Mental illness can be defined as a health condition affecting the cognitive ability of a person; the thinking ability, feeling ability, mood and socialization ability. It can result from diminishing ability to cope with daily life demands, injuries, drugs use and abuse, genetic makeup, diseases along other milder causes. These mental disorders include; schizophrenia, obsessive compulsive disorder (OCD), depression, bipolar disorder, post traumatic stress disorder, panic disorder and border line personality disorder. Mental illness is a condition that can affect anyone irrespective of age, religion, race or status. It necessarily doesn’t reflect personal weakness, poor upbringing, cultural background or lack of character. However, the good news is that majority of these conditions are treatable except in some extreme severe cases. Medical treatment can be used in severe cases. Depending on the severalty of the condition in a patient, psychosocial treatment like interpersonal therapy, cognitive behavioral therapy and peer support group can be applied in his/her treatment. In enhancing a stable mental condition, it is recommendable to observe good diet, physical exercise, get enough rest and sleep, voluntarily involving oneself in community activities, socialization and basically good leisure spending. (National Alliance of Mental Illness, 2008)
Mental disorder is generally common in every population in the world. The world health organization indicates that major causes of disability in a population roots from mental disorders. Statistics have shown that one fifth of Americans suffer from some milder mental disorders of which are diagnosable at every given year. It has also affected children of school going age. Severe mental disorders are however less common affecting about 3% of the general population (American Psychiatric Association 2005)
The United States of America government has made efforts in diagnosing mental illness among its citizens. Not only has the government invested in matters concerning mental illness but also in other health matters. Unfortunately, African Americans have been misdiagnosed when it comes to mental illnesses treatment.
Generally the health management of African American patients is a bit fulfilling but requires more attention in mental health care. They have been insufficiently attended because of mild discriminations that still exist among the Americans. In addition, they have been economically victimized and politically misrepresented. However civil rights activists are making effort to end this kind of victimization with some progress in economic, social subclasses and heterogeneity of educational related discrimination. (Ahmed, T.A et al, 2007)
Studies have been done that compares African Americans and white patients diagnoses in state hospitals. The results have indicated that in mental illness diagnosis, African American were likely to be diagnosed of schizophrenia irrespective of whether they were suffering from other major depressive disorder. Clinicians have assumed that, African Americans are heavy drinker and alcohol abusers which have exposed them to organic brain syndromes. Other studies have shown that mood changes and psychosis disorders among African American have been diagnoses as schizophrenia. African Americans have also been associated with cognitive impairment, panic attacks, drug abuse and phobia. Statistics from epidemiologic catchments area (ECA) survey show that African Americans have been mentally disorders misdiagnosised than any other racial community in the United States. These misdiagnoses have been based on the social status of black people, race factors, gender and age. Aged African Americans have not been sufficiently taken care off. The rural environmental location of African Americans has come along with limited treatment resources. Their habitations are not fully serviced with sufficient health cares. The significant large number of mentally ill African American have been associated with their high substance abuse, less attention in cognitive impairment, mental states; anxiety, panic, phobias and medical problems. These medical complications include diabetes mellitus. Accidents causing head trauma is also considered in assessing African American patients. (Gaw, A, 2002)
Many scholars have rejected these arguments about African American to having higher rates of schizophrenia. Other notion that white Americans are likely to suffer from mood disorders more than African American have been rejected. Their schizophrenia diagnosis was only a routinely and misdiagnoses. Many debates have arisen over the misdiagnosis issue. Its complexity has led to all these debate and which have come up with controversial arguments. Available mental services have not considerably considered ethnic differences impacts on patients that may determine symptoms expression. This is an important factor in mental health treatment. A lot has been written about misdiagnosis of African American in mental illness. Much of these studies show that this is a routine. However most of these data is not clear and not definitive (Neighbors, W.H, 1997)
There are some myths and stereotypes existing about why racism has affected mental illness treatment among the African American society. Ever since time in memorial, the slavery ages, most enslaved Africans were neglected from health attention. They were never admitted in hospital and in severe cases they were admitted in segregated units like the almshouses or in jails. In 1900s, psychiatric literature African Americans were expressed as too emotional lazy, sexually promiscuous, criminally minded and authority anxious. Some people even expressed them as too inferior and deficits of intra-psychic framework that brings depression. In those years white men were mostly diagnosed as alcoholic while black as schizophrenic. Unfortunately racism still existed in other locus of treatment among the Americans. Institutionally, African Americans were marginalized to accessing mentally retardation care. Therefore, families were forced to take care of their patients to even severe cases when their patients became violent. Most of these families were economically poor; therefore they could not seek health attention from hospitals or even private physicians. (Gew, A, 2002)
