Black, Deaf, and Mentally Ill: Triple Jeopardy
Reichelle P. Anderson
Deaf Options, Inc., Detroit
This paper explores and discusses mental health issues, theories, and treatment philosophies unique to black deaf people. The objectives are to present a theoretical foundation for developing mental health services to meet the needs of black deaf individuals, to provide information for human services workers and others regarding the special characteristics of mentally ill black deaf people, and to provide cultural insights as a basis for effectively working with this population.
Introduction
In order to determine whether an individual’s psychological functioning is healthy or disturbed, a therapist must be aware of what is appropriate and effective within the patient’s specific cultural milieu. This is crucial to the delivery of effective mental health services. Explaining what it is to be black—or to be black and deaf—in America is beyond the scope of this paper. Instead, we are attempting to capture the essence of the dilemma in which black deaf mentally ill individuals find themselves as a result of belonging to three unique minorities. Each characteristic—black, deaf, and mentally ill—requires recognition of its complexities. America often views each characteristic differently; therefore, those who are members of all three groups are in constant jeopardy of not regaining their mental health, their civil rights, or the substance of who they actually are.
On Being a Triple Minority in America
A. What It Is to Be Black in America.
White people seldom think about being white; however, ask black Americans to describe themselves, and invariably they will include “black” in the description. Black people are almost always aware of their minority status in America. Their self-identity generally includes race as a component; being black is the one aspect of identity that cannot be overlooked in face-to-face interactions.
Traditional theories of behavior and socialization were originally developed by white scientists to explain the lifestyles of white Americans; it is difficult, and perhaps futile, to attempt to use these same theories to understand the lifestyles of black Americans. When applied to black Americans, these theories may indicate various deficits, and inferiority-oriented conclusions may be drawn. Instead, we will approach our subject from a cultural perspective (Acosta, Yamamoto, & Evans, 1982).
In the last two decades, America has been on a self-love campaign. Improving self-esteem is currently touted as the end-all resolution to almost every psychological disturbance or abusive personality disorder. Yet, such simplistic thinking disregards the negative image and conceptualization of minorities that persists in America today. Black people are still generally perceived as culturally defective and psychologically maladjusted. This is perceived to be a result of experiences and backgrounds that provide inferior preparation for effective movement within the dominant culture.
As a black person in America, one must deal with economic disparity; stereotypical thinking; racism, bigotry, and bias; interracial fighting; overachievers syndrome; disenfranchisement; and feelings of powerlessness. Yet, against all odds, some blacks do manage to survive and achieve in America (Acosta et al., 1982). Survival and success are the good parts; there is always the chance they will not occur.
B. What It Is to Be Black and Deaf in America.
To be black and deaf in America is to experience the stigma, struggles, and economic disparity of hearing blacks, compounded by social isolation from three major segments of the population. Black deaf people deal with attitudinal and communication barriers from:
a.their family of origin,
b.American society, and
c.the deaf community.
In the family of origin of the average black deaf child (a), the majority (90%) of parents do not know, use, or promote American Sign Language (ASL). This is often true for white deaf children, as well (Peterson, 1983); however, the black deaf child often experiences increased isolation within the family of origin because black families tend to have less enthusiasm for ASL, do not view ASL as a language, and feel stigmatized by having a “handicapped” child. The lack of enthusiasm stems from ASL being visible, which makes the “handicap” more noticeable.
The stigma of deafness is directly linked to guilt and/or embarrassment regarding the child’s communication abilities. The phrase “deaf and dumb” is still pervasive in the black community; the phrase is interpreted, mistakenly, to mean stupid. For too long, many black people have been made to feel stupid in white America. Any hint of, or innuendo relating to, stupidity is a call to arms. The parents of black deaf children often expect less of their own child because of this archaic, insulting term. White families are more often directed to resources that support them as they work through the shock, grief, guilt, and acceptance stages of adjusting to a child with a disability. White families also tend to accept “home” signs, often attending sign language classes.
