Cover image for Lay my burden down : unraveling suicide and the mental health crisis among African-Americans
Lay my burden down : unraveling suicide and the mental health crisis among African-Americans
Poussaint, Alvin F.
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Boston : Beacon Press, [2000]

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194 pages ; 24 cm
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E185.625 .P68 2000 Adult Non-Fiction Central Closed Stacks
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Suicide is now the third leading cause of death among Black males ages 15-19, after homicide and accidents. Although lifestyles in many cases differ dramatically, there have been no studies to determine whether or not the risk factors among African-Americans differ significantly from those of whites. These startling statistics demonstrate a real crisis in America's social landscape, and more specifically in our health care system. Leading child psychologist and co-author of the classic RAISING BLACK CHILDREN, Dr. Alvin F. Poussaint and award-winning journalist Amy Alexander, both of whom have lost siblings to suicide, offer LAY MY BURDEN DOWN as a serious and urgent response to a national medical emergency. Beginning with a concise analysis of the often troubled realtionship between African-Americans and a white medical establishment, Poussaint and Alexander trace the culturual factors that inhibit Blacks from seeking any type of medical treatment, let alone the much stigmatized mental health care, and the lack of a concerted response by white health care professionals. Most importantly, however, they ask us to look again at drug abuse, gang-banging, and the increase in HIV not as issues of poverty, but instead as medical/mehtal health issues--suggesting that they are in fact examples of suicide attempts that have never before been evaluated as such. Intervention is possible, and Poussaint and Alexander cite a number of ways that our national health care system and health care professionals may offer help, while noting the programs and policies that have already begun to make a difference.

Author Notes

A former consultant for The Cosby Show, Alvin F. Poussaint, M.D., is professor of psychiatry at Harvard Medical School and the Judge Baker Children's Center in Boston, Massachusetts
Amy Alexander is a freelance journalist

Reviews 3

Booklist Review

The strength and determination of black people that helped them survive hundreds of years of slavery and racism are apparently wavering as the suicide rate among blacks, particularly young black males, is rising. Alexander, a journalist, and Poussaint, a psychiatrist, explore the complex reasons behind this trend. They cite several case studies, including their own brothers, whose depression triggered self-destructive behavior and even suicide. Working without hard data, the authors examine the prominent theories on depression among blacks: a sense of fatalism because personal aspirations are frustrated by racism and the middle-class angst that greater achievement and income haven't resulted in greater acceptance. The authors explore the pervasive hopelessness that has led to suicide and homicidal rage among black people. Blacks' distrust of the medical establishment because of historic abuse and neglect and cultural stereotypes of black people as emotionally uncomplicated have compounded the problems of recognizing and treating mental illness among black people. The authors look at promising changes in mental health care and offer recommendations for curbing self-destructive behavior among black people. --Vanessa Bush

Publisher's Weekly Review

In a much needed cultural wake-up call, Poussaint, a clinical professor of psychiatry at Harvard Medical School, and Alexander, a journalist and editor, present the startling revelation that suicides among black youth jumped 114% from 1980 to 1995. From its unsentimental opening showing the decline of two promising young men who fatally succumbed to the burden of mental illness, drug abuse and racism, this book seeks to unravel the puzzle of increasing despair and depression among black youth. The authors begin by showing how poor, sometimes even cruel, treatment of African-Americans by the health-care establishment has alienated many black people, even though their children may need care for self-destructive and suicidal behavior. Having both lost younger brothers to suicide, Poussaint and Alexander know suicide's pain and finality first-hand, and how it can be as sudden and abrupt as a gunshot to the head or as lengthy and extended as heroin addiction or alcoholism. Using case histories and interviews, their book puts a human face on the act of suicide, while employing current research data to discuss the narrowing gap between black and white suicide rates. Eager to dispatch the old stereotype of "the blues and poverty" as leading causes of suicide among African-Americans, the authors insist it also occurs among blacks who are educated, productive and successful, due to the psychological stress of working daily in a white setting. Poussaint and Alexander conclude their well-documented discussion of the crisis with clear-eyed recommendations for how society can curb the soaring number of African-American suicides. Agents, Lori Perkins and Ike Williams. (Sept.) (c) Copyright PWxyz, LLC. All rights reserved