There exist some myths among the African Americans that hinder them mental health attention. Some African traditional beliefs still exists among these communities. There were beliefs associating mental illness with curses from gods or ancestors, witchcraft and magical fright. This led them to seek less health attention from hospitals. They were traces of discrimination of these patients as some were termed as a bad omen or seen as outcasts. Mental illness was considered as schizophrenic or madness even though it could have resulted from other depressants. There existed traditional mental treatment. Some herbs were believed to treat mental retardation. Some rituals were as well associated with such treatment. The African American had strong religious beliefs far from their cultural practices. Some mental illnesses were termed as a curse from God. They could even consult God in treating these illnesses. However, it has been documented that some of the herbs and rituals healed these mental disorders though there exist no scientific explanation to explain this. (Aleman, S, 2000)
Continued studies have been done and which sometimes contrast previous studies. In a previous study, blacks had higher rate of mental illness than their white counterparts, surprisingly enough is that some recent research have shown white males in a higher rate of mental disorders than the African American counterpart. On the other hand black women had higher chances of substance abuse related mental illness than their white counterparts. However, these finding have brought significant understanding in mental disorder treatment with respect to race, gender and social class. The exposure of African America to poor social conditions is a risk factor not only to mental illnesses but also in physical illnesses. This has brought about higher rates of mentally illnesses related deaths through suicides, pulmonary diseases and violence among the African Americans. (Williams R.D 2008)
We can not just put the blame of misdiagnosis on the racial discrimination, government negligence and social factors existing in the United States . To some extent we can blame the African American themselves. In a number of ways they have contributed to their misdiagnosis in mental illness.
The existence of a difference in symptoms expression is one personal oriented cause to misdiagnosis. Cultural and ethnic differences influence willingness to seek treatment which in turn can cause misdiagnosis. symptoms presentation may vary from one patient to another. African American patients are more likely to disclose psychotic symptoms ignoring the affective symptoms making the clinicians diagnose schizophrenia assuming other disorder. The patient doctor relationship affects information disclosure. There are a number of factor influencing this relation among them the racial background. African American are more likely to disclose affective information to clinicians with their racial background and the vice versa. Assuming the clinician is white, he is likely to misdiagnose the patient. He may be limited to symptoms or may misinterpret unfamiliar idioms as thought disorders. Treatment delay, dropping or refusal is another personal oriented cause. The patient may be reluctant, ignorant or may delay in seeking metal illness treatment. Some patients lack adequate knowledge on mental illness management. Others fear involuntary commitment and hospitalization. They therefore seek care from immediate family members and faith communities. This care is often unskilled and may not solve the patients’ problem adequately. Many African Americans sort metal illness care in limited mental health services. Some of these health centers are inadequate in managing mental illnesses. Bipolar disorder management exceeds the ability of these community resources. Therefore many of the patients end up in the streets or in jails. Statistics show that up to 50% jail inmates may be mentally ill. In fact mental ill patients with signs of irritability are more exposed to imprisonment. There is also the problem of co morbidity. Most African Americans abuse alcohol and drugs irrespective of their mental conditions. They might be ill and after attending health care, their drunkenness state and excessive use of other stimulants may confuse the clinicians. He may therefore diagnosis un-existing symptoms. Substance abuse impersonates psychopathology and may affect symptoms presentation. (Georgiopoulos, M.A 2005)
African American who may be diagnosed with schizophrenia can be treated with antipsychotic. In cases where misdiagnosis may occur, antipsychotic may cause extra pyramidal side effects. Over the past years, there has been a recommendable progress in understanding mentally related illnesses. The National Institute of Health has supported this progress. Basic research of studies on neurological system and the brain has brought understanding on the role of neuronal connections, genetics and neurochemistry in cognition processes, emotions and in psychopathology. These studies have proven useful too in mental illness treatment. They have also motivated the public understanding on matters concerning mental illness as well as their policies. These studies have characterized hopes for treating mental illnesses. (Good, J.B, 1997)
Treating mental illnesses can now be done in a number of ways. However, it is recommendable to in-depth analyze the symptoms not only in African American but also in other races. This will seal off chances of misdiagnosis.
