INTERVIEW: ALVIN F. POUSSAINT

Alvin F. Poussaint has been studying suicide rates among
African-Americans, specifically young males, for more than 30 years.

In his new book, co-authored with journalist Amy Alexander, the
psychiatrist and Harvard Medical School associate dean explores the
social and cultural factors behind an "alarming increase" in suicides
among young African-American males in the 1980s and '90s. In Lay My
Burden Down: Unraveling Suicide and the Mental Health Crisis among
African-Americans, he debunks the myth that African-Americans don't
kill themselves.

This belief, he says, is promoted by denial in the African-American
community and by the indifference of white providers of mental-health
services. A stoic posture "within the race" regarding emotional pain
and suffering, he says, helps preserve the stereotype.

Dr. Poussaint, an expert on African-American families, served as a
script consultant for The Cosby Show and A Different World. He is the
author of Why Blacks Kill Blacks and the co-author of Raising Black
Children.

His interest in suicide is more than professional. One of his
brothers killed himself after a long struggle with heroin addiction.
Dr. Poussaint was recently interviewed by telephone by Dallas Morning
News staff writer Ira J. Hadnot. Here are excerpts:

Q: What does your research show?

A: The suicide rates among black people have been low in comparison
to those of the white community. But they have increased since 1979 -
with the rise among young black males being the most dramatic.

It is interesting to note that the rate for black women is lower than
for black men and even lower than that of white men and women. And
that the gap between black suicides and whites is beginning to shrink.

I wanted to know what was behind these numbers, to find the social
and cultural dynamics. Historically, public health officials have
noted that blacks have been less disposed to committing suicide than
whites. Suddenly, the numbers show a shift. What has happened in that
20-year period to create what the surgeon general has called a
public-health crisis?

Part of the suicide puzzle, but not all of it, might be explained by
the increase in drugs, availability of guns, rising crime rates and
further fragmentation of the black family that happened in the last
half of the 20th century. Overshadowing all this is the notion among
blacks, and whites, that black people do not kill themselves, that
the ability to survive poverty, racism and historical oppression
gives some type of immunity against such behavior.

My research led to many more questions needing answers.

Q: Does the increase in suicides and what you call "slow deaths," due
to drug and alcohol abuse, risky sexual conduct and violence, say
something about the failure of black civil society?

A: It may say that the community institutions are not as cohesive and
supportive as they should be in looking out for one another. We need
to be working with young people in recognizing forms of
self-destructive behavior.

Historically, the black church has shored up black people, giving
them the strength to survive hardship. Christianity sees suicide as
morally wrong. Even our gospel musical tradition - from songs like
"Nobody Knows the Trouble I've Seen" to "Burden Down" - underscore
the belief that life down here is going to be hard for us, but to
bear up and in the end redemption will be there. It has not been
about getting the help you need now, but waiting until the hereafter.

There has been this wall of silence in the black community around
suicide to such a degree that black people treat it as a myth. There
is denial that it happens until somebody famous like
singer/songwriter Donny Hathaway takes his own life.

This thinking has even carried over into the mental health community,
with some white professionals missing severe clinical depression and
failing to see other risk factors in black people. Because many of us
have survived hardship, there is the image of the long-suffering
black person who somehow rises above debilitating circumstances.

Q: The "stoic" fronts that African-Americans put on: How much of that
is a reaction to the indifference of whites regarding conditions in
the ghetto and to the lives of African-Americans in general?

A: Black people are distrustful of the white medical establishment,
and that is something that will have to be overcome on both sides.
Many still remember the 40-year Tuskegee study in which black men
with syphilis were deliberately denied life-saving antibiotic
treatments by white government doctors. The story of this study has
been embellished and held up over time as a symbol for why blacks
should not trust doctors.

On a practical level, many remember not being treated by segregated
hospitals or being made to wait for long periods of time and then
receiving inferior care. There is a lot of white indifference and
neglect - even by government agencies. They can't tell you who these
black men are who have been killing themselves. Finding out who and
why aren't priorities.

There can be unintentional bias and prejudice because white
mental-health professionals don't know much about the black community
or the conditions of black people's lives. Thus they lack the
confidence they should have in making the right diagnosis. Also, fear
and misunderstanding of the behavior of young black men can overcome
rational judgment.

