Some people cope in couch-potato fashion: When having fun seems too much trouble, it's easy to camp out every night in front of the television, raiding the refrigerator during commercials. Low-grade depression and poor eating habits frequently go hand in hand. Scientists aren't sure of the exact biological mechanism, but there is evidence that eating carbohydrates temporarily boosts a person's mood by altering the brain's level and use of serotonin. People with low-grade depression quite often binge on high-carbohydrate foods—pasta, crackers, popcorn—in what some doctors see as an unconscious effort to self-medicate. Ferber frequently sees patients with low-grade depression who are significantly overweight—a fact that, for women living in a culture obsessed with thinness, quickly becomes a vicious cycle: Depression leads to overeating, to a dispiriting look in the mirror and, from there, to deeper depression.

For others, keeping the demons at bay involves sex or drugs. "I was okay until I was about 14, and then I started experimenting with drugs and drinking," Aguirre says. She and her best friend were kicked out of school. "I was high most of the time," she says—which she now realizes was an effort to mask her feelings. Sex was another emotional narcotic. "I was very promiscuous, starving for the wrong kind of attention. I'm lucky I don't have HIV," she says.

Feeling Good Again
Unfortunately, many women get worse before they get better. Danquah had an episode of major depression when she was 22. "I couldn't bathe. I couldn't wash dishes. I barely ate," she says. "I knew something had gone wrong but didn't know why. It's like you're walking down the street, and something falls on you, and you think, If I ignore that, maybe it won't happen again." But when her daughter was born two years later and postpartum depression set in, she could ignore it no longer. "That's what motivated me to really investigate what was going on," she says. "I had made a choice to have a child. It was something I wanted to be present for."

Looking for a good therapist requires perseverance. Both Danquah and Hawkins faced obstacles in the rarified world of psychiatry because they were women of color. Hawkins saw three psychiatrists, all of them white men, without getting much help because she simply didn't feel comfortable speaking openly. And since she was poor at the time, she didn't have much choice about who her doctor was.

Danquah recalls going to an emergency room because she was unable to get a quick appointment with a private psychiatrist. The doctor who examined her was from the Middle East. "He said, 'What do you do?' and I said, 'I'm a writer,' and he said, 'What kinds of things do you write?' And I said, 'I write for The Washington Post and the Los Angeles Times.' He said, 'How long do you believe The Washington Post has been giving you writing assignments?'" She had to put him on the phone with her literary agent to prove she was not delusional.

Doctors are not immune to cultural stereotyping, says Michelle O. Clark, M.D., associate clinical professor of psychiatry at the University of California in San Francisco and an expert in cross-cultural psychiatry. Clark says discussions of psychiatric conditions in African-Americans are influenced by the historical myth of the "happy darky"—the idea that black people are somehow incapable of experiencing depression. Added to that, she says, is the fact that for a member of a minority group to seek help, she or he must violate a basic rule of survival: Don't put your business in the street. "In the black community, anything and everything you say can be used against you," Clark says. "Three-year-olds know the Miranda warning."


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