Smile Through the Pain: The Complexities of Narratives about Mental Health in the Black Community


The perception of mental health in the Black community is multifaceted. There are systemic challenges related to mental health that continue to stand as a barrier to receiving mental health services. Some of these barriers include accessibility of culturally competent providers, cost and/or lack of insurance to see a provider, and historical and present discriminatory practices by mental health professionals that heightened distrust of medical and even psychological communities (Novacek et al., 2020; Hines et al., 2017; Otado et al., 2015).

In addition, the stigma associated with mental health continues to play a role in how it is experienced and even talked about in Black communities. Phrases like “smile through the pain” or “I have to laugh to keep from crying,” have become anthems of resilience in the Black community. These phrases often serve as a protective strategy for the emotional, physical, relational, financial, and societal pressures experienced by Black people. However, these phrases may also normalize pain as something the individual should be ok with or that they can resolve without additional mental health support. Either way, there may be clinical implications for the individual and our profession.

According to the Health and Human Services Office of Minority Health, 20 percent of Black adults are more likely to report a mental health issue such as depression and anxiety than their white counterparts (ADAA, 2023). Black youth are 20 percent more susceptible to having instances of Post-Traumatic Stress Disorder (PTSD) in relation to exposure to violence. What further compounds these statistics is accessibility of services. As research indicates, just one in three Black people who struggle with a mental health issue will receive appropriate treatment. Thus, Black individuals are less likely to see therapy as a viable option for them, even when experiencing mental health disorder symptoms.

So, how do we begin the conversation about the significance of mental health when we ourselves may struggle to identify the complexities of what we’re going through? Furthermore, how do we unpack the messaging behind phrases like “struggle through” that are often necessary to use, rather than showing we can be vulnerable and ask for help? These statements reflect the systemic process of mental health in Black communities, thereby “if I do not believe my concerns will be validated and/or understood, I am less likely to seek treatment.” Consequently, if clinicians believe the client is managing their stressors well, they may not ask probing questions to get to the client’s deeper issues. As such, a possible resolution to this issue requires engagement of clients, clinicians, and our society as a whole.

The symptoms of a mental health issue can often be overlooked even by the individual themselves, because it can be masked by strength and hope (Castelin & White, 2022; Abrams et al. 2014; Beauboeuf-Lafontant 7). For example, depression symptoms like feeling sadness, loss of energy, or loss of interest (American Psychiatric Association, 2022) may look different for Black people. A Black client appearing to be “pushing through” a difficult emotional experience may seem more productive, determined, and even show concern for others. Internally, they may believe they are navigating through the difficulty well (Castelin & White, 2022; Beauboeuf-Lafontant, 2007). Thus, feeling more of a sense to present an outward image of strength, thereby discounting their own internal emotional needs. The silencing paradigm, explains how denying one’s own emotional needs might be related to other mental health issues like depression (Jack, 1991).

Ultimately, for many Black individuals, the identification of a mental health issue can be nuanced. On one hand, we may struggle to identify specific signs and symptoms within ourselves because we have adopted viable coping strategies. On the other hand, these same strategies allow us to navigate through spaces where showing vulnerability might be invalidated, misunderstood, or cause further harm to us.

Other factors that may influence how Black people cope with mental health include our perception of adversity and inherent resources. A study by Assari and Lankarani (2016) found that in the face of adverse experiences, maintaining a sense of hope was related to less depressive symptoms in Black individuals than White individuals. Furthermore, having family connections, reliance on community and religious networks can be viewed as resources to keep the individual afloat, even when they are still struggling to maintain stability (Anderson, 2019). While there is no doubt that both one’s attitude and support system can influence the experience of a mental health issue, there may be instances in which the perceived expectation to appear outwardly strong and resilient may be deleterious in other ways.

We cannot fully unpack the messaging behind these differing coping statements without examining the inherent resilience connected to them. Researchers have examined Black families’ ability to persevere despite “historical and contextual” forms of oppression as a mark of resilience (e.g., Murry et al., 2018).

Our cultural identity is made up of family connections, values, music, reliance on community support, and religious practices that have allowed Black people to escape the debilitating effects of slavery while maintaining a sense of human dignity. These practices provided strength, hope, and support that was then passed down from generation to generation and has stood as a protective factor and a way of being. And while resilience should not be something that is “celebrated” in spite of the atrocities Black individuals experienced during slavery, it does point to a larger systemic issue in which the message received is that to be “strong” one must ignore their pain in order to overcome (Kelly et al., 2020; Young, 2018). However, as we endeavor to expand the narrative of mental health in the Black community, it is imperative that we highlight the notion that there is strength and healing in vulnerability and seeking support outside of ourselves.

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Similar to the idea that mental health in the Black community is multifaceted, the steps to change both the barriers and perception of it is multifaceted as well. The resolution requires reimagining how we view coping strategies in the Black community, specifically, our cultural norms, language, and traditions that help us continue to persevere and celebrate our heritage. We must also be open to deeper reflection and evaluation that some of these cultural norms may not serve us in all situations and instead could be creating more obstacles or pain for us than support. A new perspective on mental health would normalize these issues as something that doesn’t have to define or limit the person, rather, getting help shows more courage in facing the issue head-on.