Library Journal Review

Though grounded in the statistic that the suicide rate of young African American men has more than doubled during the relatively affluent years since 1980, this book ventures into much wider territory. Poussaint (psychiatry, Harvard Medical Sch.) and journalist Alexander (editor, The Farrakhan Factor) have both experienced suicide in their families. They share their stories and relate case studies as well as statistical evidence, a research review, and a powerful, policy-oriented analysis of the social, cultural, and historical factors that cause deficiencies in the healthcare of African Americans. Their coverage of black suicide and other self-destructive behavior suggests that the topics are under-researched and that a national dialog on mental healthcare is needed. The book concludes with a valuable descriptive list of suicide-related web sites. A stimulating work on important issues, this book is recommended for African American studies and mental health collections.DAntoinette Brinkman, Southwest Indiana Mental Health Ctr. Lib., Evansville (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.



Prologue Brothers Remembered The Star Bethel Missionary Baptist Church is a whitewashed monument to faith on San Pablo Avenue in Oakland, California. It is the tallest building on its block, a three-story fortress surrounded by a tattered shopping district and faded apartment complexes. Its congregation comes from the immediate area, and although members of other ethnic groups have been welcomed, its majority represents a cross section of Oakland's working-class black residents--government workers, day laborers, single mothers, teenagers, children, and retirees.     For several decades Star Bethel has anchored a neighborhood perpetually in transition, an edgy community constantly at the brink of urban decay. Over the years, other stretches of San Pablo Avenue have slid beyond that edge. The black-owned barbershops, restaurants, record stores, and clothing boutiques that once flourished along its several miles have become immigrant-owned enterprises or now turn shuttered faces toward the street. Star Bethel is not the most prosperous of the city's predominantly black Christian churches, but its stucco and wrought-iron bulk has always been a stabilizing presence in this corner of Oakland. In the early-morning hours of February 28, 1979, it provided an unexpected solution for a troubled young black man in distress.     Carl Michael Burton, twenty-five, had lived in Oakland off and on for much of his life. At six feet two inches tall, with a high forehead, wide-set brown eyes, and large, straight white teeth set off by a smooth, caramel-colored complexion, he had been, in better times, a bit of a ladies' man.     As a teenager, Carl had ambitions, and after graduating from Woodrow Wilson High School in San Francisco in 1970 he set out to fulfill them. For almost six years he worked as a union laborer at the Chevron refinery in Richmond. By the mid-1970s he had reached a salary level (about $24,000 a year) that allowed him to buy his mother, Hazel Fermon, a washing machine and dryer for the basement of her home in San Francisco's Ingleside district. Confident and easygoing, Carl was a sharp young man on the go, a child of the civil rights era who believed that hard work would deliver him to the doorstep of personal prosperity. But in 1975, following a visit from a fast-living Midwest-based male cousin who'd "turned him on," Carl had quietly developed an addiction to heroin.     By midwinter of 1979, the clothes that Carl had once maintained with meticulous devotion hung from his large frame in dusty wrinkles. His cousin Michael Carse, an auto mechanic who lived not far from Star Bethel, would often see him marching along the streets of Oakland with a purposeful, militaristic gait, his eyes glazed, his knees snapping upward with each step, his lips moving in a silent cadence. On this particular morning in late February, the mid-length wool coat that Carl wore, its black-and-red checked pattern bristling with grime, did little to keep out the biting Northern California chill, and the crown of thick hair that he had once picked and patted into a splendid full-moon Afro now jutted and peaked in odd angles.     He had spent much of the previous night in a public park not far from Star Bethel, shooting drugs with some other San Pablo Avenue regulars. Before dawn he had turned up at his aunt Sara's apartment building, a low-slung structure on Stanford Street, behind the church. For the next several hours he thrashed and hurled his body against the walls of the small apartment, and his aunt and his cousin Lloyd were unable to calm him or to soothe his moaning cries. Years later, his cousin Michael recalled that Carl's hand and footprints were visible on the interior walls of Sara's apartment: "Whatever he'd been shooting, whatever he was dealing with, it literally had him climbing the walls."     