African Americans Have Eluded Mental Illness, but Is It at the Cost of Physical Health?
When a psychologist needs a little inspiration, he or she might turn to the wise words of an old master, seeking in some eternal axiom the courage to move forward in the face of uncertainty. Many likely turn to Sigmund Freud, others to William James, a few possibly to B. F. Skinner. James S. Jackson turned to Dan Quayle.
Jackson remembered when Quayle, the notoriously misspoken former Vice President, once (mis)said, “a mind is a terrible thing to lose.” If the statement contained an absurd shred of sagacity, Jackson found it: “I’m going to vindicate Vice President Quayle,” Jackson said during his spring 2004 talk Physical and Mental Health Disparities Among African Americans. “He’s made a very important contribution to science.”
APS Fellow and Charter Member Jackson went so far as to attribute his entire current series of research studies to the quote: “It’s the motivation about losing one’s mind that leads to the differences and discrepancies we see for African Americans between physical health and mental health outcomes,” he said.
While Quayle was the inspiration for the recent research — an expansive, multi-generational study that ran for over two years—Jackson was undoubtedly the impetus. In order to get a comprehensive understanding of how ethnicity effects mental and physical illness, Jackson issued over 6,000 participants a mammoth, 38-section interview called the National Survey of American Life, covering areas such as group and personal identity, discrimination experiences, demographics, immigration status, politics, detention, and use of health resources. Intense medical scrutiny followed the preliminary questions, seeking a participant’s mental health status and family medical history, and even screening them for psychosis.
What Jackson found were two major contributing factors to the above average mental and below average physical health of African Americans in the United States. First, bad structural conditions are related to bad physical health outcomes. And second, the behaviors a person engages in to cope with stress contribute to good mental health outcomes.
“Structural inequalities cause physical health disparities, and they cause psychological and psychiatric disparities,” Jackson said. “What links these two are behaviors.”
But while the connection is straightforward, the rationale behind the behaviors is rather complex.
“Precursors to mental health problems are more available to consciousness than are those of physical health problems,” he said. “If I’m having a bad day, and I’m stressed, I know that I’m stressed. If I’m growing a cancerous tumor, I don’t know that until later. This awareness motivates people to action, because one of the worst things you can do is to lose your mind.”
The motivation Jackson referred to is one that diverts the onset of mental illness through physically abusive activities. Jackson tracked the phenomena to a highly detrimental degree, where dangerous behaviors such as smoking, drinking, and even drug use can have immediate, mollifying effects on the onset of mental anguish.
“You tell people not to drink or smoke because it’s no good for them, and people say, ‘No, I know it’s good for me. I feel less stress, and I feel better about myself.’ ” Though flawed, the logic is difficult to disregard, because the gratification is so instantaneous. “The only problem is, [these behaviors] are killing you.”
Jackson argued that the accumulation of many social factors, tracing back to a person’s youth, contribute to health disparities in African Americans throughout the course of a lifetime. “There are links from childhood in terms of understanding health disparities,” Jackson said. “The roots occur in youth, but the differences don’t emerge until middle and older ages. You cannot understand health disparities outside of a life course perspective.”
The numbers overwhelmingly support him. “Over the life course, blacks more than any other group live the fewest years and have the highest percentage of these years in poor health,” he said. Part of the problem is structural, in that African Americans, instead of experiencing a convergent trend with majority culture lifestyle figures, are actually diverging more precipitously than in the past. For example, the difference in per capital income between whites and blacks is merging at such a glacial rate that the two groups will not achieve parity until the year 2582, according to Jackson.
Similarly, it will take 210 years to reach parity in the child poverty rate, 150 years for the overall poverty rate, and 72 years for the college completion rate. An even more unsettling number is 32.2 — the percent probability in 2001 that an African American would be imprisoned by the end of his life.
Yet even these numbers quiver in comparison to the numbers of years it will take for whites and blacks to achieve home ownership parity: 1,664.
“African Americans are probably the most segregated group, in terms of housing, in the United States,” Jackson said. “That has very real implications for health and mental health disparities. … You really have to understand the material conditions of life to understand disparities.”
Jackson identified four staples in many African American populations, none of which is particularly conducive to peak physicality: churches, liquor stores, fast food outlets, and check cashiers. Fresh food markets and exercise facilities, both increasingly pervasive conduits of health, are noticeably absent.
The unfortunate irony — and even more unfortunate truth — is that by keeping a tight grip on their minds, African Americans are doing irreparable damage to their bodies, creating a Catch-22 as incorrigible as a Dan Quayle quote.
“For African Americans under stressful conditions, if you do not engage in bad behaviors, you’re more likely to suffer from mental health disorder than if you do engage. Those bad behaviors actually buffer the effect of stress on the probability of suffering from mental disorder,” Jackson said. “The differences are not easy to understand.”
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