Previously referred to as manic depression or manic depressive illness, bipolar disorder is one of several disorders that causes unusual changes in a person’s mood. For some, these mood swings can be unpredictable and cause severe symptoms that impact daily life. Most people develop bipolar disorder as young adults, but it can present at any age, and it is typically diagnosed with the first manic symptoms.
Some races are disproportionately affected by bipolar disorder, although they experience symptoms similarly. African Americans with bipolar disorder have manic symptoms and depression just as non-Hispanic White people with bipolar disorder do. However, healthcare inequities and other barriers create unique and daunting challenges.
Below, we examine some of these challenges, what we can do to confront them, and African Americans who are doing just that.
Types and Symptoms of Bipolar Disorder
Symptoms of bipolar disorder vary depending on the type and severity. The three most common types of these mood disorders are cyclothymic disorder, bipolar II disorder, and bipolar I disorder. All three include depressive symptoms and manic episodes, although in varying degrees of intensity.
Mania typically lasts a week or more with symptoms ranging from racing thoughts, distractibility, and restlessness, to increased risky behavior and decreased sleep. Depressive symptoms include fatigue, difficulty concentrating, feelings of worthlessness, and loss of interest.
- Cyclothymic Disorder: This is the milder form of bipolar. It includes many of the symptoms of hypomanic and depressive symptoms, but these symptoms may not be severe enough to qualify as true episodes.
- Bipolar II Disorder: Bipolar II disorder requires at least one hypomanic episode and one depressive episode within the previous two years. It is often accompanied by anxiety disorders or substance use disorder.
- Bipolar I Disorder: The inclusion of manic episodes and depressive symptoms indicate Bipolar I disorder.
Barriers to Care for Black People
African Americans experience symptoms of bipolar disorder the same and in similar numbers, but their care is vastly different. This is because of the barriers they face, mostly caused by a delay in treatment for a variety of reasons, from hesitation on a personal level to socioeconomic factors.
Hesitation
Many people with bipolar disorder, regardless of race, hesitate to seek treatment because of stigma around mental illness. For African Americans, this reluctance is compounded by several factors, including a mistrust of the national health care system. This mistrust is not without reason, although it can sometimes hurt those who could benefit from a mental health evaluation and possible treatment. Another reason Black Americans may wait to speak to a provider is an ingrained sense of “toughness” when overcoming whatever challenges they face. This cultural barrier has become a wall between African Americans and the health care system.
Misdiagnosis
While misdiagnosis in mental disorders is more common than physical ones, it seems to be more prevalent among Black people with bipolar disorder than other races. The most commonly misdiagnosed condition is schizophrenia. While several anti-psychotic medications can treat both schizophrenia and bipolar disorder symptoms, the mental illnesses are treated differently by providers, especially therapists. Appropriate care is vital to long-term quality of life when living with a mental health condition, so misdiagnosis among African Americans can pose complications long-term.
Lack of Providers
The American Psychiatric Association and American Psychological Association have determined one barrier to proper mental health care for African Americans is a lack of Black providers. Over 13% of Americans identify as Black compared to only 2 percent of psychiatrists and 4 percent of psychologists. There is already a shortage of providers, which makes finding care challenging in some locations, let alone finding one experienced in treating bipolar disorder that an African American can relate to and feel comfortable working with.
Lack of Health Insurance
Hispanic Americans continue to report the highest numbers of uninsured, at over 2.5 times that of White Americans. However, African Americans are still suffering the effects of a lack of health insurance with 10.9% reporting have inadequate or no health insurance compared to 7.2% of non-Hispanic White people. These findings, reported by the Kaiser Family Foundation, show that the number of un- or underinsured are declining, but more needs to be done to ensure that everyone has equal access to mental health care.
Vicarious Stress
Personal trauma is difficult to process and often results in PTSD, anxiety, depression, and other mental disorders. However, vicarious stress is trauma from supporting others you know or even your community with their trauma. It could be the death of a friend’s loved one or an act of violence that occurred near your home. African Americans are subjected to vicarious stress in many ways, including acts of racism. Because many in the community feel that they aren’t the only ones to struggle with it, they often feel as if they shouldn’t need to seek help when that struggle becomes too much. Long-term exposure to vicarious stress can affect mental health as well as physical health. One BeWELL study found that it has a profound effect on those with systemic lupus erythematosus (SLE).