Carl's cousins were aware of his addiction to heroin. They did not know, however, that he'd also taken to shooting methamphetamine, or "speed," into his veins; nor did his cousins know that Carl had been diagnosed with schizophrenia in 1977.     Many times that night Sara begged her nephew to settle down and try to sleep. At daybreak she phoned Carl's mother in San Francisco, only to find her sister gone, already on the way to her job in Richmond. Around 7 A.M., agitated and uncertain, Sara left Stanford Street for work, saying she would phone Hazel again once she reached her office. But by the height of rush hour, Carl was on the street again. This time he walked the twenty yards from his aunt's apartment to an outdoor stairwell on the side of Star Bethel.     He shrugged off his wool coat, folded it, and placed it on the bottom step. Moving stiffly in a white T-shirt and Levi's, he mounted the stairs to the second story of the church, where he came to a locked door.     Reaching out beyond the guardrail, he grabbed the last rung of the fire escape ladder and pulled himself up. He then climbed to the landing on the outside of the third floor, where he was confronted by another locked door. By extending his arms all the way above his head, he could just grip the edge of the roof. Once, twice, perhaps three times his workboots scraped for traction against window hinges as he sought leverage. Finally he managed to hoist himself halfway onto the roof, his stomach and hips pressing into gravel as he swung first one leg, then the other, over the tar-paper rim.     Shortly after 8 A.M., a neighbor spotted Carl pacing along the edge of the church roof overlooking Stanford Street. "Hey, man! What're you doing?" he called up. Carl didn't answer and retreated from view. As the man moved to mount the staircase, Carl walked deeper onto the roof, away from the edge. He stopped and turned again. Then he ran toward the edge--and kept going. He landed headfirst thirty-six feet below, on the sidewalk next to the church, his four-year battle with drug addiction and failed dreams quieted at last.     Carl's family--including his youngest sister, coauthor Amy Alexander--never expected that he would kill himself. Almost two decades passed before his mother and three younger siblings were able to assess Carl's decision with any degree of emotional detachment. In 1979, paralyzed by shame and guilt, they sought to honor their lost son and brother in the only way they knew how--by moving beyond the pain of his suicide with a quiet resolve to "get on with their lives." At the time and place of his death--the San Francisco Bay Area in the twilight of the Age of Aquarius--suicide did not seem a plausible result after the many minefields that they had watched Carl traverse. "Cowardly" is how Eric Fermon, Carl's younger brother, described the suicide at the time. And while Eric stood alone in expressing his anger at Carl's death, other family members shared Eric's sense of shame and confusion.     No one in their large circle of friends and relations had ever killed themselves. The only other black American they were aware of who had taken his own life was a promising pop singer, Donny Hathaway, who killed himself by leaping from the fifteenth floor of a Manhattan hotel just a month earlier, in January of 1979. Media reports of Hathaway's suicide mentioned the singer's "battle with depression" but provided few other details. Following Carl's death, the term "depression"--meaning an emotional state widely regarded by mental health professionals as a surefire indicator of a potential for suicidal thinking--did not occur to any of his survivors.     Did the suicide of Donny Hathaway, a rising star who'd had a handful of Top 40 hits in the 1970s, influence Carl's decision to leap from the roof of Star Bethel? Carl's family did not discuss the possibility. They knew that he had experienced several disappointments over the course of his young life. At the same time, they had seen in him a determination to make the best of his opportunities.     An average student throughout his years in high school, Carl had applied to the very selective Berkeley campus of the University of California during his senior year, through the university's equal opportunity program. Although he attributed his subsequent rejection to favoritism on the part of the program's coordinator--a Latino administrator whom he believed reserved his recommendations for a handful of Latino students from Wilson High--Carl's family members could not be sure of the accuracy of this belief, and Carl himself didn't seem unduly resentful of his failure to gain entry to Berkeley. Rather than attend college, he decided to go to work.     