Since the '50s, studies about black attitudes toward doctors and
health-care institutions have repeatedly revealed that black
Americans feel alienated by insensitive treatment and an atmosphere
of cultural intolerance.

Q: How directly can racism be implicated in some of these suicides?

A: During slavery, you could say there was a direct relationship. We
know that slaves jumped from ships in the Middle Passage rather than
live in the New World. Suicide and infanticide were part of
plantation life.

Now, racism can be seen as something that causes stress on you. More
black people suffer from stress-related conditions and treatable
illnesses like heart disease and hypertension. Black Americans have
been neglected in funding for medical research and do not get into
medical programs at the rate whites do.

So we can say racism does have an effect on all aspects of black
people's lives. Health and social and economic well-being are
interrelated. Racism can lead to a sense of fatalism - not caring
what happens to you or anyone else. It is a contributing factor to
depression and feelings of hopelessness. It has been shown that some
black middle-class professionals who have spent their careers
"playing by the white man's rules" and still wind up victims of
discrimination, have trouble coping with their anger and
disenchantment.

My co-author, Amy Alexander, who also lost a sibling to suicide, and
I write about post-traumatic slavery syndrome.

Q: Some would say that blaming slavery is a pat excuse and whites
experience some of the same conditions. How would you answer them?

A: Racism's persistent presence, despite significant legal, social
and political progress, has created a psychological risk for black
people that is virtually unknown to white Americans. Post-traumatic
slavery syndrome is a culture of oppression, a byproduct of this
nation's development and the tremendous toll it has taken on the
minds and bodies of black people.

Q: How do you view your brother's death today, and in what ways has
your life been affected?

A: I watched my brother Kenneth shoot drugs while I was a student at
Columbia University. I'd come into the room to study, and he would be
there, with his stuff. I knew that unless he stopped, it would lead
to his death. In 1975, at age 42, he died in an emergency room at
Harlem Hospital. I had seen him put in a straitjacket at the state
psychiatric hospital and incarcerated many times for petty crimes. He
developed bacterial infections, and his body finally failed him. [Ms.
Alexander's brother, also a drug addict, jumped off the top of a
church in his Oakland, Calif., neighborhood.]

His death changed my life. I saw how profoundly self-destructive his
behavior was. He was unable to see failure as a temporary setback.
The more I saw him go down, the more I knew I wanted no part of it.
His death motivated me, somewhat, to go into psychiatry. It motivated
me to want to do something.

Q: What do you attribute the gender differences in suicide rates
among African-Americans to?

A: There are no scientific studies on the gender difference. What I
learned came from talking with black women. Black women feel they
need to be there for their children and represent the family more.
They are also connected to the fabric of the community, the church.
This gives them a network to share problems and solutions.

Black women suffer from depression at significant rates, but it does
not lead to suicide. The low numbers do not mean that black women do
not suffer from emotional illness, lack of self-esteem and the
hardships of poverty. They may mask other forms of self-destruction
like alcoholism, drug abuse, promiscuity, violence and
underachievement.

Q: What can be done to break the stigma African-Americans have about
seeking out mental health professionals?

A: We as a people have to stop seeing needing emotional help as a
personal failing. It is human to have feelings of loss due to
divorce, death of a loved one or loss of a job. It is human to feel
frustrated and even angry if you are constantly shut out of basic
opportunities. ... When we see other people experiencing profound
sadness, isolation, changes in diet, sleep and behavior, we need to
reach out to help or suggest they get help.

Q: What are the parents of young African-American males missing?

A: What is society missing? To see African-American males as
predators is to acknowledge for them what they already believe about
themselves. And that is they are not wanted, and are feared. Acting
out against oneself, the drive-by shootings and gang bravado, are
also ways to seek attention. These kids want to mean something to
somebody.

Shortly after I finished a paper on suicide and black youth, the
murder-suicides happened at Columbine. There was great concern about
the mental state of these young white boys and who might have failed
them. I'd like to think we would someday reach the same level of
empathy for reaching out to young black men with treatment rather
than de facto incarceration.