*This piece is edited from an original article published in the Summer 2022 issue of CAPITAL PSYCHIATRY, the Washington Psychiatric Society’s e-magazine.

As part of PRMS’ ongoing efforts to support the behavioral healthcare community and promote the organizations that work towards this mission, we are pleased to feature William B. Lawson MD, PhD, DLFAPA, and Donna Holland Barnes, PhD, as guest bloggers this month. Dr. Lawson is a Founder and Director of the Institute for Reducing Racial Disparities, Professor of Psychiatry and Behavioral Sciences at The George Washington University, Adjunct Professor at the University of Maryland College of Medicine, and Director of Mental Health Research at Emerson Clinical Research Institute. Donna Holland Barnes, PhD, is a certified grief recovery specialist, a certified life coach, and author of The Truth About Suicide, part of the “Truth About” series for middle school and high school students. Drs. Lawson and Barnes share their experience and thoughts on teaching about suicide in African American communities to psychiatric residents and medical students.

The Washington Psychiatric Society (WPS) is having a Presidential Symposium that is presenting the state of the science of suicide from a biopsychosocial issue, and our hope is that it will put suicide in the forefront of health issues. Suicide should be looked at as a public health issue impacting our communities, one that psychiatrists have special expertise in developing preventive measures and treatment strategies. Moreover, consideration of this issue is relevant across all communities in the DC-area.

For many years, psychiatrists learned to treat patients with suicidal thoughts and gestures with medication, and the problem would be solved. There was rarely any delving into what caused the patient to think that death was an option to solve their issues. The fact that the WPS is embarking on suicide from a biopsychosocial perspective is monumental. The suicide rates have increased yearly for the past 30 years, an increase of 33%.^1,2 If medication was the answer, shouldn’t we have experienced a decrease at some point?

As a medical student, I “discovered” that African Americans did not kill themselves. The faculty member who made that statement was not articulating an obscure observation. After all, it was thought that people of color rarely became depressed.³ During slavery, Africans were thought immune to most mental disorders, especially depression, since they were thought not to have the mental apparatus nor did they need to face the societal complexities that white people had to deal with.²

I was raised in rural Virginia in a poor, mostly African American community where these demographics were thought not to favor individuals killing themselves. Yet I remember a neighbor killing herself, a schoolmate resolving the domestic disputes in her family by killing herself, and an employee of my grandfather killing himself because he was diagnosed with cancer. Were these formally listed as suicides? I doubt it, if given the stigma about it in a rural community in the ‘50s and ‘60s.

Later while at Howard University, I participated in a study involving the DC medical examiner’s office. A young African American man was found in the street with a gun clutched in his hand and pointing at his head, which had a lethal gunshot wound. The medical examiner noted that this obviously was a homicide because black people did not kill themselves.

The rate of homicide in predominantly African American communities universally is higher than the rates of suicide. We have higher rates of drug induced deaths and higher rates of accidents than suicide.⁴ If fully investigated, could some of these deaths actually have been suicide?⁴

During my tenure at Howard University’s Department of Psychiatry as Chair, I insisted that my psychiatric residents have more education on suicide and hired a sociologist who specialized in suicidology. She conducted seminars with the psychiatric residents on suicide risk management and taught managing a suicidal patient to the 3rd year medical students rotating to the department of psychiatry.

It was important to me that my students received the proper education, especially after I asked one of my psychiatrists what happened to one of his patients. He replied, “She killed herself.” I asked, “How did that happen?” He replied, “She said she was going to kill herself, and I didn’t believe her.” Furthermore, the Psychiatry Department was the first responder to a suicidal patient in the Emergency Room or on campus.

Thanks in no small part to the work of Poussaint and Alexander³, the recognition of suicide among African Americans has become more recognized. Today, the data shows that young African American boys have the highest suicide rate of any racial or ethnic group.^{4, 5, 6}

That was not always the case, as the rate has jumped substantially in recent years. Moreover, the coronavirus pandemic is likely a precipitating factor increasing suicide, homicide, and overdose deaths among African Americans through its impact on isolation, stress, limited access to care, and despair. It should also be considered that some of these health-related deaths may even be be suicide equivalents.

References:

1. Lindsey MA, Sheftall AH, Xiao Y, Joe S. Trends of Suicidal Behaviors Among High School Students in the United States: 1991–2017. Pediatrics. 2019;144(5):e20191187.
2. Reed DD, Stoeffler SW, Joseph R. Suicide, Race, and Social Work: A Systematic Review of Protective Factors among African Americans. J Evid Based Soc Work (2019). 2021 Jul-Aug;18(4): 379-393. doi: 10.1080/26408066.2020.1857317. Epub 2021 Feb 23. PMID: 33622190.Thomas A and Sillwn S: Racism and Psychiatry. 1972 New York, Brunner and Mazel.
3. Davis, K. Blacks are immune from mental illness. Psychiatric News. Published Online:1 May2018 https://doi.org/10.1176/ appi.pn.2018.5a18
4. Poussaint, A., and Alexander, A: Lay My Burden Down: Suicide and the mental health crisis among African Americans, by Alexander, Beacon: Boston, 2000.
5. Bridge JA, Horowitz LM, Fontanella CA, et al. Age-Related Racial Disparity in Suicide Rates Among US Youths From 2001 Through 2015.JAMA Pediatrics. 2018;172(7):697.
6. Bridge JA, Asti L, Horowitz LM, et al. Suicide Trends Among Elementary School–Aged Children in the United States From 1993 to 2012.JAMA Pediatrics. 2015;169(7):673.
7. Sheftall AH, Asti L, Horowitz LM, et al. Suicide in Elementary School-Aged Children and Early Adolescents. Pediatrics. 2016;138(4):e20160 436-e20160436.
8. Biography https://www.biography.com/news/crime-and-scandal, searched 4/30/2022

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