By Graham Danzer, MSW PPS
CSMS Magazine Staff Writer
“Thank you sir,” people often hear Darrin say. His striped dress shirt tucked into crisply ironed dress pants, posture erect and manners as humble as they are graceful. A young man with a bright future, in his own eyes as much as others. Searching eagerly for work, considering going back to school with help from state scholarships eager to invest their money into so promising a life prospect. Such wasn’t always the case.
Darrin’s early childhood life was marked by his birth parents being stricken by drug addiction and poverty, unable to care for themselves, let alone their son. Sadly, his transition into the foster care system was all too common for youth in the black community. According to The Adoption and Foster Care Analysis and Reporting System (AFCARS) Preliminary Report of 2005 http://www.acf.hhs.gov/programs/cb/systems/index.htm), the rate of black to white children in the foster care system is roughly 3 to 1, though rates of childhood abuse and neglect are similar across color lines.
Darrin lived from foster homes to group homes. He displayed disruptive, volatile behaviors. From group homes, he went to psychiatric hospitals, and upon release, he went from hospitals to Juvenile Hall—a frightening place for most youth to enter, especially for those who has never been there before, as it was initially for him. But at least Darrin was prepared for a lifetime of institutionalization. “Group homes are just like being in jail,” he once said. “They tell you what to do, where you can go, where you can’t, just like jail.” Understandably, freedom has always been very important to Darrin. Upon release from various forms of being held against his will, maintaining autonomy is of his highest priorities. A job, a pretty girl and a fresh new set of clothes sound good. Understandably, he is highly suspicious of the programs social workers offer him throughout his numerous contacts with the system. The programs provide ongoing services including counseling, groups, and job training for youth whose life circumstances might not permit easy transition into a structured, nine-to-five life. Having spent a lifetime in these institutions, Darrin isn’t exactly up in arms to “make a choice to do time” as he used to put it. If he did, he might be as crazy as his friends, and family thought he was.
His chaotic and frightening mood swings had his friends and loved ones on edge, ready for anything and afraid of what he would do next. At times bursting at the seams with energy, talking a mile a minute in frantic, unintelligible blatherings. He was easily irritated, paranoid, staying up for nights on end, reckless and impulsive, argumentative and dangerous. It would seem never to end until a sudden crash would bring Darrin caving in on himself, crying in heavy sobs, hopeless, dark and gloomy, with all likelihood that he would kill himself if only he had the energy to. Darrin was 20 years old. His younger brother, only 13 years of age at the time, seemed as battle weary as any Vietnam veteran. His beanie pulled low over his head and pants drooping at the waist more from exhaustion then style, eyes in bags, too worn out even to speak, sagging in the chair next to Darrin when they first came to a city clinic for help. This little brother was 13 going on 50. Darrin’s girlfriend was likewise overwhelmed, begging him to get help. His most recent foster mother, who loved him dearly and taught him his most charming of present day manners, kicked him out, given his outbursts, and threateningly bizarre behaviors. Others around him were as afraid of him as he was of himself.
Darrin suffered from bi-polar disorder. This involves alternating period of mania and depression, or impulsive and reckless behaviors, going long without sleep, and/or irritability followed by a hard crash and ensuing despair and guilt, crying and other such symptoms. It is an organic brain abnormality that is dangerous, fear inducing, and chaotic for the individual with bi polar disorder as well as those around them, though it is also very treatable.
Given appropriate medications, therapy, and life structure, people with bi polar disorder can go on to fulfilling, otherwise normal lives. Mood stabilizing and / or anti-depressant drugs are effective in 70% of cases according to the Adolescent Mental Health initiative, though a trial and error process of getting the person onto the right combination plus side effects like weight gain make medication compliance a challenge. Staying medication compliant is absolutely necessary for people with bi polar disorder, though is often difficult given the stigma of taking psychiatric medications. Darrin, like others with mental health issues, fear that taking medications or going to counseling would confirm “being crazy.” Such is typical for most people who take psychiatric medications, and especially in the black community.
The black community historically has distrusted the medical and mental health systems. The worst case scenario has involved atrocities such as the Tuskegee experiments, in which a scientific study involved black subjects suffering immensely rather then being treated by medical professionals, so that the medical system could study the deterioration involved in syphilis. The San Francisco Chronicle ran a story in 2007 on youngsters in the black community often being diagnosed with ADD and prescribed Ritalin. Given high rates of violence and trauma in the black community, many of these youth are being found to have Post Traumatic Stress Disorder, which involves similar symptoms, though can also be (albeit with some difficulty) differentiated through follow up care and more thorough examination. It is possible that these traumatized youth may have received treatment that would have got them well, rather then ineffective treatments for misdiagnoses.
In the best case scenario, this can be viewed as public providers having being woefully understaffed, making higher quality care difficult. However, the Surgeon General’s Report of 1999 states that 22% of Black Americans live in poverty as compared to 13% of non-Hispanic whites (www.surgeongeneral.gov). Given those in poverty having a higher propensity for mental health issues, it can be expected that those in poverty (more often black people) will be in the greatest need for public health and mental health services. Given poverty and related factors, Black Americans are at greater risk for mental illness then White Americans, and receive a lower level of care than the majority of white people, often having private insurance.
