Thesis (M.D.) - Yale University, 2001

No Abstract submitted, substituted introduction: Researchers have examined healing from the perspective of the healer and they have explored the structure and function of healing systems (1,2,3,4). However there is a paucity of research that explores healing from the context of those who have experienced it (5). It has been noted that many mental disorders in the United States remain either untreated or poorly treated, especially in the African-American community (6). The 1999 Surgeon General's Report on Mental Health states that at present the United States mental health system is not equipped to meet the needs of racial and ethnic minority populations and describes a "constellation of barriers" deterring members of such populations from seeking treatment (7). The phenomenon of African-American aversion to mental health care is not new. African-Americans have historically shied away from psychiatric care with utilization rates consistently less than those of Caucasians, even when data are controlled for sociodemographic differences (8). The stigma attached to mental illness in the African-American community (11, 17), the history of racist practices in psychiatry (12, 13, 14, 15, 16), and the fear of institutionalization (9) have been suggested as possible explanations, either individually or conjoined, to explain why African-Americans do not seek mental health services. In contrast to mental health services, the importance of the religious community in many African-American lives can not be overstated. The church has historically served as a source of freedom, democracy, belonging, and hope for many AfricanAmericans (19,20,21). In light of the past and present difficulties that African-Americans in particular face, it is not uncommon to find those who agree with author James Baldwin's belief that if it were not for religion and the African American church black folk would have lost their minds (18). In fact, religious coping behaviors are common among African Americans (22). Churches in the African-American community have been recognized as therapeutic systems that provide salient physical and psychological support (23). Moreover, they have been documented as places in which healing actually takes place (24). One aspect in particular that serves as a valuable mediator of the therapeutic value of the African American church is that of testimony (20)

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