Journal of Systemic Therapies, Vol. 32, No. 1, 2013, pp.

1–13

APPLYING RESISTANCE THEORY TO

DEPRESSION IN BLACK WOMEN
AGNES MARTIN
Boston Public Schools
NOREEN BOADI
CAROLINE FERNANDES
Northeastern University
SHERRY WATT
University of Iowa
TRACY ROBINSON-WOOD
Northeastern University

Depression in African American women is often invisible, misdiagnosed, and

ineptly treated. Black women are vulnerable to depression due to chronic
environmental stressors of racism, sexism, poverty, cultural socialization prac-
tices, and social health difficulties. Middle-class and college-educated Black
women are also vulnerable to depression, although less of the research has
focused on this segment of Black women. We highlight psychological literature
that explores the phenomenon of depression among Black women. By way of
a clinical case study, we discuss how counselors and psychologists can use
Resistance Theory to identify and treat depression in a highly functioning
college-educated, middle-class, single African American woman.

Depression is the world’s most pervasive psychiatric disorder. Individuals diagnosed

with this mental illness often suffer from severe social, physical, and psychologi-
cal impairments, limiting their overall functioning in all areas of life. Worldwide,
depression is the fourth leading cause of disability as well as the leading cause of

The terms Black and African American are used interchangeably here to describe diverse groups of
people of African descent residing in the United States (e.g., Africans, African Caribbean, and Latinos
of African descent). We recognize that the majority of the current psychological research regarding
Black people describes people native to America (e.g., African Americans). It is our hope that mental
health and medical professionals will consider race, class, and ethnic diversity when working with all
clients of African descent residing in America.
  Address correspondence to Agnes Martin, PhD, School Psychologist, Boston Public Schools, Office
of Special Education and Student Services, Department of Behavioral Health Services, 443 Warren St.,
Dorchester, MA 02121. E-mail: amartin@boston.k12.ma.us

G4218.indd 1 5/29/2013 2:10:33 PM

 2 Martin et al.

nonfatal disease (Williams et al, 2007). According to the Diagnostic and Statisti-
cal Manual of Mental Disorders, Text Revision (American Psychiatric Association
[APA], 2000), a diagnosis of major depressive episode is established when five
or more symptoms are present within a consecutive 2-week period, representing
a significant change in the individual’s functioning. These symptoms include:
depressed mood daily, decreased interest or pleasure in activities, weight gain or
weight loss, lack of or over-sleep, psychomotor agitation or retardation, loss of
energy, feelings of guilt and/or worthlessness, inability to concentrate or make
decisions, and, finally, recurrent thoughts of death.
Depression affects more than 18.8 million American adults annually and approxi-
mately 16.2% of adults in the United States will experience an episode of major
depressive disorder in their lifetime (Centers for Disease Control and Prevention
[CDC], 2010a; Kessler et al., 2003). An estimated 1 in 10 adults in the United
States meet the criteria for depression (CDC, 2010a).
Women are more likely to experience depression than men, and more than 25% of
women will experience an episode of depression throughout their lifetime. Among
African Americans, depression is frequently undetected, under-diagnosed, under-
reported, and undertreated. Only 7% of Black women will receive some type of
mental health treatment (Beauboeuf-Lafontant, 2007). According to the National
Survey of Life, the largest psychiatric epidemiologic study of Blacks in the United
States (including a large sample of Caribbean-origin Blacks), the persistence of
depression is higher for African Americans (56.5%) and Caribbean Blacks (56.0%)
than for Whites (38.6%) (Williams et al., 2007). Several factors interfere with
Black people seeking mental health services and receiving a proper diagnosis
and treatment. These include disparities in health care access and quality, stigma
associated with receiving mental health care, and the disproportionately small
number of counselors and psychologists of African descent. Reliance on religious
faith to cope with stress and cultural differences in the manifestation of depressive
symptoms among some African Americans are also relevant factors (Brown et al.,
2010; Nadeem, Lange, & Miranda, 2009; Nicolaidis et al., 2009).
The National Center for Health Statistics conducted the National Health and
Nutrition Examination Survey III between 1988 and 1994. African Americans and
Mexican Americans were oversampled among the 8,449 respondents, ages 15–40.
It was found that Whites were more likely than African Americans and Mexican
Americans to have major depressive disorder; however, African Americans and
Mexican Americans were more likely to have dysthymic disorder. Among Black
women the prevalence of dysthymic disorder was highest among those with less
education (0–8 years), yet, college-educated Black women had the same prevalence
for dysthymic disorder as did Black women with a high school education (Riolo,
Nguyen, Greden, & King, 2005). It appears that the benefits traditionally associ-
ated with college attainment did not buffer Black college-educated women from
dysthymic disorder and its many symptoms.

