Bipolar disorder, formerly called manic depression or manic depressive illness, is one of several disorders that cause unusual changes in a person’s mood. For some, these mood swings can be unpredictable and cause severe symptoms that affect daily life. Most people develop bipolar disorder in young adulthood, but it can appear at any age and is usually diagnosed with the first manic symptoms.
Certain races are disproportionately affected by bipolar disorder, even though they experience similar symptoms. African Americans with bipolar disorder have manic symptoms and depression at the same rate as non-Hispanic whites with bipolar disorder. However, health disparities and other barriers create unique and daunting challenges.
Below, we explore some of these challenges, what we can do to address 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 involve depressive symptoms and manic episodes, although to varying degrees of intensity.
Mania usually lasts a week or more, with symptoms ranging from racing thoughts, distraction, and restlessness to increased risk-taking behavior and decreased sleep. Depressive symptoms include fatigue, difficulty concentrating, feelings of worthlessness, and loss of interest.
- Cyclothymic disorderThis is a milder form of bipolar. It includes many symptoms of hypomania and depressive symptoms, but these symptoms may not be severe enough to qualify as true episodes.
- Bipolar II disorderBipolar 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 disorders.
- Bipolar I DisorderThe inclusion of manic episodes and depressive symptoms is indicative of bipolar I disorder.
Barriers to care for Black people
African-Americans have the same symptoms and the same number of bipolar disorders, but their care is very different. This is because of the hurdles they face, which are mainly due to delays in treatment due to various reasons ranging from personal level variation to socio-economic factors.
Many people with bipolar disorder, regardless of race, hesitate to seek treatment because of the stigma surrounding mental illness. For African Americans, several factors add to this reluctance, including distrust of the national health care system. This mistrust is not without reason, although it can sometimes harm those who could benefit from a mental health evaluation and possible treatment. Another reason why black Americans may wait to talk to a provider is because of an ingrained sense of “toughness” as they overcome all the challenges they face. This cultural barrier has become a wall between African Americans and the health care system.
Although misdiagnosis of mental disorders is more common than physical, it is more common among blacks with bipolar disorder than other races. The most common misdiagnosed condition is schizophrenia. Although several antipsychotic medications can treat the symptoms of both schizophrenia and bipolar disorder, mental illnesses are treated differently by providers, especially therapists. Appropriate care is vital to long-term quality of life when living with mental health issues, so misdiagnosis in African Americans can cause long-term complications.
Lack of suppliers
The American Psychiatric Association and the American Psychological Association determined that one barrier to adequate mental health care for African Americans is the lack of black providers. More than 13% of Americans identify as black, compared to only 2% of psychiatrists and 4% of psychologists. There is already a shortage of providers, making it difficult to find care in some places, let alone find someone 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 number of uninsured, more than 2.5 times that of white Americans. However, African Americans still suffer the consequences of not having health insurance, with 10.9% reporting that they have insufficient or no health insurance, compared to 7.2% of non-Hispanic whites. These findings, reported by the Kaiser Family Foundation, show that the number of uninsured or underinsured is declining, but more needs to be done to ensure everyone has equal access to mental health care.
Personal trauma is difficult to process and often leads to PTSD, anxiety, depression, and other mental disorders. However, vicarious stress is trauma when you support others you know or even your community with their traumas. It could be the death of a loved one of a friend or an act of violence that happened near your home. African Americans experience vicarious stress in many ways, including acts of racism. Because many in the community believe that they are not the only ones struggling with this, they often feel they don’t need help when the struggle becomes too much. Prolonged exposure to vicarious stress can affect mental as well as physical health. One study of BeWELL found it to be highly effective in those with systemic lupus erythematosus (SLE).
Facing the problem
While we know these mental health barriers exist, more needs to be done to reduce them so African Americans with bipolar disorder can get the care they need.
Addressing systemic racism
Hesitation and misdiagnosis are just two of the many possible outcomes of systemic racism. Many young people are referred to the juvenile justice system instead of getting the mental health care they need. We can only solve these and other problems by addressing the racism that is so prevalent in the mental health care system. According to research published in the American Journal of Psychiatry, this can only be done through education and advocacy, changing social norms and addressing public policy.
Appropriate training for providers
The federally funded Substance Abuse and Mental Health Services Administration (SAMHSA) created the Center of Excellence for African American Behavioral Health. This center supports behavioral health systems across the country, better supports black communities with better intervention and treatment options, education and training for professionals, and much more. Ongoing efforts are being made to train existing providers at the state level and in communities.
Encourage more African American mental health providers
Through school scholarships and college recruitment efforts, we can raise awareness of the dire need for mental health providers in African American communities. While it will take years for prospective and current students to complete the required courses and enter the workforce, these efforts must begin now so that the next generation of blacks can take advantage of a more diverse population of providers from which to choose.
Black people with bipolar disorder
African Americans help sponsor support groups and scholarships through nonprofit organizations and social media platforms. Some of your favorite celebrities may understand mental illness even more than you realize. Let’s look at some black people with bipolar disorder.
Ruenshawn Miller didn’t know how to recognize bipolar disorder, let alone seek help for it. This is common for many African Americans, but especially for men. Another obstacle she faced was overcoming what she had been taught from a young age about mental health. As a black man, it was never okay to show your feelings, share them, or seek help if something is wrong with them. He describes a very real fear of being too loud, noisy, or angry in public because of the threat of violence that could lead to tragedy, as it does for others. A manic episode can become difficult to manage, compounding these fears. He fell into depression, alcoholism and lost weight.
Like many bipolar patients, his first attempt at treatment was not successful. It wasn’t until she saw an African-American male therapist that she was able to connect with him, which allowed her to accept therapy and other treatment options. He now directs Eustress Inc, an organization that provides scholarships to black men pursuing careers in mental health services.
Lindsay Anderson understands the weight of living a difficult life juggling career, school, motherhood, supporting her mom, and being an African-American woman with bipolar disorder. She was once told that “black women exaggerate everything” when discussing the many conflicts she struggles with, without mentioning the mood episodes she experiences. These mood swings caused by bipolar disorder make managing many external burdens internal, which can be difficult to cope with. Lindsey understands more than most what it means to be an African-American with a mood disorder at 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 about their story and sharing their daily struggles with mood episodes. Instead, many are discounted or pushed aside as overrated or false truths. As a mental health advocate, Lindsey is the founder of Consciously Coping, a network of social media platforms dedicated to supporting Black women living with mental illness through transparency.
Not even fame and money can cure this lifelong disease. Do you recognize any of the names listed below? If so, know that you are not alone in living with bipolar disorder, no matter what form you are living with. Many celebrities are working hard to raise awareness of mental health and the importance of seeking help, regardless of illness or symptoms.
- Ye (Kanye West)
- Mariah Carey
- Chris Brown
- Lisa Nicole Carson
- Jennifer Lewis
Bipolar in blacks. a larger mental health issue
As you can see, coping with bipolar disorder as an African American is no small challenge. However, many rise to the challenge as well as advocate for others by raising awareness and becoming advocates for their communities. Black Health Matters is one such advocate. We hope you will join us as advocates for Mental Health Awareness Month this May.