Pharmacotherapy is a major way for treating mental illness. It is applicable both in severe and mild illnesses. This involves treatment through the use of drugs. These drugs include antipsychotic, antidepressants, antimanic and antianxiety. Clinician can also treat mental disorder through verbal or non verbal communication. This is generally termed as psychotherapy. In treating the African American psychotherapy is an important tool as it develops trusting relationship between the clinician and the patient enhancing disclosure. This leads to the understanding of symptoms reducing chances of misdiagnosis. The following are some common psychotherapy forms:
Behavior therapy. This involves the modern theories of learning and conditioning in treatment of mental illness. It is particularly useful in treating depression, obsessive disorders and anxiety. Cognitive therapy bases it treatment on interpreting how an individual behaves. It is useful in treating delineated maladaptive disorders like phobias. Cognitive behavior therapy combines both the behavioral and cognitive therapies in treatment. Family and group therapy are other forms of psychotherapy. Their main focus is on the larger patient’s environment in trying to resolve his/her problem. They explore the larger system for example the family or society then moves to the specific patient. Psychoanalysis and psychoanalytic therapies can also be applied. They are based on Sigmund Freud’s theory of dynamic, unconscious and psychological conflict. Electroconvulsive therapy can also be used especially in severe psychiatric disorders. However it has been met with critics over its applicability as it exposes the individual to cruelty and inhuman treatment. Other therapies include the light therapy and sleep deprivation (Rockville, M.D. 1999)
The suggestions that the misdiagnosis of African American is related to their pathologization of their culture, their stereotype, cultural differences in life and in value should not primarily be blamed on their misdiagnosis. There is a need to come up with a racially and culturally insensitive diagnosis not only in metal illnesses treatment but also in other diseases. However, it is important for the government to lift the equal health care burn to all Americans irrespective of their cultural, racial or status background. There should also be a convenient health infrastructure reaching far to those areas where it is limited irrespective of who inhabits the areas. Researchers and scholars studying these issues should be encouraged. Obviously, some African Americans myths and beliefs are outdated. They should be discouraged from relying on them in explaining and treatment mental disorders. There is need to educate the African Americans not only on issues concerning seeking medical attention but also on their civil rights. This will enable them to be conscious in situations where they are being discriminated with respect to their race. They will also learn to disclose psychic and affective symptoms to clinician, identify with them irrespective of their racial background. By doing so, misdiagnosis of mental illness in African Americans communities will seize from existing.
References:
National Alliance on Mental Illness (2008) About Mental Illness. Retrieved on Tuesday, November 11, 2008 from http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_I llness/About_Mental_Illness.htm
American Psychiatric Association (2005) Mental illness. Retrieved on Tuesday, November 11, 2008 from http://www.healthyminds.org/multimedia/whatismentalillness.pdf
Neighbors, W.H. (1997) The Misdiagnosis of Mental disorders in African Americans http://www.rcgd.isr.umich.edu/prba/perspectives/winter1997/hneighbors.pdf.
Gaw, A (2002) Culture, Ethnicity, and Mental Illness: American Psychiatric Publishers.
Williams, R.D. (2008) African American mental health: Persisting questions and paradoxal findings. Retrieved on Tuesday, November 11, 2008 from http://www.consumerstar.org/pubs/AAMH.pdf
Georgiopoulos, M.A & Rosebaum, F.J (2005) Perspectives in Cross-cultural Psychiatry: Massachusetts General Hospital Handbook of Cross-Cultural Psychiatry: Lippincott Williams & Wilkins.
Good, J.B (1997) Studying Mental Illness in context: Harvard Medical School. Retrieved Thursday, November 13, 2008 from
http://www.anthrosource.net/doi/abs/10.1525/eth.1997.25.2.230
Rockville, MD (1999) Treating Mental Disorders: US Department of Health and Human Services. Retrieved Thursday, November 13, 2008 from http://www.brainexplorer.org/factsheets/Psychiatry_Treatment.pdf.
Ahmed, T.A, Mohammed, S.A & Williams, R.D (2007) Racial Discrimination and Health: Harvard University. Retrieved on Tuesday, November 11, 2008 from http://icmr.nic.in/ijmr/2007/October/1009.pdf.
Aleman, S (2000) Therapeutic Interventions with Ethnic Elders: Health and Social Issues: Haworth Press.