IN THE SHADOWS: Shame and stigma can be barriers to treatment for mental illness. Could this be one reason for the secrecy surrounding Rep. Jesse Jackson Jr.’s mood disorder hospitalization?

After weeks of speculation about why U.S. Rep. Jesse Jackson Jr. (D-Ill.) has been on medical leave from Congress for “exhaustion” since early June, his office finally announced that he is receiving “intensive” inpatient treatment for an unspecified mood disorder and is “expected to make a full recovery.” The statement did not say what the disorder is, where Jackson is being treated, or who is treating him, The Chicago Tribune reported, but it did say he is not being treated for alcoholism as had been rumored. Citing privacy concerns, Jesse Jackson Sr. has declined to discuss the specifics of his son’s illness with the press, but surrogates have shot down rumors that Jackson Jr. attempted suicide. Speaking at the Rainbow PUSH coalition conference in Chicago last week, his mother, Jackie Jackson, said her son “is unwell” and “needs a moment to heal.” She also suggested that he lacks the internal resources of his parents in dealing with political “disappointments.”  “I want to encourage him to hold on – to hold on to God’s unchanging hand, not this politics. See, I play politics, I don’t live it. I live in the house with God,” said Mrs. Jackson.

JESSE JACKSON JR.: The congressman has been sidelined by scandal and now an unspecified mood disorder.

Jackson Jr. has been caught up in the scandal that sent former Illinois Gov. Rod Blagojevich to prison for attempting to sell President Obama’s vacated U.S. Senate seat. He is currently under investigation by the House Ethics Committee for allegations that he participated in a scheme to fund raise for Blagojevich in exchange for the seat. Amidst the scandal, Jackson Jr. also admitted to having an extramarital affair.

Randy Auerbach, a psychologist and instructor at Harvard Medical School, told ABC News that Jackson may have “a genetic predisposition that might make him more vulnerable to a mood disorder.” Depression and bipolar disorder are cited as common mood disorders in the article, with nearly 17 percent of the population experiencing depression in their lifetimes and 4 percent receiving a bipolar diagnosis. “An individual may have a certain vulnerability and in presence of stress, it may trigger the onset of a disorder,” Auerbach said. “Significant life stress is enough to contribute to a depressive episode about 50 percent of the time.”

Because stigma and shame are often barriers to treatment for African Americans and may be playing a role in the secrecy surrounding Jackson Jr.’s diagnosis, we decided to talk to  LaTonya Mason Summers, executive director of LifeSkills Counseling and Consulting Group in Charlotte, North Carolina, about Jackson Jr.’s hospitalization and common barriers to treatment in the Black community. Our interview has been edited for length and clarity.

UrbanFaith: Jesse Jackson Jr. has reportedly been hospitalized for a mood disorder. In general, something serious has to be going on for someone to be admitted for inpatient treatment. Is that correct?

LaTonya Mason Summers: Yes, absolutely. There are usually three criteria to go inpatient. You have to be homicidal, suicidal, or in a psychotic state. People are not admitted for mental exhaustion, unless it’s mental exhaustion with suicidal ideation and a plan. For mental exhaustion, you go on vacation.

If someone has financial resources, could they just check themselves into a facility?

That I don’t know. The criteria may not be the same at centers where you go when you have money. But on our level, you have to be psychotic, suicidal or homicidal.

I’ve heard at least one person express skepticism about Jackson Jr.’s diagnosis. As a journalist, I understand that, but I still find it difficult to believe someone would accept the stigma of having a mood disorder to avoid prosecution.

You would be surprised. I’m not saying that is true or not, but there is a protection when it’s mental health. If you go out of work for mental health, you cannot be fired. When you are in an inpatient hospital, you cannot be arrested. There are certain things that cannot happen until you are discharged.

In our email conversation, you said decreasing barriers to mental health in the Black community is your “soapbox.” Why?

Because here in North Carolina, there are not many African-American providers and I think it helps to have African-American providers, so that African American clients have more access to care. Because there are not many providers, the consumers haven’t necessarily been there, but the number is growing.

One thing I do is I groom African-American providers in the community through the North Carolina Black Mental Health Alliance. A friend of mine and I formed that so that professionals in the community could go further. Some of them might have Bachelors degrees and we encourage them to get Masters degrees. We provide internships and opportunities and we supervise them through licensure so that they are more qualified to provide services. And then, I groom clinicians so that they can become private practitioners and not necessarily work in mental health institutions. There is more of a stigma with those institutions, so African Americans are not as likely to get services if they have to go to a local mental health center. But on a more private level, it’s more acceptable.

Also, churches are becoming more accepting of mental health problems. For African Americans, the church has always been the place to go when you needed help. But the church would say, “Just pray,” “Let go and let God,” and “Keep it in the church or keep it to yourself.” Now that they’re becoming more open, more African Americans are coming to counseling.

