Black men’s mental health matters

Culturally competent treatments for Black men take these realities into account and, as such, share certain ingredients, say psychologists involved in this work. These include:

Addressing masculine norms: Black men are even more likely than White men to endorse aspects of traditional masculine ideology, such as the need to act tough and in control and to avoid emotional expression, research finds. According to Baron K. Rogers, a psychology doctoral student at the University of Akron in Ohio, that is because they have additional reasons beyond those of White men to assume these stances—namely, “to stave off societal pressures and oppression,” he said. The idea that racial factors intersect with unhealthy masculinity norms is also highlighted in the book Cool Pose: The Dilemmas of Black Manhood in America (Touchstone, 1993) by psychologist Richard Majors, PhD, and sociologist Janet Mancini Billson, PhD. They argued that poor, urban Black men sometimes assume a stance of “aloof swagger” to defend against the harsh realities and racism they encounter in daily life, which wears away at their physical and mental health.

In fact, such internalized views of masculinity “make a lot of Black men resistant to therapy and more likely to seek informal ways of addressing their mental health through barbershops, church, religion, or talking to family members,” said psychologist Erlanger “Earl” Turner, PhD, an assistant professor at Pepperdine University in Los Angeles. So when a Black man does enter therapy, “it’s important to tread lightly as he starts to open up and share his emotions,” he said, “because if you push to discuss emotions too soon and he isn’t ready, he may decide not to return.” (Turner’s podcast, The Breakdown With Dr. Earl, destigmatizes mental health treatment for Black men and boys in an engaging manner, using a psychological science focus.)

Jessica L. Jackson, PhD, a counseling psychologist in Houston and global diversity, equity, inclusion, and belonging care lead at the mental health tech firm Modern Health, has done some of this work with Black men in settings including the VA Greater Los Angeles Healthcare System, the Harris Health System (Texas), and private practice. To help these men identify and become more comfortable with their emotions, she uses a tool called the Feelings Wheel, which labels the spectrum of emotions from the most basic to the most nuanced.

When Black men start to gain a more extensive emotional vocabulary, it provides fuel for the next stages of therapeutic work: addressing past traumas and learning how to communicate more effectively in relationships, Jackson said. She knows they are making progress when they start to bring what they have learned home—for example when they begin communicating with their partners about their feelings instead of brooding or responding with anger. “It’s like they’re getting unstuck,” she said.

Addressing racism: Culturally competent treatment for Black men also involves directly and therapeutically addressing issues of racism, said Rogers, who is on internship at the counseling center at Penn State University.

That means making space for clients to identify racist incidents that they have experienced and the feelings that arise because of them, and, more important, to understand and work toward overcoming internalized racism. The many facets of internalized racism include believing negative racial stereotypes, adopting White cultural values while undermining one’s own, and denying that racism exists, Rogers explained.

For White psychologists to work effectively with Black male clients, it is imperative that they develop a deeper understanding of racism and its impacts by keeping abreast of the latest scholarship, taking continuing-education classes, and getting training in the area. (In fact, for license renewal, several state licensing boards specifically require courses in cultural diversity.) White clinicians should also become familiar with the APA Guidelines on Race and Ethnicity in Psychology, approved by the APA Council of Representatives in 2019. Among other points, the guidelines state that psychologists should consider their own biases, privileges, and socialization in relation to race and ethnicity and work to address organizational and social inequities and injustices inside and outside of the field.

In addition, therapists should be aware that issues of racism and masculinity can intersect in complicated ways, added Rogers, who is working on a scale to identify and understand how and where these domains overlap. That scale, which has now been tested on some 600 Black men, explores what he calls “racist gender role strain”—the idea that if you endorse specific views of manhood but cannot meet them, it creates internal conflict and stress. For example, some Black men may internalize ideas that they should be good protectors, providers, or role models. But, Rogers said, “if you’re in a system that oppresses you or makes you internalize these beliefs but doesn’t give you access to fulfilling them, it causes stress and frustration.”

In a general sense, encouraging clients to talk about racism opens the door to more fulfilling therapy overall, Turner added. “It allows clients to feel that they can talk about anything in this room,” he said. “For me, that’s a really important piece about having that conversation.”

Addressing within-group differences: Working in culturally responsive ways with Black men also means understanding individual differences in terms of socioeconomic status, age, education, U.S. region, country of origin, belief systems, level of acculturation, sexual orientation, and more, Turner said.

On a broad scale, it is helpful to recognize that Black men born in the United States probably incorporate some version of both African-American cultural values—which emphasize the importance of extended family networks, interdependence with groups and relationships, spirituality, and flexible notions of time, for example—and Eurocentric values—which emphasize individuality, nuclear family structure, and competitiveness, Turner noted.

It is also important to understand the complex issues of intersectionality that Black gay, transsexual, and bisexual men face, said Lisa Bowleg, PhD, a professor of applied social psychology at The George Washington University in Washington, D.C. Her research shows that gay Black men often experience racial discrimination from gay men who are not Black, for example, while bisexual Black men experience race and sexual orientation discrimination in both gay and heterosexual communities (Sex Roles, Vol. 68, No. 11–12, 2013).

“Any effective mental health programs need to work with these men holistically and intersectionally,” she said. She also recommends focusing on these men’s strengths and assets—because many of their problems arise from external factors, not internal ones—and holding therapy groups specific to the sexual orientation and race of the men served.

Clinicians also need to be aware of differences in Black men’s backgrounds and countries of origin and incorporate that knowledge into therapeutic work, Turner emphasized. For example, 8% of Black people in the United States are immigrants from countries in the Caribbean, Africa, and elsewhere, and there are significant differences among them. Those who grew up in predominantly Black cultures, for example, are less likely to view themselves as inferior because they have not been exposed to historical racism in their home country. Hence, their cultural identity may serve as a buffer, he noted.

There are many other cultural differences among these groups as well. For example, Jamaicans often identify themselves first as Jamaican and tend to frame mental, psychological, and psychiatric issues as medical or spiritual conditions that need interventions from spiritual healers such as shamans, said Turner, who discusses these topics in his book Mental Health Among African Americans: Innovations in Research and Practice (Lexington Books, 2019).

“As a mental health practitioner, you should be aware of these different cultural and spiritual values,” he said. “But you should also avoid overgeneralizing this information.”

Incorporating group work: Working with Black men in group formats can also be a powerful intervention, thanks to the sense of camaraderie these groups foster. Seeing that other men have similar difficulties can make care less stigmatizing, Jackson explained.

When she was doing her postdoc at the Los Angeles VA, for example, Jackson and a colleague launched a racial trauma support group for veterans of color. That arrangement proved at least as effective as one-on-one therapy, she said.

“Even after they finished the group, the biggest feedback we received is that they continued to meet outside of that setting,” Jackson said. “They became friends, and they wanted to continue. They knew they had a language [for their emotions], and they were able to use it with each other.”

At Penn State, Rogers provides group trainings to students of color on how to address racial microaggressions at the time that they occur. Part of that training includes a series of questions he developed that helps students consider details of the event itself, possible responses, possible consequences and how to handle them, and how their own values and supports can serve as protective factors.

“I felt that it was important to empower students beyond just self-care—to be directly proactive,” he said.