G4218.indd 2 5/29/2013 2:10:33 PM

 Resistance to Depression in Black Women 3

Dysthymic disorder refers to a chronically depressed mood that occurs for most of
the day more days than not for at least 2 years. People with this condition describe
their mood as sad or down and may have insomnia or hypersomnia, feelings of
hopelessness, poor appetite or overeating, poor concentration, or difficulty making
decisions. The symptoms associated with the disorder have become such an inte-
gral part of everyday existence for many women that unless a clinical interviewer
specifically asks about symptoms, they are not reported (APA, 2000). Extreme
self-criticism and perceptions of oneself as not being either interesting or very
capable are common among those with dysthymic disorder.
Due to multiple jeopardy, Black women have unique stressors that are being
explored in research. Multiple jeopardy refers to the several and simultaneous
oppressions of racism, sexism, and classism that Black women face and the mul-
tiplicative and intersecting relationships among these sources of discrimination
(King, 2007). An intersectional perspective positions race, gender, and class at the
center of analysis. The psychological literature has investigated depression among
Black women, particularly those of lower socioeconomic status (SES) (Beauboeuf-
Lafontant, 2007; Jones & Ford, 2008; Kohn, Oden, Munoz, Robinson, & Leavitt,
2002; Nicolaidis et al., 2010; Settles, Navarrette, Pagano, Abdou, & Sidanius,
2010). Absent from the investigation is a cultural and gender-focused theory that
may assist mental health professionals in detecting and treating depression among
Black college-educated and/or middle-class women. Understanding Black college-
educated women’s vulnerability to and management of depression could lead to
better clinical treatment (Robinson-Wood, 2009) among a population that may
not evidence the traditional symptoms of depression in women. Thus, the purpose
of this article is threefold: (1) to explore the contextual variables that contribute
to depression in Black women’s lives, particularly among those who are middle
class and college educated; (2) to define Resistance Theory; and (3) to link, by way
of a clinical case study, Resistance Theory to a highly functioning, yet depressed
middle-class and college-educated Black woman.

DEPRESSION AND BLACK WOMEN

Factors associated with depression among Black women include: racial disparities,
microaggressions, poverty, cultural socialization, social health, obesity and diabetes,
and exposure to interpersonal and community violence. Due to an overrepresentation
of established factors for depression, such as race, gender, and class inequities, Black
women are at a disproportionately higher risk for this mental illness (Gildersleeve,
Croom, & Vasquez, 2011; McKnight-Eily et al., 2009).
Throughout history, Black women have been forced to manage numerous life
stressors on their own. Over the years, this fact has become culturally rooted in the
expectation for Black women’s ability to show strength and fortitude, even in the

G4218.indd 3 5/29/2013 2:10:34 PM

 4 Martin et al.

midst of struggle. Within the Black community, women are recognized as being
persevering, particularly during adversity (Boyd-Franklin, 1989). Culturally, Black
women are socialized to be strong and to care for others (Beauboeuf-Lafontant,
2007) and are reared to function, to be tough, resilient, and self-sufficient (Nicolai-
dis et al., 2010; Shorter-Gooden & Jackson, 2000). “Keeping it together” is often
achieved at all costs and for the sake of others, mainly children, men, and communi-
ties. Culturally specific behaviors to “keep on keepin’ on” may explain high levels
of productivity, social engagement, and service to others in the face of real sadness
(Parham, 1992). Being “neat as a pin” so as to counter racist stereotypes of Black
people as dirty and poor may also encourage depressed Black women to dress up.
Race-related stress appears to be a significant correlate of mental health among
Black women in that it has been linked to the development of depression and lowered
self-esteem (Utsey & Ponterotto, 1996). As a chronic stressor, racism can lead to
severe psychological outcomes, such as depression and feelings of worthlessness.
Settles et al. (2010) found that depression in African American women was associ-
ated with both how they believe others perceive their racial group and how they
themselves perceive other Black people. Multiple vulnerabilities increase Black
women’s risk for depressive symptoms and other health problems (Flaskerud &
Lee, 2001). According to the National Mental Health Association (NMHA) survey
on attitudes and beliefs about depression in African American communities, nearly
63% of African Americans believe that depression is a “personal weakness,” with
about 30% stating that they would “handle it” if depressed. Of great significance
was that nearly 66% of African Americans stated that prayer and faith would suc-
cessfully treat depression “almost all of the time” or “some of the time,” suggesting
that internal rather than external forces contribute to the trajectory and treatment
of this illness (Cordian & O’Connell, 2003).
Generally, Black women are more religious than Black men and function to
bind the family into a church-centered support system of persons in particular
roles, activities, and social life (Boyd-Franklin, 1989). Constant religious refer-
ences to “going home to see Jesus” may bespeak of depression-induced fatigue
and an existential desire to lay down burdens. This may explain the reliance on
religious contexts for help with depression. Dessio et al. (2004) found that of the
812 African American women in their sample, 43% reported using spirituality or
religion to address health issues including depression, cancer, and heart disease.
Although pharmacology, psychotherapy, or both can be helpful to approximately
80% of persons suffering from depression, barriers exist to help-seeking as well as
naming depression. Black women are also more disapproving of pharmaceutical
interventions when treating depression (Hall et al., 2010; Nicolaidis et al., 2010).
Disproportionately, African American women have high rates of obesity and
weight-related diabetes (White, 1994) Almost 60% of black women are obese,
compared to 32% of white women and 41% of Hispanic women (Dingfelder, 2013).
Other health challenges are associated with obesity, including diabetes, arthritis,
and cardiovascular disease. In addition to adverse implications for physical health,

