by Sharon Woodson-Bryant
Statistically speaking, depression is a workplace issue. The job is a major source of stress, especially for black professionals. Often, they are treated as if they do not deserve to be there. As a result, they feel intense pressure to outperform colleagues, just to gain acceptance. Black professionals are not always aware that these situations of subtle discrimination lie behind depression. For black women it appears the worse. One in five of all working women suffer from depression. The more intelligent you are, the more you are at risk. Chances are that you probably know someone who has been depressed.
Depression at work feels like depression anywhere else: A wave of hopelessness overcomes you and you have no idea why it’s there or what to do to get rid of it. But if you are working, it’s more likely to happen at your desk. If you have a door on your office, you lock it. If you have an opportunity to “work from home”, you announce you’re taking it. These were the tactics a former co-worker used. But they don’t work for her very long. She told me later that she never realized how optimistic getting out of bed was until she had depression. Getting up in the morning is an act of hope – that there is something to look forward to in life. When depression came, hope and faith left for no apparent reason. Depression was immobilizing, and when she was depressed, she spent most of her time at work covering up the inability to get anything done. For a while, people assumed she was taking care of things because that was just the kind of person she was.
But it’s hard to hide depression at work. I can’t fully explain this but she started acting weird to me. Other people also noticed, for example, that she couldn’t have a conversation about anything because conversation requires interest and depression made her uninterested in everything. Everyone has an off day during an important lunch. But you can’t have too many of those. If career success is about building a strong, competent image of yourself over the course of time, then depression is the antithesis – it destroys your image relatively fast. People started to wonder who my co-worker really was. And she began to question her own abilities, because she couldn’t seem to make decisions, she couldn’t keep a schedule, suddenly she was just not reliable and no one knew why. Depression made her hide. And because she wasn’t married and didn’t have kids, it made her hiding relatively easy. The only people who needed her on a day-to-day basis were her teammates at work. So, the office was her only barometer for how much she was falling apart. She went to a psychiatrist because she didn’t want to lose her job. But she told me later that in her depressed mind, she felt that if she destroyed her career, the feelings of hopelessness would kill her. I had no idea how scary it must have been for her.
But now she reminds her friends that it was her work that saved her. She said that work has been a mirror reflecting back and her career has been the thing she ultimately sought to save by getting medical help for mental illness. For the 34 million people who identify themselves as African Americans, depression is as prevalent a problem as it is for the population as a whole, affecting six percent in any year. Within the black community there are groups whose experience or environment makes them especially vulnerable to depression. Yet, among African Americans, depression still carries a stigma. It is a word that is not easily uttered. Nor is the condition readily talked about. One major consequence is that depression is often misunderstood by those who have it, undetected and untreated, perpetuating unnecessary suffering at a time when helpful treatments are available and capable of preventing the long-term damage now thought to result from recurring bouts of depression. According to an update on the U.S. Surgeon General’s groundbreaking 1999 Report on Mental Health, black Americans receive needed mental-health care at a rate only half that of whites. By some accounts, only seven percent of black women suffering from depression get any treatment, compared with 20 percent of the general population.
Shaped by culture as much as by biology, depression in blacks may find expression in symptoms that don’t look very much like mood changes, such as fatigue, backache, and hypertension or overeating. The disorder is not only disguised in form, it is concealed in language, expressed in terminology definitely not that of the mental health system. According to a black psychiatrist quoted recently in Psychology Today, blacks don’t label it depression instead we say we’re on our last nerve and” if you push me any further, I’m going to lose it.” Part of the reason is that blacks feel that they are supposed to put up with all of the burdens placed on them. “Sixty three percent of blacks see depression as a weakness, a problem only white girls can afford,” the psychiatrist reported. “We’re supposed to ‘bear up.’ And if we don’t, we are being disloyal to our community in general and our aunts and grandmothers in particular. Of course, blacks also know that owning up to a bona fide mental health problem could be used as one more way to look negatively at them. Unfortunately, many blacks have come to believe that they are not subject to depression and don’t recognize when they are struggling with it. And, of course, don’t seek targeted help that can relieve disorder and prevent recurrences.
Symptoms of depression don’t necessarily speak up in the blunt language of mental health either. Sure, there is the classic symptom of sadness. But studies show that up to 50 percent of all depressed persons don’t display depression in emotional terms. Instead, they report somatic symptoms. And African Americans are especially likely to be among them. Often, neither patient nor doctor is aware of the true source of the problem. Physical symptoms of depression commonly include chronic or recurring headache, abdominal pain, musculoskeletal pains in the shoulder, neck and lower back. Depression has long been associated with pain. It was once thought that people whose primary symptom was pain were somehow “denying” emotional disorder. The revised view is that somatic complaints are the way some people get depressed; there is a malfunction in the pain perception pathways. Depression is, after all, a disorder of mind and body. It’s more acceptable to suffer chronic pain than to say you are hurting.
Unfortunately, some say that in black culture there has long been a contest as to who has suffered more, the black male or black female. No one knows whether some cultural or neurochemical uniqueness underlies the symptom presentation of major depression in blacks. But subtle neurobiological differences appear to affect the expression of other mental conditions in African Americans. “There may be cultural universals and cultural specifics,” says Carl C. Bell, M.D., professor of psychiatry and public health at the University of Illinois at Chicago. He has, for example, gathered evidence suggesting that blacks have a propensity to auditory hallucinations in bipolar disorder, and that blacks are unusually subject to sleep paralysis. “I began wondering whether Freud is relevant for us,” Bell told Blues Buster. “We need a black psychology.”
Fatigue is a classic accompaniment to depressed mood for many, but especially in black women it may be the only sign of depression. Typically it is not picked up by primary care physicians, who are the main providers of help. Fatigue is such a cardinal symptom of depression among black women that when West Coast mental health activists recently launched the California Black Women’s Health Project to address the prevalence of undiagnosed and untreated emotional distress in their communities, they appropriated as the title for their launch the famous remark of civil rights activist Fannie Lou Hamer: Sick and Tired of Being Sick and Tired. Anger is another common manifestation of depression in the black community, among women as well as men. Some black psychiatrists have written that it is more acceptable for blacks to be angry than hurt over losses. They see anger especially among women struggling with a sense of loss and abandonment over not having had a male presence in their early life. It sets women up to feel negative about themselves, especially if they are not in a relationship. And it leads to difficulty in relationships, playing out powerfully in relationship conflict, a common source of depression among all women. The high mortality rates for heart disease and stroke and the prevalence of high blood pressure, obesity and diabetes are also traceable to depression. Stress shows up not only as depression, but it also shows up in obesity, hypertension and anxiety disorders. Depression is a common, treatable illness. If you think you might have it, get medical help now. And keep an eye on your coworkers. Someone in your office may be depressed. He or she might be hiding from friends and family, but it’s much harder to hide from work. Don’t be afraid to recommend that person gets help – stepping up at work to say what you see just might save a life.