Additionally, it encourages clinicians to look at the historical and contextual factors associated with the client’s presenting issue to allow for a greater understanding and empathy of the client’s experience. Systemically, clinicians may not acknowledge the severity of the issue but rather focus on the resilience of the person. Therefore, it is imperative that as clinicians, we are curious about the “pain” experienced more than the process through the pain.

It would be an understatement to say that the Black community remains resilient, but with resilience comes a continued examination of the history of our cultural norms and language and its implications on our continued growth as a community. If we are going to see long-lasting, impactful growth and healing in Black communities, there has to be a systemic change as clinicians, how we might be further promoting this notion of resilience in spite of pain without considering the harmfulness associated with this stance.

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We must also be open to deeper reflection and evaluation that some of these cultural norms may not serve us in all situations and instead could be creating more obstacles or pain for us than support. 


Denise Williams, PhD, LMFT, is an AAMFT Approved Supervisor, and an Associate Professor at Indiana Wesleyan University, Division of Counseling, Marriage and Family Therapy program. Her research is focuses on marital issues, couple conflict, and underrepresented groups such as undocumented and international students. She has worked with a variety of clinical issues, including substance abuse, homelessness, and families going through different life transitions. Dr. Williams has a passion for the profession and enjoys equipping new clinicians with skills for the field of Marriage and Family Therapy.


Abrams, J. A., Maxwell, M., Pope, M., & Belgrave, F. Z. (2014). Carrying the world with the grace of a lady and the grit of a warrior: Deepening our understanding of the “Strong Black Woman” schema. Psychology of Women Quarterly, 38(4), 503-518.

ADAA. (2023, February 25). Black and African American communities. Anxiety &

American Psychiatric Association. (2022). What is depression? Retrieved from https://www.psychiatry.org/patients-families/depression/what-is-depression

Anderson, L. A. (2019). Rethinking resilience theory in African American families: Fostering positive adaptations and transformative social justice. Journal of Family Theory & Review, 11(3), 385-397.

Assari, S., & Lankarani, M. M. (2016). Depressive symptoms are associated with more hopelessness among white than black older adults. Front Public Health, 4(82).

Beauboeuf-Lafontant, T. (2007). You have to show strength: An exploration of gender, race, and depression. Gender & Society, 21(1), 28-51. https://doi.org/10.1177/0891243206294108

Castelin, S., & White, G. (2022). “I’m a Strong Independent Black Woman”: The strong Black woman schema and mental health in college-aged Black women. Psychology of Women Quarterly46(2), 196-208. https://doi.org/10.1177/03616843211067501

Hines, A. L., Cooper, L. A., & Shi, L. (2017). Racial and ethnic differences in mental healthcare utilization consistent with potentially effective care: The role of patient preferences. General Hospital Psychiatry, 46, 14-19. https://doi.org/10.1016/j.genhosppsych.2017.02.002

Jack, D. C. (1991). Silencing the self: Women and depression. Harvard University Press.

Depression Association of America. Retrieved from https://adaa.org/find-help/by-demographics/black-african-american-communities

Kelly, L. C., Spencer, C. M., Stith, S. M., & Beliard, C. (2020). “I’m Black, I’m Strong, and I Need Help”: Toxic Black femininity and intimate partner violence. Journal of Family Theory and Review, 12, 54-63. https://doi.org/10.1111/jftr.12358

Lankarani, M. M., & Assari, S. (2017). Positive and negative affect more concurrent among Blacks than Whites. Behavioral Sciences (Basel, Switzerland), 7(3), 48. https://doi.org/10.3390/bs7030048

Murry, V. M., Butler-Barnes, S. T., Mayo-Gamble, T. L., & Inniss-Thompson, M. N. (2018). Excavating new constructs for family stress theories in the context of everyday life experiences of Black American families. Journal of Family Theory & Review, 10(2), 384-405. https://doi.org/10.1111/jftr.12256

Novacek, D. M., Hampton-Anderson, J. N., Ebor, M. T., Loeb, T. B., & Wyatt, G. E. (2020). Mental health ramifications of the COVID-19 pandemic for Black Americans: Clinical and research recommendations. Psychological Trauma: Theory, Research, Practice, and Policy, 12(5), 449-451. https://doi.org/10.1037/tra0000796

Otado, J., Kwagyan, J., Edwards, D., Ukaegbu, A., Rockcliffe, F., & Osafo, N. (2015). Culturally competent strategies for recruitment and retention of African American populations into clinical trials. Clinical and Translational Science, 8(5), 460-466. https://doi.org/10.1111/cts.12285

Young, M. S. (2018). The relationship between the strong Black woman archetype and attitudes towards seeking professional psychological help in intimate partner violence relationships among African American women. Seton Hall University Dissertations and Theses (ETDs). 2557.

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