Indeed, throughout his teens, Carl had held down an after-school job at a day care center in San Francisco's Potrero Hill neighborhood. His three younger siblings attended the center, and administrators there had offered him a job as an aide when he was only fourteen, because they saw him as a responsible and conscientious young man. After he failed to get into Berkeley, the child care center's director arranged for Carl to interview for a job at Chevron in the East Bay, where her son worked as a supervisor.     For the next few years, Carl traveled each day from San Francisco to a big refinery in Richmond, on a hillside northeast of Oakland, where he donned a hard hat and monitored a series of valves and fixtures in his job as a chemical operator.     During this period, he also attempted to become a police officer. In 1975 he took the entrance exam for the San Francisco Police Academy. To his younger brother Eric, Carl explained that he saw himself as a good candidate for "special agent" in the S.F.P.D's elite corps. Eric wasn't sure what that might entail, but he watched as his older brother studied long and hard. When Carl failed to pass the exam (no one in his family was sure whether it was the written, oral, or physical part of the battery of tests that had been his undoing), once again he didn't seem to take the rejection too hard. What his family members didn't know at the time was that Carl may have been turned down by the academy because of a 1973 arrest for possessing a small amount of marijuana.     Later that same year, a male cousin that the family hadn't seen in decades came to visit, and attended a neighborhood party with Carl. During this visit, Carl, who had experimented with marijuana while in high school, got his first taste of heroin. At the time, he seemed to be happily dedicated to his work at Chevron. He'd moved out of his mother's house in San Francisco and traded in his rickety old Valiant for a gleaming black shark-shaped Dodge Charger.     As he became addicted to heroin, however, his life began to unravel. His supervisors at Chevron, alarmed by his erratic behavior, pulled him off the job and enrolled him in a drug rehabilitation service run by their employee assistance program. He completed the sixty-day program and returned to work but fell back into drug use within a year. When his supervisors again noticed telltale signs of heroin use they fired him. Without a steady job, Carl returned home to live with his family and enrolled in another drug rehabilitation program.     By 1977, Carl had completed half a dozen detoxification and rehabilitation programs, only to return to heroin use after each stint.     He became increasingly frustrated with his inability to quit using drugs or hold down a job, and his mental health began to deteriorate. At some point in 1977, he became convinced that a former classmate and sometime drug-using pal was responsible for the downward spiral his life seemed to be taking. He walked to the young man's house in San Francisco, broke in, and waited several hours for the former friend to return from work. When the young man got home, Carl surprised him in his darkened living room and beat him bloody with a length of pipe. It was a violent, irrational act, and out of character for a twenty-three-year-old man who had theretofore been a passive, easygoing individual. He served twenty-two days in the San Francisco City and County Jail for the assault, after which the district attorney, at the behest of Carl's mother, ordered him sent to a state psychiatric hospital.     For five months in 1977, Carl underwent drug counseling, anger management sessions, and psychiatric treatment at Atascadero State Hospital, on California's central coast. There staff doctors diagnosed him as having a "chronic, undifferentiated" type of schizophrenia and recommended that he begin taking Haldol, a psychotropic medication. After his release, Carl returned to live with his mother and three younger siblings in San Francisco. For a time he attended regular drug counseling sessions and seemed to stay away from heroin; by late 1978, however, his behavior at home had become disruptive. He stopped attending drug treatment programs and refused to take his medication. His mother, concerned for the well-being of her three school-aged children, asked Carl to leave. "Where do you expect me to live?" he asked her during a tense conversation in the autumn of 1978. "On a park bench? I don't have anywhere to go--it's not feasible to kick me out!"     