According to a National Alliance on Mental Illness fact sheet on African American mental health, only two percent of psychiatrists, two percent of psychologists, and four percent of social workers are Black. Does that sound about right to you?

Absolutely.

What kinds of things are barriers to care?

One is a language barrier. This is a double-edged sword, but a lot of African-American clients come to me and say, “I’m  so glad that there are African-American providers because I can say things to you that I wouldn’t say to a White person.” They might say, “Girl, I wanted to beat the black off my kid.” Well, that is a common colloquialism, but should they say that to someone who is not African American, then the department of social services might be called. The double-edged sword is that we African-American therapists may miss abuse because we understand that terminology.

Also, there is a class issue. I had a White therapist who used to work for me when maybe 90 percent of my practice was African American. She was working with a child and also working with the mom on parenting issues. She told the mom to get the child a dog. Now, we know dogs are therapeutic and if you say that to one culture, that may be more acceptable, but to this African American family that was struggling financially, the mom was thinking, “I can’t really feed my kids. How in the world am I going to go get a dog?”

Another thing is that White clinicians may recommend medications more readily than African-American clinicians. I’ve been doing this for 16 years and African-American clients still freeze up when I recommend medication because there is a stigma of taking medications, whereas in the White population that’s okay.

I’ve read that African Americans tend to be diagnosed with more severe mental illnesses than Whites who present with similar symptoms. What do you recommend to overcome these kinds of obstacles?

I definitely recommend counseling and I don’t recommend that African Americans only go to African Americans. I would say there are some African Americans we may not be able to relate to. Culturally, lower income populations may not necessarily come to a designer dressed African-American professional because that might present a barrier. But for someone who can come down a bit and be more urban, but still professional, they may be able to relate. I also recommend that churches be open to recommending counseling and psychiatry and I recommend diversity training for those in the mental health field.

Has the situation gotten any better?

LA TONYA MASON SUMMERS: “For African Americans, the church has always been the place to go when you needed help.”

No. Most of the studies that are done for medications are done on White middle class volunteers, so psychiatrists and physicians still have to adjust the medication and dosages for African Americans. We feel like guinea pigs in trying to find the right dosages. Volunteers in the some of the depression studies are White middle class Americans. Africans Americans don’t show up for stuff like that. So it’s kind of hard to put something together for us because we don’t participate in those kinds of things. I was trained at primarily White Appalachian State University, and even counseling theories were developed by Whites. And so, African-American clinicians have to adapt those theories for African Americans, because they just don’t fit.

And yet, according to the NAMI fact sheet, some of the social barometers that hinder African Americans in regard to wealth, employment, family structure, etc. are associated with greater risk for mental illness. Have you seen an increase in distress among Blacks since the economic downturn?

Yes. I started doing trainings three or four years ago on treating “recession depression.” Someone made up that description, but I thought it was great and started doing research and started publishing on it. The thing that would happen in my practice is that there were Caucasians and upper class African Americans who used to have money and would come for counseling to deal with downward emotions and a down-turned economy, but then the lower income African Americans who had always struggled were struggling even more, so I would have to adapt counseling for two different populations.

How did you adapt it for those populations?

In counseling we don’t ask about money, and so when I started training therapists, I was saying we have to ask people about money, because money is still taboo. People would tell us everything under the sun, but would not bring up financial issues. When you ask, you hear people are in foreclosure, repossessions, and filing bankruptcy. But those are things we would have never known and still don’t know unless we ask. Then, knowing community resources and national resources. What is North Carolina doing for homeowners? What is the U.S. doing? What’s going on in the White House, where they are providing resources for people who are losing their houses and jobs?

It can be difficult for working class people to pay for treatment in a good economy. I can’t imagine in this economy that it’s even an option.

I take Master’s degree level students who are training to become counselors as interns twice a year, and I run a free counseling program, because so many North Carolinians are without insurance. If you don’t have insurance, the only resources available are local mental health centers, but African Americans do not want to go there. No one wants to go there. They’re loud. You may not get the best care. You’re a number. All of that. So, we run a five-month program twice a year, for ten months throughout the year with these students. With supervision, they counsel people who don’t have insurance. It’s a huge program. There are a couple of my colleagues who do the same thing, but if many of us would take it on, people who don’t have insurance could get the help they need.

What I hear you saying is that you would encourage people to get help if they need it.

Yes, I certainly would and hopefully there will come a day when we’ll be able to name disorders, and it won’t be some mystery illness. Should Jackson Jr. name it, there might be more people who come forward, especially as influential as he is. Politically, I know they may not necessarily want to say, but when we lay people see celebrities dealing with stuff, we find it inspirational and encouraging. But there’s still that stigma of mental illness where you can’t give a name. It has to be some mystery.