Kinstler: Examining mental health stigmas in racially diverse communities

A discussion with Professor Sarah Hope Lincoln

Ethan Kinstler, Staff Columnist

In the United States, there is a profound stigma against seeking mental help, which precludes people from pursuing therapy, increasing the burden these disorders can have. Furthermore, this stigma is even more pronounced in racially diverse populations. Overcoming this stigma has recently been a well-studied topic for psychological researchers both in standard research settings and in clinical arenas. Case Western Reserve University Assistant Professor Sarah Hope Lincoln in the Department of Psychological Sciences offers her professional thoughts on this racial stigma both as a clinician and as a researcher.

According to Lincoln, there is no one catalyst that creates the bias against seeking mental health in racially diverse communities. Instead, Lincoln suggests the cause of the stigma is the mindset people within these communities have—internalized ideas like “I should deal with this within my family,” “I don’t actually have a reified disorder” or “I should be able to manage this on my own.”

Lincoln states that because of this stigma, clinical research trials often lack diversity, making it difficult for researchers to legitimately generalize research findings to an entire population. This lack of diversity means that researchers cannot accurately gauge the effectiveness of treatments being studied.

From a clinical perspective, Lincoln believes the stigma’s main consequence is that people who could really benefit from therapy simply do not seek the help they need. 

Consider, for instance, that it has been well-documented that African American individuals are more likely to be diagnosed with a psychotic disorder than their white counterparts. Lincoln notes that because we know Black populations are more likely to present certain characteristics—a bias of individuals—it is important that we do not misinterpret symptoms that may not be present. Doing so can skew the prevalence of a disorder towards certain groups of individuals by giving a false diagnosis, further stigmatizing seeking therapy within those communities. For example, a common question a psychologist may ask regarding schizophrenia is, “Do you feel like you are being watched?” Well, especially in the current political climate, individuals living in more diverse communities are actually being watched more than those from majority white communities. With this in mind, Lincoln highlights the importance of differentiating between symptoms and reality. How are we thinking about symptoms? Are we pathologizing symptoms that do not really exist? Are we making help accessible for all people? These are all questions that need to be asked and answered in order to understand and resolve the stigma.

Lincoln also offered a solution to breach this stigma and reach more diverse groups. One common research practice is the use of community-based participatory research (CBPR). In this approach, researchers go directly into the communities of interest and establish a rapport and relationship with members and leaders of the community in order to create a level of understanding and trust. Lincoln believes using this approach could mend the relationship between researchers and racially diverse communities as researchers take the time to understand what the community needs. More generally, in order to assuage the general fear all people may have about therapy, Lincoln suggests increasing the visibility of mental health resources and therapists. Perhaps a social worker or a psychologist should be included in primary care offices so those services are readily accessible to patients who need them. Think about how many times you may have visited University Health Services, but do you even know where to find University Counseling Services on campus should you need it?

Lincoln believes that the integration of primary care and mental health services could also benefit communities in which stress has been normalized. This idea is particularly applicable to college students who may think “I’m really stressed, but so is everyone else, so it just means I’m smart and I’m doing difficult work—it’s normal.” Instead, increasing funding and visibility for mental health services may help universally decrease stress levels as students begin to associate chronic stress and therapy the same way they see a rash and the doctor’s office. Lincoln notes that you can still be really smart and do really difficult work without being depressed, overly stressed and anxious. 

Finally, for people who have been thinking about seeking mental help but are afraid to, Lincoln offers this advice: “It’s normal to be afraid to [seek mental help] … it is hard to overcome that, and so just acknowledging that ‘I need the help’ is a really big deal. There are lots of different ways to get treatment … and know that it may not work the first time … the first time is not the end-all be-all.”