Black families are more reticent toward seeking support services and sign classes. Often, parents do not adequately adjust to the deafness; they may overlook their child’s needs as the family deals with the struggles of being black in America. Black deaf children thereby find themselves isolated; deaf culture is unheard of at home, and so residential school staff often become pseudo-family members.
The black deaf person must develop coping skills as a deaf person in a hearing society (b). Until the “Deaf President Now!” movement at Gallaudet in 1988, American society seemed grossly unaware of 21 million deaf and hard of hearing Americans. The entire country suddenly became cognizant of an overlooked population, and the “silent minority” with the “invisible handicap” was catapulted into the nation’s consciousness.
For the black deaf American, the issues of being black and deaf are complicated. America’s dominant society already views black Americans as second-class citizens. In the last decade, the backlash against affirmative action has effectively eroded many of the gains that black Americans achieved through the civil rights movement of the 1960s and 1970s. Despite the passage of Section 504 of the Rehabilitation Act of 1973, which was meant to ensure rights and accessibility for handicapped individuals, persons with a disability are viewed with stigmatizing attitudinal barriers.
Some of the complications faced by black deaf people include:
•less knowledge of and access to community resources;
•exposure to fewer educational opportunities;
•lack of black role models;
•lack of black human service professionals working in deafness;
•families of origin tend to seek services later, when the child becomes older or encounters problems;
•black deaf people are often steered into entry level or minimal skills fields by rehabilitation workers, rather than toward college preparatory or college programs;
•black deaf children seldom see black deaf teachers, principals, administrators, or interpreters as they go through school.
Note: Dr. Glenn Anderson is being run all over the country as the first black deaf person in America with a Ph.D. There are only two black deaf individuals with Ph.D.’s in the United States!
Black deaf people also experience isolation and attitudinal barriers in the Deaf community (c). In 1980, at the National Association of the Deaf (NAD) Centennial Convention, members of the Black Deaf Concerns Caucus found it necessary to present a list of concerns and demands to the predominantly white convention membership. Three thousand convention members saw the presentation of the Caucus statement, which stressed better communication between NAD and the black deaf community; minority involvement in the national state organizations; heightened awareness of black deaf people through role models, better publicity, and modification of sign language to exclude derogatory signs; and increased minority membership. The statement was well-received and politely ignored. Not until 10 years later, in 1990, did the NAD announce the appointment of the first black Board member in its 110 year history. In addition, the Caucus requested that black deaf Americans be equally represented in the NAD publication Deaf American, rather than only in the sports section. Still, cover stories on black deaf Americans have been few, the implications being that black deaf achievers do not exist, black deaf achievement outside of sports is not newsworthy, or stories on black deaf individuals are of no interest to the readership of the Deaf American.
Many private social clubs for deaf people continue to systematically and surreptitiously exclude black deaf members, and potential role models are discouraged from attempting higher education by so-called “professionals” in the mental health, rehabilitation, and social service fields. In Michigan, for example, there are only five black deaf college graduates. Four of the five moved to Michigan from out-of-state to accept professional positions; at present, two work professionally, one is returning home, and one holds a degree in a non-professional field. The civil rights movement only hit the black deaf community in 1981, with the formation of National Black Deaf Advocates (NBDA). Through NBDA, black deaf Americans have a forum for self-advocacy, self-discovery, networking, and skills building, and a showcase for black deaf talent and role models.
C. The Sum Total of Being Black, Deaf, and Mentally Ill.
Studies reveal nearly 23% of the 21 million deaf and hard of hearing citizens of the United States urgently need mental health hospitalization, outpatient counseling, and therapy. The inference is that specialized mental health services for deaf people are needed. Effective therapy with deaf people must be made available and culturally and communicationally accessible. Unfortunately, mental health services for deaf individuals began only 30 years ago, and services are still not available in many parts of the country.