Unmarried and hardworking, Carl's mother had reached the end of her resources in terms of her son's addiction. He had never known his father, but in the past that had not seemed to trouble him. Hazel had hoped that the months at Atascadero might return Carl to a healthy course; when he relapsed she was at a loss. For much of his young life, Carl's cousins and uncles had served as male role models, and his mother suggested he find a place to live with one of them, in the East Bay. One of the cousins, Lloyd Richardson, arranged for Carl to stay in the apartment he shared with his mother, Sara. It was from their front door near San Pablo Avenue that Carl walked to the fire escape at Star Bethel.     In a front-page story about Cad's suicide that appeared in the Oakland Tribune on March 12, 1979, a reporter attributed the young man's death to despair over his fight with drug addiction and his inability to hold a job. The Tribune account was accurate--but it was far from the whole story. "I knew something was riding him," Michael Carse recalled some twenty years later. "I don't know if you'd call it depression, but he was definitely being torn up by something."     During the last months of his life, as his mental health deteriorated and his drug abuse increased, Carl had begun to confide in his older cousin Michael. He expressed frustration about not being able to hold a job and sometimes railed at "the system" that seemed to be keeping him down. Raised in an integrated community, he never singled out any particular white person as contributing to his troubles, but in his mind the road to happiness seemed to be blocked by a powerful, white-dominated external force. He spoke of how circumstances seemed to be out of his control, and of how the cards appeared to be stacked against him. "He wasn't paranoid that someone was out to get him," Michael said. "He just seemed to feel that he faced a whole lot of obstacles and that `the system' was set up in such a way that he couldn't get his life together. But he couldn't quite articulate what these things meant." In a curious twist of the process known as internalization, however, Carl's only act of lashing out against the perceived "system" had been carried out against a black man--the former classmate he'd attacked with a pipe in 1977.     Haunted by a looming sense of hopelessness and shame, Carl also shared his suicidal thoughts with Michael. At the time, Michael instructed Carl to "stay clean" and "stay strong." "I didn't know if he was serious, but I told him that killing himself was not the answer."     Just as Donny Hathaway's death had engendered shock and confusion within the black community nationwide--"We didn't think black people killed themselves" was a whispered refrain in many black households--so Carl's suicide provoked grief, shame, and silent introspection among his friends and family in California. And in some cases that grief became destructive. Lloyd, Michael's younger brother and Carl's sometime "running buddy," was not Carl's closest confidant, and he had been unable to stop Carl from leaving the apartment on the morning of his death. After his cousin's suicide, Lloyd slipped into a life of heavy drinking and drug abuse. Since that cold morning in 1979 when police officers brought him to the grim spot beside the church to identify Carl's broken body, Lloyd has lived on the streets of Oakland and Berkeley, panhandling and hustling for money to support his habits. His sister, Anita Carse, a nurse and another of Carl's older cousins, believes that Lloyd is engaged in a slow, determined suicide attempt of his own.     For a time following Carl's death, the violence and suddenness of his act pushed aside any consideration of the larger psychological and societal questions raised by his mental illness and his suicide. The same shame, guilt, and sadness endured by all suicide survivors--black, brown, or white; low-income or middle-class--were magnified in a family where a long tradition of education and work had always seemed to be the key to healthy, successful living. Moreover, no one had ever looked upon the uncles who drank too much or the young cousins who fell into drug abuse as possibly engaging in suicidal actions, forms of "slow suicide" manifested by chronic life-threatening behaviors.     "Work was the goal," said Anita Carse, who has spent a lot of time over the past twenty years trying to put Carl's predicament--and Lloyd's--into context. "Even if you worked yourself to death, what mattered most to our parents and grandparents was a strong work ethic. The drinking, drug abuse, and other health problems were overlooked as long as you went to work every day."     Carl's family had no point of reference for what had happened to him, and what little they knew about Hathaway's high-profile suicide did not prevent them from feeling alone in their shame and confusion. Since that brisk morning in 1979 they have borne in silence their grief and shame and their frustrating inability to answer so many key questions about Carl's death. Did the mental health care community fail Carl? Why did he keep returning to drugs despite completing numerous treatment and rehabilitation programs? Had schizophrenia made him completely irrational? What was it about his life that made living it so unbearable? Was it cowardly of him to kill himself rather than continue trying to cope with his problems?     