G4218.indd 4 5/29/2013 2:10:34 PM

 Resistance to Depression in Black Women 5

there are mental health challenges as well. Carpenter, Hasin, Allison, & Faith
(2000) observed that obese women across racial groups were at an increased risk
of depression and suicidal tendencies, even after controlling for socioeconomic
status. In their study of 113 African American women, Davis, Rovi, and Johnson
(2005) found that Black women who were obese were more likely to be anxious,
have poorer perceptions of physical health, and more psychological problems in
their family of origin. Black women who are depressed are more likely to put on
weight as opposed to losing weight and depressive symptoms during adolescence
increase the risk for obesity in young adulthood (Dingfelder, 2013).
Social variables unique to Black women contribute to depression. For example,
exercise can maintain healthy weight, lower blood pressure, and alleviate depressed
mood by producing depression-combating brain chemicals. Yet, African American
women report that safety issues, lack of access to sidewalks and parks, babysitting
problems, and concerns about perspiring that would adversely affect hairstyles in-
terfere with consistent exercise (Dingfelder, 2013; Singleton, 2003; White, 1994).
Although Black men are more likely to marry Black women than women from other
racial or ethnic groups, marriages between Black men and White women increased
190% between 1980 and 2009, from 122,000 to 354,000. Moreover, high rates of
homicide, incarceration, and underemployment have seriously impacted the number
of marriageable Black men available to Black women (Robinson-Wood, 2013).
According to the National Intimate Partner and Sexual Violence Survey, Sum-
mary Report (CDC, 2010b), 40.9% of African American women are subject to
physical assault at some point in their lifetime. In fact, the number one killer of
African American women ages 15 to 34 is homicide at the hands of a current or
former intimate partner (Africana Voices against Violence, 2002; Rennison & Wel-
chans, 2000). The majority of women of color who have been victims of trauma
such as rape, childhood incest, and physical and emotional abuse also suffer from
depression as well as substance abuse and addiction (Coridan & O’Connell, 2003).
The social health of Black women may also enhance their vulnerability to depres-
sion. Among all race groups and Hispanic/Latino-origin groups, Black people have
the lowest sex ratio, with females outnumbering males throughout every decade.
Compared to other heterosexual women, Black women, including college-educated
women, are less likely to be married and more likely to be single parents (U.S.
Census Bureau, 2011). When Black women marry, their rates of divorce and separa-
tion are higher, contributing to family and income instability (U.S. Census Bureau,
2009, 2011). In the United States, 23.8% of non-Hispanic White children are in
single-parent families. Among African American children, 66.8% are in such homes.

OPTIMAL PSYCHOLOGY

Optimal psychology addresses how coping and strategies of resistance might impact
depression in Black women. Within African psychology, theorists have examined

