POST TRAUMATIC SLAVE SYNDROME AND MENTAL HEALTH SERVICE USE OF AFRICAN AMERICANS: A SYSTEMIC INTERPRETATION A Dissertation Presented to The Graduate Faculty of The University of Akron In Partial Fulfillment of the Requirements of the Degree of Doctor of Philosophy Symphonie D. Smith April 27, 2018 POST TRAUMATIC SLAVE SYNDROME AND MENTAL HEALTH SERVICE USE OF AFRICAN AMERICANS: A SYSTEMIC INTERPRETATION Symphonie D. Smith Dissertation Proposal Approved: Accepted: Committee Chair Interim School of Counseling Director Karin Jordan, Ph.D. Faii Sangganjanavanich, Ph.D. Committee Member Interim Dean College of Health Professions Rebecca Boyle, Ph.D. Elizabeth Kennedy, Ph.D. Committee Member Executive Dean of the Graduate School Heather Katafiasz, Ph.D. Chand Midha, Ph.D. Committee Member Date Ingrid Weigold, Ph.D. Committee Member Zachery Williams, Ph.D. ii ABSTRACT This interpretive qualitative study used Post Traumatic Slave Syndrome (PTSS) and Bowen Family Systems (BFST) theories to explore mental health service use by African Americans. The goal of the study was two-fold. First, to increase understanding of the lived experiences of African Americans, with consideration of the impact of historical and ongoing race and oppression, across generations. Second, to explore mental health service use via the lens of the African American experience. Data collection included the use of two semi-structured interviews, a focused genogram and a demographic questionnaire. All participants self-identified as African American and were comprised of seven females and two males. The data analysis revealed themes in two main categories: The African American Experience and Conversations about Mental Health. The resulting themes as follows, with four in the first category and three in the second, respectively: ongoing racism and oppression, symptoms of PTSS, strength and character, The Talk, types of sharing, perception and the service use advocate. The findings provide the context through which the African American experience influences mental health service use. iii ACKNOWLEDGEMENTS “It takes a village” are words that have come a long way from a cheesy saying recited by my African American principal in elementary school. It indeed took a village to help me move from that elementary school to this moment. As happy as I am to be here and as proud of myself as I am for doing the work, I have been beyond blessed to have such a vast and loving village to help me along the way. Because there are too many individuals to name, from family, friends, my dear sisters, mentors, my wonderful cohort, Trio and even old classmates randomly congratulating me on my accomplishments at a local fast food spot, I will like to generally acknowledge all of them in bulk here. Thank you! However, below I must name some of the chief members of my village. Olin Smith Jr.: My amazing father and number one cheerleader from the beginning! Lemonard Anderson: My loving mother who never failed to provide love and nourishment, right on time, every time! Tina Reynolds Smith: My stepmother, who chose voluntarily to join my village and never once missed an opportunity to participate with full support! Zenobia Johnson: My dear “Aunty Snoop” who found a way to provide the perfect balance of nourishment and motivation to get me to “keep it simple” and progress! Dr. Margaret Manoogian: My more-than-a-mentor who saw the researcher in this “kiddo” when I was far from willing or able to. iv Stefanie Ankle & Shawntaya Singfield: Best support squad ever! Dr. Karin Jordan: A committee chair, cheerleader, motivational speaker and nurturer all in one! Committee Members: Dr. Rebecca Boyle, Dr. Ingrid Weigold, *Dr. Zachery Williams and Dr. Heather Katafiasz, your support is appreciated. *Thank you for introducing me to PTSS, it has changed my life! Amari Gay: My sweet baby girl who has waited as patiently as possible for the day she no longer has to share her mother with this process. *She is literally facetiming me as I write this, begging me to hurry and come home (I escaped to a place with less distractions). Kevin Gay: Last but absolutely not least, my loving husband who has also waited patiently to stop sharing his friend, girlfriend, fiancé and now wife with this process. With zero complaints, you have been a supporter and powerful example and encourager for me to “do the hard work”! It is done. Thank you! Special thanks: God my creator and Jesus my Savior: The purpose, you gave me, fuels me and You sustain me. Dr. Joy DeGruy Leary: Post Traumatic Slave Syndrome, helped to open my eyes and gave me another tool to help others do the same. Your work also helped me to connect with my final acknowledgment recipient; what an unexpected and priceless gift from this journey. Thank you. The Ancestors: Thank you for enduring, surviving, adapting, protecting, praying and fighting for me! I know I am your wildest dream! v TABLE OF CONTENTS PAGE CHAPTER LIST OF TABLES ............................................................................................................ xii I. INTRODUCTION ......................................................................................................... 1 Background .................................................................................................................... 2 Risks to Mental Health .............................................................................................. 2 Mental Health Service Use ........................................................................................ 3 Barriers to Mental Health Service Use .................................................................... 5 African American Experience .................................................................................. 6 Author Statement .......................................................................................................... 8 Theoretical Framework ................................................................................................ 9 Post Traumatic Slave Syndrome ............................................................................ 10 Bowen Family Systems Theory .............................................................................. 11 Statement of the Problem ........................................................................................... 13 Significance of the Study............................................................................................. 14 Research Questions ..................................................................................................... 14 vi Operationalized Terms ............................................................................................... 14 Summary ...................................................................................................................... 19 II. REVIEW OF THE LITERATURE ......................................................................... 21 Post Traumatic Slave Syndrome ................................................................................ 21 Vacant Esteem.......................................................................................................... 23 Ever Present Anger ................................................................................................. 24 Racist Socialization .................................................................................................. 26 Bowen Family Systems Theory .................................................................................. 32 Foundational Principles .......................................................................................... 33 Core Concepts .......................................................................................................... 34 Family Diagram and Genograms ........................................................................... 39 PTSS and BFST ........................................................................................................... 41 Mental Health Service Use ......................................................................................... 