During the same time period, the 1970s, countless other African-American families with middle-class goals, values, and aspirations were faced with a similarly devastating situation and a similar set of questions. The troubled life and premature death of Kenneth Poussaint, an older brother of coauthor Alvin Poussaint, shows many parallels with Carl Burton's. While Kenneth Poussaint died in 1975 from acute meningitis, his family is uncertain if he was using heroin at the time, and an examination of his life reveals the possibility that his willingness to engage in life-threatening behaviors also represented a slow form of suicide.     Whereas Carl leapt to his death in a sudden, single, violent act, Kenny chose a lingering but equally certain path. And throughout Kenny's years-long battle with mental illness and drug abuse, and his brushes with criminal activity, his relatives carried in silence their overwhelming grief, shame, and confusion. Like the members of Carl's family, they felt isolated in their sadness and frustration, unsure of where to turn or how to help Kenny as he struggled with his illness. Ironically, both young black men were self-destructing at a time when the Black Power and civil rights movements were thought by many to have secured new opportunities and brighter futures for African-Americans.     During the late 1950s and into the 1960s, Kenny had been an average student in the New York City public school system. One of eight children, he was athletic, witty, and gifted with an intuitive nature that made him a whiz at sports and card games. He wanted to follow his father into the printing business and attended a vocational high school to learn the trade. An outgoing young man, Kenny was also a leader among his peers in the East Harlem neighborhood where he lived.     His family members are not certain of the details, but somewhere along the way Kenny developed an addiction to heroin. By the time he turned eighteen--the year his mother died--his relationship with his father had become tense; his addiction was known to the family, and he had often been beseeched to give up drugs. Kenny was torn up about his mother's passing. He was an eighteen-year-old high school graduate and this was a turning point in his young life. He vowed to give up drugs as a tribute to his mother, and he did--at least for a while.     It was during this period of abstinence that his siblings first noticed signs of mental illness in Kenny. He talked of their mother constantly in the present tense, as if she still moved through the rooms of their East Harlem home. She had been a light-skinned woman, and after her death, Kenny, who boasted a coffee-colored complexion, began washing his hands and face obsessively, saying, "If I keep washing, I'll become as white as Momma." He began describing his younger brother, Alvin, as being "white, like Momma," even though Alvin's complexion was the same coffee tone as his. He spun wildly paranoid, delusional stories, and in one harrowing incident threatened other members of the family with physical harm.     Finally Kenny locked himself in his bedroom and refused to let anyone else come in, saying he would "destroy" them if they did. Hours later he allowed Alvin, with whom he shared the room, to enter. When the police came to the home, Kenny begged his family not to let them take him away, and they sought to reassure him as the officers restrained him. Kenny was taken to Bellevue's psychiatric unit, where he was put in a straitjacket. Later he was transferred to Creedmore State Hospital, where psychiatrists diagnosed him as a paranoid schizophrenic.     Over the next year, Kenneth Poussaint was confined in the state mental hospital and treated with a combination of medications and insulin shock therapy. The latter treatment had been developed in the 1930s, following observations by psychiatrists that schizophrenic patients who for some reason lapsed into a coma later showed improvement in their mental status: doctors induced comas in such patients by injecting them with insulin, producing a hypoglycemic (low blood sugar) coma which was terminated after a period of fifteen minutes to an hour by a sugar injection. These induced comas were terrifying for Kenny, and he only gradually improved with the help of medications. In general, the effectiveness of insulin coma therapy was difficult to evaluate at best, and it was already falling into disuse in the 1950s and 1960s, as new antipsychotic drugs became available. The quality of Kenny's treatment was suspect, but the family was unsure of how to challenge the doctors about the level of care he received.     