This article appears in our Summer 2015 issue, Blue. Subscribe today!

Hannah Horvath (Lena Dunham) on Girls can’t stop counting because of her OCD. CIA officer Carrie Mathison (Claire Danes) precariously manages her bipolar disorder on Homeland. Toni Collette plays an artist, mother, and wife who must cope with her dissociative identity disorder in United States of Tara. Increasingly, we’re seeing more women onscreen dealing with mental illness, often in ways that treat their disorder as just one element in a fully human, complex character. But all of these women are white. Women of color—specifically African American women—are not afforded the same type of humanity onscreen, if they’re even represented at all.

Of the limited shows and films that feature African American women protagonists, only a few have characters with mental illnesses. The lack of images of African American women with mental illness, combined with the myth of the “strong Black woman,” contributes to the mistaken notion of mental health issues as “a white-girl thing” and compounds their stigma among African American women. It’s no secret that African American women are underrepresented on the big and small screens, especially in starring or lead roles. According to reports from the Center for the Study of Women in Television and Film, among the top-grossing 100 films in 2014, 74 percent of female characters were Caucasian and 11 percent were African American. The numbers aren’t much different in the realm of television (including cable and Netflix), where 77 percent of female characters were white and 13 percent were African American in 2013–14.

In the infrequent instances when we actually see leading African American women on-screen, their portrayals tend to reinforce the stereotype of the strong Black woman: stoic, hypercompetent superwomen who soldier on without complaint regardless of their circumstances. (See “Precious Mettle: The Myth of the Strong Black Woman,” no. 63.) From doting mammy figures to Claire Huxtable to the cool and collected Olivia Pope, these women rarely buckle under pressure, creating the false impression that Black women can (and should) weather any storm. These seemingly positive representations of strength and independence can be damaging, as they discourage African American women from seeing themselves as ordinary women with ordinary struggles.

“It makes people think that the myth of the strong Black woman is something that they really ought to live into,” says Chanequa Walker-Barnes, author of the recently published book Too Heavy a Yoke: Black Women and the Burden of Strength. “And it makes it much harder [for] people experiencing symptoms of depression to feel that their emotional problems are valid.”

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There is limited and somewhat conflicting data on African American women and mental health in part because some studies have small, unrepresentative sample sizes or do not disaggregate data by both race and gender. In “The Epidemiology of Mental Disorders and Mental Health among African American Women” in In and Out of Our Right Minds: The Mental Health of African American Women (2003), Dr. Diane R. Brown and Dr. Verna M. Keith report that rates of schizophrenia, generalized anxiety disorder, somatization (unexplained physical symptoms of psychological distress), and phobia were highest among African American women (as compared with African American men, white men, and white women). The study found that over the course of a year, almost five African American women out of a hundred were diagnosed with depression. This was similar to the numbers for white women (4.6 out of 100) but much higher than the 1.0 for African American men and 2.1 for white men. Among African American women, the diagnosis of mental disorders is highest for major depression, simple phobia, agoraphobia, social phobia, and PTSD.

Lesbian and bisexual women experience higher rates of depression compared with African American women in general, according to a study from UCLA. The National LGBTQ Task Force found that almost half of Black transgender respondents (not separated by gender) have attempted suicide. These studies highlight how intersections of one’s identity may exponentially impact the mental health status of Black women. Some of the risk factors for psychological distress and depressive symptoms among African American women include age, marital status, poverty, poor health, and stressful life events such as financial issues and family conflict. But African American psychologist Dr. Kira Hudson Banks, an assistant professor of psychology at St. Louis University in St. Louis, Missouri, cautions against focusing on particular risk factors. Banks explains, “While it’s important to think about the intersection of race, class, and place, there are stressors that you don’t escape being a Black woman.” She argues that because of discrimination and other factors, even African American women who are affluent and educated face environmental stressors.

