Running head: BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 1

Black Americans’ Cultural Mistrust of the Mental Health Community

Zachary Osheroff

Simmons College

Peter Marimaldi & Erina White

BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 2

Black Americans’ Cultural Mistrust of the Mental Health Community

Following a 2001 US Department of Health and Human Services supplemental report to

the Surgeon General, which described the disparity between racial minorities and whites in the

utilization of mental health services, there has been increased academic attention on this issue

and the possible causes of it. This disparity is well documented (Gloria, Hird, & Navarro, 2001;

Wu et al., 2001; Wang, Berglund, & Kessler, 2000; Neighbors et al., 2007; Cuffe et al., 2001).

The present literature review will focus on one growing area of research: the postulation that a

partial explanation for this discrepancy among African Americans is that they avoid professional

mental helpers for fear of racist and discriminatory treatment.

The examined phenomenon that lower levels of professional help-seeking are found in

African American populations (Snowden, 1999; McMiller & Weisz, 1996) may signal that the

discrepancy is not just one of access, but one of choice. There exists a split in the explanatory

theories as to why blacks might choose not to put their faith in professional helpers, yet there is

some agreement that it may be related to a racial divide. One side of the debate is exemplified by

a concept forwarded by Vontress and Epp (1997), that of “Historical Hostility.” This theory

claims that African Americans, as a community, have suffered trauma (i.e. racism) at the hands

of white Americans and therefore have developed a cultural pathology which has caused

“cognitive distortion in transference,” preventing them from being able to tell the difference

between “friend” and “foe.”

Alternatively, in 1984 Charles Ridley penned an important essay that forwarded the

concept of “Healthy Cultural Paranoia,” which posited that black clients who approached

professional helpers with caution should not be pathologized, but ought to be seen as instead

healthily adapting to a potent historical and contemporary context. Indeed, Gamble (1997)
BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 3

reviews the literature and asserts that that African Americans’ perception of being treated

differently exists not only because they were treated differently but because indeed they often

are being treated differently. Arthur Whaley (1997) gathered evidence for distinguishing three

separate constructs—“Distrust (DST), Perceived Hostility of Others (PHO), and False Beliefs

and Perceptions (FBP)”—and found that there was “decreasing ethnic–racial or sociocultural

differences and increasing psychopathology along with movement from mild (DST) to moderate

(PHO) to severe (FBP) paranoid symptoms.” In other words, there is a spectrum which can be

used to differentiate pathology from an adaptive response to discrimination. He thus advocates

for the use of the term Cultural Mistrust to be associated with the presence of DST and low

levels of psychopathology, as opposed to the pathologized Cultural Paranoia (2001). Further

review of the literature finds extensive documentation of discrimination against African

Americans by the mental health community, suggesting that the documented presence of cultural

mistrust is grounded in conceptions both valid and contemporary, and therefore not entirely

lasting trauma from a racist history.

Historically, the preeminent example of racist treatment within healthcare institutions is

the Tuskegee Syphilis experiment. It has had a lasting effect on the attitudes of blacks: Katz et al.

(2008) found that blacks were four times as likely as whites to have heard of the experiment.

This event is often cited as a major reason for mistrust, but more recent examples of abuses

abound. For instance, there has been an over representation of blacks in involuntary

commitments to public mental institutions (Lindsey & Paul, 1989). Another study suggests that

given the same behavior, black youths are four times more likely to be restrained then the white

counterparts (Bond, DiCandia, & MacKinnon, 1988). Delbello et al. (2001) found that African

American male youth in psychiatric units are more likely to be diagnosed with schizophrenia and
BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 4

other psychotic disorders whereas their white counterparts are more likely to be diagnosed with

affective disorders, even when controlling for SES; this despite evidence that rates of affective

disorder tend to actually be the same between whites and blacks (Cuffe et al., 1995). Other

research suggests that blacks are less likely than whites to receive the best quality treatments for

depression and anxiety, and that this effect was not due to differences in insurance coverage or

income (Young et al., 2001; Wang, Berglund, & Kessler, 2000). Jenkins-Hall and Sacco (1991)

posit that this disparity in quality of care may be caused by therapists having a more negative

reaction to depressive symptoms in blacks than whites.

Cultural mistrust, if it is derived from the above experiences, has a negative effect on

help-seeking behavior amongst black Americans (Whaley, 2001; Nickerson, Helms, & Terrell,

1994), and it seems that cultural mistrust is not due to sociodemographic factors (Halbert et al.,

2006). In fact, the assumption that African Americans who voice concerns about discrimination

are irrational may directly lead to the high rates of schizophrenia diagnosis amongst African

Americans (Collins, Rickman, & Mathura, 1980; Cuffe et al., 1995; Jones & Gray, 1986; Lewis,

Croft-Jeffreys, & David, 1990).

Little research addresses how mental health professionals can combat feelings of cultural

mistrust; therefore, more research is needed on what steps individual clinicians can take, not only

to make their clients more trusting, but also to increase the help-seeking behavior amongst

potential clients who are hesitant to see professional helpers because of legitimate concerns.

There is no current research that suggests whether cultural mistrust in an individual is directly

related to personal experiences with therapy. If this is not so, then a culturally competent practice

may not be enough to reach whole communities. To better understand this, researchers must

investigate what kinds of therapy experiences cause there to be less cultural mistrust in
BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 5

individuals, if there are any, and whether cultural mistrust can be affected on an individual scale

or whether it requires interventions and reform on a community or institutional scale.

BLACK AMERICANS’ CULTURAL MISTRUST OF THE MHC 6

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Breland-Noble, A. (2004). Black adolescents. Psychiatric Annals, 34, 535–538.

Collins, J. L., Rickman, L. E., & Mathura, C. B. (1980). Frequency of schizophrenia and

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Cuffe, S. P., Wallwe, J. L., Cuccaro, M. L., Pumariega, A. J., Garrison, C. Z. (1995). Race and

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