The poor, working-class, or minority person who needs psychotherapy is characteristically underserved by mental health establishments, which are primarily geared to the needs of middle- and upper-class, non-minority patients. Therapists who make up the mental health establishment often lack the knowledge necessary to work effectively with minority populations; this lack of knowledge and the existence of racism in America combine so that many mental health professionals have prejudicial attitudes toward black deaf individuals. Such attitudes can be manifested in outright rejection, or in the provision of less intensive, less interested, or less enthusiastic care for the black deaf patient who is mentally ill. Few medical schools or graduate programs for mental health professionals address themselves to the issues of deaf people in general, let alone black deaf people. Deficiencies in the instructional literature regarding deafness, black deaf individuals, and black deaf mentally ill people abound; it therefore follows that black, deaf, and mentally ill individuals are likely to encounter obstacles in the availability of services and the lack of qualified personnel. For black, deaf, and mentally ill people to seek mental health services is to be stigmatized, misunderstood, and sometimes shunned by other deaf people. Black professionals with the necessary knowledge of deafness and adequate sign skills are scarce. Black deaf individuals are more often referred to psychotherapists, while white deaf individuals are referred to either psychologists or psychiatrists, and black deaf people are disproportionately misdiagnosed as schizophrenic. Again, this situation is compounded by the paucity of mental health services for deaf people in general.
Most of the aforementioned obstacles would be met by black deaf individuals who are seeking mental health services. In actuality, the majority of black deaf people who are in need of mental health services do not seek services. Services become an issue only when symptomology and behavior indicate a need for hospitalization. This happens in part because the hearing families of black deaf people are not skilled in communication with the deaf family member. Black families are not usually in touch with the deaf community or knowledgeable of black deaf culture; they are generally unable to separate healthy deaf cultural suspiciousness from paranoia as a symptom. Withdrawal and depression are often overlooked or ignored. Acting out behaviors linked to the frustration of communication are often misinterpreted. Black hearing families, in general, avoid seeking mental health services; often, they will wait until a crisis before attempting to address mental health issues. The black family with a mentally ill deaf person further handicaps the individual through their confusion and hesitation. Attempting to locate a service only increases the burden of the crisis. Black, deaf, and mentally ill individuals therefore find themselves in a state of triple jeopardy.
Theoretical Views on Black Deaf Mentally Ill People
A. Characteristics Unique to the Black Community Regarding Mental Illness.
It has already been stated that black families tend to seek services later, often only in a crisis situation. It can also be said that black patients tend to remain in treatment for shorter durations, with an average of eight outpatient visits; it has been estimated that white patients average 12 visits. However, blacks are beginning to seek mental health services in increasing numbers.
Often in the delivery of services, problems arise related to the social class of the patient and the race of the therapist. Black patients encountering difficulties often leave treatment prematurely as a result of misunderstandings and misinterpretations by non-black professionals. Examples include:
1.Social support system
Often, white therapists misinterpret the social support systems used by black Americans and view them as a sign of weakness. Attempts by the patient to involve extended family in the therapy are viewed as resistance or overdependence.
2.Cultural factors
Therapists tend to prefer playing the role of the expert. When white therapists don’t understand, acknowledge, or appreciate cultural components of the patient’s history, they are often reluctant to ask for clarification; this reluctance often leaves the therapist uninformed and unable to analyze certain aspects of the patient’s culture such as values, familial roles, language, mores, and behavior.
3.Communication style
White therapists often misinterpret lack of eye contact, limited answers, limited body language, and indirect responses to mean that the patient has poor verbal skills, poor abstract reasoning abilities, or a lack of insight.
4.Skin color
For black Americans, skin color has been an issue within the black community since slave masters interbred with slaves. Failure to understand its importance in a cultural context is to miss an opportunity to understand the self-concept or self-esteem of the black patient.