G4218.indd 5 5/29/2013 2:10:34 PM

 6 Martin et al.

the ways African Americans cope and optimally resist living in a society that has
historically valued power rooted in Whiteness and maleness. Myers’s (1991) Theory
of Optimal Psychology is based on an Afrocentric worldview. In communicating the
basic assumptions of her theory, she makes a comparison between a suboptimal and
an optimal worldview (Myers et al., 1991). The suboptimal worldview is parallel to
the Eurocentric value system in which our society functions. In this value system,
spirit and matter are separate, while self-worth is based on external validation. The
suboptimal conceptual framework leaves people looking for meaning and peace
outside of themselves. Existence is based solely on what the eyes can see.
The optimal worldview parallels the Afrocentric value system. In this value
system, there is a recognized connection between spirit and matter. Self-worth is
placed on intrinsic value. In the optimal worldview, the “self . . . is seen as multi-
dimensional encompassing the ancestor, those yet unborn, nature, and community”
(Myers, 1991, p. 56). At the foundation of Myers’s (1991) theory is the individual
search for self-knowledge. The motivation to search for self-knowledge is to live
the set of conditions called optimal. Optimal conditions are a life that yields peace,
joy, and harmony. The well-being of the whole is increased.
In 1991, Robinson and Ward defined a theory of resistance, initially developed for
Black adolescent girls to address the intersections of race and gender in a woman’s
life. One of its primary goals is to help Black girls and women identify, name, and
resist race, gender, and class oppression that press down on their lives. Two other
goals associated with Resistance Theory are to help Black women recognize and
utilize optimal resistance strategies and to help Black women recognize and actively
avoid suboptimal resistance strategies.
Suboptimal and optimal strategies are included in Resistance Theory (see Table 1 for
a summary of optimal and suboptimal resistance). Optimal or healthy resistance is
linked to Myers’s Theory of Optimal Psychology and the Nguzo Saba, a Swahili term
for “first fruit” (Pack-Brown, Whittington-Clark, & Parker, 1998). Seven principles
are associated with the Nguzo Saba, which is best known through its association
with Kwanzaa, an annual cultural holiday observed for 7 days, from December
26 through January 1. Optimal resistance incorporates the seven principles of the
Nguzo Saba and reflects an awareness of environmental stressors and institutional
oppression that press down on Black women’s lives.
Optimal resistance reflects a sociopolitical consciousness of oppression towards
naming and opposing it (Robinson & Ward, 1991). It is characterized by com-
munity involvement, is proactive, and reflects a state of being (Brookins & Rob-
inson, 1996). Seeking assistance from a mental health care professional to deal
with one’s depression is characteristic of optimal resistance. It is also associated
with a reliance on multiple resources: psychotherapy, pharmacology, exercise, and
community and spiritual resources that may be in the service of prevention and
intervention. Resistance is deliberate, conscious, proactive, and methodical and is
not dependent on the cessation of the stressor. Optimal resistance requires energy
but also replenishes energy (Robinson & Howard-Hamilton, 1994). While Resis-

G4218.indd 6 5/29/2013 2:10:34 PM

 Resistance to Depression in Black Women 7

TABLE 1.  Suboptimal and Optimal Resistance

Suboptimal Resistance Optimal Resistance
Isolation from others or inability to be alone. Umoja—Unity with others across race,
gender, class, and age
Chronic feelings of irritability, worthlessness, Kujichagalia—Incorporation of a healthy
pessimism about one’s life and future. identity
Excessive caregiving and responsibility to Ujima—Healthy reliance on self and
“fix” things and please people. ­others.
Inability to ask for help; inability to say no Ujaama—Sharing fiscal and human
to others’ requests. resources
Feeling like one is always under a cloud. Nia—Having a sense of agency and
Chronic feelings of fatigue and “being tired.” purpose.
Passive coping; Lack of insight into problem Kuumba—Actively creating new and
solving; a passive belief that God will take empowering ways of being in the world
care of everything.
A pervading sense that things are not going Imani—Trusting that life gets better and
to change. that the universe is benevolent and
responsive

tance Theory does not claim that Black women who optimally resist will avoid
depression, resistance supports health and healing. The avoidance of negative and
depressive thought patterns that directly impact behavior and emotional states is
critical to optimal resistance.
Suboptimal resistance is associated with a disempowered state, linked to a strong
tendency to depression, feelings of inferiority, insecurity, and less gratification
(Robinson & Kennington, 2002). Suboptimal or survival-oriented resistance refers
to short-term dysfunctional cognitive and behavioral adaptations to chronic stress
and/or depression. Short-term adaptations do not serve women well in the long
run, although they tend to have immediate or short-term numbing, soothing, and/
or pleasure-inducing effects.