Tracee Ellis Ross as Rainbow on Blackish (Photo credit: ABC)

Still, Banks cautions against concluding that African American women experience mental illness at inherently higher levels. Instead, she says, “it may be the case that they might be in certain spaces and locations that put them at higher risk for mental health issues.” And, although there may be some patterns relating to African American women’s risk factors and experiences in the mental health care system, African American women are a complex group and should not be viewed as monolithic. Banks explains, “I try to avoid being too reductionist, too cookie-cutter in discussing Black women’s experiences.” Banks emphasizes the importance of noting differences among African American women, including socioeconomic status, ethnicity, nationality, sexual identity, and skin tone.

One of the primary barriers to proper diagnosis is the failure of some African American women to recognize symptoms and to realize that they can get help. Walker-Barnes refers to this phenomenon as “walking with broken feet.” She coined this phrase to describe the experience of African American women regarding pain not as pathological but as normative. This racialized and gendered “burden of strength” keeps African American women from noticing that something is wrong physically or emotionally because they do not regard it as abnormal. Race, gender, and class affect the particular ways that patients express their psychological distress, and medical professionals who are unaware of these differences may not properly diagnose mental illness among African American women. A lack of cultural competency can also play out in potential misdiagnoses of African American women. Ramou Sarr, cocreator of the podcast Black Girls Talking and a freelance writer whose work explores media representations, believes that people who don’t readily know many people of color resort to ideas that they learned from television. “They think that that’s how Black women are. With such limited [roles] given to Black women, you don’t get to see our full range. We aren’t given autonomy, and we aren’t seen as individuals.”

This can have dire consequences when it comes to mental health treatment. Despite the prevalence of mental illness among African American women, those who meet the criteria for major depression are often untreated or undertreated as compared with other subgroups. “It would be completely reasonable to suggest that there are Black women who are experiencing depression who are not being identified. One, because they’re not accessing the treatment. But two, they might be presenting in a way that looks different than what a clinician is familiar with in terms of depression,” Banks says.

Typical symptoms of depression may include depressed mood, anhedonia (loss of pleasure), or lethargy, but African American women do not tend to manifest depression that way. They mask their depression with overactivity, such as being too busy and overscheduling, and report agitation and irritation. They may try to cope through binge eating or compulsive shopping in an effort to self-medicate. According to Banks, research suggests that across races the same set of symptoms will receive different diagnoses. For example, despite presenting with the same symptoms, an African American might be diagnosed with schizophrenia, whereas someone who is white might be diagnosed as bipolar.

Preconceived notions of African American women play out in other ways. “Some clinicians seem to think ‘She’s a Black woman. She’s not crying, so she’s fine,’ as if Black women don’t need mental health services. As if they don’t have the ability to break,” says Imade Borha, the creator of the blog Depressed While Black. She said a psychiatrist refused to prescribe medication to her although she was suicidal. The psychiatrist told her, “You’ll be fine; it’s just a little phase.” For African American women, not presenting in expected ways may mean that they do not receive the same level of care or are not treated with the same urgency as patients of other races. Many African American women recognize that a non-African American therapist might lack understanding and compassion regarding their responsibilities, family expectations, or religious and community obligations. Walker-Barnes says that patients in her practice tell her, “I got tired of having to educate my therapist about my reality.” But finding a culturally competent Black mental health professional creates its own challenge: According to 2014 membership data from the American Psychological Association, only 1.4 percent of its members self-identified as Black.

Even after recognizing that something might be wrong, the cultural stigma against seeking help is another roadblock in the way of treatment. In their 2004 study, “African Americans’ Perceptions of Psychotherapy and Psychotherapists,” Vetta L. Sanders Thompson, Anita Bazile, and Maysa Akbar found that cultural and financial barriers, lack of knowledge, and alternative outlets (such as consulting a minister) played a large role in lack of treatment, as well as cultural stigma, which is intertwined with shame and embarrassment. There is an emphasis on the importance of “strength” among African Americans and the desire to resolve family issues internally. Male participants regarded seeking psychotherapy as related to “weakness and diminished pride,” while women participants pointed out the “historical requirement that they be the anchor and source of strength in the family.”

“It’s almost as if the stereotype tells the world Black women are not human,” says Borha. “And we don’t cry like you. We don’t hurt like you. We don’t go through pain like you. So we don’t need the same level of care—and that’s a lie. We need the same level of care that any other human being needs.”

