Long ago, in the 1960s the critic of racial colonialism, Frantz Fanon, argued forcefully that colonization causes the colonized serious psychological problems, because of the continual assaults it inflicts on their personalities. Numerous studies have documented the harmful effects of workplace stress on the health of employees of any racial orethnic group. Although work is a primary source of stress for many individuals, some research shows that certain types of job stress are unique to the experiences of Americans of color, and may contribute to their facing unique physical and mental health challenges. Certain social conditions, including racial inequality, blocked opportunities, and discrimination are major generators of pain and distress for individuals. Physical and mental health problems can stem from the stresses of discrimination. Recent research has highlighted the need to take into account three dimensions in considerations of the role of stress in the lives of African Americans. The first is the individual-level interactions between race and health; the second, interpersonal relationships and health; and the third, societal factors, such as poverty and racism, that contribute detrimentally to African American health. Research has found that African Americans are caught in economic, social, and political conditions that are harmful to their health. Mirowsky and Ross conclude that this pain and distress can take two psychological forms: being depressed, being demoralized, and feeling hopeless; and feeling anxiety, fear, and worry. Karasek and Theorell have shown that variations in control and socio-emotional support at work predict variations in psychological depression.

Demoralization, anxiety, and anger over everyday discrimination are to be expected under the circumstances faced by African Americans in U.S. society, but they are nonetheless unhealthy at the levels experienced. A few recent research studies have touched on the relationship of discrimination to mental health problems. In addition to older studies of African Americans such as that of Grier and Cobbs, three recent studies of Mexican Americans have found that experience with discrimination is linked to higher levels of stress and psychological suffering, including depression and lower levels of life satisfaction. An analysis drawing on the National Study of Black Americans has also suggested that recent experience with discrimination may be associated with poor mental health.

Often a worker of color finds he or she is one of few, or even the only person of that racial-ethnic background within their work environment. This status often does not allow them the social support that could help to alleviate workplace stress. Additionally, this isolated status may draw an inordinate amount of attention to the minority group member's job performance, and may cause a stigmatizing "token" status to be ascribed. Thus, African Americans in predominantly white work settings may feel pressure to prove that they were not hired strictly because of affirmative action, as may often be the assumption of their white colleagues. This pressure, coupled with experiences with exclusion and other discrimination, may lead to stress for African Americans as well as other Americans of color.

Although some research has been done on the mental health of African Americans, the findings have been contradictory. Some studies point to the resilience and coping skills of African Americans and conclude that African Americans have much lower rates of mental illness than do whites. Other studies findthat African American rates of mental illness are higher than those of whites. Still other studies have found that rates of mental illness for people of various racial-ethnic backgrounds are moderated by demographic characteristics such as marital and socioeconomic status. These contradictory findings have led some to suggest that public health researchers abandon racial comparison research altogether. Others have called for qualitative research, such as ethnographic research and case studies, as well as longitudinal studies that cover more time, in order to supplement contradictory research findings. Still others have suggested that various societal stereotypes regarding African Americans lead to bias in mental health diagnoses, making any findings regarding the mental health of African Americans dubious. Contradictions in quantitative research regarding the mental health of people of color suggest that researchers should consider that perceptions of people of color may play a primary role in the diagnosis and treatment of those who are psychologically troubled.

Historically, the mental health treatment of African Americans has been conducted on a foundation of stereotypical ideas about African Americans. In the 1800s, some enslaved African Americans who either disobeyed their masters or ran away were given specific diagnoses of mental illness. During Reconstruction, mental health practitioners asserted that the supposed increase in mental illness of African Americans was due to the loss of the many civilizing "benefits" of slavery. In the early 1900s, African Americans were often characterized by whites as promiscuous, emotionally and criminally volatile, childlike, and unintelligent. Psychiatric research generally relied on these racist stereotypes in diagnosis, and researchers even congratulated themselves on the "fortunate guidance" of members of society through whom many African Americans have been "saved" from physically and mentally ruining their lives. Some mental health studies written between the late 1800s and the mid 1900s even stated that African Americans lacked the psychological complexity to become depressed, given their "inferior" psyches. By the early 1960s, new research was beginning to turn to cultural, rather than biological, explanations for racial differences in mental health, and suggested that the more integrated African Americans became, the more they would experience depression, often designated as "the white man's malady."

