Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Mental distress in Black populations has increased considerably over the last decade, exacerbated by intersecting experiences of poverty, race, and gender: People living in poverty show higher rates of mental illness; women experience mental health issues at greater rates than do men; and women of color face more mental health-related hardship than do White women (Zahran, Kobau, Moriarty, Zack, & Giles, 2004). Studies in several disciplines consider access to services and culturally-appropriate mental health treatment for common psychosocial disorders (Bentley, 2005; Rosen, Tolman, & Warner, 2004; Takeuchi & Kim, 2000; Wilson, 2001), but these often rely on practitioner-reports and agency-based data rather than first-person interpretations of Black women who live with mental illness. Much of the research presumes a medical model, prioritizing treatment and eradication of symptoms, rather than a functional assessment of strengths and strategies used by women to establish and maintain relationships (Raja, 1998). Racial-ethnic differences are often obscured in the absence of a dedicated examination of intersections of race, class, and gender.

This qualitative study investigates the life experiences of eight women who self-identify as racially Black, who have histories of clinically-diagnosed severe and persistent mental illness (e.g., schizophrenia, psychosis, obsessive-compulsive disorder, and major depression), and are either moderate or high-functioning. Data were collected through confidential in-depth, first-person interviews, using life history methodology (Atkinson, 1998; Creswell, 1998; Denzin & Lincoln, 1998; Gluck & Patai, 1991). The sample was recruited using a critical case sampling strategy (Morse, 1998), using referrals by mental health professionals. An iterative analysis was conducted using Nvivo. Respondents reviewed the results for accuracy and further interpretation.

The reality of living with mental illness is quite stark and complex. Race, class, and gender are defining factors in the experiences of some respondents, but for others these factors were less important than characteristics of the mental health problems. Discrimination by and distrust of professionals and employers was common; mixed experiences with and mistrust of family and same-race community members were significant in all narratives. Unmet expectations for support within social networks (whether they could rely on others) both reduced and increased personal strength; caring for children motivated several women to seek and maintain health and employment supports. Differences between Black women's and other women's experiences lie in individual, cultural, and community-based resources and strengths. Suggestions for improving Black women's experiences include community-wide consciousness-raising about mental illness, broadening the range of health and employment options, and including children in interventions.

Few studies have investigated how Black women's interpretations of their experiences may inform mental health policy and programs. The need for this research is evident in the prevalence and severity of the problem (Geronimus, Bound, Waidmann, Colen, & Steffick, 2001) and the potential for alternative practice and policy models to address the unique interests of Black women living with mental illness, their families, and communities. Social work and mental health professionals, educators, and students can benefit from these respondents' insights. The results indicate directions for further research into the prevalence of the factors uncovered in this study.