Racial Disparities in Mental Health

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Racial Disparities in Mental Health




Guest:  Steve McLeod-Bryant - Psychiatry & Behavioral Sciences

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m talking, today, with Dr. Steve McLeod-Bryant, Associate Professor of Psychiatry at the Medical University of South Carolina.  Steve, you’ve had an interest in racial disparities in mental healthcare and also healthcare in general for many years.  And you have been working in South Carolina for, how many years now?


Dr. Steve McLeod-Bryant:  Since 1988.


Dr. Linda Austin:  So, close to 20 years of experience here in this state alone.  What are some of the most salient observations that you have had as you’ve observed racial disparities and racial issues in our field?


Dr. Steve McLeod-Bryant:  Well, probably the most salient is something I’ve learned from the general health disparities literature.  And that is that most of the excess morbidity and mortality that people of color have from cardiovascular disease, cancer, HIV, and so forth, can be tied to the behaviors that they engage in, whether it’s too much alcohol, drug use, promiscuous sex, sedentary lifestyle, poor eating habits, and so forth, most of the excess mortality can be tied directly to those things.  And it seems that people of color have been more prone to engage in those “negative” lifestyles, life behaviors, than their majority counterparts.


The question is, well, you know, why is that; a person’s color shouldn’t determine how they actually behave?   And that the fact of the matter is that it’s a much deeper issue than just surface skin color.  There are a lot of factors associated with those differences, and that’s what I’ve found particularly fascinating.


Dr. Linda Austin:  And I know that you have explored what some of those factors are, what have you learned about that?


Dr. Steve McLeod-Bryant:  Well, a lot of it can be tied to disparities in so-called proxies for race and ethnicity.  For example, poverty has been an area that’s been explored, particularly in the oncology field, as well as in other fields, where people who have fewer economic resources tend to behave, have attitudes, and perhaps values that are prone to causing them to engage in behaviors that cause them greater morbidity and mortality. 


In mental health, in particular, what is of interest is the fact that individuals, whether it’s poverty, other sorts of cultural determinants, are more prone to having childhood adverse incidents that occur, like physical abuse, sexual abuse, one or both parents who engage in excessive alcohol or drug use, a parent who winds up in jail while the child is growing up.  Those adverse incidents appear to predispose to traumatic incidents in children that lead to risky behaviors as adults.


Dr. Linda Austin:  I often say to my patients that the human brain evolved over a couple of million years to be healthy, and when it’s not healthy, usually there’s a reason.  Sometimes it’s a sporadic genetic issue, but usually there’s a reason, and often that reason is something like substance abuse or stress, or trauma, or loss, or something, sometimes physical illness can do that.  Is that the sort of thing that you’re talking about? 


Dr. Steve McLeod-Bryant:  Yeah, I think so.  The Group for the Advancement of Psychiatry has recently, sort of a subcommittee of that particular group, has posited the notion of the so-called social brain, which says that, to a certain extent, there may not be true psychiatric diseases much like we see in other branches of medicine from the point view of, you know, if I have influenza, I know that there’s a specific virus that causes that.  Or, if I have I lung cancer, there’s a particular type of tumor cell that’s causing it, and you either give it chemotherapy or cut it out, or whatever.


In Psychiatry, we haven’t been able to find those sorts of either genetic or sort of biological sorts of etiologies that you can cut out or just give this one medicine and it magically disappears.  What seems to be more the case is that there’s sort of a spectrum of behaviors that, in certain social environments, predispose one to be ill.  And depending on the sorts of behaviors that one is taught, that one learns, in social situations, it could lead to serious disability, or it may be quite functional, depending on where one is.