Case Study
This case has been adapted from real-life events. A pseudonym has been provided.
Karen is a 38-year-old single African American woman. Her cousin had a child
born with cerebral palsy but was unable to adequately care for her. Karen adopted
her cousin’s daughter during the child’s infancy; she is now 11 years old. Karen
works as an assistant to the operations manager at a large credit union and has been
with the bank for 16 years. She has aspirations of becoming a manager. Within a
6-month period, Karen’s mother died, her boyfriend of 9 months suddenly termi-
nated their relationship, her father was diagnosed with advanced-stage prostate

G4218.indd 7 5/29/2013 2:10:34 PM

 8 Martin et al.

cancer, and she was denied a promotion. Since her father’s surgery, Karen has been
caring for him. Daily during lunch and every evening, she travels to his home to
provide meals and company.
Karen rises daily at 4:30 to pray and retires generally after 11:00 at night. She
teaches Sunday school and is one of her church’s deaconesses. Karen relies on her
faith to cope with the many challenges in her life. She has gained 20 pounds in
5 months—she eats late at night after caring for her father and daughter. Although
she is exhausted, Karen is well dressed and appears polished. She has noticed
heart palpitations and has difficulty falling asleep at night because “my mind is
always racing.” Karen’s father has encouraged her to get a nurse for him and his
granddaughter. Karen denies any need for help and says that she does not want a
stranger taking care of her family. When caring for her father and daughter, she is
very patient. Karen’s mother was opposed to Karen hiring a nurse, insisting that
Karen “step up” and care for her family as needed.
Due to her recent breakup with her boyfriend, Karen seriously doubts she will
ever get married. She is also fearful that her father will not regain his health. She
prays that God will help her to become vice-president at the bank. Karen has not
inquired as to the reasons why she was passed over twice in the past 4 years for a
promotion. She would like to be promoted but struggles with persistent feelings
of worthlessness. She rehearses in her mind what she would like to say to her su-
pervisor but can never gather the nerve to initiate the conversation. Her mother’s
insistence that Karen not make her boss uncomfortable by asking a lot of questions
is a message that she replays in her mind along with her mother’s advice that Karen
should just be glad she has a good job.

Application of Resistance Theory

Karen has experienced considerable loss with the death of her mother, the change
in her father’s health status, and the ending of a significant and intimate relation-
ship. In an attempt to juggle her roles as a single mother of a child with a chronic
disability, an only child, and a worker who is frustrated with her stunted career,
she suffers from role strain. Seeking to establish a balance among these compet-
ing and conflicting roles, women often find themselves dealing with physical and
emotional stress (Robinson-Wood, 2013).
On the surface Karen does not appear to be depressed or anxious; she does not
evidence psychomotor retardation common to most depressed people. Karen is col-
lege educated, articulate, attractive, friendly, impeccably dressed, and her hair and
makeup are always neat. She is highly functional at home, work, and church—the
first to cheerfully offer her services to care for, relieve, and support colleagues,
family, and church members. She does not appear to be sad, mad, nervous, or angry
although she feels each of these emotions intensely. Her life, by all appearances,
suggests that she invokes more optimal strategies of resistance than she actually
does. Her heart palpitations, racing thoughts, and obsessive rituals (e.g., rehearsing

G4218.indd 8 5/29/2013 2:10:34 PM

 Resistance to Depression in Black Women 9

conversations that do not occur, comfort eating every night) point to symptoms
associated with anxiety. The use of both optimal and suboptimal strategies are
evident in Karen’s life, however, there are more suboptimal strategies than optimal.
A therapist using Resistance Theory would help Karen explore her use of sub-
optimal strategies with a goal of understanding how utilization of these strategies
interferes with personal and professional aspirations. Karen’s resistance is survival-
oriented resistance in that she uses short-term dysfunctional cognitive and behavioral
adaptations to chronic stress and/or depression by soothing herself with late-night
emotional eating. Although emotional eating comforts her and may even numb her
anxiety and sadness, the significant weight gain does not support physical or mental
health. Karen’s therapist understands Karen’s sadness and that it is tied to having
done the “right thing” by avoiding teenage pregnancy, getting a college education,
finding and keeping a good job, and taking care of others, yet being lonely, alone,
and stuck in the same position at work for 12 years.
Karen’s isolation from sources of support and help is in contrast to Umoja or
unity. Karen’s mother socialized her to be completely self-reliant so as to not appear
weak or needy before others. Such practices drive Karen’s exhaustion, encourage
her selflessness, and suppress her voice. A resistance-oriented therapist is able
to identify how society at large and both the Black and church communities, in
particular, support racially gendered behavior that can contribute to excessive and
exhausting care-giving among Black women.
A therapist who practices from a resistance orientation would explore Karen’s
difficulties with self-advocacy, characteristic of selflessness, feelings of worth-
lessness, and a tendency to consistently offer her best to others instead of herself.
Kujichagalia or a healthy identity is missing from Karen’s life. The extent to which
racial and gender oppression are implicated in Karen’s career as a Black woman
needs to be broached by the therapist. Karen is silent about race and gender in her
life. It is possible that Karen is unaware of the subtle and overt ways in which sexism
and racism manifest in the 21st century among women of color, given the federal
laws prohibiting racial and gender discrimination. Clearly, the majority of people
in management, particularly in the financial sector, do not look like Karen. There
may be multiple factors that explain Karen’s denial of promotion. It is therefore
irresponsible on the part of the therapist not to consider race and gender. It is also
irresponsible to consider these constructs solely.
Karen is excessively busy. The U.S. culture values productivity, work, and prog-
ress (Robinson-Wood, 2013). Consequently, many people mistake Karen’s church
involvement, full-time work, and dutiful care of her ailing father and chronically ill
child as indicators of success instead of the over-functioning behavior it is, mask-
ing anxiety and depression from others as well as from Karen. The therapist using
resistance theory would recognize Karen’s suboptimal need to fix the broken places
or make everything right. These behaviors are in contrast to Ujima or healthy reli-
ance on self and others. Skillful questions that Karen’s therapist could ask Karen
include, “What would your life look like if you gave yourself permission to hire

