Stemming the high rate of suicide among blacks

November 02, 1999|By Alvin F. Poussaint and Amy Alexander

THIS PAST summer, Dr. David Satcher, the U.S. surgeon general, identified suicide as a major public health threat and unveiled a comprehensive program to reduce suicides nationwide.

Recently, he shed much-needed light on this tragedy by testifying in the first Senate hearings on suicide. Aside from the high-profile cases, such as the Columbine High School tragedy, suicide is not a hot subject for many news organizations, even though it has claimed far more lives in America for decades than homicides.

Last year, 29,264 people committed suicide; there were 16,914 homicides. Still, the general public, saturated with murder news coverage, tends to believe that the number of homicides far exceeds suicides. Therefore, the Senate hearings and the surgeon general's suicide prevention campaign are opportune.

Within the government's figures are overlooked aspects of modern American suicide that merit special attention.

Our rapidly changing society is spawning complex issues that are combining to make suicide one of the most profound psychosocial challenges facing Americans at the dawn of the 21st century: More teens and young adults are killing themselves today (mostly with firearms) than during any other period in recent history.

Dr. Satcher called particular attention to the alarming rise of suicide among black youths. Self-murder among young blacks, formerly a relatively uncommon occurrence, has risen sharply in recent years.

The suicide rate for blacks ages 10 to 19 years doubled from 2.1 per 100,000 in 1980 to 4.5 per 100,000 in 1995. Although whites, particularly white males, have a higher suicide rate than blacks, the gap is narrowing.

And due to a historical tendency by officials to under-report suicides in general and among African-Americans in particular, the black suicide rate is probably much higher than statistics indicate.

In a cultural sense, the rise in youth suicide has far-ranging implications. What does it suggest about our nation's psychological health when record economic growth is accompanied by an increase in suicide, especially among young people?

Meanwhile, suicide's emotional toll on surviving family members and friends is made all the more onerous by its hidden-in-plain-sight nature.

While the stigma-related silence that once surrounded certain self-destructive behaviors has abated somewhat during the past few years, suicide remains stubbornly taboo.

This stigma, and the silence it engenders, is particularly acute among blacks. And considering the disparities in health care provided to black people through much of this nation's history, we question whether health officials will take a culturally sensitive approach to addressing the growing problem of black suicide.

Because of past disclosures about the neglect of blacks by the medical community -- for example, the 40-year-long Tuskegee syphilis study and, more recently, a Georgetown University study showing that white doctors are less likely to recommend black patients for early treatment of heart ailments -- it is possible that the undercurrent of distrust and tension between predominantly white mental-health professionals and blacks will impede programs aimed at addressing black mental-health concerns.

Acknowledging the impact of historic racism, both on the current state of black mental health and on black skepticism toward the medical community, is essential if the government is to succeed in its campaign.

Therefore, at the Senate hearings the problem of suicide in the black community should be specifically addressed. Public policies and educational programs needed to stem the tide of black self-destructive behaviors must address the availability of mental health services and the risk factors, including drug and alcohol abuse and a sense of hopelessness, that are often associated with suicide.

Stepped-up action is necessary to address the suicide problem among blacks, including: training mental-health practitioners to be more sensitive to black clients; organizing campaigns to remove the stigma surrounding mental illness; making blacks aware, through community-based educational programs, that clinical depression can be treated with anti-depressant medications and talk therapy; offering alcohol and drug-abuse treatment programs that are culturally appropriate; expanding violence prevention programs that focus on reducing the easy availability of guns; and launching a vigorous political movement to make health insurance for disenfranchised Americans a top priority.

Such a campaign may have additional benefits. As Dr. Satcher noted in a recent interview, hopelessness and isolation -- two risk factors that tend to be present in most suicides -- may also be significant on the list of risk factors for high rates of homicide in the black community.

For that reason, we must continue to ameliorate the discrimination and poverty that contribute to severe mental stress in black neighborhoods already suffering from poor education and high rates of crime and violence.

Dr. Satcher's plan is a tall order, but it has the potential to benefit the mental health of Americans across all cultural groups. Dr. Alvin F. Poussaint is a professor of psychiatry at Harvard Medical School. Amy Alexander is a Cambridge, Mass., journalist. They are authors of a forthcoming book on black suicide. They wrote this for the Boston Globe.

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