Dr. Linda Austin:  I had a very interesting experience over three and half years.  I worked up in Maine in a rural area.  Two mornings a week, I worked in an indigent care family practice clinic as a psychiatrist, which was interesting because nobody there had ever seen a psychiatrist in that part of the country.  Now, Maine is a very poor state, about 35 to 40 percent of the population live in trailers.  It’s different than southern poverty, which tends to be African-American.  But in the south, the African-American community, at least I think, has a lot of social interconnectedness through multiple generations and kinship lines, and the church.


Up in Maine, where there’s a lot of cheap land, you see poor people living in trailers, often on huge tracts of land, very isolated from each other, there are the same high levels of illnesses that we see down south in the Black population, illnesses like obesity, diabetes, hypertension, substance abuse, domestic violence.  Actually, Maine has the highest rate of domestic violence in the country.  And, my experience, I was blown away by how much terrible domestic and family and sexual abuse there is up in Maine.  So, is what you’re talking about, then, some of the things we’re thinking about as racial differences, really, is that more connected then, in your view, to this culture of poverty?


Dr. Steve McLeod-Bryant:  I think, in many respects, it is.  That’s sort of the commonality that I think many people who suffer these diseases have, more so than the color of their skin or the way that they talk.  There are certain things that poverty predisposes one to in this country that will lead to certain behaviors that lead into health difficulties. 


Now, how people become impoverished may, to a certain extent, depend on the way they appear, their age, their gender, and so forth.  There’s no question that the pathway to poverty may be laden with a lot of racial or ethnic issues.  But once folks are in that situation, there’s not a whole lot that, I think, differentiates them when it comes down to their physical and mental health.


Dr. Linda Austin:  The human brain is a cultural brain, and it develops over 20 years, and under the impact of culture.  You have been a longtime student of how culture affects the developing brain and mind.  What are some of the observations that you have made over time?


Dr. Steve McLeod-Bryant:  Well, everything from the language that one speaks, there’s a fairly well known example of, you know, the Eskimo population around the having a plethora of words for snow.  You know, you or I, when we think of snow, we want to stay away from it, basically.


Dr. Linda Austin:  Me in particular.


Dr. Steve McLeod-Bryant:  But, those sorts of notions about the sense of, you know, depression, of psychosis that, as one grows and learns from one’s own cultural group what is correct behavior, what is ideal behavior, what is abnormal behavior, that one’s language, sort of the values that the culture places on that, can shape the way one expresses distress, can shape the way one seeks help.  For example, very common in the African-American community, which has a certain amount of suspicion about mental healthcare, particularly when it comes to coercive uses of mental healthcare, say in emergency situations, that they may avoid seeking out mental healthcare when, in fact, the person who is depressed or psychotic may rather go to their pastor, or a family member.  And that help-seeking behavior leads to disparities in the way mental healthcare is handled in Black America.


Dr. Linda Austin:  I read a very interesting article this weekend, in the Smithsonian magazine, about the fallacies and limitations of genealogy.  And the author quoted an article that was in Nature magazine, in which geneticists had computed that if you go back five to seven thousand years ago, every human being alive now was descended from the same man and woman at that time, which is not to say that they were Adam and Eve back, because there were hundreds of thousands of other human beings alive.  But none of the other ones, they said, who were alive then have any living descendants, and all of us have those common ancestors.  So, as I calculated back, if my math is right, that’s about 150 generations ago, which means that we’re all 150 cousins to each other.  Yet, obviously, there are a lot of differences.  And those are the cultural differences that you’re talking about. 


Dr. Steve McLeod-Bryant:  Absolutely.  Another way of saying that is that the differences that have been attributed to race, traditionally, like skin color, thickness of the lips, curliness of the hair, and that sort of thing, if you actually look at the human genome, there’s only one out of ten thousand genes that actually speak to those particular differences, that, at least in America, we’ve paid so much attention to.  There’s much more that we have in common than we have that makes us different.


Dr. Linda Austin:  Dr. Steve McLeod-Bryant, thank you very much.


Dr. Steve McLeod-Bryant:  Thank you.


If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection:  (843) 792-1414.


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