5.Discrimination
Studies indicate that social class has been an important determining factor in services offered. Stereotypical views of black Americans by therapists tend to strongly parallel those of society in general.
B. Characteristics Unique to the Black Deaf Community.
Black deaf culture is a compilation of being black and being deaf in America. Some unique characteristics noted in the black deaf community are:
1.Social interaction and mores
Social gatherings in the black deaf community tend to be informal; activities are less organized and casually planned. Any activity that offers refreshments draws a large crowd; major events usually require more formal attire and include a meal.
There appears to be a shortage of black men in general, and of black deaf men in particular. Therefore, fidelity and monogamous relationships are viewed differently in the black deaf community than they are in mainstream society. It is considered a major taboo for black hearing women to date black deaf men. Apparently, it is more acceptable for black deaf men to date white deaf women, although this is not embraced; this is similar to the hostility black women feel toward white women who date black men.
2.Values
College graduates are somewhat revered in the black deaf community. Their opinions and ideas often go unchallenged, which can be a problem if the college graduate is outspoken. The tendency to dominate the social structure of the local town is strong; for areas blessed with a large group of college graduates (more than five), conflicts arise due to political maneuvering for power and authority.
Church attendance is valued in the black deaf community, much as it is in the black community, since black deaf people grow up seeing their hearing parents attend church services regularly. Black deaf people will attend churches where deaf ministries provide interpreters, regardless of whether the church is predominantly black or white. The majority of black interpreters get their start as religious signers in church.
3.Sense of community
The major strength of black deaf culture is its sense of community. Black deaf people view themselves as different from white deaf people, even though there are some commonalities based on deafness. Black deaf people are acutely aware of their minority status; the community embraces itself as a subculture of black hearing culture, while still celebrating its differences. ASL is naturally the native language of black deaf people. Black hearing individuals are welcomed into the community if they are honing their skills, are willing to volunteer or loan skills and resources to the community, and respect black deaf people as leaders in their own right. The majority of the leaders in the black deaf community do not view deafness as a disability or a handicap; despite the fact that most black deaf people have experienced attempted “healings,” deafness is viewed as a unique characteristic with accompanying adjustments.
4.Identity
Black deaf people view themselves as deaf and black; this is an important distinction from white deaf people, who view themselves simply as deaf Americans. It has been stated that there is no black sign language, yet black deaf people do sign differently than white deaf people; the main difference is in style. The oppression of black people in this country has filtered through to the black deaf community, as evidenced by lowered hand positioning for signs; most black deaf people place their signs lower in relation to the body during casual conversation. This is directly related to black people being made to feel like second-class citizens, often placed in subservient roles. Other stylistic differences relate to the naturally expressive nature of black culture.
C. Treatment Issues Related to Black Deaf Mentally Ill Persons.
Despite the increasing numbers of black Americans seeking mental health services, black families with deaf members are not seeking services. As the family of origin struggles simultaneously with issues of powerlessness and oppression in America, the black deaf person’s sense of isolation within the family increases. Black families may remain in a stage of denial well into the deaf person’s adult years, claiming that the deaf person can understand conversations and can hear when he or she wants to.
1.Communication-related disturbances
The frustrations encountered by black deaf individuals attempting to communicate with their families are numerous, and they often lead to miscommunications, confusion, and limited exposure to resources through the family. Inadequate communication skills within families of origin can cause depression and withdrawal, social retardation, and lowered self-esteem.
2.Violent behaviors
If parents do not communicate well, the child does not learn effective impulse control, cause-effect relationships to behaviors, delayed gratification, or abstract reasoning; it therefore follows that many black deaf people end up in psychiatric inpatient units due to acting-out and/or violent behaviors. These behaviors are the result of frustration, resentment, and a limited ability to express feelings. They may take years to manifest themselves, and they may be masked for some time by substance abuse. Limited resources are always an issue for the black deaf mentally ill individual, since the majority of them come from lower income families with fewer networking experiences. Parents of deaf adults often use the hospital as a last resort when they can no longer control the emotional outbursts; as a result, it is the medical system that generally sends the black deaf person for mental health services, as opposed to the white deaf person whose family seeks a referral to “get help.”