G4218.indd 9 5/29/2013 2:10:35 PM

 10 Martin et al.

a nurse to help you care for your father and daughter?” “What would it mean as
a loyal daughter to choose self-care even if your choices were contrary to your
deceased mother’s decree to take care of everything and everyone all by yourself?”
“What do you think and do that activate depression and anxiety?”
Karen’s depression and anxiety limit her agency. Agency involves “increased
powers to do for others while developing a greater sense of one’s capacities . . . and
permits more clarity about one’s choices within a relationship” (Jenkins, 2002,
p. 71). In addition to difficulties with agency, Karen lacks a sense of Nia or purpose.
Although Karen expends tremendous amounts of energy based largely on others’
prescriptions of how she should live her life and spend her time, such effort is not
reflective of personal agency or purpose. Karen passively relies on God to create
the change that she wants to see happen in her life. This practice points to restric-
tions in agency as well as to ongoing challenges with Kuumba or creativity. Karen’s
tendency not to see change emanating from herself reflects a lack of personal power.
Karen’s inability to assert herself and ask questions of management compounds
her confusion and powerlessness, and does not encourage her upward mobility at
her place of employment. Her queries would require her supervisors to explain
their reasons for denying her promotion. That a plan has not been put into place
to remediate any observed difficulties suggests that the company is not invested in
Karen’s professional growth beyond the position she currently occupies.
A therapist could help Karen honor and strengthen her use of optimal resistance
strategies. For example, Ujaama, or the sharing of fiscal and human resources, is
characteristic of optimal resistance and part of Karen’s life. As a woman of faith,
Karen cultivates her spiritual life. Balance, however, is needed towards Karen
becoming aware of how she so freely extends vast and deep resources to others
while she goes wanting. Self-care is not selfish, and yet this is the message that
many women receive (Dingfelder, 2013). Karen needs help distinguishing faith
from passivity or inactivity. With her therapist’s support and clinical skills, Karen
could come to realize that her ability to love herself and engage in ongoing self-
care is critical to bringing the change she desires into her life. Getting women like
Karen to therapy, however, is very difficult. Her primary care physician and pastor
could both play critical roles in normalizing therapy and encouraging Karen to
seek the help of a competent therapist and provide appropriate referrals. Not only
would individual therapy help Karen, but belonging to a group with other women
could assist Karen with learning how to confront the real challenges in her life
(Dingfelder, 2013). Without therapy, Karen is unlikely to develop insight into the
reasons for her loneliness, depression, and anxiety.

CONCLUSION

A case study of a college-educated, middle-class Black woman was presented to

help mental health professionals apply Resistance Theory to identify depression

G4218.indd 10 5/29/2013 2:10:35 PM

 Resistance to Depression in Black Women 11

and effectively intervene. The multiple forces that contribute to disordered mood
among Black college-educated women were explored, including cultural socializa-
tion towards selflessness rooted in sexism and racism. The invisibility of depressive
symptoms, particularly among highly functioning Black women, was emphasized
throughout this work.