Some current research suggests that African Americans are often misdiagnosed by mental health professionals. Diagnostic tests may be racially biased, elevating the observed rates of certain types of mental illness for African Americans. Researchers have found that even when African American and white individuals present the same symptoms to doctors they are sometimes diagnosed with very different illnesses. For example, with the same symptoms, whites are often diagnosed with depression, which is treated with psychotherapy and has a good prognosis, while African Americans tend to be diagnosed as having schizophrenia, which is more serious and must be treated with medication. A study of 100 white and 100 African American women, matched by age, who had visited an outpatient family practice center from 1993 to 1994, explored the rate of primary or secondary diagnoses of emotional disorder for the two groups. The research findings showed that forty-four percent of the white women, compared to twenty-four percent of the African American women, had either a primary or secondary diagnosis of psychiatric disorder. The researchers suggested that this racial discrepancy was based on evidence that black women actually have less psychiatric disorder, perhaps due to either better family and community support network or a greater reluctance to discuss personal problems with physicians.

A white standard of normality is usually taught to and used by white therapists. However, cultural norms for what constitutes "normal" or "abnormal" behavior may be different for African Americans than for whites. Specifically, African Americans may have different ways of expressing symptoms and complaints, different culturally normative behaviors, and different coping mechanisms than do whites. Recent research has suggested that as therapists become more aware of mental health issues unique to people of color, they may need to retrospectively diagnose African American patients to correct earlier misdiagnoses.

White therapists may harbor negative views of African American patients, based on societal myths. They may communicate these feelings in their nonverbal behavior, causing African American patients to withhold the kind of self-disclosure that is necessary for psychotherapy. Researchers have found that for African Americans, psychotherapy with a white caregiver often leads to "unhealthful consequences." Many call for better cross-cultural training for psychiatrists and psychotherapists.

Because of racial bias in the mental health care profession, African Americans have generally relied on other forms of help for psychological difficulties. Research has been done on the differences in help-seeking behaviors of whites and African Americans. Early bias in mental health care led African Americans to care for their mentally ill family members at home. Today, older African Americans in need of psychological support are often more likely to seek help from family and extended family members than from mental health professionals. Findings also suggest that African Americans are likely to see both physical and mental health as dependent on a healthy spiritual life. Thus, they often rely on prayer, ministers, and church services for psychological help. Some have noted that African American church services are similar to group therapy in offering psychological relief. This might account for the fact that group therapy seems to be more useful than individual psychotherapy, at least for African American women.

Whatever the actual differences inAfrican American and white mental illness and treatment, one observation made by many researchers is that given the amount of societal stress in the lives of African Americans, one would expect them to exhibit much higher rates of mental illness than they do. Some suggest that due to their life circumstances, African Americans may be more tolerant in coping with symptoms of stress. Thus, researchers have been urged to explore the resilience and coping skills that African Americans utilize to protect their mental health from racist attacks. To this end, a few researchers have suggested using a stress/adaptation paradigm in mental health research, which emphasizes environmental as well as personality factors in seeking the cause for African Americans' emotional problems and focuses on their unique coping skills. Some have also stressed the need for life-course research, which would offer a perspective on the strengths and structural barriers in mental and physical health care for African Americans at all stages of life.

Our focus group participants reported various psychological complaints they believed to be the result of workplace discrimination, ranging from extreme anxiety and added stress to depression severe enough to require medication or hospitalization. An administrative assistant was hospitalized for depression after she was almost laid off:

I had been in . . . my department for eleven years when I, we had a major change in staff. We had gone from a white male boss who had just left, and a white female who had taken over in the position. I had seniority in the office as far as time and had just received a promotion in the job, and had nothing but excellent, excellent performance evaluations. But when it came time to do the budget cuts, my position was offered as being ten percent cut. I was told that there was no way to avoid this position being cut. Being that at this time I was the only minority that was, that was in the office, it was devastating to me at the time because we tried to work it out. Now I'm working for an agency that advertises . . . strong affirmative action and equal employment opportunities. So I had a right to file [a] discrimination [complaint].

