Across the nation, Black Americans are facing increased levels of stress and anxiety because of the coronavirus crisis, the economic downturn and the lingering emotional scar from seeing a Minneapolis police officer kill George Floyd.
Since Floyd’s death, St. Louis psychologist Rimiko Thomas has seen a growing number of African American clients.
“There's so much stress that's going on in between Black Lives Matter, COVID and job insecurity right now,” Thomas said in a Zoom interview. “Then also they talk a lot about how to deal with stress because [they say] 'I've got all these other things going on in my mind.'”
Thomas, who is African American, said Black people often do not seek professional mental health therapy because they do not trust those in the field. Limited access to health care and the lack of Black therapists pushes many people to take their concerns to pastors or loved ones. Some suffer in silence.
Thomas spoke to St. Louis Public Radio’s Andrea Henderson about how police violence against African Americans and the coronavirus pandemic have led many Black people to seek her services.
This interview was edited for clarity.
Andrea Henderson: What does trauma do to the body, especially for African Americans?
Rimiko Thomas: Trauma is when your body is on a constant anxiety fight or flight. It can wreak havoc on your heart rate. It can wreak havoc on your blood pressure. It can also wreak havoc on your weight. It's difficult. It can wreak havoc when it comes to addictive behavior. I have clients that when they come in, the first thing I do is ask them about stress and how they're maintaining stress because they'll come in saying, "I've got these headaches that I can't get rid of. My weight is up and down and my blood pressure." I notice a lot of times they'll come in with a lot of somatic symptoms. And the majority of times that is due to constant stress that their body is constantly under.
Henderson: What types of trauma are Black people coming in to talk to you about?
Thomas: A lot of racial trauma. Trauma is when you see things over and over and over, and it doesn't have to be a lot of pain when it comes to trauma. They talk about micro-aggressive behavior and overt and covert racism. You know, those are things that society does not think can be traumatic, but it really can, because you're constantly being exposed to that mindset, those behaviors, those aggressions. Even the witnessing of an event like George Floyd’s [death], but if you're seeing a person of considered authority standing on somebody's neck and somebody that looks just like you, then it’s going to trigger you. I have clients that come to me and say, “I personally was not affected, but when I was pulled over by police I was nervous, my heart was beating, and I hadn't been in trouble with police before.” But you have to take a look at all that you've witnessed. You're having a reaction, which is a part of trauma. And just because you did not witness it personally, how many times have you witnessed it secondary. Secondary trauma actually can be very, very, very problematic and difficult and can create a lot of anxiety and angst.
Henderson: Take me back to the week of George Floyd’s killing. What was your workload like?
Thomas: My workload was the same at that time. But I attribute that to shock and kind of really needing a moment to process within what happened. Again, we cannot get more blatant than this gaslighting that is happening. And so the clients that I had at the time were voicing a lot of shock. So there was actually a lot of silence, a lot of tears, again, with witnessing the trauma and sitting with that trauma. My caseload at that particular week did not increase until a week or two later. I think that's because it really took time to process it and figure out how it's affecting us. I had some clients that were vocal in feeling grateful for the advocacy that was coming out of the protests, but then I also had some clients that expressed conflicting feelings. But this is not new. This is our everyday occurrence.
Henderson: In the Black community there is a stigma that if you seek mental therapy, then you are looked at as “crazy.” How did this stigma even originate?
Thomas: I think it goes back to experiments like the Tuskegee Experiment and how we were wrongly diagnosed and then labeled. It was always taboo for whenever somebody was dealing with a mental health concern. I think also about mental health, you can't see it. And we're still in a society that says, “If I can't see it, if I can't touch it, then it doesn't exist or I don't understand it.” And so there's an abstraction to mental health, too, that can make it very uncomfortable. And so that's some of the things that I think with mental health that has made it very difficult for the Black community to really talk about or really address it because it's not seen. There are all of these stereotypes, whether it's within television or film or in our own family structures. But it's deeply entrenched.
Henderson: Why aren’t African Americans offered the same access to mental health care services as other communities?
Thomas: A lot of times with mental health care, many psychologists and psychiatrists are not on insurance panels, and a lot of them are self-pay. The average price of a psychologist can range up to $200 a session and then the psychiatrist will be even higher. There are some providers that do not accept insurance. Some clients are coming out of pocket, and the cost is just way too exorbitant. I think this is where institutionalized racism comes in. A lot of people do not have the resources, and I think that's a huge barrier that makes it difficult.
There is also the mistrust. Schizophrenia for Black men is ridiculously misdiagnosed, and post-traumatic stress disorder is largely underdiagnosed. And so there's also that mistrust, and if they do talk to a mental health provider about what they are going through, then would they successfully and accurately diagnose them or will they be labeled in a situation? And that also goes back to a lack of cultural competency of mental health providers that are out there. So there are a lot of factors and multiple barriers to accessing mental health in the Black community.
Henderson: If you could re-imagine mental health support without the stigma, what would it look like to you?
Thomas: It would just be open. We would be open with physical ailments. Also I would put a focus on the destigmatization of medication. I would like it to be just like taking a vitamin or just like taking something every day for a physical symptom. There's so much within mental health that's not being addressed. There's so much unknown that I think that to destigmatize it, then we have to make it more familiar, more known, more normalized. My wish is that there would be more education around it, so it's not this big scary elephant because it is really not, it's very treatable if it's addressed. And actually it's even more treatable if it's addressed and talked about in time, before it gets to the point where a person doesn't feel like there's any return or we’re doing behaviors that we do not feel helps our mental health. And so that's what I wish it would be.
Follow Andrea on Twitter: @drebjournalist.