42 Low Mental Health Service Use ............................................................................. 42 Exceptions................................................................................................................. 47 Barriers to Mental Health Service Use ...................................................................... 51 Cultural Mistrust ..................................................................................................... 52 Stigma ....................................................................................................................... 56 Inaccessibility ........................................................................................................... 59 John Henryism ......................................................................................................... 61 vii Systemic Nature of Barriers ................................................................................... 64 Attempts to Overcome Barriers ................................................................................. 68 Attempts by African Americans ............................................................................. 69 Attempts by Professionals ....................................................................................... 71 Summary ...................................................................................................................... 74 Restatement of the Research Questions .................................................................... 77 III. METHODS AND PROCEDURES ......................................................................... 78 Methodological Framework ....................................................................................... 78 Sample .......................................................................................................................... 79 Sample Criteria ........................................................................................................ 80 Sample Size ............................................................................................................... 80 Participants .............................................................................................................. 82 Recruitment .............................................................................................................. 83 Confidentiality of Records ...................................................................................... 85 Data Collection ............................................................................................................ 85 Data Analysis ............................................................................................................... 88 Recording and Transcribing................................................................................... 88 Managing Bias ............................................................................................................. 90 Research Questions ..................................................................................................... 91 Risks and Benefits ....................................................................................................... 91 viii Summary ...................................................................................................................... 92 V. RESULTS ................................................................................................................... 93 Review of Research Questions ................................................................................... 93 Systemic Lens............................................................................................................... 94 The Participants .......................................................................................................... 94 Participant One: Maybelline .................................................................................. 96 Participant Four: Angelica ..................................................................................... 97 Participant Five: Leroy ........................................................................................... 97 Participant Six: Steph ............................................................................................. 97 Participant Seven: Tasha ........................................................................................ 98 Participant Eight: Kesha......................................................................................... 98 Participant Nine: Stacey ......................................................................................... 98 Themes.......................................................................................................................... 99 African American Experience ................................................................................ 99 Conversations About Mental Health ................................................................... 112 Summary .................................................................................................................... 119 V. DISCUSSION ........................................................................................................... 121 Discussion of Findings ............................................................................................... 122 Ongoing Racism and Oppression ......................................................................... 122 Symptoms of PTSS ................................................................................................ 124 ix Strength and Character ........................................................................................ 125 The Talk.................................................................................................................. 126 Perception ............................................................................................................... 129 Service Use Advocate ............................................................................................. 130 BFST ....................................................................................................................... 131 Implications................................................................................................................ 132 Mental Health Professionals ................................................................................. 133 Marriage and Family Therapists ......................................................................... 134 Strengths .................................................................................................................... 138 Limitations ................................................................................................................. 140 Recommendations and Future Directions............................................................... 142 Future Research ..................................................................................................... 142 Researcher .............................................................................................................. 143 Summary .................................................................................................................... 144 REFERENCES .............................................................................................................. 145 APPENDICES ............................................................................................................... 160 APPENDIX A ............................................................................................................ 161 APPENDIX B............................................................................................................. 163 APPENDIX C ............................................................................................................ 165 APPENDIX D ............................................................................................................ 166 x