3.Lowered self-esteem
Low self-esteem is not new to the black community in general, and it is pervasive among black deaf mentally ill people. It appears that members of this group feel an increased sense of powerlessness, which is often manifested in sexual acting-out behaviors, substance abuse, domestic violence, and poor employment habits. Many black deaf adults in need of mental health services delay or resist services because of ignorance about the world around them; often, “mental health” is interpreted as “crazy,” which has a negative connotation. Black deaf community members do not believe that confidentiality exists in the mental health profession, and so they are convinced that others will find out they are receiving services.
Conclusion
Issues for black deaf individuals who are mentally ill are layered in complexities that necessitate an understanding of what it means to be black in America, what it means to be black and deaf in America, and what it means to be black, deaf, and mentally ill. Thus, the “triple jeopardy” state: the struggle to understand the world, relate to it, adjust to it, survive in it, and feel good about it.
As a black person, one must deal with economic disparity, stereotypical thinking, attitudinal barriers, racism, and a sense of powerlessness in America. As a deaf person, one must deal with communication barriers within the family of origin, America’s dominant society, and the deaf community itself. The sense of isolation experienced in the family of origin is characterized by the family’s long-term denial, shame, and ineffective communication.
Treatment issues for black, deaf, and mentally ill individuals usually center around communication-related disturbances, violent acting-out behaviors, and an immobilizing lowered self-esteem. Services for mentally ill people must be sought by families who have limited knowledge of resources and who often wait until mental health issues reach crisis proportions; the majority of black deaf people receiving mental health services enter inpatient programs without prior outpatient treatment. In addition, the staff of most mental health programs for deaf people is generally not mixed along ethnic and racial lines, which can cause problems during treatment.
The situation is not as bleak as it sounds; in fact, the saving grace lies in the strength of black culture. The adaptability of family roles, the strong kinship bonds, the belief in work, achievement, and religion, and the strong sense of community allow for the survival of black deaf mentally ill people, despite their state of “triple jeopardy.”
On Empowerment
As the founding executive director of Deaf Options, Inc., I believe people can become empowered if they have choices. Empowerment is the process by which a person recognizes, owns, and uses his or her inherent personal power.
Empowerment happens as a person integrates his or her culture, personal resources, educational opportunities, and support systems. Empowerment is choosing to be; accepting the self with love and affirmation. Upon choosing self-empowerment, a person can do the things he or she wants and needs to do.
At Deaf Options, Inc., staff members do not use the word “help,” nor do they believe in “helping” deaf people. “Help” implies an imbalance in a relationship; the so-called expert “helps” the less fortunate, less knowledgeable client. Instead of helping people, we offer services: we offer our skills, talent, training, experience, and knowledge for the benefit of others. Choosing to engage in our various programs is the first step on the path to empowerment.
About the Presenter
Reichelle P. Anderson, M.A., is founding executive director of Deaf Options, Inc., the second of two outpatient mental health programs serving deaf people in Detroit. Ms. Anderson has 11 years’ experience in the deaf community as a family therapist, psychotherapist, interpreter, clinical psychologist, and, currently, administrator of Deaf Options, Inc. She has a B.S. in special education and an M.A. in clinical psychology. She established three deaf ministries at three black churches, is past secretary of Detroit Black Deaf Advocates, and is treasurer of National Black Deaf advocates.
References
Acosta, F. X., Yamamoto, J., & Evans, L. A. (1982). Effective psychotherapy for low income and minority patients. New York: Plenum Press.
Peterson, E. W. (Ed.) (1983). Deafness and mental health: Emerging responses (Monograph No. 12). Silver Spring, MD: ADARA.