REFERENCES

Africana Voices Against Violence. (2002). Statistics. Boston, MA: Africana Voices Against
Violence, Tufts University.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental
disorders (4th ed., text rev.). Washington, DC: Author.
Beauboeuf-Lafontant, T. (2007). You have to show strength: An exploration of gender, race,
and depression. Gender and Society, 21(1), 28–51. doi:10.1177/0891243206294108
Boyd-Franklin, N. (1989). Black families in therapy: A multisystems approach. New York:
Guilford Press.
Brookins, C., & Robinson, T. L. (1996). Rites of passage as resistance to oppression. Western
Journal of Black Studies, 19, 172–185.
Brown, S. L., Casey, S. J., Bishop, A. J., Prytys, M., Whittinger, N., & Weinman, J. (2010).
How black African and white British women perceive depression and help seeking:
A pilot vignette study. International Journal of Social Psychiatry, 57, 362–374.
doi:10.1177/0020764009357400
Carpenter, K. M., Hasin, D. S., Allison, D. B., & Faith, M. S. (2000). The relationship
between obesity and DSM-IV major depressive disorder, suicide ideation, suicide
attempts: Results from a general population survey. American Journal of Public
Health, 90, 251–257.
Centers for Disease Control and Prevention. (2010a). Current depression among adults–
United States, 2006 and 2008. Morbidity and Mortality Weekly Report, 59, 1229–1235.
Centers for Disease Control and Prevention. (2010b). National Intimate Partner and Sexual
Violence Survey, Summary Report. Retrieved October 17, 2011, from http://www.cdc.
gov/v­iolenceprevention/pdf/nisvs_report2010-a.pdf
Cordian, C., & O’Connell, C. (2003). Meeting the challenge: Ending treatment disparities
for women of color. Alexandria, VA: National Mental Health Association.
Davis, E. M., Rovi, S., & Johnson, M. S. (2005). Mental health, family function, and
obesity in African-American women. Journal of the National Medical Associa-
tion, 97, 478–482.
Dessio, W., Wade, C., Chao, M., Kronenberg, F., Cushman, L. E., & Kalmuss, D. (2004).
Religion, spirituality, and healthcare choices of African American women: Results
of a national survey. Ethnicity and Disease, 14, 189–187.
Dingfelder, S. (2013). African American women at risk. Monitor on Psychology, 44(1), 56.
Flaskerud, J. H., & Lee, P. (2001). Vulnerability to health problems in female information
caregivers of person with HIV/AIDS and age-related dementias. Journal of Advanced
Nursing, 33, 60–68. doi:10.1046/j.1365-2648.2001.01638.x
Gildersleeve, R. E., Croom, N. N., & Vasquez, P. L. (2011). “Am I going crazy?!”: A critical
race analysis of doctoral education. Equity & Excellence in Education, 44(1), 93–114.

G4218.indd 11 5/29/2013 2:10:35 PM

 12 Martin et al.

Hall, S., Chui, G., Kaufman, D., Kelly, J., Link, C., Kupelian, V., & McKinlay, J. (2010).
General exposures to prescription medications by race/ethnicity in a population-based
sample: Results from the Boston Area Community Health Survey. Pharmacoepide-
miology and Drug Safety, 19, 384–392. doi:10.1002/pds.1920
Jenkins, E. J. (2002). Black women and community violence: Trauma, grief and coping.
Women & Therapy, 25, 29–44. doi: 10.1300/J015v25n03_03
Jones, L. V., & Ford, B. (2008). Depression among African American women: Ap-
plication of a social competence practice framework. Affilia, 23, 134–143.
doi:10.1177/0886109908314324
Kessler, R. C., Berglund, P., Demier, O., Jin, R., Koretz, D., Merikangas, K. R., et al.
(2003). The epidemiology of major depressive disorder: Results from the National
Co-morbidity Survey Replication (NCS-R). Journal of the American Medical As-
sociation, 289, 3095–3105. doi:10.1001/jama.289.23.3095
King, D. K. (2007). In B. Landry (Ed.), Race, gender, and class: Theory and methods of
analysis (pp. 16–38). Upper Saddle River, NJ: Pearson Education.
Kohn, L. P., Oden, T., Munoz, R. F., Robinson, A. L., & Leavitt, D. (2002). Adapted cogni-
tive behavioral group therapy for depressed low-income African American women.
Community Mental Health Journal, 38, 497–504. doi: 10.1023/A:1020884202677
McKnight-Eily, L. R., Presley-Cantrell, L., Elam-Evans, L. D., Chapman, D. P., Kaslow,
N. J., & Perry, G. S. (2009). Prevalence and correlates of current depressive symp-
tomatology and lifetime diagnosis of depression in Black women. Women’s Health
Issues, 19, 243–252. doi:10.1016/j.whi.2009.04.003
Myers, L. J. (1991). Expanding the psychology of knowledge optimally: The importance
of world view revisited. In R. Jones (Ed.), Black psychology (3rd ed., pp. 15–28).
Berkeley, CA: Cobb and Henry.
Myers, L. J., Speight, S. L., Highlen, P. S., Cox, C. I., Reynolds, A. L., Adams, E. M., &
Hanley, P. (1991). Identity development and worldview: Toward an optimal concep-
tualization. Journal of Counseling & Development, 70, 54–63.
Nadeem, E., Lange, J. M., & Miranda, J. (2009). Perceived need for care among low-income
inmigrant and U.S.-born Black and Latina women with depression. Journal of Women’s
Health, 18(3), 369–375. doi:10.1089/jwh.2008.0898
Nicolaidis, C., Timmons, V., Thomas, M. J., Waters, A. S., Wahab, S., Mejia, A., & Mitchell,
S. R. (2010). “You don’t go tell White people nothing”: African American wom-
en’s perspectives on the influence of violence and race on depression and depres-
sion care. American Journal of Public Health, 100(8), 1470–1476. doi:10.2105/
AJPH.2009.161950
Pack-Brown, S. P., Whittington-Clark, L. E., & Parker, W. M. (1998). Images of me: A guide
to group work with African-American women. Boston: Allyn and Bacon.
Parham, T. (1992). Counseling African Americans [Video]. Amherst, MA: Microtraining
and Multicultural Development.
Rennison, C. M., & Welchans, S. (2000, May). Intimate partner violence. Bureau of Justice
Statistics Special Report. (NCJ 178247). Washington, DC: US Department of Justice,
Bureau of Justice Statistics. Available at http://bjs.gov/content/pub/pdf/ipv.pdf
Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C.A. (2005). Prevalence of depression by
race/ethnicity: Findings from the National Health and Nutrition Examination Survey
III. American Journal of Public Heath, 95, 998–1000.

