaning great disaster or calamity, has been applied to explain the post traumatic stress disorders that surround African peoples who have been dispersed throughout the Diaspora.
Recognizing the limitation of our diagnostic tools that are not constructed on culturally inclusive models, nevertheless, in a report published by the U.S. Department of Health and Human Services, 2001, African Americans have higher rates of schizophrenia, post traumatic stress, phobic and somatization disorders as well as higher rates of Alzhiemier's Disease and other cognitive impairments as compared to Euro-Americans. African Americans are half as likely to receive sought after mental health services than Euro-Americans, but are more likely to use emergency rooms for mental health treatment. Lastly, African Americans are more likely to be hospitalized for psychiatric reasons than receive community based treatment. This can be attributed both to inherent racism but also the lack of culturally appropriate diagnostic tools (Davis & Ford, 2004; Davis & Ford, 2001).
Behavioral health issues still bear great stigma in communities of African descent. Therefore, older consumers in particular will revert to prayer and other traditional healing methods, some based in ancient cultural practices, before seeking mental health treatment from modern systems. Because of blocked access to institutions, Africans in the Americas were forced into self-reliance. Older African Americans have developed an insulating layer of wariness and distrust of mainstream providers of mental health services. They will continue to quote the atrocities of research experiments as the reason they shy away from doctors, formal system medical interventions or any kind of research.
Elders are venerated in African societies and respected for their wisdom but also as the keepers of the culture. Family responsibility goes beyond blood lines. As in African American families, it is very common that there are no distinctions made between blood relatives and fictive kin. Unlike the ageism that is predominate in the United States, old age is considered a great achievement across African cultures (Mattelaer, 2004). Elders have a special place in the life of the villages. However, as more and more younger people move from villages to cities with increased urbanization and diminished resources, there is a concern that older people will not receive the care that was traditionally taken for granted. Older men and women have reduced physiological, psychological and financial support and live in isolation (Mattelaer, 2004). People coming from the over 50 countries of the continent of Africa have the additional burden of concern for the elders left behind.
Life in the United States for people of African descent is hard. Day to day stressors wear on the mind and the spirit. However, African peoples are not victims. The way to keep healthy in the African community is to keep the spirit intact which entails the Sancofa concept of knowing your past and its connection to the present as a determinant of one's future.
References:
Davis, S.D. & Ford, M.E. (2004). A conceptual model of barriers to mental health services among African Americans. In L. A. Chadiha (Ed.). (pp. 44-54). African American Research Perspectives. University of Michigan.
Davis, S.D. & Ford, M.E. (2001). Mental health: Culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. Rockville, MD: United States Department of Health and Human Services
Mattelaer, J.J. (March, 2004). The aging male in ethnic cultures in Black Africa. Aging Male. 7(1) 72.
Pinderhughes, E. (1982) Family functioning of Afro-Americans. Social Work. 27(1) 91-97.
Randall-David, E. (1989). Strategies for working with culturally diverse communities and clients. Washington DC: Association for the Care of Children's Health.
Schiele, J. (2000). Human services and the Afrocentric paradigm. New York: The Haworth Press.
Thomas, N. (In Press). Multicultural inclusive practice: A practitioner's guide to working with diverse populations of older adults. Baltimore: Health Professions Press.
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