DEPRESSION IN WOMEN OF COLOR
VeLora Lilly, PhD., LCSW
University of California, San Francisco Medical Center
San Francisco, California

According to relational theorists women's psychological growth and well being is fostered by their connection with others: . . .connection with others is a key component of action and growth ... what is important is women's sense of taking an active role in the process of facilitating and enhancing connectedness with others ... the extent to which women can act and feel empowered by their relational capacities is highly dependent on the extent of societal and individual valuing of these strengths ... this powerful denigrating of relational qualities has restricted the vast majority of women to less than the full use of their own resources, too often limiting their actions at home or in the workforce ... when women are severely constricted in the full development of their relational capacities and when women are strongly discouraged or punished for self-expression, the conditions are established that can lead to depression." (*Kaplan, pp. 208-209).

As previously noted, most cultures of which women of color are a part, strongly value family (nuclear and extended), community, spirituality and respect for authority. There is a sense of interconnectedness with family, community and spirituality which greatly influences their identities, styles of coping and ways of relating. However, their backgrounds are often infused with racism, sexism and colonization, Relational theories emphasize the importance of mutuality in connections and too often it is a one-way street for women of color.

Early in their lives their cultures teach them what expectations to have of themselves and others. In terms of Black women, Mitchell/Herring describe the "superwoman lessons":

1. "We are the mules of the world." We are both powerless and strong. Suffering through the generations has given Black women endurance and fortitude while exacting a great psychological toll. "Many Black women find it hard to admit they are overworked, overwhelmed, underloved and depressed," writes Professor Barbara Warren (1997), describing many of the African-American women in her practice, "they're alive, but barely, and are continually tired, lonely and wanting."

2. "Mama duties don't stop at your front door!" In the extended family tradition relatives can often be counted upon to take you in when you are down on your luck. For some Black women their willingness to help needy family members translates into a self-destructive sense of responsibility to others. "Such women feel they must take care of everyone, but they neglect to take care of themselves or their primary relationships." (Mitchell et al, p. 71)

3. "What's (self) love got to do with it?" For many Black mothers over the generations, loving your child meant staying alive for them and keeping them alive. Love = Survival and there was little time for more. "It has been for most of our years on American soil, much more important for Black children to learn their place than to feel good about themselves." (p. 73) Many Black women were not given the tools to love themselves; what they were given were lessons on "how to work, how to raise children so they don't get killed, how to take care of a man who the rest of the world treats like a child and how to get by on your own. Our parents showed their love through these lessons and through providing for your physical and material needs... Black women have too much to do and too much to worry about to get hung up on loving ourselves!" (p.74) Women may experience increased stress, guilt and depressive symptoms when they have role conflicts between their family's survival and their own developmental needs. (Carrington 1980; Outlaw 1993)

Mental health professionals describe Latinas as most often distressed about interpersonal conflicts in marriage and family. Acosta (1982) noted concerns about family breakdown, acculturation stress and impact of discrimination as well as somatization of emotional problems. Organista, Dwyer, Azocar (1993) also describe issues of adjustment to chronic medical conditions and war- related losses and post-traumatic stress disorder in Central American patients (we can expect these issues to be salient for many other refugee and immigrant women). Reports Organista et al, "the problems of Latina patients are consistent with the culture's emphasis on personalism," or a personal orientation to relationships, and "marianismo" which values the Latina's role in the family as self-sacrificing and enduring of suffering inflicted by men."

Other traditional values of "respecto,""familiarismo", and traditional sex role behaviors are described by Comas Diaz (1985)as having limiting effects on Latinas' ability to be assertive: "respecto" prescribes deferential behavior towards others on the basis of age, social position, economic status and sex. For women this requires obedience and respectful behavior toward figures of authority, older people, parents, relatives, males, husbands and others. "This norm is one that discourages assertive behavior... more frequently in females." We see similarities in Asian cultures.

The extended family system significantly limits a family member's degree of privacy and individual control over her life. "It is common for the needs of the individual to be subordinated to the needs of the family . . . the ability to act assertively, that is, express and pursue individual rights and feelings, is clearly potentially at odds with the focus on giving priority to the needs of the family as a unit." (Comas-Diaz et al, p. 465.)

Torres-Matrullo (1982) emphasized culture and gender-related issues in the depression of Latinas (Puerto Rican) noting that their depressed thinking appeared related to "unrealistic sex-role expectations with respect to prohibiting the expression of anger, remaining married despite the quality of the marriage and expecting to give help but not request it. "Organista et al describe their patients' tendency to "guardar" -- hold in anger rather than express it to spouses and family with whom they might be upset. Comas-Diaz comments that Latinas are "regarded as subordinate, first in relation to their fathers, then in relation to their husbands ... the subordination of the Puerto Rican female appears to occur regardless of level of education." Traditional values help to maintain the Latina in a docile, dependent, oppressed position vis a vis men.

Unfortunately some family relationships cannot only be limiting but overtly destructive and dysfunctional. Home is often not a safe place for girls and women of color. Many of us know the statistics of probability of abuse for all women. We know that even today, children are often the most victimized and least protected members of our communities. A child who grows up without a sense of safety, of being loved and protected, will grow up with fear and mistrust. She may have difficulty getting close to others and develop into a lonely, isolated person in childhood and later life. We also know that abused children often believe themselves unlovable and blame themselves as warranting the hurt inflicted upon them. Poor self image and low self esteem persist into adulthood. Women who survive childhood physical and sexual abuse often try to hold these experiences secret and become hopeless, unable to trust or connect, addicted, ashamed, depressed and suicidal.

As women, regardless of color, we long for loving, affirming, supportive relationships. Too many women of color find themselves alone and isolated. A number of studies have shown that companionship seems to protect women from loneliness and isolation that can trigger depressive episodes and that married women have lower rates of depression than single women.

Per Mitchell/Herring, 57% of Black women never marry or are separated or divorced . . . therefore fewer experience the protective effect of marriage. Black women have longer life expectancies than Black men, so many married Black women will spend years as widows, which increases the risk of depression.

Some immigrant women arrive in the USA having lost their partners to war and strife or needing to separate in order to work and send financial help to their loved ones back home. Too many sisters alone!

Even working women of color may find that their ambitions and successes can estrange them from their families and communities whom they need for support. Success can sometimes become a double-edged sword. The work schedule and demands may leave little time to maintain old friendships or if old friends don't have similar jobs, empathy and understanding may be lacking.

Women of color who are doing well financially may feel responsible for family and friends who aren't doing as well as they are, or they may be members of the "sandwich" generation, caring for parents and children. Attempts to emulate the lifestyle valued by the dominant society may leave some career women financially bankrupt and subsequently depressed. (End)

*Kaplan, A.G. (1991) The Self in relation implications for depression in women. In J. Jordan et al (Eds.) Women's Growth in Connections : Writings from Stone Center. Guilford Press, NY.