'Don't Show Weakness'

DR. ALVIN POUSSAINT remembers clearly a visit to the housing projects of Boston in the late 1960s. A public-health nurse had directed him to a woman in need of help. When he identified himself as a psychiatrist, says Poussaint, who is black, the woman refused to open her door. ""She told me there were two individuals who could have her locked up. One was the police. And one was the psychiatrist.'' The experience taught him a lesson about the power relationship between his profession and the black community. ""I realized that in poor black communities, the psychiatrist was seen as someone who had the power to say you were crazy, to have you committed'' - or to take your children away.

When Mike Tyson announced last week that he planned to seek psychiatric treatment, it was something of a watershed. African-Americans have traditionally tended to avoid openly talking about their psychological problems or seeking treatment for them. ""This whole notion of therapy is not really embedded in the African-American culture,'' says Bertha Holliday, who runs the American Psychological Association's office of ethnic-minority affairs. Many can't afford it or don't have insurance; others fear the stigma or prefer alternatives - mostly clergy, but also astrologers or psychics. Black men especially remain wary of therapy, with possibly dire consequences. The suicide rate for young African-American males has risen more than 50 percent in the last decade. Dr. Linda James Myers of Ohio State contends that untreated depression, ""particularly among [black] men, is why drug use and alcohol levels are so high and homicide is so high - people are trying to medicate themselves.''

Middle-class people of all races are more likely to seek therapy. But some of the obstacles for blacks cross class lines. ""It's much more difficult for us to ask for help,'' says one New York professional who was recently diagnosed as manic-depressive. ""In rough neighborhoods you can't show weakness. That mentality gets passed down, even if you're middle class. And if you're the superblack doing well on Wall Street, the psychological armor that you need to get through the day doesn't allow you to admit weakness.'' Robert Watts, 35, says he spent his first year at Harvard sunk in depression. ""I was embarrassed that with all the problems black people have - living in poverty, dying in the streets - here I was not able to handle being at Harvard. I didn't think people would understand or sympathize.''

Many blacks are also uncomfortable with white therapists -and, says Poussaint, vice versa. ""I've supervised cases where blacks talk about issues of discrimination and the white therapist sees the response as paranoia. [White] therapists sometimes see bringing up race as a resistance to getting to issues. They make it the patient's problem.'' In response, the American Psychological Association is now pushing for more multicultural training, and black psychiatrists like Myers have developed Afrocentric approaches.

Most psychiatrists interviewed for this article believe the stigma against treatment is easing and more blacks are seeking help - especially when it's called counseling rather than psychotherapy. One limited study of county facilities in Los Angeles and Seattle found that blacks used them more than other ethnic groups did, though with poorer results. But for too many, Myers observes, mental-health issues remain taboo, something you don't talk about. If nothing else, Tyson's statement might help open the door.