After his release, Kenny returned to East Harlem and the family home. Within two weeks he had succumbed to the lure of heroin once again. His family members saw him high and knew that he was caught up again in a life that included petty thefts and other criminal pursuits carried out to support his drug addiction. During this period, Alvin was sharing a room at home with Kenny while studying at Columbia University, and sometimes late at night he saw Kenny prepare and shoot drugs.     On several occasions he awoke to find his brother lying unconscious on the floor with a needle dangling from his arm. At these times Alvin feared that Kenny would die from an overdose; he began to wonder, in fact, if his brother would one day commit suicide this way.     Over the next few years, Kenneth Poussaint was arrested for petty, nonviolent crimes numerous times, and he served several sentences in prison on Rikers Island in New York. During this period be lost touch with his family.     When he resurfaced in East Harlem in the early 1970s, Kenny was a changed man. He told his family that he had entered a drug treatment program. Their contact with Kenny thereafter was sporadic, but when they did see him he seemed to waver between participation in various therapeutic methadone programs and periodic returns to intravenous heroin abuse.     For a time Kenny lived in a rented room and held down a job as a clerk in the county health department. His old friends and family, during their limited encounters with him, encouraged him to stay on course. For several years Kenny seemed to be doing well and enjoying the most stable period of his adult life; no one saw any signs of depression or serious problems in his social or work life.     To the Poussaint family, Kenny no longer showed symptoms of the mental illness that had surfaced in his late teens, but neither did his life appear to be completely stable. When they learned that he had contracted meningitis, some of his relatives wondered whether he was off heroin or had contracted the illness by injecting himself with a contaminated needle. (A friend later reported that he was still shooting heroin.) One of the risks of using dirty needles--a common practice among intravenous drug users--is bacterial contamination injected directly into the bloodstream, which may quickly infect the membranes of the brain; a rapidly progressing meningitis develops that is often fatal. (Today, of course, besides bacterial infections, addicts are at high risk for contracting HIV/AIDS when sharing contaminated needles.)     In 1975, Kenny Poussaint died in the emergency room at Harlem Hospital at age forty-two, his vital organs defeated by years of drug abuse and a final fatal physical illness.     Like Carl Burton's family members, the Poussaint family found that their love for Kenny was, over the years, tempered by shame, and in both cases that shame was marked by frustration and anger at a loved one's seemingly willful self-destructive behavior. Amid their individual progress, their gradual climb into the great American middle class, the families of Kenneth Poussaint and Carl Burton still mourn their loss, and the fact that, for all their promise, these two young men died in so much pain is a weighty burden that they continue to bear.     Now, some twenty years later--as more instances of black Americans struggling with mental health problems become public and the rate of suicide among black people shows a slow, steady increase--Carl's and Kenny's surviving family members find little consolation in realizing that they are not alone. And they still struggle to make sense of it all.     Consequently we hope that this book will help African-Americans better understand and seek help for relatives and friends who manifest mental disorders and self-destructive behaviors. Alvin F. Poussaint, M.D. Amy Alexander Boston, Massachusetts January, 2000 Copyright © 2000 Alvin F. Poussaint, M.D., and Amy Alexander. All rights reserved.

Table of Contents

Prologue: Brothers Rememberedp. 1
Introduction: Posttraumatic Slavery Syndromep. 12
1 "He Didn't Seem Depressed": Faces behind the Numbersp. 21
2 Suicide in Black and White: Theories and Statisticsp. 45
3 "Boy, You Must Be Crazy": Racism's Historic Impact on Black Physical and Mental Healthp. 63
4 Hoping and Coping: Expectation versus Reality for African-Americansp. 84
5 "Stay Strong": The Legacy of Bearing Upp. 101
6 Blacks and Victim-Precipitated Homicide: "Suicide by Cop," Fatalistic Behavior, and Mental Illnessp. 114
7 "He Went Out Like a Man"; "She Was a Strong Sistah": Questions about the Suicide Gap among Black Men and Womenp. 128
8 The Road Ahead: Society's Role in Prevention and Treatmentp. 142
9 Casting Off the Burden: Where to Find Helpp. 158
Notesp. 169
Acknowledgmentsp. 182
Indexp. 184