When public mental health providers are understaffed and overburdened, they often weed people out through denying services to people judged to be having more of a substance abuse then mental health issue. San Francisco State Universities’ conference on co-occurring disorders in 2007 (www.sfsu.edu) included a report that black people are far more often given a substance abuse diagnosis, excluding them from services, and that black people who present for mental health treatment (understandably given the prior explanations) as initially resistant and distrustful, are often misdiagnosed as schizophrenic.
Given such remnants of institutionalized racism, mental health issues in the black community often go undiagnosed and untreated, or as a client once told the author, medications and therapy were seen as “white folk s—.” The Surgeon General’s Report of 1999 (www.surgeongeneral.gov) states that rates of reported mental health issues are similar in black and white communities, affecting roughly 1% of the national population according to the Adolescent Mental Health initiative. However, mental health issues may be more often hidden from the systems view until a series of major crises sends the suffering person into a city clinic at the pressure of friends and family.
Such people (Darrin included) are seen by themselves and others, as “crazy” or as Darrin’s girlfriend called him, “doing too much.” However, Bi Polar disorder is organic and comes about for reasons still under study, though it cannot be willfully controlled given it being a medical issue, thereby no different then cancer or heart disease. People cannot “get over it” or “just calm down” as Darrin’s friends and family had often demanded. Though supportive people often have encouraging intentions by making such statements, they do harm by making the suffering person feel more responsible than they are for their mood swings and erratic behavior. The person suffering is not “weak” or “crazy,” nor did he ask for or deserve his illness, just as someone who develops heart problems does not do so due to any personal failure or choice to suffer.
Such information was relieving for Darrin to hear, when he burst into a city clinic yelling, flailing at the arms, sweating, his short afro wild and uncombed, panic in his eyes, having been up for 4 nights in a row. His younger brother trailing defensively behind him. Darrin was nearly arrested and / or hospitalized that day, as clinic staff initially feared he might be dangerous to himself and others. The author spent nearly an hour and half with him in a back clinic office, listening, reflecting, staying patient. Darrin’s energy and volume dropping by the minute. By the time the police had arrived, he was beginning to stabilize, relieved to hear that something beyond his control maybe in effect, that he had been through a lot and that the clinic were now here to help him so that he no longer needs bear his private hell alone. That medications would help him feel better and meant not that he were crazy, but that he cared for himself enough to receive treatment, had suffered enough, and maybe now deserved to feel better after all he and his family had been through.
Young advocates are in a place to be there for the Darrins of the black community when they are unable to be there for themselves. By sharing knowledge of mental illness and speaking out against teasing and ignorance, the next generation can be one that allows the Darrins of the world to get well without shame and embarrassment. If a friend or family member seems to have mood swings, unprovoked aggressive behaviors, or is often sad or teary, take his pain seriously, and help him find a provider who can have him assessed. The process of being diagnosed and treated for mental health issues can be stigmatizing, and means a lot to the Darrins of the world to hear from their loved ones that they will be supported in their efforts to get well.
Furthermore, if members of the black community see that the stigma around mental health services is understandable given experience, maybe they can also take into account how community members may have suffered enough, and that treatment with medications and therapy is overwhelmingly effective despite the understandable adversity.
Likewise, Darrin is a rousing success. Grateful to see the police sent away and a team of professionals at his side, he began medication treatment plus counseling and had begun to feel better. With his moods and thought processes more stable, he saw how and why he was distrustful of group homes and other public services, to weigh the pros and cons, and then to enroll in transitional housing services. He now has a place to live, hasn’t had an argument with his girlfriend in a record of 3 months, has better relationships with his friends and family members. Stepping into the clinic sometimes after his first visit, he looks ready for an interview at Bank of America. Sitting relaxed in a chair in front of the author, discussing his prospects for school and work, Darrin is a totally different person than the one who was nearly carted away to psychiatric emergency by the police just a month ago. His backpack full of notes and papers in regards to his many appointments, meetings, and interviews. His eyes glisten with hope, his head nodding in rhythm. Though the I-Pod ear phones dangling out of his ear plays the latest hit by 50 Cent, Darrin’s nodding is more to his own rhythm then 50’s. The rhythm is taking hold in his life. He is the future of Black America and he is beginning to know it. He not only understands that he has suffered enough, but that he has had an experience that he can share with others in his community who may also need professional help.
It was a privilege to be part of Darrin’s revival as it would be for other young advocates in a position to help such a strong, and yet wayward young man. Money, fame, possessions, friends, all come and go. But this experience can’t be taken away by famine, poverty or thievery. Though continued maintenance and improvement will be contingent upon Darrin’s adherence to treatment, the author and Darrin gave each other something that can’t be taken away. Darrin was very grateful. But so was the author. At the conclusion of their last counseling session, Darrin said “Thank you sir,” . . . “No, thank you sir” replied the author.
Note: Graham Danzer is a writer who lives in San Francisco. Mr. Danzer also holds a master’s degree in Social Work. He is our new staff writer.