G4218.indd 12 5/29/2013 2:10:35 PM

 Resistance to Depression in Black Women 13

Robinson-Wood, T. L. (2009). Love, school and money: Stress and cultural coping among
ethnically diverse Black college women: A mixed-method analysis. Western Journal
of Black Studies, 33, 77–86.
Robinson-Wood, T. L. (2013). The convergence of race, ethnicity, and gender: Multiple
identities in counseling (4th ed.). Boston, MA: Pearson.
Robinson, T. L., & Howard-Hamilton, M. F. (1994). An Afrocentric paradigm: Foundations
for a healthy self-image and interpersonal relationships. Journal of Mental Health
Counseling, 16, 327–339.
Robinson, T. L., & Kennington, P. D. (2002). Holding up half the sky: Women and psycho-
logical resistance. Journal of Humanistic Counseling, Education, and Development,
41, 164–177.
Robinson, T. L., & Ward, J. V. (1991). “A belief in self far greater than any one’s disbelief ”:
Cultivating resistance among African American adolescents. Women & Therapy,
11(3–4), 87–103.
Settles, I., Navarrette, C., Pagano, S., Abdou, C., & Sidanius, J. (2010). Racial identity and
depression among African American women. Cultural Diversity and Ethnic Minority
Psychology, 16, 248–255. doi:10.1037/a0016442
Shorter-Gooden, K., & Jackson, L. C. (2000). The interweaving of cultural and intrapsychic
issues in the therapeutic relationship. In L. C. Jackson & B. Greene (Eds.), Psycho-
therapy with African American women (pp. 15–32). New York: Guilford.
Singleton, D. K. (2003). Broken silence: Opening your heart and mind to therapy: Black
woman’s recovery guide. New York: One World.
U.S. Census Bureau. (2009). American Community Survey. Washington, DC: U.S. Depart-
ment of Commerce.
U.S. Census Bureau. (2011). Table 3. Detailed years of school completed by people 25
years and over by sex, age groups, race, and Hispanic origin: 2010 annual social
and economic supplement. In Current Population Survey. Washington, DC: U.S.
Census Bureau.
Utsey, S. O., & Ponterotto, J. G. (1996). Development and validation of the index of race-
related stress. Journal of Counseling Psychology, 43, 490–501. doi:10.1037/0022-
0167.43.4.490
White, E. C. (1994). The Black women’s health book: Speaking for ourselves. Seattle, WA:
Seal Press.
Williams, D., Gonzalez, H., Neighbors, H., Nesse, R., Abelson, J., Sweetman, J., et al.
(2007). Prevalence and distribution of major depressive disorder in African-American,
Caribbean Blacks, and non-Hispanic Whites. Archives of General Psychiatry, 64,
305–315. doi:10.1001/archpsyc.64.3.305

G4218.indd 13 5/29/2013 2:10:35 PM

Copyright of Journal of Systemic Therapies is the property of Guilford Publications Inc. and
its content may not be copied or emailed to multiple sites or posted to a listserv without the
copyright holder's express written permission. However, users may print, download, or email
articles for individual use.