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The tide against the recognition of mental health issues is turning thanks to advocacy from Black women offscreen. Chiara de Blasio, daughter of New York City mayor Bill de Blasio, is a mental health advocate and has publicly shared her experiences with substance abuse and depression. She has become a spokesperson for a New York City program aimed at helping young people with depression. Singer Fantasia Barrino, former Destiny’s Child member Michelle Williams, and other celebrities have discussed their efforts to cope with depression. First Lady Michelle Obama has helped launch Change Direction, a national effort to educate Americans about mental health issues. These public steps create greater visibility for mental health issues and help dispel the myth that depression does not affect Black women.

As the film and television landscape continues to change, we are slowly seeing more nuanced portrayals of Black women in mainstream pop culture. Borha felt empowered to seek treatment after watching the Girlfriends episode where Tracee Ellis Ross’s character sees a therapist. “The show made a huge imprint on my life and normalized mental health treatment for Black women.” More encouragement comes from the unexpected realm of reality television. For all their staged fights and shallow setups, Braxton Family Values and Real Housewives of Atlanta have featured several episodes where participants engage in therapy sessions with African American clinical psychologist Dr. Sherry Blake. “Seeing a Black woman as a therapist—that takes some of the mystery and the fear and the stigma out of therapy,” says Walker-Barnes. While these programs do not really reflect the work involved in long-term therapy—which may scare some people from pursuing counseling—these quick televised consults offer much-needed insight into the process for an audience that is unfamiliar with what therapy can look like. In addition, African American women are creating new communities, spaces, and discourse through YouTube, Tumblr, and web series.

Dennis McKinley, left, and Porsha Williams go to couples therapy on Porsha’s Having a Baby (Bravo)

More mainstream depictions are coming, slowly but surely. In the Shonda Rhimes law procedural How to Get Away with Murder, Annalise Keating (Viola Davis) is all at once an assertive lawyer, a capable professor, and a person with vulnerabilities. Toward the end of the first season, Annalise grapples with the investigation of her husband’s murder and eventually seeks solace in her mother, Ophelia (Cicely Tyson). Her mother’s tough love approach pushes Annalise to a breaking point, and she finally confronts her mother about childhood abuse she endured at the hands of her uncle, Ophelia’s brother. Annalise asserts that her husband, a psychology professor, was the only one who truly understood her mental health issues. Ophelia replies, “Ain’t no reason to talk about it and get all messy everywhere. Certainly no reason to go to a headshrinker for help and end up marrying him.” In a single short scene, viewers are shown both a generational and a cultural gap between Annalise and her mother—for whom the idea of treating one’s mental health feels frivolous.

In addition, Andre Lyon (Trai Byers) on the wildly popular Empire has bipolar disorder. In her post “Grin and Bear It No More” on the blog For Harriet, writer Jordan Maney discusses her struggle and acceptance of her PTSD diagnosis and the impact watching Byers’s performance had on her. His scenes of “suicidal ideation, the euphoria of mania, the depression that follows, the untethered emotions, the raging thoughts” mirrored her own, perhaps none more significant than “the feeling that to suffer alone and pretend to be fine is better than to speak up and possibly lose everything.” She thanked Byers and the show’s creators for “bringing reality and humanity to mental health issues seldom explored through the perspective of African Americans on television before.”

Television and film portrayals of African American women may seem trivial when compared with such “real world” health issues as poverty and insurance coverage. Still, we consume onscreen images, and they have an effect on our offscreen lives, shaping our understanding of ourselves and others and helping to define our notions of what is normal and expected behavior. In April 2015, Shonda Rhimes was inducted into the National Association of Broadcasters’ Broadcasting Hall of Fame. In her acceptance speech, Rhimes said in part, “In Shondaland, our shows look like how the world looks. Everyone can see themselves when they turn on the TV on Thursday nights on ABC. To me, that was not some difficult, brave, special decision I made. It was a human one. Because I am a human.” With showrunners like Rhimes, we may be able to see more realistic and honest portrayals of African American women—helping to break down stereotypes and the myth that Black women just don’t get blue.