This article works in conjunction with my previous article titled “It’s All in Your Head: How Anxiety Has Molded Me,” in which I discuss my personal struggles with social anxiety and how it has molded my life.

As a black woman who grew up in the average struggling black household, I was often told that my anxiety was just everyday nerves and fears. There was nothing to be worried about, nothing wrong with me, and nothing worth agonizing over. After all, I was a child; I didn’t have to worry about bills or putting food on the table or keeping a roof over anyone’s head, so why should I have anxiety about anything?

I’ve only mentioned having anxiety to my immediate family and close friends, and these were the frustrating responses I’ve received. And the only thing I could say in response was that this was just how my brain worked, and I couldn’t control it. My white friends were, ironically, more understanding and expressed their struggles with their own anxiety, so I felt more solidarity with them, and I tended to gravitate to them more. It wasn’t until college and beyond that I’ve met a more understanding group of multicultural friends. It led me to ponder something: Why do African Americans have such a strong bias against mental illnesses?

Contrary to popular African American belief, the same mental conditions that exist in the white community exist in the African American community. Mental illnesses aren’t white people diseases. According to the National Alliance on Mental Illness, about 18.6 percent of African Americans have mental illnesses compared to 19.3 percent of the white population. However, because African Americans are more likely to experience violent crimes and racial discrimination, they are 20 percent more likely to have mental illnesses like depression, PTSD, and ADHD.

That said, only 6.6 percent of African American men and 10.6 percent of women seek mental health services.

Comparing these percentages to the 11.3 percent of white men and 21.5 percent of white women who seek services for mental health issues, it’s clear that many African Americans shy away from treatment from a medical professional. The reasons behind African Americans avoiding professional help is multifaceted. Access to healthcare, financial troubles, self-medication, and cultural ideology all contribute to the response African Americans have to mental illnesses in their community.

First, affordability is one of the key factors for African Americans to seek mental healthcare services. According to the U.S Census Bureau, in 2017, the uninsured rate for black people was at 10.6 percent. That is a high uninsured rate compared to the 6.3 percent of uninsured white people and 7.3 percent of uninsured Asians. Only Hispanics had a higher uninsured rate at 16.1 percent. These censuses were taken while the Affordable Care Act was active to ensure that more individuals in low-income homes could afford health insurance. So, despite the help that the Affordable Care Act gives to low-income families, there is still a significant percentage of the black population that isn’t insured.

Compared to white and Asian populations, more black and Hispanic people have no access to healthcare and cannot afford mental health services and, therefore, do not seek treatment. According to the US Census Bureau, in 2017, the average median household income for black families was only $40,258, which was the lowest median household income compared to other communities. It was $50,486 for Hispanic households, $68,145 for white households, and $81,331 for Asian households. More so, the rate of black families that earned under $15,000 a year in 2017 was 19.6 percent.

With the lowest median income and insured rate and the highest poverty rate, it is no wonder that black people don’t seek out medical professionals for mental illness.

After all, for many members of the black community, the necessities of life—primarily food, shelter, clothing, and transportation—are weighed by the dollar. Accessing healthcare isn’t high on the priority list for many black families because of the fear of incurring bills from hospitals, doctors visits, and necessary medications. When it comes to putting food on the table and paying the utility bills or seeing a medical professional for symptoms of chronic fatigue, weight loss, and sleeplessness, the choice often falls to bills and food on the table. Because of poverty, most African Americans are often struggling to survive and focus all of their energy and meager finances on survival instead of mental health.

Another barrier is the self-medication hypothesis. The self-medication hypothesis is the idea that alcohol, marijuana, and illegal drugs can be used to handle mental health problems instead of seeking aid from a professional. But self-medication can lead to larger problems, such as addiction, depression, anxiety, and other symptoms, along with legal consequences from acting under the influence.

Like the self-medication hypothesis, lack of awareness and education also create a hurdle for African Americans seeking treatment. Some symptoms of mental illnesses are unrecognizable for what they are. For example, chronic body aches and pains are a lesser known symptom of depression that could get misdiagnosed as another illness entirely. Some people attribute depression to feeling down or experiencing “the blues,” and they claim that one can simply fight their way out of it. Similarly, anxiety disorders become simple nerves or worrying too much. These misunderstandings stall African Americans and prevent them from finding the care they need.

In addition to the lack of awareness, there’s also mistrust. It is not an uncommon belief that therapists are useless white people who merely ask, “And how does that make you feel?” Many believe that they’re unable to relate to the social and economic struggles that black people face daily. This is, of course, untrue. When I went to therapy, not once did my therapist (white) ask me how something “made me feel.” If anything, she put me at ease by helping me assuage my irrational, anxiety-induced fears and showed camaraderie, suffering from the same illnesses as I.

The most important barrier is cultural. Mental illnesses and seeking mental health services is still strongly stigmatized in the black community, regardless of upbringing and wealth. But why?

It varies slightly from person to person, but culturally, many view it as embarrassing. Admitting to having problems with anxiety,  depression, and other similar mental illnesses is akin to being crazy or dramatic in the black community. After all, such illnesses are still largely considered “white people problems” among black people.

Commonly, those who question their own mental health and try to verbalize these problems with their community are often told that what they’re experiencing is all in their head and not worth spending the money on therapeutic sessions on. Culturally, black people are very proud of strength and perseverance. Surviving the historical horrors of slavery, Jim Crow laws, and continued disenfranchisement and institutionalized racism and poverty has instilled in African Americans the need and respect for strength, money, and endurance. Ultimately, admitting to struggles of depression and anxiety does not fit with the image of the strong, successful, triumphant African American.

In the Psychology Today article “Why African Americans Avoid Psychotherapy” by Monica T. Williams, Ph.D., she notes that seeking a therapist is, for black people, like venting their dirty laundry and revealing that they are not able to settle and control their problems internally. Coupled with the stigma of mental illnesses is the stigma surrounding negative feelings, such as sadness, loss, grief, embarrassment, inadequacy, and pain.

All are considered weaknesses, and it goes back to the desire for strength and endurance in the black community. Being down, bothered, and upset are all negative in the black community, even though they’re natural human emotions. But that’s the way the black community has begun to shield itself. Facing the struggles we experience and dealing with negative emotions on top of everything else is overwhelming. And besides, being in your feelings doesn’t pay the bills.

With all of these barriers between the black community and adequate mental health care, one has to ask if we are doing ourselves a disservice by not seeking help that we need.

Granted, the cultural and educational aspects of this problem are perpetuated by members of our community. Mental illnesses are real problems that the African American community rejects as a whole. So, the cultural perpetuation of mental illnesses being fake or not important is a problem.

By avoiding treatment, black society is doing a disservice to themselves. Black people are at an economic and social disadvantage compared to other races, and this impacts their ability to seek mental health care. To overturn the silence that African Americans have around mental health and encourage more to seek treatment if they need it, cultural and institutional advancements need to be made.

The black community needs to understand that mental illnesses are not just isolated experiences inside the mind, and they are just as important to focus on. Additionally, our healthcare systems need to be further revised to better suit everyone’s social, economic, and cultural needs to provide more opportunities to seek mental health services. Only then can African Americans begin to remove the shroud of silence and shame surrounding mental illness in the community.