One of the myths is referred to the negative attitudes toward the health care system: even if Black patients have insurance coverage, they strongly believe that White doctors do not want to cure them, but instead will give them pills that eventually will only worsen the situation. At the same time, the stigma of being crazy is the first one to be avoided; the normal belief is that if treatment will be conducted though a therapy – then, it is better to talk to a family member or a friend. Clinicians are perceived to contribute to the problem rather then provide a solution to it; as a consequence, there is the process of negative attitude formation that can be perceived by clinicians as a symptom of a psychotic disorder including schizophrenia.

Mental treatment of African Americans has a cyclical nature: as Blacks have a negative attitude towards health care system, clinicians, who lack cultural competency, are likely to respond back with misdiagnosis, which further contributes to negative attitude to the health care system – and then the process starts all over again. For example – the story of Tuskegee Experiment is known among African Americans far and wide. This story refers to the research conducted by United States government on African American males who were deprived of treatment for syphilis in order to examine the natural flow of the disease until death. Another issue is referred to black women assumed to be retarded because they were sterilized without their agreement. Partially myths and partially reality – these instances become a word of mouth in the Black community, as a consequence, distrust is omnipresent.

Distrust, in its’ turn, leads to the label of paranoid from the side of clinicians, which continues to only worsen the situation: often the response of a treating professionals matches with the one expected by a Black patient. Clinicians tend to stereotype, depersonalize, and patronize. When feeling resistance and lack of engagement from the side of a patient, a clinician assumes that a patient is either unable or unwilling to receive the treatment and does not have insurance coverage to cover the costs. Psychological feedback is rarely given. As a consequence, such behavior only contributes to bias formation from both – the side of a member of an African American community, and a member of a health care system – in turn, African Americans turn for help only when situation gets completely out of control and still tend to remain suspicious – clinician then reflect back with misdiagnosis, and the cycle continues on.