She then described the resolution, which involved a black elected official interceding for her:

Because I was looking at a layoff. . . . [He] basically went in and told this supervisor that, "With all these vacant positions that we have in this county, you will find her a job." I was told on a Friday by the department they wanted to transfer me to, that I had to make a decisions over the weekend and let them know by that following Monday whether I was going to accept this job, which was a [big] cut in pay . . . or go in the unemployment line. I had to help take care of two children, so I chose to go for the transfer. But . . .through all this, and, the mental anguish that I went through, I was hospitalized for nine days. It was just devastating, because I saw it as blatant discrimination. . . . There was nothing they could go to in the file and find in terms of not performing or anything like that. And then the amount of time, get basically kicked out the door is what happened. . . . But then, but not only the financial burden, but just the toll that it took. . . . I think the toll was so hurtful because I saw it strictly as racial.

It appears that much racially linked mistreatment in work settings is disguised by the perpetrators in bureaucratic terms, as here in a budget cut. This woman's judgment of discrimination is not arbitrary but comes from past experience as the "only minority" in an almost exclusively white department. Her ability to read the situation may also be grounded in past experience in a variety of settings. In such cases significant achievements are ignored and serious mental and physical pain can result.

A teacher described a situation in which her boss moved her to a different position just before school started. This woman discovered later that she was moved in order to make room for a new and less experienced white teacher. She described the stress she underwent as a result of having to change so quickly:

I was so upset I didn't know what to do. Just totally wiped out. I'm thinking about all of this stuff I've got to move. She promised that the janitors would help me move. Nobody helped me. People were almost in tears watching me move all of this stuff in a shopping cart. . . . And, it took me, that means I had to organize my stuff, move it, and get ready for another grade level and be ready to teach. . . . So I did my pre-planning; it almost killed me. . . . Nobody came to help me, but everybody was giving me sympathy. I had to go to the doctor. . . . and I had become hypertensive. But I felt myself, I could hardly work, I was so upset. And I had gotten prayer, and, was reading my scripture, and meditating . . . .

When the moderator asked her if she had been hospitalized for hypertension, the woman answered:

No, he put me on an antidepressant . . . in addition to the medication I needed to take-I'm glad you made me clarify that, helped me to clarify it, brother. I had to go on an antidepressant. I didn't take it very long, but that's how upset I was, had to see a physician. I was under his care for awhile. But, I mean, they brought these three white women on. . . . That's what irks me, when I hear about the white people attacking affirmative action, when it's worked in reverse, and it's still happening-to them. They're, nobody hears about how they get hired, and they're less qualified than we are. Nobody hears about how many times we're hired with extra qualifications, more than qualified, to do the same job that they're hired to do.

Thinking along similar lines, an engineer spoke of a black coworker's experience of depression. His view, shared by other respondents, is that African Americans are reluctant to seek assistance with psychological pain:

But it's kind of more, against black culture to go for any type of psychological . . . testing, or, I had one friend who actually went to a depressive state . . . because he was the type of person who just tried to do the best he could at everything. And sometimes you just can't do that, or do everything. So in this particular case, he went to the point where his body just collapsed, mentally. Where some people's bodies can collapse physically, his collapsed mentally. I personally didn't experience that, but I saw the pain that he went through. And likewise he's having racial type things at his job, where his counterparts would get promoted at a certain level, where he would stay on a level below, after years. And he was as qualified-sometimes they get you in a position to think that you're not as qualified as the next person, where in reality you may be more qualified than the person that got promoted over you. But a promotion doesn't necessarily mean that this person does higher quality work. It means, sometimes that person knows how to network with the boss better than you do.

Again the suffering of one black person is communicated to and felt by others in a social network. Research shows that most African Americans rely on informal social networks for emotional support, thus the concerns of one individual are often known in great detail by a larger support network. After this comment, a woman in this man's group added that black employees have less time to network with the boss because they are working extra to prove themselves as capable. The engineer agreed with her statement, then continued:

And if you're working, you can't network with the boss, and drink coffee with him, and tell him what kind of work and stuff that you're doing. Because you're actually out there in the trenches going to work. So it was not my personal case, but his particular case, he might have gone to a stage where he had such depression he had to actually take medication.

This idea about black qualifications is a theme that one finds in other accounts by African Americans of discrimination in the workplace, yet it receives little public or media attention. From the black middle class perspective, it is often the less qualified whites who get special privileges over better qualified people of color. This recurring white advantage can create much psychological pain, including depression, for its black victims. Of additional importance is the networking theme suggested in previous comments. In the United States economy many racial barriers are linked, directly or indirectly, to white "good-ole-boy" networks, which are commonly at the core of workplaces and even of large business sectors. In these networks whites commonly exclude outsiders from critical information flows.