Racism and Psychiatry

The negative effects of racism on older people of color are vast. Racism is associated with increased depression, anxiety, and psychological distress because it is an undeniably negative, demeaning, and threatening reaction to an immutable personal characteristic. Racism acts at many different levels, with stigmatized groups internalizing the dominant society’s ideology about their biological and/or cultural inferiority. It is an undeniably negative, demeaning, and threatening reaction to an immutable personal characteristic. Furthermore, systemic factors, such as redlining, transportation challenges, language barriers, and financial obstacles, contribute to persistent disparities in the ability of older people of color to access mental health care services.

Medical racism has laid the foundation for marginalized communities to distrust mental health care. In American psychiatry, diagnostic criteria, questionnaires, and treatment practices have a long history of pathologizing cultural and racial differences that deviate from norms accepted by White American mainstream culture. My colleagues and I recently reviewed evidence documenting the ways in which racism still distorts mental health care.

Older African Americans, for example, are more likely to express irritability, social isolation, loneliness, and loss of control rather than stating that they are depressed or anxious. Attempts to share the realities of racism and mistrust in their lives risk being misinterpreted as pathological paranoia or psychosis. The result has been an overdiagnosis of schizophrenia and underdiagnosis of affective disorders among African Americans due to clinician prejudice and lack of contextual diagnostic analysis.

Let’s seize opportunities to remain mindful of the historical, cultural, and contextual experiences of older people of color and how those experiences relate to their treatment preferences.

Older Latinos often express mental health distress (anxiety and depression) as physical ailments (malaise, pain, headaches, fatigue, gastrointestinal distress) rather than by more traditional symptoms, such as sadness or loss of interest. This may explain, in part, why older Latinos are less likely to be screened, diagnosed, and treated for depression and anxiety than their White counterparts.

Furthermore, the way older Asian Americans express their mental illness may not be captured by instruments designed for White populations. For example, Chinese American respondents are often reluctant to report psychological distress and likely to use psychosomatic terms, such as loss of sleep and fatigue, to describe depressive symptoms. Similarly, symptom patterns and forms of depression in Korea are not identical to those in the U.S. And older Hmong adults may not recognize depression as a mental health problem as there is no direct translation of or definition for the term, “depression” in the Hmong language. Consequently, the “model minority” myth, which refers to the misconception that Asian Americans are well-adjusted and thriving in the U.S., gets perpetuated. This stereotype overlooks the heterogeneity within the Asian American community and their psychosocial and mental health needs.

To combat medical racism, mental health programs need to make changes that incorporate cultural values and beliefs. These adaptations are vital. Even though older people of color may not be concerned with whether their mental healthcare providers are from the same ethnicity or speak the same language as them, a sense of cultural understanding is still appreciated and reflects more positive health outcomes. In one example, the term “nervios” (“nerves”), which is extensively used as a synonym for anxiety among Latinos, was associated with less stigma than the formal psychiatric label of an anxiety disorder.

Let’s seize opportunities to remain mindful of the historical, cultural, and contextual experiences of older people of color and how those experiences relate to their treatment preferences. Only then can mental health providers begin to dismantle well-earned patient distrust and begin to build culturally humble and respectful therapeutic relationships with older patients of color.

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