Confronting the Problem
While we know these mental health barriers exist, more needs to be done to bring them down so African Americans facing bipolar disorder can get the care they need.
Address Systemic Racism
Hesitation and misdiagnosis are only two of the many possible outcomes caused by systemic racism. Many youth are directed to the juvenile justice system instead of receiving the mental health care they need. We can only address these problems and others by resolving the racism so prevalent within the mental health care system. According to a study published in the American Journal of Psychiatry, this can only be done with education and self-reflection, by changing social norms, and addressing public policies.
Relevant Training for Providers
The government-funded Substance Abuse and Mental Health Services Administration (SAMHSA) has established the African American Behavioral Health Center of Excellence. This center supports behavioral health systems across the country better support Black communities with better intervention and treatment options, education and training for professionals, and much more. There are continued efforts being made on the state level and within communities to train existing providers.
Encourage More African American Mental Health Providers
Through scholarships and college recruiting efforts in schools, we can raise awareness of the dire need for mental health providers in the African American communities. While it will take years for future and existing students to complete the required coursework and enter the workforce, these efforts need to begin now so that a new generation of Black people can benefit from having a more diverse population of providers from which to choose.
Black People with Bipolar Disorder
African Americans are helping to sponsor support groups and scholarships through non-profit organizations and social media platforms. Some of your favorite celebrities may even understand mental illness more than you realize. Let’s look at a few Black people with bipolar disorder.
Rwenshaun
Rwenshaun Miller didn’t know how to recognize bipolar disorder let alone seek help for it. This is common for many African Americans, but males especially. Another hurdle he faced was overcoming what he’d been taught from a young age about mental health. As a Black male, it was never okay to show your emotions, to share them, or to seek help if something was off about them. He describes the genuine fear of being too loud, boisterous, or angry in public because of the threat of violence that could result in tragedy, as it has for others. A manic episode could become difficult to manage, compounding these fears. He spiraled into depression, alcoholism, and lost weight.
Like many bipolar patients, his first attempt at treatment was not successful. It wasn’t until he saw an African American male therapist that he could connect with that allowed him to embrace therapy and other treatment options. He now heads Eustress Inc, an organization that awards scholarships to Black men pursuing a career in mental health services.
Lindsay
Lindsay Anderson understands the weight of living a challenging life with a career, school, being a mom, supporting her own mom, and being an African American woman with bipolar disorder. She was once told that “Black women over exaggerate everything” when having a conversation about the many conflicts she struggles with, without mentioning the mood episodes that she experiences. These mood swings caused by bipolar disorder make managing the many external burdens an internal one that can be difficult to endure. Lindsay understands more than most what it means to be an African American with a mood disorder in a time when most are advocating for more open communication about mental health.
For many Black women, it’s not as simple as opening up to share their story and daily battle with mood episodes. Instead, most are discounted or pushed aside as overstated or untruths. As an advocate for mental health, Lindsay is the founder of Consciously Coping, a network of social media platforms aiming to support Black women living with mental illness through transparency.
Famous People
Even fame and money can’t cure this lifelong illness. Do you recognize any of the names listed below? If so, realize that you aren’t alone in living with bipolar disorder, no matter what form. Many celebrities work diligently to raise awareness of mental health and the importance of seeking help, no matter the illness or symptoms.
- Ye (Kanye West)
- Mariah Carey
- Chris Brown
- Lisa Nicole Carson
- Jenifer Lewis
Bipolar in Black People: A Bigger Mental Health Problem
As you can see, facing bipolar disorder as an African American is no small challenge. However, many are standing up to the challenge, as well as standing up for others by raising awareness and becoming advocates for their communities. Black Health Matters is one such advocate. We hope you’ll become advocates with us this May for Mental Health Awareness Month.
